As if one weren't bad enough, scientists now have shown that problem gambling and cocaine abuse interact in a great many cases. Both stem from a need - a need to gamble, a need to use, a need to escape. Before the need gets to the stage of addiction, it's referred to as a problem or abuse, as in problem gambling and cocaine abuse.

In order to look at the interaction between problem gambling and cocaine abuse, it's first necessary to understand a bit about what each is, how you can recognize it, and what it does to the individual.

Cocaine Abuse

Cocaine is a powerful stimulant drug. It is also illegal, classified as a controlled substance under the Controlled Substances Act. In its powdered hydrochloride salt form cocaine can be snorted, or dissolved in water and injected. The form of cocaine known as crack is cocaine base that hasn't been acid-neutralized to form hydrochloride salt. Crack comes in rock crystals that are heated to produce vapors, which are then smoked.

Three methods of administering cocaine - snorting, injecting, and smoking - can lead to addiction and several other severe health issues, including HIV and other infectious diseases. When someone snorts cocaine through the nose, the drug is absorbed through the nasal passages and travels into the bloodstream. Smoking cocaine involves inhalation of the vapor or smoke into the lungs with the result that the drug goes into the bloodstream as fast as by injection.

Why do people use cocaine? They want the high, the increased energy, reduced fatigue, the feeling of mental alertness. How long the high lasts and how intense it is depends on how the user administers the drug. The faster cocaine is absorbed into the bloodstream and subsequently gets to the brain, the more intense the high. Smoking or injecting cocaine produces a more intense high, but it's also the shortest duration - maybe 5 to 10 minutes. Snorting the drug takes longer to reach the high, but it also lasts longer - usually about 15 to 30 minutes. Any route of administration typically involves repeat use, in order to sustain or recapture the high. For this reason, cocaine abuse often involves bingeing - repeated use within a short period of time, and at increasingly higher doses.

Cocaine affects the brain's pleasure center, along with movement. When abusing cocaine, users feel a sense of euphoria due to increased levels of dopamine the drug produces in the brain. This excess of dopamine, over time, leads to tolerance. That means the user has to use more and more cocaine and more frequently in order to achieve the high. By attempting to recapture the intensity of previous highs by upping the dose or frequency, cocaine abusers increase their risks of adverse psychological and physiological effects, as well as risk of addiction.

In 2009, according to the 2009 National Survey on Drug Use and Health (NSDUH), there were 617,000 persons age 12 or older who had used cocaine for the first time within the past 12 months. The average age of first usage was 20 years old. Another alarming statistic from the 2009 NSDUH is that in 2009, 1.1 million persons age 12 or older were classified with dependence on or abuse of cocaine.

Problem Gambling

There is a distinction between problem gambling and pathological gambling. The former is the beginning of the downward spiral, whereas the latter is the addictive stage of gambling. Problem gambling, according to the National Council on Problem Gambling, is behavior that causes disruptions in any major life area - psychological, physical, social, or vocational.

The essential features of problem gambling are increasing preoccupation with gambling, the need to bet more money more frequently, restlessness or irritability when attempting to stop gambling, "chasing losses, " and loss of control which results in continuing gambling behavior despite mounting serious negative consequences. In the most extreme cases of problem gambling - when it has not only reached addictive stage but has continued for a long period of time - it can result in financial ruin, legal problems, loss of family, career, incarceration, and even suicide.

Problem gambling is more than just a financial problem for the gambler and his or her family. Problem gambling is an uncontrollable obsession. The problem gambler cannot stop gambling on his own, even if there's a sincere desire to do so.

What causes someone to become a problem gambler? It may be precipitated by a change in behavior, such as the stress caused by a job change or loss, retirement, or other change in personal or family circumstances. It isn't the amount of money that the gambler loses that result in problem gambling, it's when the gambling causes a negative impact on any area of the person's life.

Here's what happens in the brain. Problem gambling is very similar to drug use in that the individual gets the same effect as if he or she consumed a drink or took a tranquilizer. Gambling alters their mood, making them feel alive and euphoric, and they keep on repeating the behavior - gambling - in an attempt to achieve the same effect. But, just as tolerance to drugs and alcohol develops, with gambling, the same type of effect eventually occurs. The gambler resorts to gambling more money and more often in the increasingly vain attempt to recapture the high. As the craving to gamble increases, the gambler is less and less able to resist it.

In the United States, it is estimated that about 4 to 6 million (2 to 3 percent) of the population are problem gamblers. About 2 million (1 percent) of the population are estimated to meet the criteria for pathological or compulsive gambling each year.

Some form of gambling is legal in 48 states plus the District of Columbia. Only Utah and Hawaii have no legalized gambling.

Co-occurring Disorder: Substance Use and Gambling

Information from the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that in individuals with co-occurring disorder (COD), cocaine and gambling may coexist as part of a broader lifestyle marked by antisocial behavior. For example, a person who is addicted to cocaine may see gambling as a means of obtaining money in order to support their continued drug use. Pathological gamblers (those who are addicted to gambling) may use cocaine to keep their energy level high and maintain their focus during gambling. They may also sell drugs in order to get money for gambling.

Cocaine use may artificially inflate the gambler's sense of certainty about his or her gambling skill and chance of winning. Both of these contribute to the gambler's taking even greater gambling risks.

