Pharmacological management of gambling disorder: an update of the literature

ABSTRACT

Introduction

Gambling disorder (GD) is a mental health condition characterized by persistent and problematic betting behavior. GD generates distress and impairment, and treatment options include psychological and pharmacological interventions.

Areas covered

This narrative review explores existing pharmacological treatments for GD. The following classes of medications were considered: opioid-receptor antagonists (e.g. naltrexone and nalmefene), serotonin reuptake inhibitors (e.g. fluvoxamine, paroxetine, sertraline, escitalopram, and citalopram), glutamatergic agents (e.g. N-acetylcysteine (NAC), acamprosate, and memantine), mood stabilizers (e.g. topiramate, carbamazepine, lithium), and other medications (e.g. modafinil, nefazodone, olanzapine, haloperidol, tolcapone, and bupropion).

Expert opinion

Due to the limitations of the studies reviewed, solid conclusions regarding the optimal choice of pharmacotherapy for individuals with GD are challenging to draw at this time. Despite some medications, such as naltrexone and nalmefene, showing promising results, efficacy has varied across studies. The review highlights current gaps/limitations, including small sample sizes, limited diversity in participant demographics, the need for exploring different gambling subtypes and treatment responses, high placebo response rates, lack of longer-term longitudinal information, limited investigation of neurobiological correlates and co-occurring disorders, and the importance of implementation research. Further research is needed to address these gaps and explore additional medications, as well as interventions like neuromodulation.

KEYWORDS:

• Addictive behaviors
• impulsive behaviors
• compulsive behaviors
• gambling disorder
• opioid-receptor antagonists
• serotonergic drugs
• glutamatergic agents
• mood stabilizers

Article highlights

• Gambling disorder (GD) is a significant mental health issue.

• It is important to identify and treat GD.

• No drugs have formal indications for GD treatment.

• Co-occurring disorders may help guide medication selection in GD treatment.

Declaration of interest

MN Potenza has served as a consultant for Opiant Pharmaceuticals, Idorsia Pharmaceuticals, AXA, Game Day Data, Baria-Tek, and the Addiction Policy Forum and has been involved in a patent application with Yale University and Novartis. He has also received research support (to Yale) from Mohegan Sun Casino, Children and Screens and the Connecticut Council on Problem Gambling and has participated in surveys, mailings, or telephone consultations related to internet use, addictions, impulse-control disorders or other health topics. MN Potenza has also consulted for and/or advised gambling and legal entities on issues related to impulse-control/addictive disorders. In addition to the funding agencies listed above, MN Potenza has also performed grant reviews for the National Institutes of Health. Finally, MN Potenza has given academic lectures in grand rounds, CME events, and other clinical or scientific venues. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

MN Potenza’s involvement was supported by the Connecticut Council on Problem Gambling. G Mestre-Bach and this study were supported by the ITEI B23-010 project (Universidad Internacional de La Rioja) and by the Ministerio de Consumo (SUBV23/00024).