Abstract
In the present paper we discuss the current status of drug treatment for pathological gambling and the scientific rationales underlying the various pharmacological approaches. Specifically, we summarize the treatment study results of serotonin reuptake inhibitors, mood stabilizers, opioid antagonists, and atypical antipsychotics in pathological gambling. We also discuss dosage strategies, the duration of treatment, issues surrounding medication compliance, and approaches to treatment-refractory pathological gambling, such as pharmacological and behavioral augmentation.
Similar content being viewed by others
References
Albanese, M.J., Khantzian, E.J., Murphy, S.L., & Green, A.I. (1994). Decreased substance use in chronically psychotic patients treated with clozapine. American Journal of Psychiatry, 151, 780–781. [Letter].
American Psychiatric Association Committee on Nomenclature and Statistics. (1980). Diagnostic and statistical manual of mental disorders (3rd Ed.). Washington, D.C.: American Psychiatric Association.
American Psychiatric Association Committee on Nomenclature and Statistics. (1987). Diagnostic and statistical manual of mental disorders (3rd Ed.-Revised). Washington, D.C.: American Psychiatric Association.
American Psychiatric Association Committee on Nomenclature and Statistics. (2000). Diagnostic and statistical manual of mental disorders (4th Ed.-Text Revision). Washington, D.C.: American Psychiatric Association.
Barrett, R.P., Feinstein, C., & Hole, W.T. (1989). Effects of naloxone and naltrexone on self-injury: a double-blind, placebo-controlled analysis. American Journal of Mental Retardation, 93, 644–651.
Blanco, C., Moreyra, P., Nunes, E.V., Sáiz-Ruiz, J., & Ibánez, A. (2001). Pathological gambling: addiction or compulsion? Seminars in Clinical Neuropsychiatry, 6, 167–176.
Blanco, C., Orensanz-Munoz, L., Blanco-Jerez, C., & Saiz-Ruiz, J. (1996). Pathological gambling and platelet MAO activity: a psychobiological study. American Journal of Psychiatry, 153, 119–121.
Blanco, C., Petkova, E., Ibanez, A., & Sáiz-Ruiz, J. (2002). A pilot placebo-controlled study of fluvoxamine for pathological gambling. Annals of Clinical Psychiatry, 14, 9–15.
Broekkamp, C.L. & Phillips, A.G. (1979). Facilitation of self-stimulation behavior following intracerebral microinjections of opioids into the ventral tegmental area. Pharmacology Biochemistry and Behavior, 11, 289–295.
Buckley, P., Thompson, P., Way, L., & Meltzer, H.Y. (1994). Substance abuse among patients with treatment-resistant schizophrenia: characteristics and implications for clozapine therapy. American Journal of Psychiatry, 151, 385–389.
Carrasco, J.L., Saiz-Ruiz, J., Hollander, E., Cesar, J., & Lopez-Ibor Jr., J.J. (1994). Low platelet monoamine oxidase activity in pathological gambling. Acta Psychiatrica Scandinavia, 90, 427–3
Carroll, K.M., Ball, S.A., Nich, C., O'Connor, P.G., Eagan, D.A., Frankforter, T.L., Triffleman, E.G., Shi, J., & Rounsaville, B.J. (2001). Targeting behavioral therapies to enhance naltrexone treatment of opioid dependence. Archives of General Psychiatry, 58, 755–761.
Chambers, R.A., Krystal, J. H., & Self, D.W. (2001). A neurobiological basis for substance abuse comorbidity in schizophrenia. Biological Psychiatry, 50, 71–83.
Chambers, R.A. & Potenza, M.N. (2001). Schizophrenia and pathological gambling. American Journal of Psychiatry, 158, 497–498. [Letter].
Chambers, R.A. & Potenza, M.N. (in press). Impulse control disorders. In M.J. Adinoff & R.B. Daroff (Eds.), The encyclopedia of neurological sciences. San Diego, California: Academic Press.
Crockford, D.N. & el-Guebaly, N. (1998). Naltrexone in the treatment of pathological gambling and alcohol dependence. Canadian Journal of Psychiatry, 43, 86. [Letter].
