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She clung to the fantasy that if she could hit one last, bank-breaking jackpot she could bail her family out of four years of losses and thereby shake her compulsion. In September 2004, she wheedled a $15,000 loan from a friend and an additional $15,000 from her bank and turned back to her home computer, which she had, months earlier, reprogrammed to defeat the blocking software.
Each morning, she would enter the Spin Palace online casino with high hopes, believing a huge jackpot was always one play away. “Sometimes I did win big, but never enough so I would stop,” she says. “Each afternoon, as my funds disappeared, I would sink into a terrible depression.”
She clutched at her delusion until her last penny was gone. Until that moment, she says, “there was a tiny part of me that could still be conned into thinking I could gamble my way out of this. . . . Now, I finally saw the lie for what it was. . . . I could not stop and I never would be able to. And if I couldn’t stop gambling, my family was doomed as well. The only surefire way I knew to stop was to be dead.”
She chose September 24, 2004-the Friday before she and Bob were supposed to meet four other couples in Three Oaks, Michigan, for an annual bike trip. Her primary concern was to make her death appear accidental-she didn’t want her children growing up with the stigma of having a mother who had committed suicide. She settled on drowning herself.
To lay the groundwork, she took walks at Elder Lane Beach, just off Sheridan Road in Winnetka. Everyone who knew her, knew of her passion for collecting sea glass-those little shards of broken bottle polished and shaped by the waves. She also loved swimming, sometimes taking solo swims on warm September mornings. Knowing the lifeguards would be gone by then and that Elder Lane Beach would be deserted in the afternoon, “I decided that swimming and glass collecting would be my camouflage.”
That late September day, she tidied her bedroom. In the top drawer of Bob’s dresser, she laid the suicide letter she had worked on as she gambled her last hopes away. In it, she assured Bob that her death was for the best. “I was admitting the gambling part of me had won, and I was taking the coward’s way out,” she says. At a little after 3 p.m., she pulled on a swimsuit, slipped on a cover-up with a pocket, and put three sleeping pills from Bob’s medicine chest in her pocket. She grabbed a plastic bag from the kitchen and retrieved a beach towel from the basement. She would fill the bag with sea glass, drop it on the towel, and then plunge into the water. Instead of swimming parallel to the shore as she usually did, she would head straight out, as far and as fast as she could. Having already taken the sleeping pills, “I would get more and more tired and eventually fall asleep, sink, and die,” she remembers thinking.
Something clearly held her back, because on her way out the door, without thinking, she says, she grabbed her cell phone. She felt dizzy. Her heart was racing. Could she really do this? She climbed behind the wheel of her car. It was a beautiful fall day, and she glanced at her home washed in sunlight, then dropped her head on her arms and began to weep. “I didn’t want to die,” she says. “I did not want to leave my family.” She picked up the cell phone and punched in the numbers for Leslie.
Her friend drove Barbara to the emergency room at Evanston Northwestern Hospital, where she waited hours in the emergency room under suicide watch. Emotionally and physically drained, she numbly answered the questions of social workers and therapists. Finally, at around 1 a.m., doctors placed her in the psychiatric care ward. After taking a sedative, she curled into a ball and fell asleep.
For months, Barbara’s psychiatrist had been urging her to contact an Evanston therapist named Christopher Anderson, who specialized in gambling addictions. Barbara had ignored the suggestions-she already had a therapist. Now that she had landed in the hospital, the psychiatrist gave her an ultimatum: no call, no discharge. She shuffled down to a small dark booth and picked up the phone. The voice that answered wasn’t what she expected. It was bright and sunny, with a hint of a Texas twang. “Oh, you’re the one with the medication issue,” Chris Anderson said. “I was told you’d be calling.”
For years, Anderson had been hearing about cases of people on dopamine agonist therapy-usually for Parkinson’s disease-struggling with gambling problems. Now he told her that the Permax she was taking might explain her problem. The words hit Barbara like a set of double diamonds. Was it possible that she wasn’t the horrible person she imagined? Until that moment, Barbara had thought of herself as very controlled, very much in charge-except for the demon of gambling. But Anderson was suggesting that an outside factor had taken over, that she in effect had become a lab rat, pushing a lever for a pellet of cocaine, or a machine programmed to carry out her own self-destruction. “I felt like I was in the twilight zone,” she says.
The first step, Anderson told her, was to get out of the hospital. Next he recommended that her medication be altered-though that wasn’t as simple as it sounded. The biggest problem was the drug’s almost miraculous effectiveness with her restless leg syndrome. If she simply stopped, the horrific insomnia would return. And she was going to need all her strength to deal with the consequences of her behavior.
