 Today, we are going to talk about gambling and other behavioral addictions. Most of us are used to the idea of addiction to substances, addiction to alcohol, addiction to drugs, etcetera. But, I am sure you heard of people being addicted to their work, you have heard of terms like workaholism, you have heard of now, I am sure you would have read somewhere that you know some people are more than a little fond of their face book pages, you know staying on face book or you know more than a little fascinated by their cell phones. So, the issue is whether one can be addicted to a particular behavior. Now, how can you be addicted to a behavior, if I might show you the slide. Now, addiction to substances, addiction to patterns of behavior appear to be to lie on a continuum, because ultimately addiction is about loss of control. The badge of addiction is that there is a person has lost control over the use of a particular substance or over this particular behavior. So, while substance addictions involve abuse of and dependence upon chemicals such as alcohol, nicotine, heroin, cocaine, etcetera. Behavioral addictions involve problem use, repetitive use of potentially pleasurable or compulsive activities. I mean most of them are activities which are normally done in society, you know they can be gambling, they can be sex, can be working, spending, you know when you go to people, people go on spending sprees, eating, etcetera. And sometimes what happens is some people struggle with both types simultaneously and often and that is the point I am going to try and make to you is that it is the same people who are at risk for both types of addiction. General public often mistakenly view these addictions as moral flaws in the same way that the general public often views people who use drugs and alcohol as somehow morally weak, somehow you know having less control over what they do. And therefore, bad as less serious, but they also can you know the general public also have a feeling that these are somehow less serious than the substance addictions, the behavioral addictions I mean. But what is true and this is something that we see in our clinics is that these addictions to behaviors can also go totally out of control and they cause as much havoc on families, on persons themselves as drug addiction and alcoholism. And it often I mean these addictions for example, gambling addiction etcetera often also contribute to a relapse to substance addictions when people have both. These potentially addictive behaviors are usually healthy essential activities you know that is the paradox that most of them start out as often essential activities eating is an essential activity, sex is an essential activity. Sometimes going and having a little you know fun is an essential activity in today's life you know listening to the cell phone is has become an essential activity. But sometimes is essential activity spiral out of control, but one of the things and this is something that we talked earlier these activities all have one common property that they appear to stimulate a very ancient reward circuit in the brain. This is a circuit which as a part of evolution has occurred in the human brain which gives you a sense of reward when you perform a certain activity or more important when you anticipate performing a certain activity. You know first time you eat a chocolate you get a warm feeling of reward in this particular circuit the next time you see a chocolate your brain goes wow just do it you know and this is a very important circuit as far as motivating humans to action is concerned. And all these whether it is the substances whether it is some of these behaviors that I am going to talk about they cause a flood of this important chemical called dopamine in this particular circuit. Now brains are already programmed to encourage these behaviors by making them highly pleasurable. Addictive drugs in alcohol trigger a similar response, but drugs induce pleasurable distraction simply by being taken you do not have to do that activity in this you have to actually perform an activity and that is the only difference. So what are the core elements of addiction seen in both substance and behavioral addictions? One as I told you is loss of control two is that you continue to do these despite negative consequences you suffer pain you suffer shame you suffer loss, but you continue to do it despite these odds. And you make multiple attempts to stop, but despite that you relapse then tolerance which means you require higher levels of a particular drug or in this case higher levels of that activity to give you the same buzz. The earlier level for example I start gambling tomorrow I need to gamble at a higher level I need to bet more to get the same buzz that you know I was getting initially. Then of course there is this preoccupation you know it is a word which is often used to describe this is salience this is so salient that this becomes the most important thing in my life. Doing this activity and planning to do this activity takes over my 24 hours you know my going and buying stuff for my child has not become that important. My coming to work is not that important even when I come to work my mind is constantly thinking about this particular thing and that is salience and if I do not do this particular activity I get a sense of withdrawal which can be sadness which can be anxiety which can be persistent thoughts about this inability to sleep you know basic difficulties. And I get cravings or an urge to perform this particular activity and these are some of the seven criteria which are necessary to signify that of behavior or use of particular substance has become addictive. Gambling what is gambling? Gambling is putting something usually money at risk in the hope of gaining of something of greater value. Now gambling is very very very very very very old in human societies and if one looks at the Rig Veda which is one of the oldest pieces of literature known to mankind one finds that there is extensive description of gambling and what they used to use is this particular five sided seed of tree called the Vibhithaka and this has been described in as one of the earliest forms of gambling. Then people started using somewhere in the Indo Iranian and Indian region the astragalus that is but the certain bones of animals which have different facets so when you throw them there is an equal chance of any side falling and this again is around 1500 B.C. I mean the earliest signs and then of course you move