Cunningham-Williams, R.M. & Cottler, L.B. (2001). The epidemiology of pathological gambling. Seminars in Clinical Neuropsychiatry, 6:155–166.
Cunningham-Williams, R.M., Cottler, L.B., Compton, W.M. 3rd, & Spitznagel, E.L. (1998). Taking chances: problem gamblers and mental health disorders—results from the St. Louis Epidemiologic Catchment Area Study. American Journal of Public Health. 88:1093–1096.
Daly, K.A. & Fatemi, S.H. (1999). Lamotrogine and impulse behavior. Canadian Journal of Psychiatry, 44, 395-396. [Letter].
Davidson, D., Swift, R.M., & Fitz, E. (1996). Naltrexone increases the latency to drink in social drinkers. Alcoholism and Clinical Experimental Research, 20, 732–739.
DeCaria, C.M., Begaz, T., & Hollander, E. (1998). Serotonergic and noradrenergic function in pathological gambling. CNS Spectrums, 3, 38–47.
DeCaria, C.M., Hollander, E., Grossman, R., Wong, C.M., Mosovich, S.A., & Cherkasky, S. (1996). Diagnosis, neurobiology, and treatment of pathological gambling. Journal of Clinical Psychiatry, 57(S8), 80–83.
De la Gandara, J.J. (1999). Fluoxetine: open-trial in pathological gambling. Presented at the 152nd Annual Meeting of the American Psychiatric Association; May 16–21; Washington, DC. [Abstract].
Farren, C.K., Rezvani, A.H., Overstreet, D., & O'Malley, S. (2000). Combination pharmacotherapy in alcoholism: a novel treatment approach. CNS Spectrums, 5, 70–76.
Feeney, D.J. & Klykylo, W.M. (1997). Treatment for kleptomania. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 723–724.
Gardell, L.R., Reid, L.D., Boedeker, K.L., Liakos, T.M., & Hubbell, C.L. (1997a). Isradipine and naltrexone in combination with isradipine interact with a period of abstinence to reduce rats' intakes of an alcoholic beverage. Alcoholism and Clinical Experimental Research, 21, 1592–1598.
Gardell, L.R., Whalen, C.A., Chattophadyay, S., Cavallaro, C.A., Hubbell, C.L., & Reid, L.D. (1997b). Combination of naltrexone and fluoxetine on rats' propensity to take alcoholic beverage. Alcoholism and Clinical Experimental Research, 21, 1435–1439.
George, T.P. & Krystal, J.H. (2000). Comorbidity of psychiatric and substance abuse disorders. Current Opinion in Psychiatry, 13, 327–331.
George, T.P., Ziedonis, D.M., Feingold, A., Pepper, W.T., Satterburg, C.A., Winkel, J., Rounsaville, B. J., & Kosten, T.R. (2000). Nicotine transdermal patch and atypical antipsychotic medications for smoking cessation in schizophrenia. American Journal of Psychiatry, 157, 1835–1842.
Gerstein, D., Hoffmann, J., Larison, C., Engelman, L., Murphy, S., Palmer, A., Chuchro, L., Toce, M., Johnson, R., Buie, T., & Hill, M.A. (1999). Gambling impact and behavior study. National Opinion Research Center, University of Chicago. http://www.norc.uchicago.edu/new/gambfin.htm".
Goodman, W.K., McDougle, C.J., Price, L.H., Riddle, M.A., Pauls, D.L., & Leckman, J.F. (1990). Beyond the serotonin hypothesis: a role for dopamine in some forms of obsessive-compulsive disorder? Journal of Clinical Psychiatry, 51, 36–43.
Goodwin, F.K. & Jamison, K.R. (1990). Manic-depressive illness. New York City, NY: Oxford University Press.
Grant, J.E. & Kim, S.W. (2001a). Demographic and clinical features of 131 adult pathological gamblers. Journal of Clinical Psychiatry, 62, 957–962.
Grant, J.E. & Kim, S.W. (2001b). Pharmacotherapy of pathological gambling disorder. Psychiatric Annals, 32, 161–170.