For starters, nine days in the psych ward had left her drained and numb-and now her marriage hung by a thread. Bob had been wonderful during her stay there, supportive and kind. And over the past four years he had been patient beyond measure. But the passing of the immediate crisis had exposed vast reserves of underlying hurt and anger that were bubbling up like lava from some molten core of rage. “I didn’t know whether to believe this or not,” Bob says. “I know I wanted to believe it. But could a simple drug really cause so much heartache?” Meanwhile, there was the staggering debt-hundreds of thousands of dollars.
The first day out of the hospital, when she checked the messages on her voice mail, Barbara discovered that more than a dozen had been left by the two online casinos she had frequented most, Spin Palace and The Virtual Casino. One said that $2,000 had been put into an account for her use. Another asked where she had been. “We want you back!” the voice said. Furious, Barbara fired off e-mails saying she never wanted to hear from them again. “I’m a compulsive gambler,” she wrote. “I can’t do this.”
She immediately began reducing the Permax from her daily dose of two milligrams, and at her doctors’ urging she tried a variety of alternatives to the drug. Researching other reports on the dopamine-gambling link, she discovered that the phenomenon had been addressed in more than a dozen studies stretching as far back as 1988. She wrote three times to the drugmaker, Eli Lilly, and also to Valeant-at that time the exclusive domestic distributor of Permax-and asked if they had any information about the link between compulsive gambling and her medication. She also asked that the companies include a label warning of what she saw as a potentially devastating side effect. She says the responses were pleasant, but that a Lilly attorney told her not enough research had been done to establish a link.
Meanwhile, she felt her will eroding. In February, feeling utter disbelief at what she was doing and contempt for herself, she climbed in her car and went to the Horseshoe. Using her lawyerly wiles, she had persuaded the casino over e-mail to drop the ban she’d had imposed on herself. She lost $500 one day, then $500 the next. But the experience put her over the top. She strode straight back to the security office. “Ban me,” she said. For life. No outs, no questions. She was a compulsive gambler, and she was never, ever to be allowed back in.
Knowing that she would almost certainly be inviting back the worms, she completely stopped the Permax on March 9th. She didn’t care. No torment was worth the hell she had gone through the last four years. She realized that as long as she believed that she could control her behavior-that her inability to stop was simply a failure to straighten up and behave-she would never be able to quit. To win back a new life, to exorcise her demon, she would have to lose the innocence about herself and replace it with something less comfortable, but more real: the idea that a drug could reach into the mind of a smart, ethical person and change a dream life into a nightmare.Last July, the Mayo Clinic issued the findings of a study that dramatically bolstered the link between dopamine agonists and pathological gambling.
Researchers found 11 Parkinson’s patients being treated with dopamine agonists who had started gambling compulsively. Eight patients whom the researchers were able to follow had all quit gambling after stopping the medication. It was “like a light switch being turned off,” said one participant. (The study also found additional behavior issues, including compulsive eating, increased alcohol consumption, and hypersexuality.)
How can a drug that affects the region of the brain associated with muscle control turn someone into a compulsive gambler? The answer, says M. Leann Dodd, a psychiatrist at the Mayo Clinic and the study’s lead researcher, lies in the dual impact of dopamine agonists. Patients with Parkinson’s disease suffer from too few dopamine-producing neurons in areas of their brain that affect movement. The dopamine agonist medications work by providing a synthetic form of that much-needed dopamine. Doing so calms the tremors and other movement problems associated with Parkinson’s disease-as well as the “worms” caused by restless leg syndrome. But those same dopamine agonists also supercharge areas of the brain responsible for cravings, pleasures, and rewards, overriding chemical messages to stop destructive behaviors. The patient, unaware that his brain has been essentially hijacked, believes he is making conscious choices, when the truth is he has been turned into a virtual automaton.
The almost Pavlovian reward-response nature of slot-machine gambling plays right into this process, by providing an activity that ignites the part of the brain affected by dopamine. The connection wasn’t discovered sooner, Dodd says, because behavior such as compulsive gambling, hypersexuality, and overeating carries so much shame that patients were reluctant to discuss these things with their doctors. What’s more, few thought to connect their behavior to their Parkinson’s medication. After a number of sufferers had come forward, researchers were finally led to make the link. “We can’t say we have proved [it] 100 percent,” Dodd says, “but the evidence is very suggestive.”
Other studies have found similar connections. In August 2003, researchers for the journal Neurology found nine of 1,000 Parkinson’s patients had become compulsive gamblers, though they had never had gambling problems in the past. All nine were taking L-dopa and a dopamine agonist when their gambling problems began.
