Pharmacological Treatments for Disordered Gambling: A Meta-analysis

Abstract

Disordered gambling is a public health concern associated with detrimental consequences for affected individuals and social costs. Currently, opioid antagonists are considered the first-line treatments to reduce symptoms of uncontrolled gambling. Only recently, glutamatergic agents and combined pharmacological and psychological treatments have been examined appearing promising options for the management of gambling disorder. A multilevel literature search yielded 34 studies including open-label and placebo-controlled trials totaling 1340 participants to provide a comprehensive evaluation of the short- and long-term efficacies of pharmacological and combined treatments. Pharmacological treatments were associated with large and medium pre-post reductions in global severity, frequency, and financial loss (Hedges’s g : 1.35, 1.22, 0.80, respectively). The controlled effect sizes for the outcome variables were significantly smaller (Hedges’s g : 0.41, 0.11, 0.22), but robust for the reduction of global severity at short-term. In general, medication classes yielded comparable effect sizes independent of predictors of treatment outcome. Of the placebo controlled studies, results showed that opioid antagonists and mood stabilizers, particularly the glutamatergic agent topiramate combined with a cognitive intervention and lithium for gamblers with bipolar disorders demonstrated promising results. However, more rigorously designed, large-scale randomized controlled trials with extended placebo lead-in periods are necessary. Moreover, future studies need to monitor concurrent psychosocial treatments, the type of comorbidity, use equivalent measurement tools, include outcome variables according to the Banff, Alberta Consensus, and provide follow-up data in order to broaden the knowledge about the efficacy of pharmacological treatments for this disabling condition.

Treatments for internet addiction, sex addiction and compulsive buying: A meta-analysis

“…A similar, but nonsignificant result was also observed for the reduction of the global severity of SA. These findings are consistent with those from Asian IA research (Chun et al, 2017), and with those gained from disordered gambling (Goslar et al, 2017;Leibetseder et al, 2011;Pallesen et al, 2005), suggesting that the manifestation of addictive behaviors requires more intensive treatment to achieve improvement.…”

“…Although most information was provided by IA treatment outcome studies, and data from controlled trials is still limited, psychological and pharmacological approaches showed favorable short-term effects across the three conditions, which are comparable to those applied for substance use and disordered gambling (e.g., Goslar et al, 2017;Grant et al, 2010) supporting our hypotheses. These findings are not sufficient for clarifying the classification of IA, SA and CB within the spectrum of psychiatric disorders due to missing validation of diagnostic criteria, and limited epidemiological, genetic and neurobiological data (e.g., Grant et al, 2010).…”

“…SGTs implemented for the treatment of IA, however, included a considerably lower number of sessions than FTFTs. Therefore, the duration rather than the type of delivery may account for these between-group differences, supporting the results of a recent meta-analysis (Goslar et al, 2017) which indicated that brief SGTs may produce lower levels of improvement than high-intensity, structured selfhelp programs. Evidence for this finding was provided by more intensive SGTs implemented for the treatment of SA z p z p Figure 2.…”

“…Large and moderate short-term gains in terms of both outcome variables were confirmed in controlled study designs, especially regarding IA and in individual studies in the SA and CB categories. These results are in the same range as those obtained in meta-analyses that examined psychological treatments for disordered Journal of Behavioral Addictions 9 (2020) 1, 14-43 gambling (Cowlishaw et al, 2012;Gooding & Tarrier, 2009;Goslar, Leibetseder, Muench, Hofmann, & Laireiter, 2017;Leibetseder, Laireiter, Vierhauser, & Hittenberger, 2011;Pallesen, Mitsem, Kvale, Johnsen, & Molde, 2005) and SUDs (Dutra et al, 2008;Tripodi, Bender, Litschge, & Vaughn, 2010). Although CBT was most commonly used across the three addiction categories, a variety of other psychological approaches proved to be equally effective for reducing problematic behaviors irrespective of the mode of treatment and-particularly with regard to IA-the cultural background.…”

Zebrafish models of impulsivity and impulse control disorders

“…On the other hand, given the lack of efficient and specific anti‐ICD drugs (Mestre et al., 2013), understanding the etiology and mechanisms of ICDs empowers the development of novel pharmacotherapies of these disorders. For example, psychostimulants (e.g., alpha‐2 agonists) and atomoxetine treat disruptive and aggressive behaviors (Pringsheim, Hirsch, Gardner, & Gorman, 2015), whereas compulsive gambling is treated with a glutamatergic agent topiramate combined with lithium (Goslar, Leibetseder, Muench, Hofmann, & Laireiter, 2019; Wittekind et al., 2019). At the same time, a correct ICD diagnosis becomes essential for selecting their optimal therapy.…”