Grant, J.E. & Kim, S.W. (2002). An open label study of naltrexone in the treatment of kleptomania. Journal of Clinical Psychiatry, 63, 349–356.
Guy, W. (1976). ECDEU Assessment Manual for Psychopharmacology. US Dept Health, Education and Welfare publication (ADM) 76–338. Rockville, MD: National Institute of Mental Health, 218–222.
Haller, R. & Hinterhuber, H. (1994). Treatment of pathological gambling with carbamazepine. Pharmacopsychiatry, 27, 129.
Head, C.A., Vessichio, J.C., Sahady, D.M., Kosten, T.R., & George, T. P. (2000). Buproprion versus placebo for smoking cessation in schizophrenia: effects of atypical antipsychotic drugs. Presented at the 7 th Annual Meeting of the Society for Research of Nicotine and Tobacco. [Abstract].
Hollander, E. (2001). “Very bad behaviors” in the Symposium “The impulsive aggressive spectrum: Challenging populations.” Presented at the 154th Annual Meeting of the American Psychiatric Association; May 7 and 8; New Orleans, LA. [Abstract].
Hollander, E., DeCaria, C.M., Finkell, J.N., Begaz, T., Wong, C.M., & Cartwright, C. (2000). A randomized double-blind fluvoxamine/placebo crossover trial in pathological gambling. Biological Psychiatry, 47, 813–817.
Hollander, E., DeCaria, C.M., Mari, E., Wong, C.M., Mosovich, S., Grossman, R., & Begaz, T. (1998). Short-term single-blind fluvoxamine treatment of pathological gambling. American Journal of Psychiatry, 155, 1781–1783.
Hollander, E., Frenkel, M., DeCaria, C., Trungold, S., & Stein, D.J. (1992). Treatment of pathological gambling with clomipramine. American Journal of Psychiatry, 149, 710–711. [Letter].
Hollander, E. & Wong, C.M. (1995). Obsessive-compulsive spectrum disorders. Journal of Clinical Psychiatry, 56(S4), 3–6.
Hollister, L., Schwin, R.L., & Kasper, P. (1977). Naltrexone treatment of opiate-dependent persons. Drug and Alcohol Dependence, 2, 203–209.
Holmes, E.K., Mateczun, J.M., Lall, R., Wilcove, G.L. (1998). Pilot study of suicide risk factors among personnel in the United States Marine Corps (Pacific Forces). Psychological Reports, 83, 3–11.
Jaffe, A.J., Rounsaville, B., Chang, G., Shottenfeld, R.S., Meyer, R.E., & O'Malley, S.S. (1996). Naltrexone, relapse prevention and supportive therapy with alcoholics: an analysis of patient matching. Journal of Consulting Clinical Psychology, 64, 1044–1053.
Kane, J., Honigfeld, G., Singer, J, & Meltzer, H. (1988). Clozapine for the treatment-resistant schizophrenic: a double blind comparison with chlorpromazine. Archives of General Psychiatry, 45, 789–796.
Kapur, S. (1998). A new framework for investigating antipsychotic action in humans: lessons from PET imaging. Molecular Psychiatry, 3, 135–140.
Kim, S.W. (1998). Opioid antagonists in the treatment of impulse control disorders. Journal of Clinical Psychiatry, 59, 159–164.
Kim, S.W. & Grant, J.E. (2001a). An open naltrexone treatment study of pathological gambling disorder. International Clinical Psychopharmacology, 16, 285–289.
Kim, S.W. & Grant, J.E. (2001b). The psychopharmacology of pathological gambling. Seminars in Clinical Neuropsychiatry, 6, 184–194.
Kim, S.W. & Grant, J.E. (2001c). Personality dimensions in pathological gambling disorder and obsessive compulsive disorder. Psychiatry Research, 104, 205–212.
Kim, S.W., Grant, J.E., Adson, D.E., & Remmel, R.P. (2001a). A preliminary report on a possible naltrexone and nonsteroidal analgesics interaction. Journal of Clinical Psychopharmacology, 21, 632–634. [Letter].
