Two medicines usually given to people who are addicted to opioid drugs also help with compulsive gambling. The finding suggests there may be similar brain circuits involved in behavioural addictions as those that cause drug addiction.
Addiction is usually thought of in the context of people who can鈥檛 stop drinking alcohol or who take drugs. A large group of these drugs are those that act through opioid receptors in the brain, such as heroin or fentanyl. This causes the release of a brain signalling chemical called dopamine, linked with feelings of reward.
Various medicines have been developed to help people who are addicted to opioids, which work by binding to the opioid receptors and blocking the effects of the drugs.
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But these medicines have also been investigated to see if they could help people with other kinds of addictions. The only help usually offered for gambling addiction is talking therapies, which don鈥檛 work for everyone.
Some randomised trials have looked into the effects of opioid-blocking medicines in gambling addiction, as well as some other therapies, such as a medicine given for schizophrenia.
狈辞飞,听 at the Southern Health NHS Foundation Trust in Hampshire, UK, and his colleagues have carried out an analysis of all randomised trials comparing such medications against placebo treatments among people with gambling addiction.
They found that the most effective was a medicine called nalmefene, usually given to people who have taken an overdose of opioid drugs, and one called naltrexone, used long term to help those who take opioids keep off the drugs.
An opioid-blocker called naloxone that is commonly used to reverse opioid overdoses didn鈥檛 work, probably because its effects are too transient, the authors write in their paper. The schizophrenia treatment, olanzapine, also didn鈥檛 work.
Despite showing promise for gambling addiction, people were more likely to stop using the two effective opioid blockers than those in the placebo groups, probably because of their side effects, which include nausea and dizziness.
鈥淕iven the limited number of treatment options identified in the current [analysis], and the high public health priority of gambling disorder, further large-scale clinical trials are urgently needed,鈥� the researchers write.
at the University of Cambridge says the two medications may work because compulsive gambling involves similar brain pathways as those involved in opioid addiction. 鈥淕ambling may start in an impulsive and sensation-seeking way,鈥� she says. 鈥淭he exciting experience and the wins activate the reward system in the brain and increases the pleasure chemical in the brain, dopamine.鈥�
MedRxiv