Gamblers may use drugs, such as cocaine, along with alcohol as a way of celebrating wins or alleviating depression when they lose.

A common clinical pattern that is seen among problem or pathological gamblers is that of sequential addiction. Frequently, a person with a history of dependence - on alcohol or cocaine, for example - may develop a gambling problem.

Cocaine and problem gambling (especially pathological gambling) may be concurrent or sequential addictions. With cocaine in particular, the individual often finds it difficult to have enough money to support both habits at the same time. There is, however, no clear evidence that one addiction is likely to precede the other. But one recent study did report that among a population of those with substance use disorders who are in treatment, gambling behavior onset was likely to precede the use of addictive substances.

Like substance abuse, problem gambling can be regarded as a chronic, recurring disorder. There is the potential for relapse in both disorders, and even greater risk for those with both disorders.

Treatment for Problem Gambling and Cocaine Abuse

In order to overcome problem gambling and cocaine abuse, professional treatment is the preferred - and often most effective - route. Such treatment should occur simultaneously and may take place in a variety of treatment settings. There are residential treatment centers that specialize in co-occurring disorders and gambling addiction, as well as other intensive treatment care facilities that provide such treatment.

Detoxification from cocaine is required prior to the individual entering the active phase of treatment for cocaine abuse. This is best accomplished in an environment where the patient is monitored 24/7 by medical professionals to ensure safe detox and minimize cravings.

Once the person gets to the active treatment phase, in individuals with co-occurring problem gambling and substance use disorders, it is often essential to identify specific trigger for each disorder. It is also important to identify the ways in which use of addictive substances such as cocaine or addictive activities such as gambling act as mutual triggers.

There is increasing evidence that suggests a greater effectiveness of treatment approaches that focus on the goal of reducing or limiting gambling - especially for problem gamblers who do not meet all the criteria for the diagnosis of pathological gambling. This approach generally involves teaching money management along with using cognitive behavioral interventions to set and achieve the patient's goals for limited or controlled gambling.

There are two main types of medication that have been reported to reduce cravings to gamble and gambling behavior. These are selective serotonin reuptake inhibitors (SSRIs), such as fluvoxamine (Luvox), and opiate antagonists, such as naltrexone, which has also been found to be effective in treating people with substance use disorders.

It has also been clinically observed that people with substance use disorders and problem gambling disorders may be more likely to suffer from a broad range of additional mental disorders, and require psychiatric medication to address affective disorders, attention deficit hyperactivity disorders, and anxiety disorders. It is estimated that up to 70 percent of people with a gambling addiction also have another psychiatric problem.

Integrated treatment of a multimodal nature is recommended to treat cocaine abuse and problem gambling. Such treatment may combine 12-Step, psychoeducation, group therapy, and cognitive behavioral approaches, among other treatment modalities.

Recovery experts caution that patients suffering from both cocaine abuse or addiction and problem gambling attend separate support groups for gambling and drug use. While it is true that the groups can act as a supplement for each other, they are not a substitute for each other.

Gamblers Anonymous (GA), the main support group for those with problem gambling or gambling addiction, may be different from 12-step groups many people may be familiar with, such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), or Cocaine Anonymous. In GA groups, while there may be less emphasis on the step work, sponsorship and structure than the other types of support groups, the fact is that GA groups do provide a unique fellowship to help the individual address his or her gambling issues. GA also may help the gambler and family members learn how to cope with money management, debt, and reputation issues through a process known as "Pressure Relief."

In the long-term, since substance abuse and problem gambling are chronic and recurring disorders, it is probably best to have a plan for return to treatment if a relapse occurs. Continuing care groups that are professionally facilitated and focus on maintenance skills in recovery can prove effective. This is especially true when such continuing care group participation is combined with attendance in mutual self-help groups such as GA. The gambler's family members are encouraged to participate in Gam-Anon, the family support group offshoot of GA.

Eliminate the Source, Work on Coping Skills

Following treatment for cocaine abuse and problem gambling, what's the outlook for the individual in recovery? Since relapse is common with both disorders, the individual who's in recovery needs to be diligent in eliminating exposure to the source of the triggers and continue to work on coping skills to deal with stress that may precipitate relapse.

Accumulation of debt caused by problem gambling often requires long-term dedication to debt repayment. Financial management counseling programs may be instrumental in helping the individual come out from under the mountain of fiscal woes. It does take time and the understanding and support of family members - and the help of others in 12-step groups - is critical to effective recovery.

Learning healthier ways of living that do not involve cocaine use or gambling is critical to the individual's long-term recovery and happiness. And, should relapse occur, there should be a plan in place to go back into treatment to further strengthen the ability to withstand triggers, overcome cravings, and solidify coping skills that work.

Is any treatment foolproof? No, there is no guarantee that any person suffering from cocaine abuse and problem gambling with miraculously be free of any craving and never abuse cocaine or gamble again. Sometimes more than one stint in rehab is required, particularly for those with chronic addiction. But cocaine abuse and problem gambling don't go away without help. And the individual has to want to get better, do the work involved to lay the foundation for recovery, and then continue the work once in recovery.

The reality is that many thousands of people have gone through treatment and are now living a drug- and gambling-free life in recovery. This is definitely a goal that is achievable.