David Brill
The opiate antagonist naltrexone could be an effective treatment for pathological gambling (PG), according to research from the University of Minnesota.
Participants who took the drug during an 18-week randomized trial had significant reductions in gambling urges and behaviour compared to those who took placebo, and displayed improvements in overall gambling severity and psychosocial functioning.
Naltrexone, which is typically used for alcohol and opiate dependence, was well tolerated at doses of 50, 100 and 150 mg/day.
Dr. Jon Grant, lead researcher of the study, said that the findings were very encouraging.
“We were excited because although we found that there was no difference in terms of response to different doses, the medication was still significantly better than placebo,” he said.
The study supports the use of medications as a tool to treat PG, according to Grant, who hopes that naltrexone will be offered routinely for future patients. He added however that there are many different options for treating PG, and that a combination of multiple interventions is likely to be most effective.
Ms. Elda Mei-lo Chan – supervisor at the Tung Wah Group of Hospitals Even Centre in Hong Kong which treats some 700 problem gamblers each year – stressed the importance of performing a holistic assessment before deciding on the appropriate treatment for each patient.
“Gambling is a very complex problem so you really have to look at the underlying causes of the behaviour,” she said, noting that medications can be effective for those whose urges are triggered by biological or neurological factors, whereas others may gamble to boost their self esteem or as a form of protest against problems in their life.
Chan added that patients receiving drug therapy should also receive some form of psychotherapy to help them fully understand the role of the medications.
“We’ve seen too many cases who come here and expect a couple of pills to solve everything. That’s not a realistic way of dealing with the problem – they really have to have the ability to improve relationships with their families and change their lifestyle so that they can still continue their work and their normal day-to-day life,” she said.
The trial involved 77 pathological gamblers, as defined by the Diagnostic and Statistical Manual of Mental Disorders. The positive treatment effect of naltrexone reached significance after 6 weeks. [J Clin Psychiatry 2008 Epub ahead of print]
Prior to enrollment, participants gambled for an average of 13.1 hours and lost US$535.54 per week. Having money was reported as the most common trigger for gambling urges, followed by stress, loneliness and advertisements.
Gambling behaviour and urges were assessed using a range of diagnostic tools, including the Yale-Brown Obsessive Compulsive Scale. Patients who improved during the trial said that they felt greater control over their actions and less of an impulse to act immediately on their urges, Grant said.
The study replicates and extends the results of previous studies into naltrexone for PG, carried out by the same group.
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