to dice which could be made out of ceramic or stone etcetera. So you have carved dice and those are pictures of some of the early dice which have been found especially in the Indian region. The gambler's lament which is in the Rig Veda is actually probably I am going to start with that because it is one of the earliest descriptions of an addiction a behavioral addiction just let us go through this it says sprung from the tall trees and windy heights these rollers meaning these dice transport me as they turn upon the table. The enlivening Vibhithaka has pleased me like the draught of Soma. So somebody is actually making a comparison between gambling and the Somras that they used to get high on and remember this is 1700 B.C. When I resolve I will not play with them I will remain behind when my friends depart to play in the brown dice thrown on the board have rattled like a fond girl I seek the place of meeting meaning it draws me it draws me this presumably a man who is saying it draws me like a young girl draws me the dice draw me. So he is talking of the craving and the urge and so on and so forth sorry and these are these are for example examples from Pahare paintings of people gambling. The game star seeks the gambling house and wonders his body all of I will I be lucky. So and it goes on and on about how one has no control and how dice are like you know as if they have thorns and they can like goads which pull elephants and they can pull you. So the point the reason why I have you know brought up this very old piece of literature is to just to tell you that this is something which has been recognized for many many years and yet in the country which probably described pathological gambling for the first time we have not had too much of serious discussion serious scholarship on pathological gambling. It also talks about you know some of the consequences of gambling that what happens to people that they lose everything that they lose their families they lose their wives all right. Let me go to the this is a very very well known scenario to all of us who have grown up in India and have listened to our grandmothers tell us the story of the Mahabharata. Did you know for example that there are different forms of gambling there are gambling over sports for example these are people who are gambling over cocks fighting with each other cocks fighting and this is very very ancient has been described in some of the early purans and you know certainly in the Mahabharata. On this side is this picture of what used to go on in Calcutta in the late 1700s there was a form of gambling called rain gambling people would gamble on the amount of rain that would fall and when rain would fall people have gambled on you know how much the cotton stocks would be in the US which would be brought in by Reuters telegraph and this was perceived I mean historically the reason why I am telling you this is this was perceived by the British colonial government as something very very harmful very very morally bad and they tried to ban gambling but in true colonial style they decided to ban gambling which the natives did and they decided that you know gambling on horse racing was not bad but it was legal because they did it and they came to this very very funny logic that gambling on horse racing actually is a scientific principle so you have to decide how the horse is going to run which horse how the horse you know how strong the horse is etc. But you know something that this is also something which is now currently used as a principle to determine what is right and what is wrong the law on gambling in India today is still based on this principle that if there is some scientific knowledge which is required then that is okay that is called gaming and if not if it is based only on chance then it is illegal because it is gambling anyway. So subsequently of course there are things which happen you know there is the game of satta which is illegal because it is based on chance but there are two two two gambling forms which are legal in India actually three one is horse racing which is come down from the British times the other one is a game of Rummy and the third one is legal in only some states which are casinos where you play certain kinds of gambling games but here some of the recent papers that we have had on you know gambling in India and what we have been trying to talk about is that some forms of gambling can be pathological like some forms of drinking can be pathological some forms of eating can be pathological and there is a segment of people who do gamble and they develop early problems okay basically what I am trying to say is that there is a continuum of risk it is not it is not a black and white thing from no gambling to casual social gambling you know for example it is very common in India during Diwali during Lakshmi puja and other things to get to gamble in at least in some parts of the country and it is part of the religious ritual and then of course you have serious social gambling where people disappear every you know weekend to play you know some form of Rummy or bridge or whatever and they lay lay bets on it then you have harmful gambling harmful involvement where people actually start losing money start developing you know going to debt because of it and then you have pathological gambling where gambling occurs to the extent of an addiction basically we talk of and the reason I am speaking on gambling is that most of the work has been done on gambling you have at risk gambling which is gambling that carries the increased risk of developing into a gambling problem but has not yet developed then there is problem gambling gambling that disrupts the damages personal family or recreational pursuits or next and most serious is gambling addiction or pathological gambling which is persistent and recurrent maladaptive gambling characterized by some of the following that I talked about remember the seven characteristics preoccupation with gambling the need to gamble with increasing amounts inability to cut back or stop chasing losses you know that I had lost so I need to recoup the loss lying about gambling adverse social and financial consequences and continuing despite knowledge of harm. So basically these are some of the criteria for pathological gambling which I just already talked about so we do not need to get into the details of this and there are different criteria depending on which part of the world you are in this is the American criteria and earlier people in