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Pathological Gambling: Update on Assessment and Treatment: Page 3 of 3

Pathological Gambling: Update on Assessment and Treatment: Page 3 of 3

Olanzapine was examined in 2 clinical trials in nonpsychotic nonbipolar participants, but no significant treatment effect was reported for pathological gambling.36,37 Recently, there was a case report of beneficial effects of quetiapine in a patient with Parkinson disease and pathological gambling, but there have not been any follow-up studies.38

In the past few years, trials with unique agents, such as N-acetylcysteine and modafinil, have shown interesting preliminary data, but replication and further testing are required.39,40N-acetylcysteine, a glutamatergic modulator, is thought to mediate learning in the reward pathway. The mechanism of action for modafinil remains incompletely understood, but it is thought to involve dopamine regulation by blocking dopamine transporters and thereby attention and executive functioning.41 Ongoing trials of memantine, acamprosate, and topiramate that will provide new insights into the specific targets of medications are being con-ducted in pathological gamblers.

Currently, only 30 states offer publicly funded gambling treatment (despite gambling being legal in every state except Hawaii and Utah). Similar to certifying bodies that administer alcohol and drug treatment certifications, there are certifying bodies that administer gambling counselor certifications. Intensive outpatient programs and residential treatment programs exist specifically for pathological gamblers, but many are prohibitively expensive and/or have little documentation and evaluation of clinical services.

Short- and long-term monitoring

No objective measure of gambling engagement, such as a urine drug screen, exists for pathological gamblers. Self-report is obviously unreliable. Collateral information, review of financial statements, assessment of life domains (work, medical health, emotional health, social capital, financial, legal, and family functioning) and the patient’s therapy adherence/retention are the best treatment indicators.42

Click to EnlargeAs with those with addictive disorders, pathological gamblers require ongoing monitoring. Significant damage and harm can occur instantly when relapse occurs. In general, patients who have been stable for more than a year and who are no longer experiencing any harmful consequences from gambling can be monitored less frequently.


Pathological gambling is a common psychiatric condition that can present with a variety of symptoms. Addressing problem gambling requires full attention to all aspects of the bio-psychosocial perspective. Even though there are no FDA-approved medications or standard treatment guidelines, there are a variety of treatment options available for pathological gamblers and their families (Table 2). As with addictive disorders, engagement and retention of gamblers in treatment will lead to improved outcomes. The next 5 years are also likely to see an emergence of newer technologies and psychotherapeutic techniques that will increase the treatment armamentarium for pathological gambling.



