Drug therapy effective for pathological gambling
Pathological gambling has a lifetime prevalence in North America of 5-10%. Traditionally, it has been seen as a behavioural disturbance, and treatment outcome studies have focused on cognitive and behavioural approaches. A review has found that drug therapy is also an effective treatment.
The authors performed a meta-analysis of studies of pharmacological interventions for pathological gambling published between 1966 and 2006. Sixteen studies met the strict inclusion criteria, with a total of 597 participants, of whom 63% were men. The duration of the studies ranged from six weeks to six months.
The studies used one of three drug interventions: antidepressants (which have anticompulsive and anti-impulsive effects), opioid antagonists (which block the effects of endogenous endorphins and modify reward mechanisms) and mood stabilisers (presumed to have anti-impulsive effects).
The review found that all the drug treatments studied were associated with substantial improvements in outcome measures compared with no treatment/placebo, with an overall effect size of 0.78 (P= <0.01, 95% CI 0.64-0.92).
Pathological gambling is increasingly seen as an addictive problem, sharing common biopsychological roots with substance addiction and other addictive behaviours. Previous studies have shown psychological interventions are effective in its management; this paper suggests that drug therapy offers an effective alternative treatment.
Pallesen S, Molde H, Arnestad HM et al. Outcome of Pharmacological Treatments of Pathological Gambling: A Review and Meta-Analysis. J Clin Psychopharmacol 2007;27:357-64Reviewer
Dr Jez Thompson
Former GP, Clinical Director, Leeds Community Drug Services