Drug changes odds for compulsive gamblers.

Conservative estimates suggest that Americans will wager $5 to $6 billion this year on the Super Bowl alone. People gamble not just on who will win and by how many points, but also on obscure facets of the big game: which team will win the coin toss, whether anyone will score in the first five minutes or if the difference in the final score will be an odd or an even number.

For the majority of participants, a wager is undertaken responsibly. However, for about six million Americans, the impulse to gamble can get out of control.

A recent clinical study by researchers from the University of Minnesota could give hope for compulsive gamblers seeking to curb their addiction. They found that nalmefene—a drug manufactured by the Finnish company BioTie Therapies Corp. that is often used to treat alcoholism—may also help gamblers control their cravings. In a paper published in the February issue of the American Journal of Psychiatry, Jon Grant, the University of Minnesota psychiatrist who led the study, along with his colleagues, demonstrated that compulsive gambling may not just be the result of moral weakness but also due to chemical discrepancies in the brain. Even more compelling is the possibility that these levels can be effectively treated through medication. A second clinical trial is underway to determine the proper dosage levels required for the drug.

“We’ve demonstrated a specific circuitry in the brain where human motivation and cravings are processed,” said S. W. Kim, Grant’s longtime collaborator at Minnesota. “We are then defining what chemicals are involved with that process and using specific medications to dampen that process.”

It’s the pleasure of gambling that namelfene actually controls. The drug affects the brain’s opiate circuits that process pleasure as well as interfering with its dopamine systems, which handle feelings of reward. Once treated with namelfene, patients reported no longer feeling the thrill of gambling—what makes it so compelling in the first place.

According to Kim, the drug keeps the brain from ramping up the urge to gamble to uncontrollable levels. Because craving precedes the excitement of actually gambling, if cravings for that “high” go down, compulsive gamblers will be less likely to gamble.

Besides alcoholism and gambling, nalmefene has also been used to treat certain forms of other compulsion-driven disorders including shopping, shoplifting and sexual addiction. However, it has not yet proven effective for curbing the desire to smoke.

Kim says he and Grant have tracked patients over long periods to show that if someone can control their compulsions for two years with the aid of the drug, it is often possible to re-establish their pre-addiction lifestyle, at which point they can go off the medicine.

While it isn’t a cure-all, this research does show promise for drug-therapy as a way to help compulsive gamblers—something that until now seemed like a long shot.

Originally published February 4, 2006

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