Pharmacological Interventions in Gambling Disorder

  • Gustavo C. Medeiros
  • Jon E. Grant


The current chapter covers pharmacological treatments for gambling disorder (GD). We discuss the role of opioid antagonists, glutaminergic drugs (NAC, memantine, topiramate), antidepressants, and other medications that have been investigated. Mechanisms of action and current evidence are examined.


  1. 1.
    Black DW, Moyer T, Schlosser S. Quality of life and family history in pathological gambling. J Nerv Ment Dis. 2003;191(2):124–6.PubMedGoogle Scholar
  2. 2.
    Grant JE, Kim SW. Quality of life in kleptomania and pathological gambling. Compr Psychiatry. 2005;46(1):34–7.CrossRefGoogle Scholar
  3. 3.
    Petry NM, Stinson FS, Grant BF. Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: results from the national epidemiologic survey on alcohol and related conditions [CME]. J Clin Psychiatry. 2005;66(5):564–74.CrossRefGoogle Scholar
  4. 4.
    Pallesen S, Mitsem M, Kvale G, Johnsen BH, Molde H. Outcome of psychological treatments of pathological gambling: a review and meta-analysis. Addiction. 2005;100(10):1412–22.CrossRefGoogle Scholar
  5. 5.
    Petry NM, Ammerman Y, Bohl J, Doersch A, Gay H, Kadden R, et al. Cognitive-behavioral therapy for pathological gamblers. J Consult Clin Psychol. 2006;74(3):555.CrossRefGoogle Scholar
  6. 6.
    Lupi M, Martinotti G, Acciavatti T, Pettorruso M, Brunetti M, Santacroce R, et al. Pharmacological treatments in gambling disorder: a qualitative review. Biomed Res Int. 2014;2014:537306.CrossRefGoogle Scholar
  7. 7.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub. 2013.Google Scholar
  8. 8.
    Blanco C, Moreyra P, Nunes EV, Saiz-Ruiz J, Ibanez A. Pathological gambling: addiction or compulsion? Semin Clin Neuropsychiatry. 2001;6(3):167–76.CrossRefGoogle Scholar
  9. 9.
    Potenza MN. The neurobiology of pathological gambling. Semin Clin Neuropsychiatry. 2001;6(3):217–26.CrossRefGoogle Scholar
  10. 10.
    Yip SW, Potenza MN. Treatment of gambling disorders. Curr Treat Options Psychiatry. 2014;1(2):189–203.CrossRefGoogle Scholar
  11. 11.
    Kim SW. Opioid antagonists in the treatment of impulse-control disorders. J Clin Psychiatry. 1998;59(4):159–64.CrossRefGoogle Scholar
  12. 12.
    Kalivas PW. The glutamate homeostasis hypothesis of addiction. Nat Rev Neurosci. 2009;10(8):561–72.CrossRefGoogle Scholar
  13. 13.
    Kim SW, Grant JE. An open naltrexone treatment study in pathological gambling disorder. Int Clin Psychopharmacol. 2001;16(5):285–9.CrossRefGoogle Scholar
  14. 14.
    Kim SW, Grant JE, Adson DE, Shin YC. Double-blind naltrexone and placebo comparison study in the treatment of pathological gambling. Biol Psychiatry. 2001;49(11):914–21.CrossRefGoogle Scholar
  15. 15.
    Grant JE, Potenza MN, Hollander E, Cunningham-Williams R, Nurminen T, Smits G, Kallio A. Multicenter investigation of the opioid antagonist nalmefene in the treatment of pathological gambling. Am J Psychiatry. 2006;163(2):303–12.CrossRefGoogle Scholar
  16. 16.
    Grant JE, Kim SW, Hollander E, Potenza MN. Predicting response to opiate antagonists and placebo in the treatment of pathological gambling. Psychopharmacology. 2008;200(4):521–7.CrossRefGoogle Scholar
  17. 17.
    Toneatto T, Brands B, Selby P. A randomized, double-blind, placebo-controlled trial of naltrexone in the treatment of concurrent alcohol use disorder and pathological gambling. Am J Addict. 2009;18(3):219–25.Google Scholar
  18. 18.
    Grant JE, Chamberlain SR, Odlaug BL, Potenza MN, Kim SW. Memantine shows promise in reducing gambling severity and cognitive inflexibility in pathological gambling: a pilot study. Psychopharmacology. 2010;212(4):603–12.CrossRefGoogle Scholar
  19. 19.
    Kovanen L, Basnet S, Castren S, Pankakoski M, Saarikoski ST, Partonen T, Alho H, Lahti T. A randomised, double-blind, placebo-controlled trial of as-needed naltrexone in the treatment of pathological gambling. Eur Addict Res. 2016;22(2):70–9.Google Scholar
  20. 20.
    Asevedo E, Mendes AC, Berk M, Brietzke E. Systematic review of N-acetylcysteine in the treatment of addictions. Rev Bras Psiquiatr. 2014;36(2):168–75.CrossRefGoogle Scholar
  21. 21.
    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(6):652–7.CrossRefGoogle Scholar
  22. 22.
    Evans SM, Levin FR, Brooks DJ, Garawi F. A pilot double-blind treatment trial of memantine for alcohol dependence. Alcohol Clin Exp Res. 2007;31(5):775–82.CrossRefGoogle Scholar
  23. 23.
    Arbaizar B, Gómez-Acebo I, Llorca J. Efficacy of topiramate in bulimia nervosa and binge-eating disorder: a systematic review. Gen Hosp Psychiatry. 2008;30(5):471–5.CrossRefGoogle Scholar
  24. 24.
    Shinn AK, Greenfield SF. Topiramate in the treatment of substance-related disorders: a critical review of the literature. J Clin Psychiatry. 2010;71(5):634–48.CrossRefGoogle Scholar
