🎰 Treatment of Gambling Disorders

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To evaluate your problem with gambling, your doctor or mental health professional will likely: Ask questions related to your gambling habits. He or.


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Inside the brain of a gambling addict - BBC News

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Being a compulsive gambler can harm your health and relationships, and leave you in serious debt. If you have a problem with gambling and you'd like to stop.


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A conversation with Jason: recovering from problem gambling

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Pathological gambling: What are the boundaries of addiction?

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The American Gaming Association estimates that as many as 1 percent of Americans may be pathological gamblers. If you find yourself in this troubling situation.


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Do you have a gambling problem? Learn the warning signs of gambling addiction and how to get the help you need.


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Addicted To Gambling... - Russell Brand

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Problem Gambling: No One Wins

While these changes remain somewhat controversial [ 6 ], retrospective analyses suggest that the revised diagnostic criteria will have relatively little impact on prevalence estimates and may improve the accuracy of diagnoses [ 7 ]. There have been two double-blind, placebo-controlled studies of naltrexone treatment which suggest significant clinical efficacy over placebo in treating GD [ 39 ; Class I; 40 ; Class I]. One small study also suggests efficacy for lithium treatment of GD among individuals without a co-occurring BSD; however, this study was not placebo-controlled [ 32 ; Class II]. Contraindications: Concomitant monoamine oxidase MAO inhibitor, thioridazine, pimozide, alosetron, or tizanidine use [ 29 ]. Main side effects: General: drowsiness, gastrointestinal symptoms, bronchoconstriction, chest tightness, fever, rhinorrhea, clamminess, stomatitis [ 30 ]; Gambling disorder: flatulence [ 50 ; Class II]. Impulse control disorders ICDs [ 17 ]. Mood disorders [ 15 ]. An imbalance in glutamate homeostasis — the relative ratio of synaptic versus nonsynaptic glutamate — may inhibit successful prefrontal cortical control over limbic regions such as the nucleus accumbens, resulting in increased reward-seeking behaviors [ 44 ]. While findings from clinical trials thus far suggest some efficacy for specific pharmacological treatments, conflicting reports also exist. Special points: May increase rates of ICDs among individuals with PD [ 47 ]; may worsen tremors in PD patients with thioridazine; may exacerbate existing mental health problems [ 30 ]; off-label for the treatment of GD. Thus, recent controlled trials have explored the efficacy of glutamatergic agents in treating GD and other addictive disorders. In particular, neurobiological research suggests alterations in serotonergic, dopaminergic, glutamatergic and opioidergic functioning. The primary aim of this surgical intervention is the reduction of levodopa-related motor symptoms [ 60 ; Class I]. Considering co-occurring disorders may be particularly important when devising a treatment plan for GD: extant data suggest that the opioid antagonist naltrexone may by the most effective form of current pharmacotherapy for GD, particularly for individuals with a co-occurring substance-use disorder SUD or with a family history of alcoholism. As with serotonin, substantial preclinical and clinical research implicates dopaminergic neurotransmission in the biology of GD e. However, not all individuals with GD respond to opioid antagonist treatment; e. Main side effects: General: hyperthyrodisim, tremor, polyuria, mild thirst, general discomfort, diarrhea, drowsiness, muscular weakness, lack of coordination, ataxia [ 29 ]; Gambling disorder: sedation, dry mouth, nausea, diarrhea, polyuria [ 31 ; Class I]. Placebo-controlled study is warranted to examine the efficacy and tolerability of tolcapone in the treatment of GD [ 64 ; Class III]. Main side effects: General: Paraesthesia, dizziness, dysgeusia, insomnia, constipation, dry