Pharmacological Treatments for Disordered Gambling: A Meta-analysis

Area of Science:

• Neuroscience
• Psychiatry
• Public Health

Background:

• Disordered gambling is a significant public health issue with severe individual and societal costs.
• Opioid antagonists are current first-line treatments for gambling disorder, with newer agents and combined therapies emerging.
• Understanding the efficacy of pharmacological interventions is crucial for effective gambling disorder management.

Purpose of the Study:

• To comprehensively evaluate the short- and long-term efficacies of pharmacological and combined treatments for gambling disorder.
• To synthesize findings from a multilevel literature search of relevant clinical trials.

Main Methods:

• A systematic literature search identified 34 studies, including open-label and placebo-controlled trials, with 1340 participants.
• Meta-analysis was used to assess the effect sizes of pharmacological treatments on gambling disorder severity, frequency, and financial loss.
• Comparison of pre-post treatment effects versus controlled effect sizes was conducted.

Main Results:

• Pharmacological treatments demonstrated large pre-post reductions in global severity, frequency, and financial loss (Hedges's g: 1.35, 1.22, 0.80).
• Controlled effect sizes were smaller but robust for short-term global severity reduction (Hedges's g: 0.41).
• Opioid antagonists, mood stabilizers (e.g., topiramate), and lithium showed promising results, particularly in combination with psychological interventions.

Conclusions:

• Pharmacological interventions, especially certain opioid antagonists and mood stabilizers, offer effective treatment options for gambling disorder.
• Combined pharmacological and psychological approaches show particular promise.
• Further large-scale, rigorously designed randomized controlled trials are necessary to confirm efficacy and guide clinical practice.