[Dr. Sanjay Gupta, Cnn Chief Medical Correspondent:] Obsessive cravings and total loss of control, whether it's from a substance or a behavior, addiction is a disease. This is "Vital Signs." I'm Dr. Sanjay Gupta. Today we're going to focus on behavioral addictions. One of the most well-known is gambling. It's not necessarily the act of gambling that's addictive but the way it feels. When the brain perceives a situation as stressful or exciting, like gambling, it sends a signal to the adrenal gland. The gland then releases adrenalin, a stress hormone causing a spike in blood pressure and a faster heart rate. Many addicted gamblers describe that adrenaline rush when they place a bet or play a slot machine. And when it comes to gambling, you might be surprised at the country that tops the list. Meet Kate Seselja. She's a loving wife, and a devoted mother to her six children. Now get ready to toss out any stereotypes you might have had about gambling addicts.
[Kate Seselja:] People always say to me, you don't look like a mother of six. They were equally shocked when I came forward and said I had a 12-year gambling problem.
[Gupta:] Kate lives in southeast Australia. It's the country with the highest rate of gambling in the world. She started gambling when she was a teenager. By the time she was 18, Kate was spending her monthly wage in just one day.
[Seselja:] Once I had that first rush on a poker machine, it just did something to me brain. Looking back now I was just pushing money into it like I was pushing paper through a shredder.
[Sally Gainsbury, Center For Gambling And Research, Southern Cross University:] Australians are actually the biggest gamblers in the world. We lose around $1,100 per person per year compared to less than $600 in the U.S. and less than $500 in Canada and Britain.
[Gupta:] Sally Gainsbury is a psychologist in Sydney who studied gambling. She says in Australia there are 197,000 electronic poker machines or pokies. You don't need to go to a casino to find them, either. Pokies are in neighborhood bars and clubs, making it harder to escape them.
[Gainsbury:] It's very easy to play, which makes them very accessible. Just put money in and press a button. You're unlikely to win the jackpot, but when you do play you do get very quick reinforcement in terms of small wins along the way that encourage you to keep betting even though in the long run you are losing.
[Seselja:] I connected with the machine.
[Gupta:] Kate got married and started a family, all while hiding the seriousness of her gambling addiction. Twelve years of her life controlled by this disease. During that time, Kate estimates she lost well over half a million dollars.
[Seselja:] There were several times during that 12 years that I tried to get help, I guess not knowing who to turn to, feeling like I was such a failure. I felt by the end that I was profoundly broken and I didn't think there was any possible recovery.
[Gupta:] Kate reached out for help with the support of her husband.
[Seselja:] I tried to get help before, and it hadn't worked. But this time, this counselor, she saw straightaway that my self-esteem was destroyed. The counselor said to me, I want you to name 10 things that you like about yourself, and I just burst into tears, and said, can I list my children individually? And she said, no. You have to tell me 10 things that you like about you. And it took me a week. And I still have that list.
[Kate Roberts, Executive Officer, Gambling Impact Society:] One of the challenges with problem gambling is that unlike drug and alcohol addiction, is you can't see it, you can't smell it.
[Gupta:] Kate Roberts is the executive officer of the Gambling Impact Society. For the past year and a half, she's also been helping Kate share her story to help others.
[Roberts:] The whole concept is the time on machine, there's a lot of design features now to envelope you into this world. And people are not aware of that, and, more importantly, there's a massive industry that is depending and building itself around that. And we need to get away from the idea that these are flawed people. What we actually have is a flawed product and a case of regulatory failure.
[Gupta:] The Australian government estimates the cost of problem gambling to the country's public is $4.7 billion a year. The government has pledged $25 million to support programs for addicted gamblers. But they also collect roughly 10 percent of their tax revenue from gambling.
[Roberts:] If it's going to be recreational, let's make it recreational. I don't believe a product that takes $1,200 an hour off you is a recreational product.
[Gupta:] At part of her own recovery, Kate Seselja has started the Hope Project, and she still has the original list of 10 things she's proud of about herself. It's a reminder of just how far she's come and what she's doing now to help millions of others just like her around the world.
[Seselja:] I want people to understand that we're human beings, and when did we lose sight of that? I really never thought I'd get to the point where I'd be thankful for the journey, but I am. I'm I wouldn't swap it.
[Gupta:] Kate gambled on the electronic poker machines, but online gambling is now posing a new challenge for programs like the Gambling Impact Society. And as technology increases in all aspects of our lives, it's becoming a behavioral addiction all on its own. Thinking of all the technology advances just in the last decade our phones and our tablets, our powerful computers. They're almost always with us. Kids know how to use tablets from a very young ages, and video games are not more mobile than ever. So I think it's no surprise that technology and gaming addiction are combining to form a serious problem. Some researchers have shown that here in the United States as many as 3 million children are addicted to video games. The manual on mental health disorders in America now includes Internet gaming disorder as a condition warranting more clinical research. It's an important first step when it comes to taking gaming addiction seriously.
[Douglas Gentile, Associate Professor Of Psychology, Iowa State University:] Scientifically documented real effects. So if they're on this side of the zero it means doing it gets you less of them.