mouth [ 30 ]; Gambling disorder: fatigue, headache, nausea, shoulder pain [ 45 ; Class I]. This shift in classification reflects the clinical and neurobiological similarities between GD and substance-related addictions. Further research into combined behavioral and pharmacotherapy with respect to different medication types e. Special points: May increase risk for suicidality and depression [ 29 ]; may be most efficacious among individuals with co-occurring GD and anxiety disorders [ 25 Class II]; off-label for the treatment of GD. Initial studies suggest some efficacy of the mood stabilizers lithium and valproate in treating GD e. Main side effects: General: anorexia, agitation, insomnia, fatigue, somnolence, dizziness, tremor, headache, dry mouth, sweating, nausea, dyspepsia, diarrhea, constipation, ejaculation failure [ 29 ]; Gambling disorder: insomnia, dizziness, headache, dyspepsia, diarrhea [ 24 ; Class I]. Alcohol-, tobacco- and other substance-use disorders [ 15 ]. Main drug interactions: May interact with flumazenil [ 43 ]. N-acetyl cysteine NAC — an amino acid that increases glutathione production and extracellular glutamate via the promotion of cysteine-glutamate exchange - has been found to reduce GD symptoms in one open-label trial with a double-blind discontinuation period [ 50 ; Class II]. There are no specific approved diet- or lifestyle-related treatment interventions for GD. Contraindications: None, but caution advised for patients with renal or hepatic problems [ 29 ]. There have been several double-blind, placebo-controlled trials of the opioid antagonists naltrexone and nalmefene which suggest clinical efficacy over placebo [ 39 ; Class I; 40 ; Class I; 41 Class I]. In contrast, lithium or other mood stabilizers may be most effective for GD for patients presenting with a co-occurring bipolar-spectrum disorder BSD. Contraindications: Liver failure, current opioid use, dependence or withdrawal, hepatitis, current use of opioid analgesics [ 29 ]. Special points: May increase risk for suicidality and depression; monitor alcohol intake [ 30 ]; off-label for the treatment of GD. Standard dosage: 2. Cross-sectional data suggests increased rates of ICDs among individuals with PD who are taking amantadine; thus, further research is needed to assess the efficacy of amantadine in the treatment of GD [ 47 ]. Epidemiological data suggest increased prevalence of multiple disorders or conditions below , and these should be taken into account when considering treatment options. There have been two double-blind, placebo-controlled trials of the atypical antipsychotic olanzapine — a dopamine and serotonin antagonist with high affinity for D 2 and 5-HT 2A receptors [ 36 ] — for the treatment of GD; however, no benefit over placebo was found in either study [ 37 ; Class I; 38 ; Class II]. Main drug interactions: May increase effects of CNS depressants including alcohol; concomitant use of oral contraceptives may cause spotting; concomitant use of non-potassium sparing diuretics may increase hypokalemia advise: measurement of potassium prior and subsequent to treatment [ 53 ]. While precise outcome measures vary across studies, the primary aim of pharmacotherapy is generally the reduction of GD-related symptoms. Additionally, as noted above, combined NAC and imaginal desensitization therapy has been found to reduce nicotine dependence and improve longer-term GD treatment outcome [ 51 ; Class I]. Contraindications: Concomitant use of MAO inhibitors or pimozide [ 29 ]. Such conflicting data may be partially due to the high rates of placebo responses reported among individuals with GD or difficulties inherent when interpreting findings from studies without appropriate control conditions e. Main drug interactions: May interact with other NMDA antagonists, urinary alkalinizers, or drugs with renal elimination mechanisms [ 29 ]. Obesity [ 18 ]. Thus, opioidergic agents may be the most effective form of current pharmacotherapy for GD reviewed in [ 14 ]. Deep brain stimulation DBS is a commonly used surgical intervention for the treatment of advanced PD, involving the implantation of electrodes within the subthalamic nucleus STN in order to provide neurostimulation [ 59 ; Class I]. Main drug interactions: May interact with neuroleptics and CNS medications; concomitant anticholinergic drug