the psychiatric world considered gambling to be a problem of impulse it was concerned considered a disorder of impulse that you could not restrict your impulse so it was called an impulsive impulse control disorder for example you know you have heard of people who pull out their hair it is called tricotillomania so this was classed in the same class as that that I have an impulse to pull out my hair and I pull it out and gambling was considered an impulse but now people are more and more because of some of the science that has accrued over the last ten years people more and more are saying look this is like addiction. So it is now being classified as an addictive disorder so anyway this was so how common is pathological gambling we are talking about this and you are you are at liberty to ask me why you talking about this is it really common what we do know is that pathological gambling occurs in about 30 to 60 percent and these are these are US figures of the population you know but these are American figures let us look at and then these are some of the tools which are used to tap gambling but one of the best screeners for gambling is just two questions have you ever felt the need to bet more and more money have you ever had to lie to people important to you about how much you gamble and these are again some of the tools which are used. Let me give you some Indian figures these are figures of you know when we asked for gambling in the population in a population in Bangalore and we looked at people who were treatment seekers who were seeking treatment for addiction what we found was that in non-treatment seekers sorry what am I looking at in treatment seekers 13 percent had gambling of any kind and seven percent had from pathological or addictive gambling in non-treatment seekers that is general population that we looked at about five percent had gambling of any kind and zero percent had pathological gambling we did an internet survey of gambling and we found again about 20 percent people reported gambling of any kind and zero percent reported pathological gambling see one of the things that we arrived at as a conclusion is that people who were seeking treatment for other addictions were at much higher risk for pathological addiction as a pathological gambling or addictive gambling as well whereas other forms of gambling the problem gambling and the social gambling were common in people who were not at also not at risk for other addictions. So these the addictive forms seem to cluster together the mode of gambling that we did find was more of you know sorry of card games involving money horse racing etc but as you can see no sorry this is a this is a slide about the mode of gambling so card games involving money seem to be the most common form that we found in our study again this particular slide really shows that the kind of problems that were there and we if you look the problems seem to be more in the blue blue strips which are people who are seeking treatment for for addictive disorders the slide I really want to show you is that problem gambling seem to be much more in people who had developed early onset addictive problems and in a previous lecture that I had talked about you know how people with early onset addiction seem to be at much higher risk for a whole host of problems. What we also found in this particular study is that these are the externalizing scores of behavior which are namely impulsivity, inattention, oppositional behavior etc so people who had greater externalizing scores were more likely to be gambling then people who had lesser externalizing scores and this is something that is been found consistently in world literature that adolescents who have attention deficit adolescents who have conduct problems are more likely to have gambling problems. Let me go past this I will not spend too much time here other than to say that brain imaging studies in people with pathological gambling have shown that the the brain sizes the brain volumes in people who have pathological gambling are different from people who do not have pathological gambling. Let me go instead to because this is a lot wrong so how does one treat pathological gambling currently the only method of treating pathological gambling are psychosocial interventions the ones which have strong evidence are cognitive behavioral therapies and behavior therapies and very recently you know we are we have started using certain pharmacological or drug medical treatment medicinal treatments for pathological gambling. Let us talk about another another form of behavioral addiction internet addiction disorder now the question is internet addiction really real the you do know about the internet of people who spend inordinate amounts of time on the net and who get very upset when they are dragged off or when their internet provider or broadband supply gets cut. So do you think internet addiction is real yeah let us examine the between 5 to 10 percent of web servers suffer from some form of dependency and this is from an American study. What is addiction like we said it is a compulsive need for and use of a habit forming substance but persistent compulsive use of a substance known to be harmful. Now internet addiction can involve excessive social networking excessive online shopping compulsive online gaming excessive blogging compulsive watching of internet videos and pornography and playing online games. So when we have one talks of internet addiction one talks of a whole cluster of of problems. Now while there is a generation of internet addicts most of them seem to be clustered in the in the younger age group well this only stands to reason because people above the age of 45 are not using the net so much and they are not as net savvy. So there are some studies which show that too much internet usage can cause structural brain damage and some of the consequences of internet addiction are loss of a sense of time that you go on being on the net without knowing how much time has passed withdrawal when the computer is inaccessible social isolation and fatigue you do not want to go into you know social groups you get tired and bored very easily tolerance that is including the need for better computer equipment that you keep upgrading your computer you keep upgrading your software. So these are some of the known consequences of internet addiction now this is again another particular another study on internet addiction and when people were asked do you normally stay online longer than you