Wall Street banker Randolph Simens had never gambled much. That is, until his mid-fifties, when he suddenly and seemingly without reason developed a severe gambling addiction. He’d spend long nights in the casinos, showing up to work exhausted, only to spend the day in an online poker room. Worse still, his habit began to spill into his work. Simens’ corner office became a private hell: sweating into his starched collar, he found himself making riskier and riskier trades. As his habit spiralled out of control, he lost $400,000 in a single day-trade, and liquidated both of his sons’ bank accounts to support his habit. Soon, he had gambled away over 3 million dollars.
Then, suddenly, he kicked his habit as soon as he had picked it up. How? For several years, Simens had been taking drugs to treat his Parkinson’s disease. And, after stopping his medication, his addiction disappeared practically overnight. (1)
Mr. Simens is not alone. In fact, it only occurred to him to try stopping his medication when he read about a similar case, in which a film director had also developed a gambling problem after taking the same Parkinson’s medication, Mirapex. Another businessman gambled away 10 million dollars! Cases like these are piling up, and the drug’s manufacturer, Pfizer, has begun to warn its users that Mirapex can cause impulsive behavior: not just gambling, but also addiction to sex, food, and alcohol! In fact, the same businessman who lost $10 million also lost his marriage and became addicted to prostitutes. One of the most perplexing cases was that of a French husband (to his wife) and father of two, who became addicted not only to gambling but also to gay sex. (2) In all of these cases, the new behavior appeared soon after beginning Parkinson’s medication, and disappeared upon ceasing medication. Pfizer and other manufacturers are facing a slew of lawsuits: early users of Mirapex claim that they were not duly warned of the danger of impulsive behavior. Many of these lawsuits, including that of Mr. Simens, have already proved successful.
But wait: let’s hold on for a second here. A judge held Simens not responsible for his gambling losses—even though it was he who rolled the dice and bought the stocks! The logic was that Mirapex had produced a chemical change in his brain, which had produced impulsivity and led to gambling losses. But what of those gamblers whose addictive brain chemistry is attributable to genetics? They seem no more responsible than Simens. In fact, if anything they should take less blame, since they have never known what it’s like to not be impulsive, where Simens has.
But if an irresponsible gambler is innocent, because his genes drove him to do it, can’t the same be said of a thief, or of a murderer? Here arises the difficult question of responsibility in criminal justice. If everything is attributable to brain chemistry, which in turn is attributed to genetic or even environmental factors, than nothing is attributable to free will and personal choice. We’ve got to draw the line somewhere—at some point people must be held responsible for their actions. It seems like the courts are drawing that line under Simens but above those who are born addicts. Apparently it really is worse to pick up a bad batch of genes than a bad bottle of pills.
What exactly does Mirapex do? Well, first let’s talk about Parksinson’s disease. Parkinson’s is caused by the death of dopamine-producing cells in the Substantia Nigra. The Substantia Nigra can be thought of as the gate to the Basal Ganglia, a group of brain regions important for motion, as well as emotion and cognition. So, when Substantia Nigra cells die, the entire Basal Ganglia network slows down, causing Parkinson’s. Mirapex acts by increasing sensitivity of Basal Ganglia cells to dopamine, thus counteracting the effects of the Substantia Nigra cell death. So why does Mirapex lead to addiction? Well, dopamine is also the primary agent of the reward pathway. I like to think of the reward pathway as that which produces the gratification of having worked a hard day’s work. Drugs like cocaine hijack the reward pathway, making it feel like you’ve accomplished something when you haven’t. Gambling and other addictions have a similar affect. Well, it appears that Mirapex increases dopamine sensitivity not only in the basal ganglia, but also in the reward pathway. So, after starting Mirapex, the symptoms of Parksinson’s will lessen. But winning at slots might change from mild amusement to an irresistible thrill. Thus, until better, more specifically-acting drugs are produced, Parkinsonian patients may have to choose between poor motor control and poor life choices. But at least they have the choice!
Or do they? If our discussion today reveals anything, it’s that our concept of the “self” may be illusory. The administration of a simple dopamine supplement is enough to change our mood, our habits, and even our sexuality. Drugs can turn an introvert into an extrovert (Prozac) (3), produce empathy (MDMA), or even reproduce the symptoms of schizophrenia (PCP) (4). Even to a non-drug-user it’s clear that our personalities are simply a product of whatever neurotransmitters and synaptic connections currently exist in our brain. Yet somehow we still maintain the notion of personal responsibility–not just in our justice system, but in our moral code. Maybe pure determinism isn’t all there is to it.
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