use may increase anticholinergic-like side effects [ 29 ]. Reducing levodopa or dopamine agonist DA dosages may partially reduce GD symptoms among patients with co-occurring PD. Main side effects: General: anorexia, somnolence, insomnia, agitation, nervousness, dyspepsia, sexual dysfunction, sweating, tremor, dry mouth, rhinitis, nausea, vomiting [ 29 ]; Gambling disorder: insomnia, dizziness, headache, nausea, weight loss, diarrhea [ 22 ; Class I]. Special points: May increase risk for suicidality and depression [ 30 ]; off-label for the treatment of GD. Main side effects: General: nausea, vomiting, tachycardia, hypertension, postoperative pain, fever, dizziness, headache, chills, hypotension, vasodilation [ 43 ]; Gambling disorder: insomnia, somnolence, dizziness, decreased appetite, nausea, vomiting, constipation, urinary infrequency, sweating, dry mouth [ 41 ; Class I]. Main drug interactions: May interact with diazepam, alcohol, levodopa, dopamine agonists, SSRIs, anticholinergics, lorazepam, hepatoxic drugs, CNS — acting drugs [ 29 ]. The relative efficacy of medications targeting these systems remains a topic of ongoing research, and there is currently no Food and Drug Administration FDA approved medication with an indication for GD. Further, serotonin reuptake inhibitors SRIs may be efficacious in reducing GD symptoms for individuals also presenting with a non-BSD mood or anxiety disorder. Main side effects: General: suicidality, insomnia, somnolence, dizziness, headache, sexual dysfunction, asthenia, dry mouth, constipation, diarrhea, sweating, tremor, decreased appetite [ 29 ]; Gambling disorder: headache, nausea, dry mouth [ 27 ; Class I]. Main side effects: General: depression, anorexia, insomnia, somnolence, appetite disorder, dizziness, diarrhea, syncope, hepatic enzyme abnormalities, nasopharyngitis, toothache [ 29 ]; Gambling disorder: nausea [ 40 ; Class I; 39 , Class I], dry mouth [ 40 ; Class I; 39 , Class I], vivid dreams [ 40 ; Class I], headache, diarrhea, constipation, dizziness, insomnia [ 39 ; Class I]. Main side effects: General: anxiety, depression, suicidality, anorexia, insomnia, hallucinations, confusion, dizziness, nausea, dry mouth, constipation, ataxia, livedo reticularis, peripheral edema, orthostatic hypotension, headache [ 29 ]; Gambling disorder: confusion, insomnia, visual hallucinations, orthostatic hypotension [ 46 ; Class I]. In the remainder of this review, we will therefore focus on findings from controlled trials, although novel findings of interest from open-label trials will also be discussed. Main drug interactions: May interact with other serotonergic agents, antipsychotics, dopamine antagonists, alcohol, anticoagulants, phenobarbital, phenytoin, fosamprenavir, desipramine, risperidone, atomoxetine, tamoxifen, metoprolol, theophylline, lithium, phenytoin [ 29 ]. Prevalence estimates suggest increased rates of GD among adolescents [ 65 ; 66 ; 67 ].{/INSERTKEYS}{/PARAGRAPH} Contraindications: Concomitant MAO inhibitor, thioridazine or pimozide use [ 29 ]. Contraindications: None [ 29 ]. Main side effects: General: anxiety, insomnia, dry mouth, weight loss, dizziness, some neuropsychiatric symptoms have been reported e. Overall, findings thus far suggest that the efficacies of different pharmacotherapies may depend on individual differences such as the presence of co-occurring disorders and familial history of alcohol use. Findings from most of these studies have been mixed or negative, and large placebo responses and high drop-out rates have been reported across studies [ 24 ]. Although no Food and Drug Administration FDA approved treatment has an indication for GD, a number of controlled trials have assessed the efficacy and tolerability of different pharmacotherapies. Standard dosage: Different dosages have been investigated; data suggest that relatively low-dose i. Contraindications: Concomitant MAO inhibitor, pimozide or disulfiram use [ 29 ]. Evidence from multiple lines of research suggest alterations in serotonergic functioning among individuals with GD e. Special points: Increased risk of death among elderly patients with dementia-related psychosis [ 30 ]; off-label for the treatment of GD. Contraindications: Pregnancy, glaucoma, hyperthyroidism, concomitant MAO inhibitor treatment, hypersensitivity to sympathomimetic amines [ 53 ]. Main