Impulse control drugs and how they relate to poker

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

I’m half-Sicilian, so it’s a pretty safe guess that I might, at times, have some impulse-control issues. Mostly, though, at the poker table, I control my impulses fairly well. My more logical side rightly advises tight play, pot control and caution when the flop is coordinated.

On occasion, however, usually after a few hours of being card dead, I tend to loosen up and act more impulsively. If I can’t play premium starting hands I’ll just have to play the rags I’m dealt and hope to catch something on the flop. That fails miserably, of course. I mistake second pairs for monsters and I push them when I should fold. My impulse to play some hands, any hands, overwhelms my logic and my carefully built stack shrinks dramatically.

I’m reminded somewhat about that forgettable 1985 movie called Lost in America starring Albert Brooks and Julie Hagarty. As a married couple they sell their house, cash out their savings, purchase a motor home and head out to discover America — conservative ad executive turned Easy Rider. On the first night of their adventure, Julie’s character sneaks out of their Vegas hotel room and blows their nest egg on the roulette wheel. If you want to see a great movie about gambling, sorry, this isn’t it, but the scene when she keeps shouting “22! 22!” at the roulette croupier is a classic picture of lost impulse control.

Thankfully, my impulse-control issues are pretty minor. After $80 or $100, I get disgusted with myself and drive home. There are, unfortunately, many people with severe impulse-control issues and for them, gambling can be a serious addiction. That is a broad and deep subject I may try to tackle in some future column. For this month, I want to issue a warning about the possible connection between impulse control and drugs used to control Restless Legs Syndrome.

I’m not talking about the I’ve-made-the-nuts happy feet described by author and Ante Up columnist Joe Navarro. Restless Legs Syndrome is a real disease that seriously interferes with sleep. The legs tingle and burn, especially at night. The unfortunate sufferer feels an uncontrollable desire to move his legs up and down, back and forth under the sheets until his sleeping partner begs him to get out of bed and go play some Internet poker.

Sadly, the drugs available to treat this difficult condition work only marginally. Several of them, however, Parkinson’s medications called Requip (Ropinirole) and Mirapex (Praimpexole), have been associated with some quite bizarre impulse-control issues that are said to have turned conservative Grannies into crazed Julie Hagartys. Some claim their life’s savings were lost and their marriages destroyed because of these drugs. They felt completely out of control as their gambling became compulsive and constant. When they stopped the drugs, they claim, the gambling impulses disappeared.

In all fairness, actual medical studies demonstrating lost impulse control on Requip or Mirapex are a bit sketchy. The best is a 2008 study that found nine out of 1,884 patients taking Mirapex (about three times more likely than the general population) developed a serious impulse-control disorder, usually gambling addiction but sometimes shopping or even sexual addiction (yikes!). Last year a jury (really, what do they know?) awarded $8.2 million to a man who lost $260,000 gambling while taking Mirapex. With pot odds like that you could draw to a one-outer. Of course, there is no shortage of lawyers willing to take those odds. Google “Requip gambling” for 75,000 hits.

Seriously, if you’re taking one of these drugs, talk to your doctor about the possible complications. If you have impulse-control issues, or if you’re taking one of these drugs and you notice an increased desire to gamble, shop or hook up, realize that it’s just possible that a drug may be contributing to your problem. And finally, no experimentation, kiddies! Understand there needs to be a lot more research before you can use Requip to turn your tight-passive playing pattern into loose-aggressive.
While we’re on the subject of drugs and poker, Ante Up Forum posters have voted overwhelmingly they do NOT believe there should be drug testing at large-event final tables. The stampede to pushers, pharmacists and energy-drink suppliers can be heard across the nation. I have no objection to drug testing. If I ever made a large-event final table, I’d seriously want to know if I were hallucinating.

— 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