A Double-Blind, Placebo-Controlled Study of the Opiate Antagonist Naltrexone in the Treatment of Pathological Gambling Urges
J Clin Psychiatry 2008;69(5):783-789
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Objective: Pathological gambling (PG) is a disabling disorder
experienced by approximately 1% of adults and for which few empirically
validated treatments exist. This study examined the efficacy and tolerability
of the opioid antagonist naltrexone in adults with PG who have urges to gamble.
Method: An 18-week, double-blind, placebo-controlled trial was
conducted to evaluate the safety and efficacy of 3 doses of oral naltrexone for
PG. Seventy-seven individuals with DSM-IV-TR PG were randomly assigned to
naltrexone (50 mg/day, 100 mg/day, or 150 mg/day) or placebo. Subjects were
assessed with the Pathological Gambling Adaptation of the Yale-Brown Obsessive
Compulsive Scale (PG-YBOCS), the urge and behavior subscales of the PG-YBOCS,
the Gambling Symptom Assessment Scale (G-SAS), the Clinical Global
Impressions-Severity of Illness scale (CGI-S), and measures of depression,
anxiety, and psychosocial functioning. Data were collected from September 2002
to June 2005.
Results: Outcomes did not significantly differ between the
various doses of naltrexone. Subjects assigned to naltrexone had significantly
greater reductions in PG-YBOCS total scores (p = .0094), gambling urges (p =
.0053), and gambling behavior (p = .0134) compared to subjects assigned to
placebo. Subjects assigned to naltrexone also had greater improvement in
overall gambling severity (reflected in the CGI-S scores) (p = .0080) and in
psychosocial functioning (p = .0177) than subjects assigned to placebo. A
completer analysis (N = 49) demonstrated significantly greater improvement on
all variables for subjects assigned to naltrexone. A sex analysis demonstrated
that men and women did not differ significantly in their response to naltrexone.
Conclusion: Subjects assigned to naltrexone demonstrated
statistically significant reductions in gambling urges and behavior in PG.
Low-dose naltrexone (50 mg/day) appeared as efficacious as higher doses (100
mg/day and 150 mg/day), and all doses were well tolerated.