Skip to main content

Advertisement

SpringerLink
Log in

Topiramate Combined with Cognitive Restructuring for the Treatment of Gambling Disorder: A Two-Center, Randomized, Double-Blind Clinical Trial

  • Original Paper
  • Published:
Journal of Gambling Studies Aims and scope Submit manuscript

Abstract

Gambling disorder (GD) is a prevalent condition for which no pharmacological treatment has yet been approved, although there is evidence that topiramate can reduce impulsivity in GD and craving in various addictive behaviors. The goal of this study was to investigate the effectiveness of topiramate combined with cognitive restructuring for GD in a two-center, randomized, double-blind clinical trial. Participants were individuals seeking outpatient treatment for GD (n = 30), treated with either topiramate or placebo combined with a brief cognitive intervention, over a 12-week period, the dose of topiramate being tapered up during the first 8 weeks. The main outcome measures were gambling craving, behavior, and cognitive distortions; impulsivity; depression and social adjustment. Topiramate proved superior to placebo in reducing gambling craving (P = 0.017); time and money spent gambling (P = 0.007 and P = 0.047, respectively); cognitive distortions related to gambling (P = 0.003); and social adjustment (P = 0.040). We found no significant effects on impulsivity or depression. These findings are in contrast with data from a previous clinical trial with topiramate for GD. In the current study, we found that topiramate affects features specifically related to gambling addiction and had no significant effect on associated phenomena such as impulsiveness and depression. We believe that this response could be due to synergistic interaction between topiramate and the cognitive intervention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders DSM-5 (5th ed.). Washington: American Psychiatric Association.

    Book  Google Scholar 

  • Amorim, P. (2000). Mini international neuropsychiatric interview (mini): Validation of brief interview for diagnosing mental disorders. Revista Brasileira de Psiquiatria, 22(3), 106–115.

    Article  Google Scholar 

  • Anderson, C., Cowlishaw, S., Dowling, N., Jackson, A., Lorains, F., Merkouris, S., et al. (2011). Pharmacological interventions for the treatment of pathological and problem gambling (Protocol). The Cochrane Library, 1, CD008936.

    Google Scholar 

  • Anthenelli, R. M., Blom, T. J., McElroy, S. L., & Keck, P. E, Jr. (2008). Preliminary evidence for gender-specific effects of topiramate as a potential aid to smoking cessation. Addiction, 103(4), 687–694.

    Article  PubMed  Google Scholar 

  • Arnone, D. (2005). Review of the use of topiramate for treatment of psychiatric disorders. Annals of General Psychiatry, 4(1), 5.

    Article  PubMed  PubMed Central  Google Scholar 

  • Association, New York Heart. (1964). The criteria committee of the New York Heart Association Inc.: Diseases of the heart and blood vessels, nomenclature and criteria for diagnosis (6th ed.). Boston, DC: Little Brown.

    Google Scholar 

  • Babor, T. F., Brown, J., & del Boca, F. K. (1990). Validity of self-reports in applied research on addictive behaviours: Fact or fiction? Behavioural Assessment, 12(1), 5–31.

    Google Scholar 

  • Beck, A. T., Steer, R. A., & Carbin, M. G. (1988). Psychometric properties of the beck depression inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8(1), 77–100.

    Article  Google Scholar 

  • Berlin, H. A., Braun, A., Simeon, D., Koran, L. M., Potenza, M. N., McElroy, S. L., et al. (2013). A double-blind, placebo-controlled trial of topiramate for pathological gambling. World Journal of Biological Psychiatry, 14(2), 121–128.

    Article  PubMed  Google Scholar 

  • Claudino, A. M., de Oliveira, I. R., Appolinario, J. C., Cordás, T. A., Duchesne, M., Sichieri, R., et al. (2007). Double-blind, randomized, placebo-controlled trial of topiramate plus cognitive-behaviour therapy in binge-eating disorder. Journal of Clinical Psychiatry, 68(9), 1324–1332.

    Article  CAS  PubMed  Google Scholar 

  • Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155–159.

    Article  CAS  PubMed  Google Scholar 

  • Cowlishaw, S., Merkouris, S., Dowling, N., Anderson, C., Jackson, A., & Thomas, S. (2012). Psychological therapies for pathological and problem gambling. Cochrane Database of Systematic Reviews, 11, CD008937.

    PubMed  Google Scholar 

  • de Oliveira, I. R. (2011). Kafka’s trial dilemma: Proposal of a practical solution to Joseph K.’s unknown accusation. Medical Hypotheses, 77(1), 5–6.

