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      The use of naltrexone in pathological and problem gambling: A UK case series

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          Abstract

          Background and aims

          To investigate the potential indications and adverse effects of using the opioid antagonist naltrexone to treat problem gamblers.

          Case presentation

          The files of the 1,192 patients who were referred to the National Problem Gambling Clinic between January 2015 and June 2016 were audited. Seventeen patients were considered appropriate for treatment with naltrexone, having attended and failed to respond to psychological therapies at the clinic. Fourteen patients were placed on a regimen of 50 mg/day naltrexone.

          Discussion

          Of the 14 patients who were treated with naltrexone, there were 10 for whom sufficient follow-up existed to analyze the treatment efficacy and side effects of naltrexone. Patients showed significant decreases in their craving to gamble and the majority (60%) were able to abstain completely from gambling in the treatment period, with a further 20% reducing their gambling to almost nothing. The reported side effects from the naltrexone included: loss of appetite, gastrointestinal pain, headaches, sedation, dizziness, and vivid dreams. Two patients with concurrent alcohol-use disorder relapsed during the treatment. One patient relapsed after the treatment period.

          Conclusions

          The study showed significant outcomes in reducing gambling cravings for the sample set. Given the design of the study as a case series, there was no control group, and a number of patients were on other psychotropic medications. We recommend care when prescribing to those suffering from concurrent alcohol-use disorder.

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          Most cited references 25

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          Gambling disorders.

          Gambling disorders, including pathological gambling and problem gambling, have received increased attention from clinicians and researchers over the past three decades since gambling opportunities have expanded around the world. This Seminar reviews prevalence, causes and associated features, screening and diagnosis, and treatment approaches. Gambling disorders affect 0·2-5·3% of adults worldwide, although measurement and prevalence varies according to the screening instruments and methods used, and availability and accessibility of gambling opportunities. Several distinct treatment approaches have been favourably evaluated, such as cognitive behavioural and brief treatment models and pharmacological interventions. Although promising, family therapy and support from Gamblers Anonymous are less well empirically supported. Gambling disorders are highly comorbid with other mental health and substance use disorders, and a further understanding is needed of both the causes and treatment implications of this disorder. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            Double-blind naltrexone and placebo comparison study in the treatment of pathological gambling.

            The authors' goal was to assess the efficacy and tolerability of naltrexone in the treatment of pathologic gambling disorder. Eighty-three subjects who met criteria for DSM-IV pathologic gambling disorder were enrolled in a 1-week single-blind placebo lead-in followed by an 11-week double-blind naltrexone or placebo trial. Naltrexone was started at 25 mg/day and titrated upward until maximum symptom improvement or 250 mg/day was achieved. Gambling symptom change was assessed with the patient-rated Clinical Global Impression (PG-CGI-PT), clinician-rated CGI (PG-CGI-MD), and the Gambling Symptom Rating Scale (G-SAS). Side effects were monitored weekly and liver function tests biweekly. Data from 45 patients were analyzed. Using random regression analysis, significant improvement was noted in all three gambling symptom measures: patient-rated Clinical Global Impression, p <.001; clinician-rated CGI, p <.001; Gambling Symptom Rating Scale, p <.019. At study end, 75% of subjects taking naltrexone were much or very much improved on both the PE-CEI PT and the PG-CGI-MD, compared with only 24% of those on placebo. Elevated liver enzymes occurred in four subjects who were taking analgesics concurrently. Nausea was common during the first week of treatment. Results suggest that naltrexone is effective in reducing the symptoms of pathologic gambling. Until further studies corroborate the present findings, our report should be interpreted cautiously.
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              Psychiatric comorbidity in pathological gambling: a critical review.

              To critically review the current literature on pathological gambling as regards the significant psychiatric comorbidities associated with it. The authors synthesized information found via electronic searches (MEDLINE) and bibliographic-directed searches in over 60 publications. Pathological gamblers frequently have comorbid substance use disorders. In addition, a subset appear to have comorbid antisocial personality disorder, but they represent a minority when compared with those people who have acquired their antisocial traits as a consequence of their gambling behaviour. A comorbidity with the mood disorders is probable, but methodological concerns and inconsistencies with the data prevent further delineation of this. Emerging research for other disorders possibly associated with pathological gambling is also reviewed. Pathological gambling is associated with significant psychiatric comorbidity. Recommendations for future research are described.
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                Author and article information

                Journal
                jba
                JBA
                Journal of Behavioral Addictions
                J Behav Addict
                Akadémiai Kiadó (Budapest )
                2062-5871
                2063-5303
                21 September 2018
                September 2018
                : 7
                : 3
                : 827-833
                Affiliations
                [ 1 ]National Problem Gambling Clinic, Central and North West London NHS Foundation Trust , London, UK
                [ 2 ]Institute of Medical and Biomedical Education, St. George’s University of London , London, UK
                [ 3 ]Faculty of Medicine, Imperial College London , London, UK
                Author notes
                [* ]Corresponding author: Sophie Ward; National Problem Gambling Clinic, Central and North West London NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK; E-mail: m1700129@ 123456sgul.ac.uk
                Article
                10.1556/2006.7.2018.89
                6426388
                30238780
                © 2018 The Author(s)

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated.

                Page count
                Figures: 0, Tables: 1, Equations: 0, References: 25, Pages: 7
                Funding
                Funding sources: This study was supported by Central and North West London NHS Foundation Trust.
                Categories
                CASE REPORT

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