‘Steroids for the brain’ may be the ticket



This column first appeared in Ante Up Magazine in March 2009.

In poker, First Level Thinking means playing your hand based only on the cards you were dealt. (What do I have?) Second Level Thinking means using your opponent’s patterns and tells to put him on a range of hands. (What does she have?) Third Level Thinking requires you to understand how your tells and patterns appear to others and to manipulate that image to set traps. (What can I represent?) Levels higher than that are reserved for guys named Phil, Doyle and Jesus.

Poker is not an easy game for me. Even when I’m playing my best, I find I must concentrate pretty hard to use higher levels of thinking. When I’m fatigued or bored, I drop back into the first level and make basic mistakes like bluffing a calling station or calling a rock with only top pair. It was my desire to combat fatigue and boredom that prompted me to investigate performance-enhancing drugs.

Last month I discussed a few drugs that some pros use to combat fatigue and improve their performance at the poker table. An abbreviated version of my conclusions from last month: caffeine doesn’t work; cocaine and speed are highly dangerous, incredibly addictive and illegal; and two promising prescription candidates, Adderall and Ritalin, are nothing more than crystal meth you buy from someone with good teeth.

New on the scene is the prescription drug Provigil (Modafinil), which some call “steroids for the brain.” The FDA has approved Provigil for narcolepsy, drowsiness associated with sleep apnea and − get this − for “shift work sleep disorder.” SWSD occurs when someone’s occupation requires a high degree of mental alertness at odd hours, commonly during the middle of the night. Sounds like a professional poker player, doesn’t it? Even the name, “Provigil” sounds like the perfect drug for someone wanting to be a “vigilant pro.”

The U.S. military has used Provigil to overcome fatigue in pilots on prolonged missions. Some medical and surgical residents in training use it to work long shifts and care for critically ill patients. My colleagues in emergency medicine have been known to take Provigil before working a night shift to improve alertness. At $10 per pill, it’s pricey but way cheaper than a malpractice suit.

Provigil is sort of like speed and sort of not. It increases wakefulness (It’s your bet, sir.), working memory (Did that guy raise or limp with his connectors last hand?), and especially pattern recognition (Which players at the table are weak-tight and which ones are loose-aggressive?). Yet, unlike speed, it doesn’t seem to increase heart rate or blood pressure very much and, because it’s legally available by prescription, obtaining a supply usually doesn’t involve handcuffs or mugshots.

Here’s what poker pro Paul Phillips said on his blog about Provigil after winning $2.3 million in 2004:

This year, I have a new chemical weapon: (Provigil)… it stimulates wakefulness and enhances focus but without the annoying side effects of an amphetamine. … Drugs are not a substitute for healthy living habits, but the WSOP isn’t a spa. With (Provigil) I feel well-rested even on limited sleep. … I can operate at my full potential for days on end.”

Researchers are not sure exactly how Provigil works but they’re pretty sure it’s not the same mechanism as speed. If you block speed receptors in the brain, Provigil still works. There’s no euphoric “high” associated with Provigil so the addiction potential is significantly less than with speed, but it’s not zero. In research studies, rats that were addicted to speed also became dependent upon Provigil. This leads me to the conclusion you should never play poker with rats. Poker-playing dogs are OK, but rats, no.

Seriously, though, any time you consider taking any medication, the potential risks have to be weighed against the potential benefits. If the benefits are relatively small, such as winning a few extra thousand in a poker tournament, then the risks of taking it should be proportionately small as well. This drug should be approached with caution and only your physician can help you decide whether it’s right for you.

In the interests of full disclosure let me assure you I own no stock in Cephalon, the drug company that makes Provigil, and the Cephalon drug reps have never so much as bought me even a pizza. If there happens to be a Cephalon rep reading this article, however, please note that as an experiment, I’m willing to volunteer to enter a major tournament, take Provigil and report back to Ante Up whether I am able to play for prolonged periods at a higher level of thinking, as long, of course, as Cephalon pays for the entry fee, transportation and lodging. I’m thinking Aruba. Call me.

Next month: Should performance-enhancing drugs be banned from tournament poker?

— An avid poker player, Frank Toscano, M.D. is a board-certified emergency physician with more than 28 years of front-line experience. He’s medical director for Red Bamboo Medi Spa in Clearwater. Email your poker-health questions to ftoscano@redbamboomedispa.com

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