[Gupta:] It's a chilly day on the campus of Iowa State University. In room 225, Professor Douglas Gentile addresses his graduate students.
[Gentile:] And that has led people to believe that maybe only certain time types of people are vulnerable to this effect.
[Gupta:] They are here to study how media affects behavior and the impact of technology and video games. Gentile is one of the world's leading researchers on video games, and all that can come with them, including addiction.
[Gentile:] Even back in the 1990s, parents were talking about their kids being addicted to games. And I thought that can't be true. I thought, all they mean is my kid spends a lot of time playing and I don't understand why. And it turns out I was wrong.
[Gupta:] Gentile's research shows roughly 8.5 percent of kids gaming in United States show signs of addiction. Across the world, he found similar numbers.
[Gentile:] One of the things we know that is a risk factor for addiction is access. So with greater access, we're going to see the problem probably increasing. How do we deal with that?
[Gupta:] In southern California addiction to this virtual world is a reality for Noelle Mathieu's family. Her 16-year-old son Griffin was in treatment for Internet gaming disorder. He didn't want to be interviewed on camera but told his mother she could speak to us about their experience.
[Noelle Mathieu, Griffin's Mother:] Griffin is very sweet, a very sweet boy. He's quite introverted. He is quiet. He's on the shy side.
[Gupta:] When he was still a child, Griffin's parents divorced. His mom says he suffered from depression and anxiety. Around age 10 he started playing video games.
[Mathieu:] Griffin is bright. He's quick to learn things so he did take quickly to it, and he became good. He's good at it. He's good at the gaming.
[Gentile:] Sometimes parents what to know why are games so compelling to kids. What is it that is drawing them? There's a theory of intrinsic motivation. What is it that makes us excited to do something on our own, called self-determination theory. And basically it's an ABC of human needs. The A is autonomy. So we like to feel we're in control. The B is belongingness. We like to feel like we're connected to other people. And the C is competence. We like to feel that we're good at what we do. Well, games are fantastic at all three of these. There's nothing wrong with that initially, but over time it can start to get out of balance.
[Gupta:] Over time Griffin's parents noted a shift in that balance and changes in his behavior.
[Mathieu:] The isolation, the wanting to be with, playing more, so then that takes away from family time, it takes away from socializing with his friends.
[Gupta:] This past summer, Griffin's parents sent him for treatment. They found a program called Outback Therapeutic Expeditions in Utah. Griffin would spend times outdoors, unplugged from technology and away from his games.
[Mathieu:] I felt very strongly about him going, that we had no other options, our hands were tied. So I was like, you know what? We're doing this for you because we love you and we care about you and we recognize you need some help.
[Gupta:] Griffin spent six weeks in treatment and returned home. His mom says he still has challenges with his tech use and his depression.
[Mathieu:] It is a battle. It is so hard, because when look back with Griffin, I was the dealer. I was mom, there's this new game came out. My friends all have it. And I was like, sure, because he is a good kid.
[Gupta:] Shortly after our interview with Noelle, Griffin sent us an e- mail. He wanted to share his message for anyone struggling like him. Griffin wrote "I want other kids to realize that the problems they are facing aren't because of what's going on around them, but also due to the fact that they won't stay inside and won't speak to anyone about them. Sitting inside and staring at a screen won't make it disappear."
[Gentile:] Parents often feel powerless, but the reality is when you set your limits on how much time and what types of media your children can use, it actually has a powerful ripple effect out into the future across a wide range of health and wellness benefits.
[Gupta:] Setting limits can work if you know what you're looking for. But what happens when the source of the addiction is hiding where you least expect it? Next, what we can all learn to protect ourselves from food. It is hard to combat an addiction when the temptations are all around you. Like technology, food addicts struggle with overwhelming access. And as more and more processed foods enter our diets, sugar consumption is on the rise. While we may not think of it on the same level as addictive substances like drugs, research has shown that sugar fires off the same reward centers in the brain as cocaine. Unlike co-cairn, we actually do need some sugar in our bodies broken down into energy for our cells. The issue is that we're eating too much of it, and it can be hard to cut back especially when hiding in foods you'd never think of. So this is a pretty standard grocery aisle. Tell me where your eyes go? Lisa Drayer is a nutritionist and a best-selling author. We've come to the best place we could think of to talk about sugar, a typical American grocery store. Everywhere you look there's sugars. And, again, not in the places you'd necessarily expect it. Spaghetti sauce, what would we find here?
[Lisa Drayer, Nutritionist:] Exactly right. So here we're looking at tomato sauce, and we see that a half a cup, which is one serving, has 12 gram of sugar.
[Gupta:] This isn't even sweet. The American Heart Association has set daily recommendations for sugar comp assumption. For women, know more than six tea spoons a day. One teaspoon is four grams of sugar, so that means roughly 24 grams of sugar in day. Men get a bit more nine teaspoons, or 36 grams. But on average, we're exceeding those numbers, big time. Here in the United States, the average adult eats 22 teaspoons of sugar a day. I think it's really striking to me that a lot of people think they're doing the right thing, they're led to believe I'm eating healthy, but in fact they're not. What are some of those misconceptions?
