NCRG Conference on Gambling and Addiction

Sunday, November 11, 2007

Can Medication Manage Disordered Gambling Behavior? Newest Trends in Research.

According to Dr. Jon Grant, associate professor of psychiatry at the University of Minnesota Medical Center, medication can help manage disordered gambling, but there isn’t a “magic pill” that can cure gambling disorders.

Grant pointed out that drug companies haven’t been all that interested in the medication and treatment of gambling addiction – even those companies who are very interested in creating medication to treat substance addiction. His experience has shown that these companies don’t see pathological gambling as a real problem. Grant implied a link between this disinterest and the fact that all medication being tested for use in the treatment of gambling addiction is “off label” as the FDA has not approved any drugs for gambling addiction. The medication used, said Grant, is largely borrowed from what’s already being used for drug addiction.

One overarching theme Grant revisited throughout the session is that not all pathological gamblers are created equal – meaning that people categorized as pathological gamblers are driven by different motivators to participate in gambling behavior, and that there are different types of biology for different types of gamblers. In early pharmacological research on addicted gamblers, Grant explained, all addicted gamblers tended to be lumped into one category. This meant that the effectiveness of medications could be “watered down” simply because the medication being tested may not be treating the right biological factors for everyone in the group.

Grant pointed out that by understanding what goes on in brain, we can understand better how to target it. Over the years, Grant and his colleagues have found that the practice of subtyping pathological gamblers – dividing them into categories based on what drives them to gamble – helps to target medications in a way that can show improved responses to medication. Since it is incredibly difficult and expensive to do genetic testing on every single patient, Grant explained that subtyping can be a “stand in” for biology.

Subtyping looks at a pathological gambler’s family history and comorbitites (i.e. other disorders they may have). Grant presented four subtypes: anxiety-driven gamblers, affective/mood-driven gamblers, impulse-driven gamblers and urges/cravings-driven gamblers.

Particular progress has been made in the area of treating pathological gamblers driven by cravings. Grant and his colleagues recently completed the first study to replicate the results of successful medication treatment for gambling addiction in craving gamblers. The drug they studied was naltrexone, an opiod antagonist that has been approved for more than 20 years for treating alcoholism. Interestingly, Grant pointed to research which shows that pathological gamblers are much more likely to report cravings (60 to 70 percent) than are alcoholics (20 to 30 percent).

Some progress also has been made in other categories. While the studies have been sparse, there has been some evidence showing that gamblers who are anxiety driven may benefit from medication that helps to alleviate that anxiety. For impulse-driven gamblers – those Grant described as people who regularly decide to engage in gambling behavior despite the potential negative consequences – Grant suggested that there may be an underlying attention deficit issue, and that it may be helpful to test and, if appropriate, treat gamblers in this group for these types of disorders.

Grant noted that medication is studied on its own – not in conjunction with other therapies – because researchers have to be able to determine if the medication actually works. Yet, in clinical settings, Grant explained that medication usually is used in combination with other methods such as Gamblers Anonymous, self-exclusion programs and other individual therapeutic treatment options. In response to a question at the end of the session about the long-term effects of medication, Grant said that not much is known, but that the target treatment time for medication in his clinical work is one year, with other therapies used in conjunction and continuing to be used afterward.

To access Grant’s 2006 study, Medication Management of Pathological Gambling, click here, or visit the Institute for Research on Pathological Gambling and Related Disorders’ NCRG Conference Resource Page. When prompted, please enter the case-sensitive password: institute.


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