intended 75 percent of people who were approach said yes unfortunately this particular study was done on people who were on the internet. So in a way it was biased to people who were on the internet for very long periods of time when asked do you sometimes choose to spend more time on online than going out with others 41 percent said yes we usually lose sleep due to late night logins 50 percent said yes do you think your job performance of productivity suffers because of the internet 42 percent said yes. So very large numbers of people who are being pulled are saying that internet usage is interfering with their day to day functioning how often do you check your email before something else that you need to do 23 percent say frequently. So is internet addiction a mental disorder now actually the whole concept of internet addiction started off as a satirical piece somebody wrote up a piece saying if this is addiction internet you know sitting on the internet is also addiction and applied the principles of addiction to internet thing. So it started off as a satirical piece by a gentleman called Goldberg in 1995 but by 2013 this is now entered the Bible of psychiatric diagnosis. So what started off as a joke has been become a serious pathological entity people of there are some people who oppose it and they say that the relationship between depression and internet addiction is because people who are depressed tend to not use not to be in contact with other people but take request to the internet and that it is usually people who are first unwell who then spend more and more time with the internet that internet usage is secondary to other mental disorders. But you cannot escape the consequences you know when one talks of Facebook addiction Facebook in 2012 had 1.06 billion users of them almost 680 million were according to one particular study addicted to Facebook. This is a US study and the time spent each month was very very high it was about 53 billion minutes on Facebook 3.2 billion were pressing the like button and 30 million uploads happened in one particular month these are huge figures these are huge figures Facebook addiction increasingly become a real problem because if you look at Facebook users and these are data taken from this particular study which looked at Facebook usage 41 percent are addicted to Facebook 63 percent are stressed by delaying their responses to a friend's request more than 30 percent one third feel guilty about rejecting new friend request 20 percent people comment on their friend's photos each day now which pan do you guys fall into 15 percent update their status each day can you imagine everybody is updating their status each day anyway this is what we are talking about gaming addiction that it is not unusual for people to get so obsessed with online gaming that they forget to eat and this they just growth in an anorexic and it does happen and we have started getting people who are coming coming to the clinic with complaints usually they do not complain it is their parents and you know relatives who complain that they stop doing every activity they just sitting on the net playing often they are playing these multiplayer massive multiplayer online games and they are on it in the daytime because all their friends in India playing and they are awake at night because they are playing with people in in some other continent in some other time zone a lot of work has been done in Korea where I believe gaming addiction is very very our gaming is very very popular and apparently 70 percent of the young people in Korea play online games and it has been estimated by two studies from Korea that 18 percent are online addicts I mean game addicts now people have often asked me that yes so what happens that people play games does it hurt anybody and these are some of the studies where people have actually killed or hurt other people or hurt themselves when they were stopped from access to their computer access to their games online gambling I was talking about earlier so I will not talk about it now internet pornography addiction is also very very you know the figures are very very high and these are again these days you can get global statistics from the net and so if you look at porn websites of all the global sites 12 percent of the websites are pornographic and there appear to be huge amounts of money which are spent on these websites these are terms which are used especially in industry have you heard of cyber loafing in gold-breaking cyber loafing is when employees use their companies internet for non-work related purposes during working hours and this in industry has become a very big drain on the productive time and therefore on the money and so people have been doing research on the impact of cyber loafing so there have been studies for and against you know some studies have said that people who take time off from their work actually have better psychological performance and better engagement with their work because they are able to take time off from their work but I do not think the bosses in the industry are very happy about people using their computers to log on to Facebook gold-breaking on the other hand is staff who use their work internet access for personal reasons while maintaining the appearance of working which can lead to inefficiency so you have one screen opened which is your work thing and another screen open on your Facebook page and you keep shifting between the two it has been estimated that almost 70 percent of businesses lose money and time because of these particular practices now this is not something that has become very popular in India but especially in the U.S. and in countries like Korea etc there is a strong move to bring about internet addiction rehabilitation. I have not heard of any such process and you know in India and honestly we really we who are in the treatment arena have not yet thought of developing interventions but we are going to need to develop such interventions let me leave you with these questions are you addicted to your smartphone do you have a smartphone I am sure you so are you addicted to it 65 percent of iPhone users surveyed said I cannot live without my phone I 40 percent said I give up my morning coffee first you know I would rather you know check my phone before I check my you know have my morning coffee 18 percent said I will stop bathing every day before I give up my iPhone and 15 percent said I give up go a weekend without my iPhone I would rather give up sex so iPhone