1. Welte JW, Barnes GM, Wieczorek WF, et al. Gambling participation in the US—results from a national survey. J Gambl Stud. 2002;18:313-337.
2. Welte JW, Barnes GM, Tidwell MC, Hoffman JH. The prevalence of problem gambling among US adolescents and young adults: results from a national survey. J Gambl Stud. 2008;24:119-133.
3. Potenza MN. Should addictive disorders include non-substance-related conditions? Addiction. 2006; 101(suppl 1):142-151.
4. Tavares H, Gentil V. Pathological gambling and obsessive-compulsive disorder: towards a spectrum of disorders of volition. Rev Bras Psiquiatr. 2007;29:107-117.
5. Johnson EE, Hamer RM, Nora RM. The Lie/Bet Questionnaire for screening pathological gamblers: a follow-up study. Psychol Rep. 1998;83(3, pt 2): 1219-1224.
6. Slutske WS. Natural recovery and treatment-seeking in pathological gambling: results of two US national surveys. Am J Psychiatry. 2006;163:297-302.
7. Sartor CE, Scherrer JF, Shah KR, et al. Course of pathological gambling symptoms and reliability of the Lifetime Gambling History measure. Psychiatry Res. 2007;152:55-61.
8. Johansson A, Grant JE, Kim SW, et al. Risk factors for problematic gambling: a critical literature review. J Gambl Stud. 2009;25:67-92.
9. Dickson-Gillespie L, Rugle L, Rosenthal R, Fong T. Preventing the incidence and harm of gambling problems. J Prim Prev. 2008;29:37-55.
10. Slutske WS, Meier MH, Zhu G, et al. The Australian Twin Study of Gambling (OZ-GAM): rationale, sample description, predictors of participation, and a first look at sources of individual differences in gambling involvement. Twin Res Hum Genet. 2009;12:63-78.
11. Wong PW, Chan WS, Conwell Y, et al. A psychological autopsy study of pathological gamblers who died by suicide. J Affect Disord. 2009 Apr 23; [Epub ahead of print].
12. Weintraub D, Hoops S, Shea JA, et al. Validation of the questionnaire for impulsive-compulsive disorders in Parkinson’s disease. Mov Disord. 2009;24:1461-1467.
13. Steeves TD, Miyasaki J, Zurowski M, et al. Increased striatal dopamine release in Parkinsonian patients with pathological gambling: a [11C] raclopride PET study. Brain. 2009;132(pt 5):1376-1385.
14. O’Sullivan SS, Evans AH, Lees AJ. Dopamine dysregulation syndrome: an overview of its epidemiology, mechanisms and management. CNS Drugs. 2009; 23:157-170.
15. Hodgins DC, Currie S, el-Guebaly N, Peden N. Brief motivational treatment for problem gambling: a 24-month follow-up. Psychol Addict Behav. 2004;18:293-296.
16. Carlbring P, Smit F. Randomized trial of internet-delivered self-help with telephone support for pathological gamblers. J Consult Clin Psychol. 2008;76: 1090-1094.
17. Petry NM, Weinstock J, Ledgerwood DM, Morasco B. A randomized trial of brief interventions for problem and pathological gamblers. J Consult Clin Psychol. 2008;76:318-328.
18. Gooding P, Tarrier N. A systematic review and meta-analysis of cognitive-behavioural interventions to reduce problem gambling: hedging our bets? Behav Res Ther. 2009;47:592-607.
19. Petry NM, Ammerman Y, Bohl J, et al. Cognitive-behavioral therapy for pathological gamblers. J Consult Clin Psychol. 2006;74:555-567.
20. Ladouceur R, Lachance S, Fournier PM. Is control a viable goal in the treatment of pathological gambling? Behav Res Ther. 2009;47:189-197.
21. Oei TP, Gordon LM. Psychosocial factors related to gambling abstinence and relapse in members of gamblers anonymous. J Gambl Stud. 2008;24:91-105.
22.Petry NM. Gamblers anonymous and cognitive-behavioral therapies for pathological gamblers. J Gambl Stud. 2005;21:27-33.
23. Iancu I, Lowengrub K, Dembinsky Y, et al. Pathological gambling: an update on neuropathophysiology and pharmacotherapy [published correction appears in CNS Drugs. 2008;22:406]. CNS Drugs. 2008;22:123-138.
24. Lowengrub K, Iancu I, Aizer A, et al. Pharmacotherapy of pathological gambling: review of new treatment modalities. Expert Rev Neurother. 2006;6: 1845-1851.
25. Grant JE, Brewer JA, Potenza MN. The neurobiology of substance and behavioral addictions. CNS Spectr. 2006;11:924-930.
26. Toneatto T, Brands B, Selby P. A randomized, double-blind, placebo-controlled trial of naltrexone in the treatment of concurrent alcohol use disorder and pathological gambling. Am J Addict. 2009;18:219-225.
27. Grant JE, Kim SW, Hollander E, Potenza MN. Predicting response to opiate antagonists and placebo in the treatment of pathological gambling. Psychopharmacology (Berl). 2008;200:521-527.
28. Grant JE, Kim SW, Hartman BK. A double-blind, placebo-controlled study of the opiate antagonist naltrexone in the treatment of pathological gambling urges. J Clin Psychiatry. 2008;69:783-789.
29. Grant JE, Potenza MN, Hollander E, et al. Multicenter investigation of the opioid antagonist nalmefene in the treatment of pathological gambling. Am J Psychiatry. 2006;163:303-312.
30. Grant JE, Kim SW. Effectiveness of pharmacotherapy for pathological gambling: a chart review. Ann Clin Psychiatry. 2002;14:155-161.
31. Black DW, Arndt S, Coryell WH, et al. Bupropion in the treatment of pathological gambling: a randomized, double-blind, placebo-controlled, flexible-dose study. J Clin Psychopharmacol. 2007;27:143-150.
32. Padala PR, Madaan V, Sattar SP. Bupropion therapy for pathological gambling. Ann Pharmacother. 2007;41:529.
33. Dannon PN, Lowengrub K, Musin E, et al. Sustained-release bupropion versus naltrexone in the treatment of pathological gambling: a preliminary blind-rater study. J Clin Psychopharmacol. 2005;25: 593-596.
34. Leung KS, Cottler LB. Treatment of pathological gambling. Curr Opin Psychiatry. 2009;22:69-74.
35. Hollander E, Pallanti S, Allen A, et al. Does sustained-release lithium reduce impulsive gambling and affective instability versus placebo in pathological gamblers with bipolar spectrum disorders? Am J Psychiatry. 2005;162:137-145.
36. McElroy SL, Nelson EB, Welge JA, et al. Olanza-pine in the treatment of pathological gambling: a negative randomized placebo-controlled trial. J Clin Psychiatry. 2008;69:433-440.
37. Fong T, Kalechstein A, Bernhard B, et al. A double-blind, placebo-controlled trial of olanzapine for the treatment of video poker pathological gamblers. Pharmacol Biochem Behav. 2008;89:298-303.
38. Sevincok L, Akoglu A, Akyol A. Quetiapine in a case with Parkinson disease and pathological gambling. J Clin Psychopharmacol. 2007;27:107-108.
39. Zack M, Poulos C. Effects of the atypical stimulant modafinil on a brief gambling episode in pathological gamblers with high vs low impulsivity. J Psychopharmacol. 2009;23:660-671.
40. Grant JE, Kim SW, Odlaug BL. N-acetyl cysteine, a glutamate-modulating agent, in the treatment of pathological gambling: a pilot study. Biol Psychiatry. 2007;62:652-657.
41. Volkow ND, Fowler JS, Logan J, et al. Effects of modafinil on dopamine and dopamine transporters in the male human brain: clinical implications. JAMA. 2009;301:1148-1154.
42. Ingle PJ, Marotta J, McMillan G, Wisdom JP. Significant others and gambling treatment outcomes. J Gambl Stud. 2008;24:381-392.
43. Stinchfield R. Reliability, validity, and classification accuracy of the South Oaks Gambling Screen (SOGS). Addict Behav. 2002;27:1-19.
44. Hodgins DC. Using the NORC DSM Screen for Gambling Problems as an outcome measure for pathological gambling: psychometric evaluation. Addict Behav. 2004;29:1685-1690.
45. Wickwire EM Jr, Burke RS, Brown SA, et al. Psychometric evaluation of the National Opinion Research Center DSM-IV Screen for Gambling Problems (NODS). Am J Addict. 2008;17:392-395.
46. Young M, Stevens M. SOGS and CGPI: parallel comparison on a diverse population. J Gambl Stud. 2008;24:337-356.
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