drug interactions: Alters effects of other opioid medications [ 29 ]. Controlled trials of multiple pharmacotherapies have been conducted; however there is currently no FDA-approved pharmacotherapy with an indication for GD. Main drug interactions: May interact with other serotonergic agents, desipramine, warfarin, sumatriptan, cimetidine, alcohol, carbamazepine, metoprolol, and other drugs influencing the CNS [ 29 ]. However, five of the 17 patients enrolled in this trial discontinued due to medication-associated adverse effects. Findings from a week, randomized, double-blind, placebo-controlled study suggest that lithium may be an effective treatment for GD among individuals with a co-occurring BSD [ 31 ; Class I]. Main drug interactions: None [ 29 ]. Contraindications: None, however may antagonize asthma symptoms [ 29 ]. Secondly, the number of criteria needed for a diagnosis of GD has been lowered to four criteria whereas five criteria were required for a diagnosis of PG in DSM-IV [ 4 — 6 ]. Standard dosage: mg initially, increase to mg after four days, increase to mg after additional four days [ 29 ; Class I]. Ongoing research into the effectiveness of combined behavioral and pharmacotherapies is being conducted; thus combined treatments should also be considered. Main drug interactions: May interact with alcohol, diazepam, lithium, tryptophan, mexiletine, theophylline, benzodiazepines, metoprolol, propranolol, warfarin, clozapine, methadone, tacrine, amitriptyline, clomipramine, imipramine, carbamazepine [ 29 ]. Main drug interactions: May interact with drugs influencing the expression of hepatic enzymes; may interact with aspirin, carbapenem antibiotics, lamotragine, protein-bound drugs e. Given the similarities between GD and other addictive disorders, many trials have focused on FDA-approved treatments for substance-use disorders e. For GD patients not willing to consider drug treatment, n-acetyl cysteine or behavioral therapies may be effective. Special points: Monitor renal and thyroid functioning; monitor for possible lithium toxicity [ 30 ]; off-label for the treatment of GD. Other treatment options, such as the reduction of levodopa or dopamine-replacement therapies, should be considered reviewed in Ongoing research is being conducted into the efficacy of different pharmacotherapeutic agents, as well as into the effectiveness of combined behavioral and pharmacotherapy for the treatment of GD. Contraindications: Hypersensitivity to nalmefene [ 43 ]. Cost: Not available in oral formulation in the United States. However, some evidence suggests that SSRIs might be effective for the treatment of GD among individuals with a co-occurring mood or anxiety disorder - with the exception of co-occurring bipolar disorder for which SSRI medications are not advised [ 25 ; Class II; reviewed in 8 ]. Special points: May increase risk for suicidality and depression; [ 30 ]; off-label for the treatment of GD. It has also been found in a randomized, double-blind, placebo-controlled trial to reduce nicotine dependence and longer-term GD treatment outcome in individuals with co-occurring nicotine dependence and GD who were receiving imaginal desensitization therapy for GD [ 51 ; Class I]. The only placebo-controlled trial of bupropion — a dopamine and norepinephrine transporter inhibitor and nicotinic acetylcholine receptor nAChRs antagonist [ 35 ] — found no benefit over placebo [ 34 ; Class I]. {PARAGRAPH}{INSERTKEYS}Preclinical and clinical research implicate several neurotransmitter systems in the pathophysiology of gambling disorder GD. Main side effects: General: hepatoxicity, pancreatitis, headache, somnolence, chest pain, paresthesia [ 29 ]; Gambling disorder: not specified [ 32 ; Class II]. Preliminary data suggest that valproate may be effective in treating GD [ 32 ; Class II]; however, further studies including a placebo group are needed to confirm this. A recently completed open-label trial explored the efficacy of tolcapone - a catechol-O-methyltransferase COMT inhibitor - for the treatment of GD found reductions in GD severity, depression, anxiety and disability and improvement in quality of life [ 63 ]. Main drug interactions: May interact with other serotonergic agents, warfarin, alcohol, diazepam, tolbutamide and other drugs influencing the central nervous system CNS [ 29 ].