usage also seems to be becoming fairly problematic now the I want to finish with the point that you know we can keep adding you know iPhone usage this that but at the end of the day what seems fairly apparent is that it is not the form of the addiction rather not the content of the addiction but the form of the addiction there are some people who lose control and these are people who are liable to lose control whether it is with cell phones or whether it is with alcohol or whether it is with drugs and ultimately the issue is to look at the characteristics of the people who are likely to or who are at a greater risk of losing control and this is what we talked about yesterday so but I am not going to repeat that and intervention lies in dealing with these characteristics which are likely to give rise to these addictive forms of behavior I will end there thank you can love will fall into this category of addiction love how are you going to define love love for music oh that is different what does fall into the category I mean for example is sexual addictions because there are people who get addicted to a either pornography or to sex as far as love is concerned love I mean if you if you if you are talking about love as in human relationships well I am sure there are some people who fall in and out of love you know consistently but I doubt whether that would really you know be be an addiction because but love to love for music yes I mean there are some people who will put on their headphones and listen to music all the time especially the head banging music and will not do anything else other than that and I suppose yes it is linked to this whole thing of these are again people who seem to be at high risk for other other problems for example it is fairly well known that people who listen to head banging music and keep listening to that music all the time up are often very prone to developing problems with drug usage you know and it is not about them being prone to drug usage or the music per se but that these are people who often use this to control the hyperactivity in their brains as we talked about last yesterday. Sir can we control gold breaking and cyber loving like when we would be to just cut off the connections to important sites like Facebook and Twitter but this could also be counterproductive because this can make them angry that they are not able to track with other fellows and I think that this would also hamper the productivity of the organization absolutely so it is a it is a it is a very good question because there is no proper answer to that it is like it is the same difficulty that is there in organizations for example you have in most organizations you are not allowed to smoke inside right so but organizations allow their workers to go outside and smoke and then they face a problem because you have people who are going out half the time you know every 5-10 minutes they are going out and smoking so are you losing more time by having allowing people to go out and have a smoke and if you do not especially for people who are addicted to smoking you will have workers there who are getting very agitated and unable to continue with their work so what do you do so a lot of age you know industry industry has now started you know giving in house tobacco cessation programs saying that let us put money in getting these people to give up smoking totally now whether that will happen with Twitter and Facebook I do not know but I am sure people can be taught not to use Facebook and Twitter while on the job you know like most serious employees will not be sitting up and ringing up their friends and having you know chatting away to glory you know while they are on a job if they are serious about their job but you are right I mean if you prevent forcibly you cut off Twitter accounts which some companies do that you have no access to the internet other than the sites that you have to visit because you are on a company internet or whatever whether that creates more satisfied employees or more disgruntled employees that is something that we really do not know about nobody is really done any work about that but good question. We talked about how internet addiction was a consequence of depression where they went into the internet addiction to get away from depression so does it ever get to a point where you finally get bored of it? Of the internet? Well I know of lots of people who unfriend themselves from Facebook but people who are really really addicted and they get up one day and say that I am not going to use the internet any longer I am sure there are like there are people who are really addicted to alcohol and one day say I am not going to drink any more but statistically I would say that I would hazard a guess because there is not any raw hard data about it but hazard a guess that they are few and far between because remember when we are talking of addiction what we are slowly understanding is that some people are getting addicted because of certain ways of brain functioning and these are people who are liable to get addicted whether to this or to that. In fact it is a well known phenomenon that in places like the AA Alcoholics Anonymous where people have come to give up alcohol there is a huge amount of smoke and there is this whole concept of shifting from one addiction to another replacing one addiction with another. So the real solution probably is to get people to shift to addictions which are adaptive, healthier addictions, safer addictions. Is there any difference in the extroverts and introverts when it comes to vulnerability to like internet addiction and all? Well that has not been studied but again I would hazard a guess that people with this impulsivity, inattention etcetera are more likely to be attached to any addictive behavior than people who are not but to your direct question whether there is difference between extroverts and introverts there is no hard data there nobody is really studied it. Please remember that these are concepts which are very very new most of the world does not believe that these concepts exist and these concepts have come up and are being put up saying that let us study this and see whether we really need to get bothered about it we really need to follow this up but as all of you know that all of you can at least count five people who sit on the internet among your friends who sit on the internet more than they require to who have cut down their social interaction because of their love for the you know for