[Drayer:] I think a lot of people that think just because something is natural it's healthy. So, for example, you know, honey is natural, but it's very caloric, and many people might even know a teaspoon of honey or agave for that matter has more calories than a teaspoon of sugar or sucrose.
[Gupta:] Speaking of misconceptions, it is remarkable, and even I am stunned, and I studied this, but I'm stunned what you think you're eating and what you're really eating. So talk me through some of this.
[Drayer:] Sure. Here we have a quarter cup of dried cranberries.
[Gupta:] Perfectly healthy and good for you.
[Drayer:] Exactly. Toss it on your salad, combine it with nuts. But in fact, it contains the same amount of sugar as a quarter cup of candy. Who would think that a quarter cup of each would have the same amounts?
[Gupta:] I mean, again that is remarkable. And to take it a step further you put that on a salad.
[Drayer:] Right.
[Gupta:] You wouldn't put this on a salad, but you're essentially doing the same thing.
[Drayer:] Essentially, when you think about sugar being sugar. Now that being said, dried cranberries do offer antioxidants which candy does not. So I just want to show you, this is actually the amount of sugar in one can of soda. One 12-ounce can. So you pretty much maxed out on your sugar intake for the entire day.
[Gupta:] Sugar is hiding in many of our foods, and there's natural and added sugar. Natural sugars are found in foods like fruit and milk in the form of fructose and lactose. Added sugars are included during processing or preparation but are really empty calories that don't offer any nutritional benefits. There's also artificial sweeteners. Decoding the nutrition label can help identify the different types. But that's easier said than done. The label doesn't distinguish between added and natural sugars, but the FDA is currently considering a proposal to change that. However, the Sugar Association in the U.S. disagrees with the proposal, saying the FDA has not, quote, "provided evidence that added sugars labeling is necessary to assist consumers in maintaining healthy dietary practices." According to the Sugar Association, sugar, as in sucrose, not high fructose corn syrup or other sweeteners, is part of the healthy diet when consumed in moderation. So salads, what could be wrong with salads and salad dressing?
[Drayer:] We think of salads as healthy and we certainly think of a fat-free salad dressing as very healthy, right?
[Gupta:] Yes. You're doing this to help take care of your body and heart.
[Drayer:] Exactly. We're going to save calories and fat. But in fact when we look here we see that one serving or two tablespoons has 10 grams of sugar. So that's for two tablespoons. If we're talking about a ladle, that would be double the amount or 20 grams of sugar.
[Gupta:] So 20 grams of fat-free salad dressing. I mean, and in two servings you get 20 grams.
[Drayer:] That's right, 20 grams. So that's actually
[Gupta:] Like a doughnut.
[Drayer:] more sugar, that's right, than four mini doughnuts. Four mini-doughnuts have 17 grams of sugar.
[Gupta:] You're supposed to be doing the right thing here, fat-free salad dressing. People might think that doesn't even taste good. I'm punishing myself by eating this, but I'm doing something good for myself, but they're not.
[Drayer:] This we expect. This we don't.
[Gupta:] That's the crucial point. Yes. Too many sugar calories leads to weight gain and obesity, straining your heart and raising your risk for a stroke or an illness like diabetes. But there's more at play here than just your sweet tooth. You might be craving sugar because it's been shown to be addictive.
[Drayer:] It seems to induce cravings and hunger that are comparable in magnitude to those induced by addictive drugs. Does that mean it's addicted? Maybe. I think one of the telltale signs is a loss of control. So if you feel like you can't stop eating the cookies, you have to finish the whole box, can't stop at one or two, you're obsessing about how you'll get your sugar fix and you simply can't focus on anything else, you have that psychological dependence, then I think you're probably talking about a food addiction.
[Gupta:] Are there other little tips to cut down on your sugar consumption?
[Drayer:] You want to look at the ingredient list. If sugar or any one of a bunch of terms are listed high on the label, you want to avoid that food. So we're talking corn syrup, high fructose corn syrup, agave, honey, molasses, and anything ending in o-s-e, "dextrose," "fructose," "sucrose." So these are the code words for sugar.
[Gupta:] All right, so here's something I think will astonish I can barely lift this.
[Drayer:] That's 25 pounds of sugar.
[Gupta:] It's 25 pounds of sugar.
[Drayer:] Right.
[Gupta:] And now I will tell you, and it would be still alarming if I told you ate this much in a year, but that's not even the case.
[Drayer:] That's not even the case. Not only are we eating this much, but we're eating a lot more. We're eating five times this amount of sugar. So that's more than some people's body weight that I know. That's a lot of sugar.
[Gupta:] Whether it's food, gambling, technology, or any other behavioral addiction, it's more than just will. It's a medical diagnose, and there is a thin line between doing something a lot and being addicted, a line even psychologists don't have a consensus on just yet. But the keys are awareness of the warning signs and acceptance of the possibility it's an addiction. Don't let the stigma of the word "addiction" hold you back from getting help. For "Vital Signs," I'm Dr. Sanjay Gupta.