Abstract
Certain behavioral syndromes (behavioral addictions), such as gambling disorder, stealing, shopping, and compulsive sexual behavior, appear to share clinical and neurobiological parallels with substance addictions. Pharmacological agents, often those used in substance addictions, have shown some benefit for behavioral addictions. This article reviews the double-blind, placebo-controlled pharmacological studies in the field of behavioral addictions. Future work is needed to develop treatment algorithms for people struggling with these disorders.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Holden C. ‘Behavioral’ addictions: do they exist? Science. 2001;294:980–2.
Grant JE, Atmaca M, Fineberg NA, et al. Impulse control disorders and “behavioural addictions” in the ICD-11. World Psychiatry. 2014;13:125–7.
Müller A, Rein K, Kollei I, et al. Impulse control disorders in psychiatric inpatients. Psychiatry Res. 2011;188(3):434–8.
Grant JE, Levine L, Kim D, et al. Impulse control disorders in adult psychiatric inpatients. Am J Psychiatry. 2005;162:2184–8.
Grant JE, Schreiber LR, Odlaug BL. Phenomenology and treatment of behavioural addictions. Can J Psychiatry. 2013;58:252–9.
Dalley JW, Fryer TD, Brichard L, et al. Nucleus accumbens D2/3 receptors predict trait impulsivity and cocaine reinforcement. Science. 2007;315(5816):1267–70.
Everitt BJ, Robbins TW. From the ventral to the dorsal striatum: devolving views of their roles in drug addiction. Neurosci Biobehav Rev. 2013;37(9 Pt A):1946–54.
Wise RA. Drive, incentive, and reinforcement: the antecedents and consequences of motivation. Nebr Symp Motiv. 2004;50:159–95.
Kalivas PW, Volkow ND. The neural basis of addiction: a pathology of motivation and choice. Am J Psychiatry. 2005;162(8):1403–13.
Vilas D, Pont-Sunyer C, Tolosa E. Impulse control disorders in Parkinson’s disease. Parkinsonism Relat Disord. 2012;18 Suppl 1:S80–4.
Weintraub D, David AS, Evans AH, et al. Clinical spectrum of impulse control disorders in Parkinson’s disease. Mov Disord. 2015;30(2):121–7.
Moore TJ, Glenmullen J, Mattison DR. Reports of pathological gambling, hypersexuality, and compulsive shopping associated with dopamine receptor agonist drugs. JAMA Intern Med. 2014;174(12):1930–3. An important examination of the possible neurobiology of sexual compulsivity.
Seeman P. Parkinson’s disease treatment may cause impulse-control disorder via dopamine D3 receptors. Synapse. 2015;69(4):183–9.
Linnet J, Peterson E, Doudet DJ, et al. Dopamine release in ventral striatum of pathological gamblers losing money. Acta Psychiatr Scand. 2010;122(4):326–33.
Clark L, Stokes PR, Wu K, et al. Striatal dopamine D2/D3 receptor binding in pathological gambling is correlated with mood-related impulsivity. Neuroimage. 2012;63(1):40–6.
Joutsa J, Johansson J, Niemelä S, et al. Mesolimbic dopamine release is linked to symptom severity in pathological gambling. Neuroimage. 2012;60(4):1992–9.
Boileau I, Payer D, Chugani B, et al. The D2/3 dopamine receptor in pathological gambling: a positron emission tomography study with [11C]-(+)-propyl-hexahydro-naphtho-oxazin and [11C] raclopride. Addiction. 2013;108(5):953–63.
Linnet J, Møller A, Peterson E, et al. Dopamine release in ventral striatum during Iowa Gambling Task performance is associated with increased excitement levels in pathological gambling. Addiction. 2011;106(2):383–90.
Boileau I, Payer D, Chugani B, et al. In vivo evidence for greater amphetamine-induced dopamine release in pathological gambling: a positron emission tomography study with [(11)C]-(+)-PHNO. Mol Psychiatry. 2014;19(12):1305–13.
Grant JE, Odlaug BL, Chamberlain SR. Neural and psychological underpinnings of gambling disorder: a review. Prog Neuro-Psychopharmacol Biol Psychiatry. 2016;65:188–93.
Marazziti D, Presta S, Pfanner C, et al. The biological basis of kleptomania and compulsive buying. Scientific Abstracts, American College of Neuropsychopharmacology 39th Annual Meeting. San Juan, Puerto Rico: ACNP, 2000.
Grant JE, Correia S, Brennan-Krohn T. White matter integrity in kleptomania: a pilot study. Psychiatry Res. 2006;147:233–7.
Miner MH, Raymond N, Mueller BA, et al. Preliminary investigation of the impulsive and neuroanatomical characteristics of compulsive sexual behavior. Psychiatry Res. 2009;174(2):146–51.
Voon V, Mole TB, Banca P, et al. Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviours. PLoS One. 2014;9(7):e102419. An excellent study using neuroimaging to understand sexual compulsivity.
Mechelmans DJ, Irvine M, Banca P, et al. Enhanced attentional bias towards sexually explicit cues in individuals with and without compulsive sexual behaviours. PLoS One. 2014;9(8):e105476.
Derbyshire KL, Chamberlain SR, Odlaug BL, et al. Neurocognitive functioning in compulsive buying disorder. Ann Clin Psychiatry. 2014;26(1):57–63.
Hodgins DC, Stea JN, Grant JE. Gambling disorders. Lancet. 2011;378:1874–84.
Kim SW, Grant JE, Adson DE, et al. Double-blind naltrexone and placebo comparison study in the treatment of pathological gambling. Biol Psychiatry. 2001;49:914–21.