surfing whatever sites they surf and so to all of you it is a real problem in some at least five people you know similarly with cell phones or not so much with cell phones not yet and so one more question what about social voyeurism is that can that also fall into what does that mean social voyeurism as in people who are like they want to know about the lives of other people who are on their Facebook friend list or something like that but they do not want to tell about their life so they keep their life as a secret their own photographs their own post status updates anything but they have that urge to know what is happening in other people's lives regularly check their profile and all that so what is the term used for it I heard the social voyeurism yeah yeah I suppose you know but then that is that is there in normal human intervention also I mean of the number of people who are here who are asking questions there be one or two who will not ask questions who will be very keenly listening to the other people asking questions will be very keenly observing what is happening so but you know to be fair there are some people who will you know be hidden and keep watching and like you are saying voyeurism looking at some of the things which are which are not very necessarily very adaptive they will be and if you go to certain sites you find that there are people who go to social media sites pick up pictures and and then they collect them and use it for not so healthy purposes and yes that is there that is the very nature of the internet that if you choose to you can be you know stay hidden answer what is the method which are being currently employed by the US society to curve the internet addiction there are certain sites not just US I mean it is there in Australia and various other countries which are looking at providing services for internet and other addictions gambling addiction etc which is similar to I showed you some of the things most of it is behavioral treatments basically most of these behavioral treatments try to get you to unlearn old patterns of behavior and learn newer and more adaptive patterns of behavior. So it uses a behavioral therapy model or a cognitive behavior therapy model cognitive behavior therapy also includes looking at the cognitions of thoughts the automatic cognitions and thoughts which one falls into and which then propels your behavior you know the shoots and woods that one has in your one's mind is it not. And sir does this also change the wiring of like earlier in the yesterday's talk you mentioned that when one is too much addicted to drugs or say alcohol the wiring the hardware will bring changes. Yes. So does similar thing happens in this abuse also like when you have one is too much addicted to say internet or gambling does the wiring of brain changes say also. There is very early data very early data which shows that there is difference between the brains of people who are addicted to some of these behavioral addictions mostly gambling and people who are not. Now the same question that we talked about yesterday is whether these changes are there before or are a consequence of this behavior that is something which we still cannot answer. But from the experience of what we have learned from substance gambling and sorry substance use disorder substance addiction one would hazard a guess that these differences in the brain size brain function existed you know before people took on the behavioral you know became behaviorally addicted. So that it is a vulnerability rather than just a consequence of this particular behavioral addiction. If someone wants to quit one kind of addiction so is it that they are more prone to fall for other kind of addictions. Yes you are absolutely right that if one quits one kind of addiction they are also prone to developing other addictions. So the ultimate aim will be to try and deal with the basic vulnerability that exists rather than just getting people to quit one addiction of the other. Unfortunately our old way of dealing with addiction has been to say stop this it has not been to say stop this and I shall also provide you with a solution to deal with whatever is causing you to get addicted. So the treatment of addiction has been like a revolving door you go in go out from the door and come back again through the door. Now recent strategies which have which we have started looking at have started looking at let us deal with the pre-existing problem rather than just looking at the tip of the iceberg it is like an iceberg you know only a small part is visible but if you do only look at that your ship gets sunk by what is under the water. Small question to ask is it that you first become addicted to one type of this which would ultimately lead you to some other consequence let us say if I am into online gaming or if I am into pornography then you see that you know first I develop addiction towards internet and then that addiction further gets a flavor of say internet gaming or pornographic material. What you are talking about is this whole concept of gateway addiction which is specifically used in drug use that the classical thing is that you start on tobacco smoking or chewing and that leaves you on to other drugs or as was earlier thought that people who start using cannabis ganja that is the gateway to lead you into others you know more serious drugs like heroin and cocaine and other substances that has proved to be not very useful model to follow. Similarly, I would not really subscribe to gateway addiction even in the behavioral addiction because I would think that what one chooses as the behavior is dependent on your circumstance if you have access to gambling you go to that if you have access to the internet you go to that and it is because of your the fact that whatever this particular thing increases activity in your reward circuit you persist with that and because in a way it deals with this particular vulnerability and normalizes this externalizing behavior that you continue with that because like I showed yesterday it seems to give you a better response better reinforcement than it gives other people and the people who are vulnerable and so you continue and you persist with that and it could be whatever you started on the issue is that sometimes when you stop one and you are not dealt with your vulnerability then you have to move on to another substance or another behavior the lesson being that one who is vulnerable is vulnerable to any or many of these behaviors or substances