  25. 25.
    Berlin HA, Braun A, Simeon D, Koran LM, Potenza MN, McElroy SL, et al. A double-blind, placebo-controlled trial of topiramate for pathological gambling. World J Biol Psychiatry. 2013;14(2):121–8.CrossRefGoogle Scholar
  26. 26.
    de Brito AMC, de Almeida Pinto MG, Bronstein G, Carneiro E, Faertes D, Fukugawa V, et al. Topiramate combined with cognitive restructuring for the treatment of gambling disorder: a two-center, randomized, double-blind clinical trial. J Gambl Stud. 2016;33(1):249–63.CrossRefGoogle Scholar
  27. 27.
    Thomas A, Bonanni L, Gambi F, Di Iorio A, Onofrj M. Pathological gambling in Parkinson disease is reduced by amantadine. Ann Neurol. 2010;68(3):400–4.CrossRefGoogle Scholar
  28. 28.
    Grant JE, Potenza MN. Escitalopram treatment of pathological gambling with co-occurring anxiety: an open-label pilot study with double-blind discontinuation. Int Clin Psychopharmacol. 2006;21(4):203–9.CrossRefGoogle Scholar
  29. 29.
    Gandara JJ, Sanz O, Gilaberte I. Fluoxetine: open-trial in pathological gambling. In Annual meeting of the American Psychiatric Association. 1999. p. 16–21.Google Scholar
  30. 30.
    Posternak MA. An open-label study of citalopram in the treatment of pathological gambling. J Clin Psychiatry. 2002;63(1):44–8.CrossRefGoogle Scholar
  31. 31.
    Hughes JR, Stead LF, Hartmann-Boyce J, Cahill K, Lancaster T. Antidepressants for smoking cessation. Cochrane Database Syst Rev. 2014;(1):CD000031.Google Scholar
  32. 32.
    Moriyama TS, Polanczyk GV, Terzi FS, Faria KM, Rohde LA. Psychopharmacology and psychotherapy for the treatment of adults with ADHD—a systematic review of available meta-analyses. CNS Spectr. 2013;18(06):296–306.CrossRefGoogle Scholar
  33. 33.
    Black DW. An open-label trial of bupropion in the treatment of pathologic gambling. J Clin Psychopharmacol. 2004;24(1):108–11.CrossRefGoogle Scholar
  34. 34.
    Black DW, Arndt S, Coryell WH, Argo T, Forbush KT, Shaw MC, et al. Bupropion in the treatment of pathological gambling: a randomized, double-blind, placebo-controlled, flexible-dose study. J Clin Psychopharmacol. 2007;27(2):143–50.CrossRefGoogle Scholar
  35. 35.
    Pallanti S, Quercioli L, Sood E, Hollander E. Lithium and valproate treatment of pathological gambling: a randomized single-blind study. J Clin Psychiatry. 2002;63(7):559–64.CrossRefGoogle Scholar
  36. 36.
    Hollander E, Pallanti S, Allen A, Sood E, Rossi NB. Does sustained-release lithium reduce impulsive gambling and affective instability versus placebo in pathological gamblers with bipolar spectrum disorders? Am J Psychiatry. 2005;162(1):137–45.CrossRefGoogle Scholar
  37. 37.
    Black DW, Shaw MC, Allen J. Extended release carbamazepine in the treatment of pathological gambling: an open-label study. Prog Neuropsychopharmacol Biol Psychiatry. 2008;32(5):1191–4.CrossRefGoogle Scholar
  38. 38.
    McElroy SL, Nelson EB, Welge JA, Kaehler L, Keck PE Jr. Olanzapine in the, treatment of pathological gambling: a negative randomized placebo-controlled trial. J Clin Psychiatry. 2008;69(3):433–40.CrossRefGoogle Scholar
  39. 39.
    Fong T, Kalechstein A, Bernhard B, Rosenthal R, Rugle L. A double-blind, placebo-controlled trial of olanzapine for the treatment of video poker pathological gamblers. Pharmacol Biochem Behav. 2008;89(3):298–303.Google Scholar
  40. 40.
    Dackis CA, Kampman KM, Lynch KG, Pettinati HM, O'brien CP. A double-blind, placebo-controlled trial of modafinil for cocaine dependence. Neuropsychopharmacology. 2005;30(1):205–11.CrossRefGoogle Scholar
  41. 41.
    Zack M, Poulos CX. Effects of the atypical stimulant modafinil on a brief gambling episode in pathological gamblers with high vs. low impulsivity. J Psychopharmacol. 2008;23(6):660–71.CrossRefGoogle Scholar
  42. 42.
    Blaszczynski A, Nower L. A pathways model of problem and pathological gambling. Addiction. 2002;97(5):487–99.CrossRefGoogle Scholar
  43. 43.
    Ledgerwood DM, Petry NM. Psychological experience of gambling and subtypes of pathological gamblers. Psychiatry Res. 2006;144(1):17–27.CrossRefGoogle Scholar
  44. 44.
    Grant JE, Odlaug BL, Chamberlain SR, Potenza MN, Schreiber LR, Donahue CB, Kim SW. A randomized, placebo-controlled trial of N-acetylcysteine plus imaginal desensitization for nicotine-dependent pathological gamblers. J Clin Psychiatry. 2013;75(1):39–45.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Gustavo C. Medeiros
    • 1
  • Jon E. Grant
    • 2
  1. 1.Department of PsychiatryUniversity of Texas, Southwestern Medical CenterDallasUSA
  2. 2.Department of Psychiatry and Behavioral NeuroscienceUniversity of ChicagoChicagoUSA

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