Meanwhile, six people who took the dopamine agonist Mirapex have sued Pfizer and Boehringer Ingelheim Ltd., of Germany, the maker of Mirapex, in a California case that may become a class action. The lawsuit quotes an FDA data base linking Mirapex to 33 compulsive disorder episodes since 1998, including 30 with “catastrophic compulsive gambling effects.” The lawsuit also alleges that plaintiffs are aware of nearly 100 cases of compulsive disorders related to dopamine agonists.
Though the Mayo patients were on different brands of dopamine agonists, Barbara has no doubt that the Permax triggered her compulsion. Neither does Anderson, though he cautions that her case is an exception. For most addicts, he says, a combination of Gambler’s Anonymous and specialized therapy yields the best results.
For Barbara, the most powerful confirmation is in how quickly she was able to stop gambling after discontinuing use of the medication. She has now launched a campaign to warn others, and to force Eli Lilly and Valeant to include a warning with the drug. (This year, after a TV special highlighted possible dangers, Boehringer Ingelheim started putting a warning in the medicine’s package that side effects could include “pathological gambling.” The company denies any wrongdoing.)
After a meeting with Lilly executives proved fruitless, in July Barbara and Bob filed a lawsuit against Lilly and Valeant, as well as Elan Corporation, which bought the rights to the drug from Lilly, and Amarin, to which the rights were transferred in 2002. The suit, now in federal court here, claims that even though the corporations were aware of research linking Permax and compulsive gambling, they failed to warn Barbara and others. Barbara and her husband are seeking compensation for pain and suffering endured because of Barbara’s gambling addiction, says Joseph M. Dooley III, the attorney representing the family.
“We’re not asking that they take the drug off the market,” Barbara says. “It’s a good drug. But people like me need to know to stop taking the medication. If there had been a warning on that bottle a year ago, it would have made a huge difference for me and my family.”
John Dames, a lawyer representing Lilly, said neither he nor the company could comment on ongoing litigation. In a response to the suit filed on August 17th, however, the defendants denied any wrongdoing. Lilly acknowledges receiving letters from Barbara, but denies that it either knew or should have known of a possible link between Permax and compulsive gambling. As for warning consumers, Lilly says it meets the requirements of the Food and Drug Administration.
These days, Barbara insists, the very thought of entering a casino turns her stomach. “I have had not even a flicker of a desire to gamble,” she says. “I walk past lottery machines in the grocery store all the time and wonder how I could have ever stood in front of one putting my money in.” The person who did that was the consummate con artist, she says, an actress, faking her way through life. “When I was gambling, even if I was sitting and talking to one of my children, half of my brain was somewhere else. For the first time in a long time, I’m fully present.”
When she speaks of her return from her experience, she uses words like “reborn” and “resurrection.” “I look at my bank account and I have nothing to hide,” she says. “I’m pure as the driven snow. I feel like I have my brain back.”
But she is not the person she was before. She looks at people, and their struggles, much differently now, with a reluctance to leap to conclusions about who they are and why they do what they do. Yes, people have a responsibility to make smart choices, but if an intelligent person like her, with no history of addiction and an otherwise happy life, can find herself doing such horrible things, acting against her own will, how can she stand in judgment of others?
It is an uncomfortable question, one she would never have thought to ask herself before. But in it lies her redemption, the thing she sought so desperately during those lonely years while she fed a fortune, and her soul, into a slot machine. “I now feel differently toward everyone,” she says. “I have room in my life for people . . . I guess it has given me a profound sense of humility.” To Bob, their ordeal strikes an equally elemental note: “It is amazingly, profoundly unsettling for what it means to be a human being,” he says.
Meanwhile, the consequences of her compulsion will be with her for years. Debts remain. She struggles again with insomnia. Bob is still grappling with the pain of the lies and betrayal. “There’s not the easy joy there once was,” he admits. How did he stick it out, through seven relapses and confessions? The answer, he says, is pretty simple. “Our marriage is the best thing that has ever happened to me. I didn’t want to give up on it. Barbara is a wonderful mother, and even if we were to separate I would want her to be with the kids. The fact is, it just didn’t compute for me.”
Barbara is now using acupuncture to treat her insomnia, and although she is getting only about three hours of sleep a night, she does so with something more precious than any luxurious slumber: a clean conscience.
One day not long ago, on one of the last warm days of summer, Barbara and Bob took a stroll after dinner at Elder Lane Beach, where Barbara had planned to kill herself. As they walked, they picked up a few pieces of sea glass. “That might sound kind of strange [going there with Bob],” she admits. “But I see it as rejecting the negative feelings about the place and reclaiming the good.”
They consider the pieces they collect as symbols of their ordeal’s end, though neither Barbara nor Bob would ever call them a jackpot. They don’t use words like that anymore. The wiser, stronger people they are, and the more honest, tempered happiness they have found, are blessings, they say. Luck has nothing to do with it.