    Article  PubMed  Google Scholar 

  • Dickson-Swift, V. A., James, E. L., & Kippin, S. (2005). The experience of living with a problem gambler: Spouses and partners speak out. Journal of Gambling Issues, 13, 1–22.

    Article  Google Scholar 

  • Gorenstein, C., Moreno, R. A., Bernik, M. A., Carvalho, S. C., Nicastri, S., Cord á s, T., et al. (2002). Validation of the Portuguese version of the Social Adjustment Scale on Brazilian samples. Journal of Affective Disorders, 69(1–3), 167–175.

    Article  CAS  PubMed  Google Scholar 

  • Grant, J. E., Kim, S. W., & Hartman, B. K. (2008). A double-blind, placebo-controlled study of the opiate antagonist naltrexone in the treatment of pathological gambling urges. Journal of Clinical Psychiatry, 69(5), 783–789.

    Article  CAS  PubMed  Google Scholar 

  • Grant, J. E., Odlaug, B. L., & Schreiber, L. R. (2014). Pharmacological treatments in pathological gambling. British Journal of Clinical Pharmacology, 77(2), 375–381.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hodgins, D. C. (2005). Implications of a brief intervention trial for problem gambling for future outcome research. Journal of Gambling Studies, 21(1), 13–19.

    Article  PubMed  Google Scholar 

  • Johnson, B. A. (2004). Topiramate-induced neuromodulation of cortico-mesolimbic dopamine function: A new vista for the treatment of comorbid alcohol and nicotine dependence? Addictive Behaviours, 29(7), 1465–1479.

    Article  Google Scholar 

  • Johnson, B. A., Ait-Daoud, N., Bowden, C. L., DiClemente, C. C., Roache, J. D., Lawson, K., et al. (2003). Oral topiramate for treatment of alcohol dependence: A randomised controlled trial. Lancet, 361(9370), 1677–1685.

    Article  CAS  PubMed  Google Scholar 

  • Johnson, B. A., Rosenthal, N., Capece, J. A., Wiegand, F., Mao, L., Beyers, K., et al. (2007). Topiramate for treating alcohol dependence: A randomized controlled trial. The Journal of the American Medical Association, 298(14), 1641–1651.

    Article  CAS  PubMed  Google Scholar 

  • Johnson, B. A., Rosenthal, N., Capece, J. A., Wiegand, F., Mao, L., Beyers, K., et al. (2008). Improvement of physical health and quality of life of alcohol-dependent individuals with topiramate treatment: US multisite randomized controlled trial. Archives of Internal Medicine, 168(11), 1188–1199.

    Article  CAS  PubMed  Google Scholar 

  • Kim, S. W., Grant, J. E., Adson, D. E., & Shin, Y. C. (2001). Double-blind naltrexone and placebo comparison study in the treatment of pathological gambling. Biological Psychiatry, 49(11), 914–921.

    Article  CAS  PubMed  Google Scholar 

  • Koob, G. F. (2000). Neurobiology of addiction: Toward the development of new therapies. Annals of the New York Academy of Sciences, 909, 170–185.

    Article  CAS  PubMed  Google Scholar 

  • Ladouceur, R., Sylvain, C., Boutin, C., Lachance, S., Doucet, C., Leblond, J., et al. (2001). Cognitive treatment of pathological gambling. Journal of Nervous and Mental Disease, 189(11), 774–780.

    Article  CAS  PubMed  Google Scholar 

  • Larimer, M. E., Neighbors, C., Lostutter, T. W., Whiteside, U., Cronce, J. M., Kaysen, D., et al. (2012). Brief motivational feedback and cognitive behavioural interventions for prevention of disordered gambling: A randomized clinical trial. Addiction, 107(6), 1148–1158.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lesieur, H. R. (1984). The chase: Career of the compulsive gambler (2nd ed.). Rochester, DC: Schenkman Books.

    Google Scholar 

  • Lingjaerde, O., Ahlfors, U. G., Bech, P., Dencker, S. J., & Elgen, K. (1987). The UKU side effect rating scale. A new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients. Acta Psychiatrica Scandinavica. Supplementum, 334, 1–100.