Grant JE, Kim SW, Hartman BK. A double-blind, placebo-controlled study of the opiate antagonist, naltrexone, in the treatment of pathological gambling urges. J Clin Psychiatry. 2009;69:783–9.
Grant JE, Potenza MN, Hollander E, et al. A multicenter investigation of the opioid antagonist nalmefene in the treatment of pathological gambling. Am J Psychiatry. 2006;163:303–12.
Grant JE, Odlaug BL, Potenza MN, et al. Nalmefene in the treatment of pathological gambling: multi-centre, double-blind, placebo-controlled study. Br J Psychiatry. 2010;197:330–1.
Grant JE, Kim SW, Odlaug BL. N-acetyl cysteine, a glutamate-modulating agent, in the treatment of pathological gambling: a pilot study. Biol Psychiatry. 2007;62:652–7.
Grant JE, Odlaug BL, Chamberlain SR, et al. A randomized, placebo-controlled trial of N-acetylcysteine plus imaginal desensitization for nicotine-dependent pathological gamblers. J Clin Psychiatry. 2014;75:39–45. One of a very few studies to examine the use of pharmacotherapy plus psychotherapy in a behavioral addiction.
Berlin HA, Braun A, Simeon D, et al. A double-blind, placebo-controlled trial of topiramate for pathological gambling. World J Biol Psychiatry. 2013;14:121–8.
Saiz-Ruiz J, Blanco C, Ibanez A, et al. Sertraline treatment of pathological gambling: a pilot study. J Clin Psychiatry. 2005;66:28–33.
Hollander E, DeCaria CM, Finkell JN, et al. A randomized double-blind fluvoxamine/placebo crossover trial in pathological gambling. Biol Psychiatry. 2000;47:813–7.
Blanco C, Petkova E, Ibanez A, et al. A pilot placebo-controlled study of fluvoxamine for pathological gambling. Ann Clin Psychiatry. 2002;14:9–15.
Kim SW, Grant JE, Adson DE, et al. A double-blind placebo-controlled study of the efficacy and safety of paroxetine in the treatment of pathological gambling. J Clin Psychiatry. 2002;63:501–7.
Grant JE, Kim SW, Potenza MN, et al. Paroxetine treatment of pathological gambling: a multi-center randomized controlled trial. Int Clin Psychopharmacol. 2003;18:243–9.
Black DW, Arndt S, Coryell WH, et al. Bupropion in the treatment of pathological gambling: a randomized, double-blind, placebo-controlled, flexible-dose study. J Clin Psychopharmacol. 2007;27:143–50.
Hollander E, Pallanti S, Allen A, et al. Does sustained-release lithium reduce impulsive gambling and affective instability versus placebo in pathological gamblers with bipolar spectrum disorders? Am J Psychiatry. 2005;162:137–45.
Fong T, Kalechstain A, Bernhard B, et al. A double-blind, placebo-controlled trial of olanzapine for the treatment of video poker pathological gamblers. Pharmacol Biochem Behav. 2008;89:298–303.
McElroy SL, Nelson EB, Welge JA, et al. Olanzapine in the treatment of pathological gambling: a negative randomized placebo-controlled trial. J Clin Psychiatry 2008; e1-8.
McElroy SL, Keck PE, Pope HG, et al. Compulsive buying: a report of 20 cases. J Clin Psychiatry. 1994;55:242–8.
Black DW, Gabel J, Hansen J, et al. A double-blind comparison of fluvoxamine versus placebo in the treatment of compulsive buying disorder. Ann Clin Psychiatry. 2000;12:205–11.
Ninan PT, McElroy SL, Kane CP, et al. Placebo-controlled study of fluvoxamine in the treatment of patients with compulsive buying. J Clin Psychopharmacol. 2000;20:362–6.
Koran LM, Chuong HW, Bullock KD, et al. Citalopram for compulsive shopping disorder: an open-label study followed by double-blind discontinuation. J Clin Psychiatry. 2003;64:793–8.
Grant JE, Kim SW, Odlaug BL. A double-blind, placebo-controlled study of the opiate antagonist, naltrexone, in the treatment of kleptomania. Biol Psychiatry. 2009;65:600–6.
Koran LM, Aboujaoude EN, Gamel NN. Escitalopram treatment of kleptomania: an open-label trial followed by double-blind discontinuation. J Clin Psychiatry. 2007;68:422–7.
Fong TW, Reid RC, Parhami I. Behavioral addictions: where to draw the lines? Psychiatr Clin North Am. 2012;35:279–96.
Wainberg ML, Muench F, Morgenstern J, et al. A double-blind study of citalopram versus placebo in the treatment of compulsive sexual behaviors in gay and bisexual men. J Clin Psychiatry. 2006;67:1968–73.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Dr. Grant has received research grants from NIMH, National Center for Responsible Gaming, and Forest, and Roche Pharmaceuticals. Dr. Grant receives yearly compensation from Springer Publishing for acting as Editor-in-Chief of the Journal of Gambling Studies and has received royalties from Oxford University Press, American Psychiatric Publishing, Inc., Norton Press, and McGraw Hill. Dr. Chamberlain consults for Cambridge Cognition, and his involvement in this study was facilitated by a grant from the Academy of Medical Sciences (AMS, UK)).
Dr. Chamberlain reports consultation for Cambridge Cognition, outside the submitted work.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
This article is part of the Topical Collection on Addictions
Rights and permissions
About this article
Cite this article
Grant, J.E., Chamberlain, S.R. Pharmacotherapy for Behavioral Addictions. Curr Behav Neurosci Rep 3, 67–72 (2016). https://doi.org/10.1007/s40473-016-0065-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40473-016-0065-6