Promising Treatment for Compulsive Gamblers

By S.W. Kim, M.D.
(April 20, 2005)

In recent years, as the number of casinos, lotteries, and other gambling venues have increased in the United States, so has the problem of compulsive gambling.

Most gamblers are able to stay within reasonable limits in the amounts they gamble. But compulsive gamblers tend to lose control and cannot stop gambling even when they continue to lose.

This often leads to severe financial problems, along with personal, family, and job-related difficulties. The number of people affected by this problem is significant; it has been estimated that up to 3 percent of the adult population may gamble compulsively.

Compulsive gamblers often say they are looking for "action," an excited or euphoric state comparable to the "high" of drug abuse. They often use gambling as a way of escaping from problems in daily life or from feelings of depression or anxiety.

Until recently, there have not been empirically tested, effective gambling treatment methods for compulsive gamblers. Individuals and families, when faced with persistent gambling problems and financial crisis, remained helpless.

Fortunately, there is new hope, in the form of experimental medications and behavior therapy. At the University of Minnesota's Impulse-Control Disorders Clinic, we have demonstrated a high success rate in treating compulsive gamblers using two new drugs.

In a series of studies, we have shown that a drug called naltrexone is highly effective in the treatment of uncontrolled cravings that are triggered by a potential reward—such as winning at a casino. Naltrexone has been approved by the FDA for treatment of alcoholism and opiate addiction. Naltrexone works by dampening craving symptoms.

In our studies we have focused only on a subset of gamblers who have insatiable urges or cravings to gamble (people who gamble to escape from depression, loneliness, or stress have not been included).

In a published study, we reported that 75 percent of the patients who were assigned to naltrexone showed much or very much improvement. On the other hand, we only saw improvement in 24 percent of the patients who received a placebo (a substance with no therapeutic value, used for comparison purposes).

We have also shown that the traditional naltrexone treatment dose, which is 50 milligrams per day, is insufficient to control human urge symptoms. At a dose higher than 50 mg/day, however, some patients develop harmfully high levels of liver enzymes. Our studies have shown that these elevations of liver enzymes are due to the concurrent use of over-the-counter pain medicines (such as ibuprofen, Motrin, Advil, Aleve, Tylenol, aspirin, certain cold medicines, Alka-Selzer, etc.). When we limited the use of these pain medicines, the enzymes were no longer a problem.

Recently, a new compound called nalmefene has been tested in treating compulsive gambling. Nalmefene is similar to naltrexone except it does not cause enzyme problems.

How soon will this treatment become available to the general population? In a few years, depending on the outcome of future clinical trials.

Dr. S.W. Kim is a professor of psychiatry at the University of Minnesota Medical School. For more information, go to www.psychiatry.umn.edu/clinic/impulsecontrol. This column is an educational service of the University of Minnesota. Advice presented should not take the place of an examination by a health-care professional. For more health-related information, go to http://www.healthtalk.umn.edu.