The role of medication in the treatment of pathological gambling: Bridging the gap between research and practice

Abstract

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.