Current pharmacotherapy for gambling disorder: a systematic review

ABSTRACT

Introduction: Gambling disorder is classified as an addictive disorder and is associated with significant distress and impairment in personal, social, occupational or other important areas of functioning. Although no pharmacotherapy has a formal indication for gambling disorder, data suggest potential benefits of specific medications.

Area covered: This systematic review evaluated findings from 19 randomized controlled trials testing pharmacotherapies for the treatment of gambling disorder.

Expert opinion: Few randomized controlled trials have studied pharmacotherapies for gambling disorder. Though results are limited, opioid antagonists like naltrexone showed promise in the pharmacological treatment of gambling disorder. Pharmacotherapy combined with psychotherapy treatments for gambling disorder may provide better rates of patient retention in comparison to pharmacology-only treatments, though further research is needed in this area. Future studies should address gaps relating to considerations of racial, ethnic, gender and other individual differences in clinical studies. Because gambling disorder often co-occurs with other psychiatric disorders, additional research is needed to test treatments for dually diagnosed patients.

KEYWORDS:

• Gambling disorder
• pharmacotherapy
• systematic review
• treatment

Article highlights

• No medication has a formal indication for treating gambling disorder (GD).

• Opioid antagonists show potential in the treatment of GD.

• Co-occurring disorders should be considered in GD pharmacotherapy trials.

• Sample-size and diversity considerations should be addressed in future trials.

• Psychotherapies may enhance retention and provide skills in GD treatment.

• Funding for GD treatment is minimal relative to gambling revenues and GD impact.

This box summarizes key points contained in the article.

Declaration of interest

Over the past three years, Dr. Potenza has received financial support (to Yale or personally) for the following: He has consulted for and advised Game Day Data, Addiction Policy Forum, and Opiant Therapeutics; He has received research support from the Mohegan Sun Casino and the National Center for Responsible Gaming; consulted for or advised legal and gambling entities on issues related to impulse control and addictive behaviors; provided clinical care related to impulse-control and addictive behaviors; performed grant reviews; edited journals/journal sections; given academic lectures in grand rounds, CME events and other clinical/scientific venues; and generated books or chapters for publishers of mental health texts. 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

This study was supported by the Center of Excellence grant from the National Center for Responsible Gaming, the Connecticut Council on Problem Gambling and by the Connecticut Department of Mental Health and Addiction Services. No funding agencies had input into the content of this manuscript.