Kim, S.W., Grant, J.E., Adson, D.E., & Shin, Y.C. (2001b). Double-blind naltrexone and placebo comparison study in the treatment of pathological gambling. Biological Psychiatry, 49, 914–921.
Kim, S.W., Grant, J.E., Adson, D.E., Shin, Y.C., & Zaninelli, R.M. (2002). A double-blind, placebo-controlled study of the efficacy and safety of paroxetine in the treatment of pathological gambling. Journal of Clinical Psychiatry, 63, 501–507.
Ladouceur, R., Boisvert, J.M., & Dumont, J. (1994). Cognitive-behavioral treatment for adolescent pathological gamblers. Behavior Modification, 18, 230–242.
Lesieur, H.R. & Rosenthal, R.J. (1991). Pathological gambling: a review of the literature (prepared for the American Psychiatric Association Task Force of DSM-IV Committee on Disorders of Impulse Control Not Elsewhere Classified). Journal of Gambling Studies, 7, 5–39.
Mason, B.J. & Ownby, R.L. (2000). Acamprosate for the treatment of alcohol dependence: a review of double-blind, placebo-controlled trials. CNS Spectrums, 5, 58–69.
Martin, A., Scahill, L., Vitulano, L., & King, R.A. (1998). Stimulant use and trichotillomania. Journal of the American Academy of Child & Adolescent Psychiatry, 37, 349–50.
Matthews, R.T. & German, D.C. (1984). Electrophysiological evidence for excitation of rat ventral tegmental area dopamine neurons by morphine. Neuroscience, 11, 617–625.
McDougle, C.J., Epperson, C.N., Pelton, G.H., Wasylink, S., & Price, L.H. (2000). A double-blind, placebo-controlled study of risperidone addition in serotonin reuptake inhibitor-refractory obsessive-compulsive disorder. Archives of General Psychiatry, 57, 794–801.
McDougle, C.J., Goodman, W.K., Leckman, J.F., Lee, N.C., Heninger, G.R., & Price, L.H. (1994). Haloperidol addition in fluvoxamine-refractory obsessive-compulsive disorder: a double-blind, placebo-controlled study in patients with and without tics. Archives of General Psychiatry, 51, 302–308.
McElroy, S.L., Hudson, J.I., Phillips, K.A., Keck, P.E., & Pope, H.G. (1993). Clinical and theoretical implications of a possible link between obsessive-compulsive and impulse control disorders. Depression, 1, 121–132.
McElroy, S.L., Pope, H.G. Jr., Keck, P.E., Hudson, J.I., Phillips, K.A., & Strakowski, S.M. (1996). Are impulse-control disorders related to bipolar disorder? Comprehensive Psychiatry, 37, 229–240.
McLellan, A.T., Arndt, I.O., Metzger, D.S., Woody, G.E., & O'Brien, C.P. (1993). The effects of psychosocial services in substance abuse treatment. Journal of the American Medical Association, 269, 1953–1959.
Meltzer, H. Y. (1995). Atypical antipsychotic drugs. In F.E. Bloom & D.J. Kupfer (Eds), Neuropsychopharmacology: the fourth generation of progress. New York: D.J. Raven Press.
Meltzer, H. Y. (1999). The role of serotonin in antipsychotic drug action. Neuropsychopharmacology, 21, 106S–115S.
Mitchell, J.E., Morley, J.E., Levine, A.S., Hatsukami, D., Gannon, M., & Pfohl, D. (1987). High-dose naltrexone therapy and dietary counseling for obesity. Biological Psychiatry, 22, 35–42.
Monti, P.M, Rohsenow, D.J., Hutchison, K., Swift, R.M., Mueller, T.I., Colby, S.M., Brown, R.A., Gulliver, S.B., Gordon, A., & Abrams, D.B. (1999). Naltrexone's effect on cue-elicited craving among alcoholics in treatment. Alcoholism and Clinical Experimental Research, 23, 1386–1394.
Monti, P.M, Rohsenow, D.J., Swift, R.M., Abrams, D.B., Colby, S.M., & Mueller, T.I. (1996). Effect of naltrexone on urge to drink during alcohol cue exposure: preliminary results. Alcoholism and Clinical Experimental Research, 20, 92A.
