A review of opioid-based treatments for gambling disorder: an examination of treatment outcomes, cravings, and individual differences

ABSTRACT

Although pharmacological treatments for gambling disorder have shown some promise, questions remain regarding the relationships between primary outcome measures, cravings and sensitivities. In this review of the clinical literature of opioid treatments for gambling disorder an analysis is presented on primary outcome measures, dosing schedules, the reasons for drop-out, and adverse effects. This review of the extant literature shows a relationship between craving and primary outcome measures that appears to be mediated by individual differences, and mirrors the complexity found in the alcohol dependence literature. This relationship implies that individual differences mediate the effectiveness of opioid treatments and indicates that tailored ‘precision medicine’ treatments are possible for gambling disorder. For example, modifying dosing schedules based on personal and familial histories of co-morbidities (e.g. alcohol dependence or prior substance use), and using pharmacologies implicated in reducing impulsive behaviour might increase treatment effectiveness. Future basic science and applied research examining the interactions between pharmacologies and neurotransmitters may elucidate a possible pharmacological treatment taxonomy for gambling disorder.

KEYWORDS:

• Gambling disorder
• problem gambling
• opioid antagonist
• treatment
• genetics
• precision medicine