    Article  CAS  PubMed  Google Scholar 

  • Mariani, J. J., Pavlicova, M., Bisaga, A., Nunes, E. V., Brooks, D. J., & Levin, F. R. (2012). Extended-release mixed amphetamine salts and topiramate for cocaine dependence: A randomized controlled trial. Biological Psychiatry, 72(11), 950–956.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Muelleman, R. L., DenOtter, T., Wadman, M. C., Tran, T. P., & Anderson, J. (2002). Problem gambling in the partner of the emergency department patient as a risk factor for intimate partner violence. Journal of Emergency Medicine, 23(3), 307–312.

    Article  PubMed  Google Scholar 

  • Pallanti, S., Baldini Rossi, N., Sood, E., & Hollander, E. (2002). Nefazodone treatment of pathological gambling: A prospective open-label controlled trial. Journal of Clinical Psychiatry, 63(11), 1034–1039.

    Article  CAS  PubMed  Google Scholar 

  • Pallesen, S., Mitsem, M., Kvale, G., Johnsen, B. H., & Molde, H. (2005). Outcome of psychological treatments of pathological gambling: A review and meta-analysis. Addiction, 100(10), 1412–1422.

    Article  PubMed  Google Scholar 

  • Pallesen, S., Molde, H., Arnestad, H. M., Laberg, J. C., Skutle, A., Iversen, E., et al. (2007). Outcome of pharmacological treatments of pathological gambling: A review and meta-analysis. Journal of Clinical Psychopharmacology, 27(4), 357–364.

    Article  PubMed  Google Scholar 

  • Park, S., Cho, M. J., Jeon, H. J., Lee, H. W., Bae, J. N., Park, J. I., et al. (2010). Prevalence, clinical correlations, comorbidities, and suicidal tendencies in pathological Korean gamblers: Results from the Korean Epidemiologic Catchment Area Study. Social Psychiatry and Psychiatric Epidemiology, 45(6), 621–629.

    Article  PubMed  Google Scholar 

  • Patton, J. H., Stanford, M. S., & Barratt, E. S. (1995). Factor structure of the Barratt impulsiveness scale. Journal of Clinical Psychology, 51(6), 768–774.

    Article  CAS  PubMed  Google Scholar 

  • Petry, N. (2005). Stages of change in treatment-seeking pathological gamblers. Journal of Consulting and Clinical Psychology, 73(2), 312–322.

    Article  PubMed  Google Scholar 

  • Petry, N. M., Stinson, F. S., & Grant, B. F. (2005). Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 66(5), 564–574.

    Article  PubMed  Google Scholar 

  • Reis, A. D., Castro, L. A., Faria, R., & Laranjeira, R. (2008). Craving decrease with topiramate in outpatient treatment for cocaine dependence: An open label trial. Revista Brasileira de Psiquiatria, 30(2), 132–135.

    Article  PubMed  Google Scholar 

  • Rosner, B. (2000). Fundamentals of biostatistics (5th ed.). California, DC: Duxbury Press.

    Google Scholar 

  • Sobell, L. C., & Sobell, M. B. (1992). Timeline follow-back: A technique for assessing self-report alcohol consumption. In R. Litten & J. Allen (Eds.), Measuring alcohol consumption: Psychosocial and biochemical methods (pp. 41–72). Totowa, WJ: Humana Press.

    Chapter  Google Scholar 

  • Sobell, L. C., Sobell, M. B., Leo, G. I., & Cancilla, A. (1988). Reliability of a timeline method: Assessing normal drinkers’ reports of recent drinking and a comparative evaluation across several populations. British Journal of Addiction, 83(4), 393–402.

    Article  CAS  PubMed  Google Scholar 

  • Sood, E. D., Pallanti, S., & Hollander, E. (2003). Diagnosis and treatment of pathologic gambling. Current Psychiatry Reports, 5(1), 9–15.

    Article  PubMed  Google Scholar 

  • Stahl, S. M. (2012). Psychotherapy as an epigenetic ‘drug’: Psychiatric therapeutics target symptoms linked to malfunctioning brain circuits with psychotherapy as well as with drugs. Journal of Clinical Pharmacy and Therapeutics, 37(3), 249–253.

    Article  CAS  PubMed  Google Scholar 

  • Steenbergh, T. A., Meyers, A. W., May, R. K., & Whelan, J. P. (2002). Development and validation of the Gamblers’ Beliefs Questionnaire. Psychology of Addictive Behaviours, 16(2), 143–149.

    Article  Google Scholar 

  • Tamada, R. S., Amaral, J. A., Issler, C. K., & Lafer, B. (2006). Treatment emergent affective switch with topiramate. Revista Brasileira de Psiquiatria, 28(2), 158.

