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Best of Liz Benston

Gaming Guru

Liz Benston
 

Search On for Drugs to Treat Gambling Addiction

13 December 2005

For problem gamblers dealing with an addiction to slots or blackjack, help may soon come in the form of a pill.

Used for years to treat other addictions such as alcohol and heroin, drugs could become more available in the future to effectively treat compulsive gamblers based on some early successes and consistent results in drug experiments.

That's according to Dr. Jon Grant, a leading researcher in the field of drug and addiction research. He revealed the results of a soon-to-be-published study at a gambling addiction conference in Las Vegas last week.

Grant spoke at the sixth annual National Council for Responsible Gaming Conference on Gambling and Addiction at Mandalay Bay. The National Council, founded by the casino industry, raises money for problem gambling research.

In a field that is still young, prescribing experimental drugs for gamblers "is one of the best studied areas of gambling addiction," said Grant, assistant professor of psychiatry at Brown University and chief of impulse control disorders at Butler Hospital in Providence, R.I.

That's because it is relatively easy to set up a classic experiment using a test group that takes the drug and a control group that takes a placebo. Several experiments in recent years have also yielded early successes, he said.

Even so, gamblers hoping to cure their addiction by taking a pill may be disappointed.

"I'm far from believing in a perfect pill," Grant said.

Compulsive gamblers often suffer from multiple disorders that can complicate treatment, he said. Gamblers also appear to benefit the most from a closely monitored combination of drugs and therapy, he added.

Grant, who has received research money from the National Council, conducted the largest gambling drug study of its kind in 2003.

It found that the drug nalmefene effectively curbed gambling cravings after about 16 weeks of use and that people were "significantly improved" after about 10 weeks of use compared with gamblers who took a placebo, Grant said.

The results are to be published in the February issue of the American Journal of Psychiatry.

Bo Bernhard, a UNLV sociology professor and director of gambling research at its International Gaming Institute, calls drug research "an important chapter in the history of the field."

Bernhard was involved in overseeing one of the first drug experiments with gamblers. The drug used in the study, Zyprexa, is made by Eli Lilly to treat people with schizophrenia and bipolar disorder.

The experiment, which used Las Vegas gamblers, found that people who took the drug reduced their gambling significantly while those who took a placebo also reduced their gambling but to a lesser extent.

The results weren't conclusive because the drug made participants drowsy and was causing them to sleep excessively, which likely accounted for some of the time they weren't gambling, Bernhard said.

However, the research paved the way for future studies, he said.

"When the Eli Lillys of the world are convinced enough about the biochemical nature of this ... that's a great leap forward," he said.

Nalmefene, a drug made in Finland, is an "opiate blocker" that works by blocking a part of the brain that makes some activities pleasurable. It has been used on an experimental basis in the United States to treat alcoholics, but has not yet been approved by the Food and Drug Administration, Grant said.

More than 200 patients in treatment centers across the United States participated in Grant's 2003 study.

Grant said he will be following up with a second study that will involve input from up to 25 different research groups nationwide. Las Vegas gamblers are among those who will participate in the study.

"We've got to go where the gamblers are," he said.

About 11 double-blind studies involving more than 350 patients have so far been conducted using drugs to treat problem gamblers, Grant said. Double-blind studies involve patients and researchers who don't know whether they are receiving or prescribing the drug in question or a placebo.

About 73 percent of gamblers in these studies got better, meaning they reported minimal to no compulsive gambling symptoms, Grant said.

The results of about seven additional studies in which patients and clinicians knew who was taking what also had similar success, he said.

Some drugs used in experiments are lithium, the anti-depressant Prozac and naltrexone, a drug that is FDA approved to treat alcoholism and heroin addiction.

Prozac has shown some success in treating gamblers who also suffer from depression, while lithium has been used to treat gamblers who also suffer from impulse control disorders and mood swings stemming from manic depression and bipolar disorder, Grant said.

Like nalmefene, naltrexone works for people who experience intense cravings for gambling and has been shown to reduce the intensity and frequency of such urges as well as a preoccupation with gambling, he said. Naltrexone can be toxic to the liver, which is why nalmefene may prove preferable, he said.

Compulsive gambling is a complex disorder and isn't easily solved with drugs or other means, Grant said.

"Gambling is one manifestation of perhaps several underlying problems," he said. "We need to figure out how all these symptoms interact. If someone is suffering from depression and is gambling, do we fix one and then the other or do we fix both at the same time?"

Smoking addiction is another complicating factor, he said. In one study, people who were addicted to nicotine had more intense gambling cravings than people who didn't smoke, he said.

Research is a slow, imperfect process, Bernhard said.

"People are frustrated with the relatively slow pace of research, especially when it comes to drug research, because of the side effects," he said.

"There's no magic pill out there. We've been looking at alcoholism for generations and haven't found it."