101464: The Role of Medication in the Treatment of Pathological Gambling

Bridging the Gap Between Research and Practice

About the Course:

After reviewing the literature on the pharmacotherapy of pathological gambling, the author discusses treatment strategies and areas for future research. The clearest indication for medicating the pathological gambler is for the treatment of comorbid disorders, primarily depression, bipolar disorder, and attention deficit hyperactivity disorder. However, there are difficulties in diagnosing the dually disordered gambler. Other current pharmacological approaches involve the use of medication to treat specific symptoms, traits, or symptom clusters; to make negative affects more tolerable; and to reduce cravings. Future approaches will be directed at subgroups of gamblers. This may include genetic profiling, paired with recognition of neurotransmitter deficits, and the identification of clinical syndromes and subtypes. The author also discusses the kindling hypothesis as it may pertain to pathological gambling. The presence of kindling would make a strong case for earlier and more aggressive use of medication and for long-term maintenance to prevent relapse.

Journal/Publisher:

Journal of Gambling Issues

Publication Date:

February 2004, Issue 10

Author

Richard J. Rosenthal

About the Author:

Richard J. Rosenthal, MD, has been treating pathological gamblers for almost 25 years. He co-authored the DSM-IV diagnostic criteria, was co-investigator on the first genetic study of gamblers, and has published articles and book chapters on the phenomenology of pathological gambling, its course, complications, and treatment. Dr. Rosenthal was a member of the National Academy of Science’s Committee on the Social and Economic Impact of Pathological Gambling. He founded the California Council on Problem Gambling and has been actively involved in the National Council. In addition to his private practice and teaching duties, he is co-director of the UCLA Gambling Studies Program.

Recommended For:

This course is recommended for health care professionals, especially addiction counselors, psychologists, mental health counselors, social workers, and nurses who seek knowledge about the role of medication in the treatment of pathological gambling. It is appropriate for all levels of participants’ knowledge.

Course Objectives:

  1. Discuss biological factors implicated in pathological gambling and the rationale for using medication in its treatment.

  2. Identify findings from the pharmacotherapy literature, including trials of seratonin reuptake inhibitors, mood stabilizers, and opioid antagonists.

  3. Explain models for treatment with medication, including neurotransmitter depletion and imbalances, kindling, withdrawal, cravings, comorbidity, and subtyping.

Exam Questions

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