Question explored with the scientific record
Is there a good drug treatment for gambling disorder
The evidence for drug treatments in gambling disorder is thin, mixed, and mostly from small, old studies.
The best-tested drug is the opioid antagonist naltrexone. A 2001 double-blind trial of 45 people found that those on naltrexone reported more improvement than placebo on clinician and patient ratings, but the placebo response was substantial and the drug caused nausea in 45% of patients and raised liver enzymes in several, especially those also taking NSAIDs [3]. A 2006 review noted that SSRIs showed mixed results and that opioid antagonists like naltrexone showed "some benefit" [1].
The glutamate-modulating supplement N-acetylcysteine (NAC) was tested in a 2007 pilot study of 27 people. In the open-label phase, gambling symptoms dropped significantly. In the 6-week double-blind phase that followed, 83% of those on NAC maintained improvement versus 29% on placebo, but the difference was a trend, not statistically significant [2]. The study was small and short.
The most important thing to know is that dopamine-boosting drugs can cause gambling disorder. In people with Parkinson's disease, dopamine agonists like pramipexole and ropinirole triggered pathological gambling in about 4-5% of patients [4, 5]. One review reported that 80% of patients improved when the dose was reduced or stopped [6]. This is a documented mechanism: drugs that raise dopamine tone in the reward system can produce compulsive gambling, not treat it.
The evidence here does not include a single large, long-term, independently funded trial comparing any drug to a true placebo or to psychotherapy. The 2022 scoping review of 445 articles on gambling treatment found that CBT and related psychological treatments dominate the research literature, not drugs [7].
My call: No drug has strong evidence for treating gambling disorder. Naltrexone has the most data but comes with side effects and a high placebo response. NAC is promising but unproven. The bigger risk is that some drugs, especially dopamine agonists, can cause the condition. The evidence is too weak to recommend any drug as a first-line treatment.
Confidence: low
Sources used 7
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Compulsive Aspects of Impulse-Control Disorders
A comprehensive review of compulsive aspects across impulse-control disorders (pathological gambling, trichotillomania, kleptomania) and their relationship to obsessive-compulsive disorder, detailing similarities and differences, neurobiological findings, and implications for tr…
DOI: 10.1016/j.psc.2006.02.002 -
N-Acetyl Cysteine, a Glutamate-Modulating Agent, in the Treatment of Pathological Gambling: A Pilot Study
This pilot study evaluated the tolerability and efficacy of N-acetylcysteine, a glutamate-modulating agent, in reducing gambling symptoms in pathological gamblers, showing significant open-label improvement and a trend toward NAC over placebo in a 6-week double-blind phase.
DOI: 10.1016/j.biopsych.2006.11.021 -
Double-blind naltrexone and placebo comparison study in the treatment of pathological gambling
This randomized, double-blind trial assessed high-dose naltrexone versus placebo in adults with DSM-IV pathologic gambling, finding significant improvements in gambling symptoms and global outcomes with naltrexone, albeit with notable hepatic enzyme elevations linked to analgesi…
DOI: 10.1016/s0006-3223(01)01079-4 -
Problematic gambling on dopamine agonists: Not such a rarity
This study investigates the prevalence of pathological gambling among Parkinson's disease patients treated with dopamine agonists, finding that 4.4% of patients developed this condition, highlighting a significant adverse effect of the medication.
DOI: 10.1002/mds.21110 -
Pathological Gambling Caused by Drugs Used to Treat Parkinson Disease
This study investigates the association between dopamine agonist therapy for Parkinson's disease and the development of pathological gambling in 11 patients, highlighting the potential reversibility of gambling behavior upon discontinuation of the medication.
DOI: 10.1001/archneur.62.9.noc50009 -
Impulsivity in Patients with Parkinson’s Disease
This review article examines impulse control disorders (ICDs) in Parkinson's disease, covering definitions, prevalence, neuroanatomical mechanisms, evaluation instruments, and treatment options. It highlights that ICDs such as pathological gambling, compulsive shopping, eating, …
DOI: 10.1515/jbcr-2017-0001 -
A Critical Review of the Scholarly Discourse on Gambling Disorder Treatment
This article provides a comprehensive 50-year scoping review of the Anglophone scholarly discourse on psychological and relational treatments for gambling disorder, detailing publication trends, dominant treatment models (notably CBT), regional and audience focus, and calls for …
DOI: 10.29173/cgs96