Moskowitz, J.A. (1980). Lithium and lady luck: use of lithium carbonate in compulsive gambling. New York State Journal of Medicine, 80, 785–788.
Nordin, C. & Eklundh, T. (1999). Altered CSF 5-HIAA disposition in pathologic male gamblers. CNS Spectrums, 4, 25–33.
O'Brien, C.P. (1997). A range of research-based pharmacotherapies for addiction. Science, 278, 66–70.
O'Malley, S.S., Jaffe, A.J., Chang, G., Schottenfeld, R.S., Meyer, R.E., & Rounsaville, B.J. (1992). Naltrexone and coping skills therapy for alcohol dependence: a controlled study. Archives of General Psychiatry, 49, 881–887.
Pallanti, S., Quercioli, L., Sood, E., & Hollander E. (2002). Lithium and valproate treatment of pathological gambling: a randomized single-blind study. Journal of Clinical Psychiatry, 63, 559–564.
Petry, N.M. & Armentano, C. (1999). Prevalence, assessment, and treatment of pathological gambling: a review. Psychiatric Services, 50, 1021–1027.
Petry, N.M. & Roll, J.M. (2001). A behavioral approach to understanding and treating pathological gambling. Seminars in Clinical Neuropsychiatry, 6, 177–183.
Phillips, A.G. & LePiane, F.G. (1980). Reinforcing effects of morphine microinjection onto the ventral tegmental area. Pharmacology Biochemistry and Behavior, 12, 965–968.
Phillips, D.P., Welty, W.R., & Smith, M.M. (1997). Elevated suicide levels associated with legalized gambling. Suicide and Life Threatening Behavior, 27, 373–378.
Physicians' Desk Reference (2001). 55th Ed. Medical Economics Company. Montvale, NJ.
Potenza, M.N. (2001). The neurobiology of pathological gambling. Seminars in Clinical Neuropsychiatry, 6, 217–226.
Potenza, M.N. (2002). A perspective on future directions in the prevention, treatment and research of pathological gambling. Psychiatric Annals, 32, 203–207.
Potenza, M.N., Fiellin, D.A., Heninger, G.R., Rounsaville, B.J., & Mazure, C.M. (2002). Gambling: an addictive behavior with primary care implications. Journal of General Internal Medicine, 17, 1–12.
Potenza, M.N. & Hollander, E. (2002). Pathological gambling and impulse control disorders. In J. Coyle, C. Nemeroff, D. Charney, & K. Davis (Eds), Neuropsychopharmacology: the 5th generation of progress (pp. 1725–1741). Baltimore, MD: Lippincott Williams and Wilkens.
Potenza, M.N., Kosten, T.R., & Rounsaville, B.J. (2001). Pathological gambling. Journal of the American Medical Association, 286, 141–144.
Potenza, M.N. & McDougle, C.J. (1998). Potential of atypical antipsychotics in the treatment of non-psychotic disorders. CNS Drugs, 9, 213–232.
Potenza, M.N., Steinberg, M.A., McLaughlin, S.D., Wu, R., Rounsaville, B.J., & O'Malley, S.S. (2000). Illegal behaviors in problem gambling: analysis of data from a gambling helpline. Journal of the American Academy of Psychiatry and the Law, 28, 389–403.
Roth, A.S., Ostroff, R.B., & Hoffman, R.E. (1996). Naltrexone as a treatment for repetitive self-injurious behaviour: an open-label trial. Journal of Clinical Psychiatry, 57, 233–237.
Rounsaville, B.J. (1995). Can psychotherapy rescue naltrexone treatment of opioid addiction? In L.S. Onken & J.D. Blaine (Eds.), Potentiating the effects of medications. Rockville, Maryland: National Institute on Drug Abuse Research Monograph, 105, 37–52.
Rugle, L. (2000). The use of olanzapine in the treatment of video poker pathological gamblers. Presented at the conference entitled, “The Comorbidity of Pathological Gambling: A Current Research Synthesis” December 3–5; Las Vegas, Nevada. [Abstract].