    Article  PubMed  Google Scholar 

  • Tavares, H. (2014). Gambling in Brazil: A call for an open debate. Addiction, 109(12), 1972–1976.

    Article  PubMed  Google Scholar 

  • Tavares, H., Carneiro, E., Sanches, M., Pinsky, I., Caetano, R., Zaleski, M., et al. (2010). Gambling in Brazil: Lifetime prevalences and socio-demographic correlates. Psychiatry Research, 180(1), 35–41.

    Article  PubMed  Google Scholar 

  • Tavares, H., & Gentil, V. (2007). Pathological gambling and obsessive-compulsive disorder: Towards a spectrum of disorders of volition. Revista Brasileira de Psiquiatria, 29(2), 107–117.

    Article  PubMed  Google Scholar 

  • Thorens, G., Billieux, J., Manghi, R., Khan, R., Khazaal, Y., & Zullino, D. F. (2011). The potential interest of topiramate in addiction. Current Pharmaceutical Design, 17(14), 1410–1415.

    Article  CAS  PubMed  Google Scholar 

  • Toneatto, T. (1999). Cognitive psychopathology of problem gambling. Substance Use and Misuse, 34(11), 1593–1604.

    Article  CAS  PubMed  Google Scholar 

  • Walker, M., Toneatto, T., Potenza, M. N., Petry, N., Ladouceur, R., Hodgins, D. C., et al. (2006). A framework for reporting outcomes in problem gambling treatment research: The Banff, Alberta, Consensus. Addiction, 101(4), 504–511.

    Article  PubMed  Google Scholar 

  • Weissman, M. M., & Bothwell, S. (1976). Assessment of social adjustment by patient self-report. Archives of General Psychiatry, 33(9), 1111–1115.

    Article  CAS  PubMed  Google Scholar 

  • Welte, J., Barnes, G., Wieczorek, W., Tidwell, M. C., & Parker, J. (2001). Alcohol and gambling pathology among U.S. adults: Prevalence, demographic patterns and comorbidity. Journal of Studies on Alcohol, 62(5), 706–712.

    Article  CAS  PubMed  Google Scholar 

  • Zeger, S. L., Liang, K. Y., & Albert, P. S. (1988). Models for longitudinal data: A generalized estimating equation approach. Biometrics, 44(4), 1049–1060.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Outpatient Clinic for Impulse Control Disorders, Institute and Department of Psychiatry, University of São Paulo School of Medicine Hospital das Clínicas, Rua Dr. Ovídio Pires de Campos, 785, Jardim Paulista, São Paulo, SP, CEP 05403-010, Brazil

    Antonio Marcelo Cabrita de Brito, Moema Galindo de Almeida Pinto & Hermano Tavares

  2. Impulse Control Disorders Clinic, Department of Psychiatry, Santa Casa de Misericórdia Hospital, Rio de Janeiro, Brazil

    Gabriel Bronstein, Elizabeth Carneiro, Daniela Faertes, Viviane Fukugawa, Angela Duque & Fatima Vasconcellos

Authors
  1. Antonio Marcelo Cabrita de Brito
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Moema Galindo de Almeida Pinto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gabriel Bronstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elizabeth Carneiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniela Faertes
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Viviane Fukugawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Angela Duque
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fatima Vasconcellos
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hermano Tavares
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antonio Marcelo Cabrita de Brito.

Ethics declarations

Conflict of interest

This study received support, in the form of the medication to be administered, from the pharmaceutical company Sandoz do Brasil Indústria Farmacêutica Ltda., in Cambé, Brazil. Dr. Tavares has worked for the Federal Bank of Brazil (CAIXA) since March/2015 as a responsible gambling consultant for its national lottery products and as a member of the Independent Assessment Panel for the responsible gambling certification of the World Lottery Association since October/2015.

Ethical Approval and Clinical Trial Registration

All procedures performed involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Study registered with the Brazilian National Registry for Clinical Trials (No. 1159.0.015.000-06) and with ClinicalTrials.gov (NCT01843699).

Informed Consent

All participants provided written informed consent.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

de Brito, A.M.C., de Almeida Pinto, M.G., Bronstein, G. et al. Topiramate Combined with Cognitive Restructuring for the Treatment of Gambling Disorder: A Two-Center, Randomized, Double-Blind Clinical Trial. J Gambl Stud 33, 249–263 (2017). https://doi.org/10.1007/s10899-016-9620-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10899-016-9620-z

Keywords

Search

Navigation