Nalmafene for your ludomania
Multicenter investigation of the opioid antagonist nalmefene in the treatment of pathological gambling.
by Grant et al. in Am J Psychiatry. 2006 Feb ; 163(2): 303-12
OBJECTIVE: Pathological gambling is a disabling disorder experienced by approximately 1%-2% of adults and for which there are few empirically validated treatments. The authors examined the efficacy and tolerability of the opioid antagonist nalmefene in the treatment of adults with pathological gambling.
METHOD: A 16-week, randomized, dose-ranging, double-blind, placebo-controlled trial was conducted at 15 outpatient treatment centers across the United States between March 2002 and April 2003. Two hundred seven persons with DSM-IV pathological gambling were randomly assigned to receive nalmefene (25 mg/day, 50 mg/day, or 100 mg/day) or placebo. Scores on the primary outcome measure (Yale-Brown Obsessive Compulsive Scale Modified for Pathological Gambling) were analyzed by using a linear mixed-effects model.
RESULTS: Estimated regression coefficients showed that the 25 mg/day and 50 mg/day nalmefene groups had significantly different scores on the Yale-Brown Obsessive Compulsive Scale Modified for Pathological Gambling, compared to the placebo group. A total of 59.2% of the subjects who received 25 mg/day of nalmefene were rated as "much improved" or "very much improved" at the last evaluation, compared to 34.0% of those who received placebo. Adverse experiences included nausea, dizziness, and insomnia.
CONCLUSIONS: Subjects who received nalmefene had a statistically significant reduction in severity of pathological gambling. Low-dose nalmefene (25 mg/day) appeared efficacious and was associated with few adverse events. Higher doses (50 mg/day and 100 mg/day) resulted in intolerable side effects.
See also this story in The Nation
Drug Shows Promise in Curbing Compulsive Gambling, Study Says
By Robert Lee Hotz in The Nation
For the estimated 6 million compulsive gamblers in the U.S., the long odds are on a pill.
In the largest clinical study of its kind, researchers at the University of Minnesota found that daily doses of an experimental drug called nalmefene, often used to treat alcoholism, appeared to curb the craving to gamble.
The research represents the latest effort to control the biology of misbehavior at a time when celebrity poker, online gambling, lotteries and sports betting have helped to make obsessive wagering a national psychiatric disorder.
"The study is part of emerging evidence that gambling, once thought to be a problem in moral integrity, is instead a problem in brain biology and can be successfully treated," said Dr. Robert Freedman, editor of the American Journal of Psychiatry, which published the study today in its February issue.