Saxena, S., Wang, D., Bystritsky, A., & Baxter, L.R. (1996). Risperidone augmentation of SRI treatment for refractory obsessive-compulsive disorder. Journal of Clinical Psychiatry, 57, 303–306.
Seeman, P. (1992). Dopamine receptor sequences: therapeutic levels of neuroleptics occupy D2 receptors, clozapine occupies D4. Neuropsychopharmacology, 7, 261–284.
Shaffer, H.J. & Hall, M.N. (1996). Estimating the prevalence of adolescent gambling disorders: a quantitative synthesis and guide toward standard gambling nomenclature. Journal of Gambling Studies, 12, 193–214.
Shaffer, H.J., Hall, M.N., & Vander Bilt, J. (1999). Estimating the prevalence of disordered gambling behavior in the United States and Canada: a research synthesis. American Journal of Public Health, 89, 1369–1376.
Shinohara, K., Yanagisawa, A., Kagota, Y., Gomi, A., Nemoto, K., Moriya, E., Furusawa, E., Furuya, K., & Tersawa, K. (1999). Physiological changes in Pachinko players; beta-endorphin, catecholamines, immune system substances and heart rate. Applied Human Science, 18, 37–42.
Stein, D.J., Bouwer, M.B., Hawkridge, S., & Emsley, R.A. (1997). Risperidone augmentation of serotonin reuptake inhibitors in obsessive-compulsive and related disorders. Journal of Clinical Psychiatry, 58, 119–122.
Stewart, J. (1984). Reinstatement of heroin and cocaine self-administration behavior in the rat by intracerebral application of morphine in the ventral tegmental area. Pharmacology Biochemistry and Behavior, 20, 917–923.
Sutherland, G., Stapleton, J.A., Russell, M.A.H., & Feyerabend, C. (1995). Naltrexone, smoking behaviour and cigarette withdrawal. Psychopharmacology, 120, 418–425.
Swift, R.M. (2000). Opioid antagonists and alcoholism treatment. CNS Spectrums, 5, 49–57.
Sylvain, C., Ladouceur, R., & Boisvert, J.M. (1997). Cognitive and behavioral treatment of pathological gambling: a controlled study. Journal of Consulting and Clinical Psychology, 65, 727–732.
van Wolfswinkel, L. & van Ree, J.M. (1985). Effects of morphine and naloxone on thresholds of ventral tegmental electrical self-stimulation. Naunyn-Schmiedebergs Archives of Pharmacology, 330, 84–92.
Verebey, K.G. & Mule, S.J. (1985). Naltrexone (Trexan): a review of hepatotoxicity issues. NIDA Research Monograph, 67, 73–81.
Volkow, N.D., & Fowler, J.S. (2000). Addiction, a disease of compulsion and drive: Involvement of the orbitofrontal cortex. Cerebral Cortex, 10, 318–325.
Volpicelli, J.R., Alterman, A.I., Hayashida, M., & O'Brien, C.P. (1992). Naltrexone in the treatment of alcohol dependence. Archives of General Psychiatry, 49, 876–880.
Volpicelli, J.R., Rhines, K.C., Rhines, J.S., Volpicelli, L.A., Alterman, A.I., & O'Brien, C.P. (1997). Naltrexone and alcohol dependence: role of subject compliance. Arch Gen Psychiatry, 54, 737–742.
Walters, A.S., Barrett, R.P., Feinstein, C., Mercurio, A., & Hole, W.T. (1990). A case report of naltrexone treatment of self-injury and social withdrawal in autism. Journal of Autism and Developmental Disorders, 20, 169–176.
Zimmerman, M. & Breen, R. (2002). An open-label study of citalopram in the treatment of pathological gambling. Journal of Clinical Psychiatry, 63, 44–48.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Grant, J.E., Won Kim, S. & Potenza, M.N. Advances in the Pharmacological Treatment of Pathological Gambling. J Gambl Stud 19, 85–109 (2003). https://doi.org/10.1023/A:1021227214142
Issue Date:
DOI: https://doi.org/10.1023/A:1021227214142