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Abstract
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.