The semantic relocation has a lot riding on it: In terms of the allocation of research and treatment funding, it's the psychiatric equivalent of moving from the outhouse to the penthouse.

The majority of psychiatrists and psychologists favor the change in light of the scientific literature supporting it. Addiction specialists call slot machines the "crack cocaine" of entertainment, citing studies that compare functional magnetic resonance imaging (fMRI) scans of the brains of pathological gamblers and cocaine addicts: When study subjects are presented with stimulating cues, the dopamine-carrying neural pathways in both populations' prefrontal cortexes light up in identical patterns.

In a sense, pathological gambling is the cruelest of all addictions. Gamblers and researchers alike refer to it as "the hidden addiction": There's no pee test, and you can't smell dice (or deuces) on someone's breath. Says Chapman: "Some vets come to me saying they wish they had a substance addiction because you pass out after too much of it. With gambling you can't pass out."

Dreux Perkins came home to Greenville, Illinois, carrying baggage he didn’t have when he was deployed to Iraq with the army’s 101st Airborne: post-traumatic stress disorder and a gambling addiction.
Dreux Perkins came home to Greenville, Illinois, carrying baggage he didn’t have when he was deployed to Iraq with the army’s 101st Airborne: post-traumatic stress disorder and a gambling addiction.

Keith S. Whyte, executive director of the National Council on Problem Gambling, a Washington, D.C.-based nonprofit, has formed a military task force to lobby Congress to earmark money for a federal epidemiological study to grasp the full scope of the problem among veterans.

"We think the evidence is pretty clear that gambling addiction is underdiagnosed and undertreated among vets," says Whyte, who believes every veteran who checks in to the VA for a mental-health problem should be screened for gambling addiction. "The VA might say they don't have many patients who present for gambling problems. But they're not asking."

This fall Whyte intends to present to Congress a white paper with the working title "Warriors at Risk: Gambling and Problem Gambling in the Military." Author Kamini R. Shah conducted the bulk of her research through the Washington University School of Medicine and the St. Louis VA while earning her doctorate from the Johns Hopkins Bloomberg School of Public Health.

"The fact males and females showed equal rates is a huge finding," says Shah, noting that in the U.S. population at large, women who are pathological gamblers are outnumbered by men, two to one. "And it's important that we say to the government: 'Hey, open your eyes.'"

When Dreux Perkins returned home, he tried not to think about the war. He began drinking close to a fifth of Jim Beam at night and having nightmares about the killings. He also continued to gamble, playing Texas hold'em at Lumière Place Casino in downtown St. Louis. He scored big early on, winning $7,800 one evening and $3,900 the next.

Eventually, says Perkins, Lumière lost its allure. So he started hitting the slot machines on the opposite bank of the Mississippi, at the Argosy Casino in Alton, Illinois.

Slowly, his demeanor began to change. He lost his sex drive, developed a hot temper, distanced himself from those closest to him and became verbally abusive to his fiancée.

Kelly Derrick, now 26, says the man she pledged her heart to was compassionate, tender and responsible with money, while the postwar Perkins was inconsiderate and deceitful.

"He was a total flip-flop," says Derrick, recounting the lies about the dwindling bank account and time spent away from home. "He'd say he was going out with friends or helping someone move, but he was going to the casino."

Says Perkins: "She didn't know what the hell was going on with me. People told me I was just numb and didn't really care about anything. Gambling was the only type of enjoyment I was getting."

They called off the engagement and eventually split for good.

On December 27, 2009, Perkins called a crisis hotline and said he'd been throwing up every day and needed help. The following week he checked into the St. Louis VA's Jefferson Barracks Division, complaining of nightmares, nausea and sitting anxiously in corner restaurant booths, watching his back.

Less than a month later, Perkins was back at the VA. "The veteran became highly anxious and tearful when attempting to recount the event(s) and chose to limit his recounting to the sight of dead bodies (particularly close friends and innocent [Iraqis])," reads a report his psychologist filed. "The veteran reported that he has nightmares about 'the dead bodies' approximately 'every night' and that he awakens in a highly anxious state with his 'heart pounding.'"

During that session, Perkins described an incident in which a rock hit his windshield; mistaking it for a bullet, he momentarily lost control of his car. He said his new girlfriend, Emily Gehrig, told him he screamed in his sleep.

Perkins' VA psychologist diagnosed him with PTSD. But the sergeant failed to follow up much at the VA that year. Instead he continued gambling. In a two-month span, Perkins says, he blew through $15,000, maxing out his credit card. Unable to scrape together enough for his monthly car payment, he began selling off personal belongings. He fell into arrears on his mortgage. And while on duty at the federal prison in Greenville, he confided to an inmate the extent of his financial straits.

Khalat Alama, an Iraqi American in his mid-twenties from Lincoln, Nebraska, was serving a sixteen-year sentence for possession of and conspiracy to distribute methamphetamine. As Perkins relates and federal investigative documents confirm, Alama offered the corrections officer $600 in exchange for smuggling two packs of cigarettes into the prison.

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