naloxone and Gambling

Neuroscientific explanations of gambling disorder can help people make sense of their experiences and guide the development of psychosocial interventions. However, the societal perceptions and implications of these explanations are not always clear or helpful. Two workshops in 2013 and 2014 brought together multidisciplinary researchers aiming to improve the clinical and policy-related effects of neuroscience research on gambling. The workshops revealed that neuroscience can be used to improve identification of the dangers of products used in gambling. Additionally, there was optimism associated with the diagnostic and prognostic uses of neuroscience in problem gambling and the provision of novel tools (eg, virtual reality) to assess the effectiveness of new policy interventions before their implementation. Other messages from these workshops were that neuroscientific models of decision making could provide a strong rationale for precommitment strategies and that interdisciplinary collaborations are needed to reduce the harms of gambling.

Topics: Administrative Personnel; Appetite Depressants; Decision Making; Diagnostic and Statistical Manual of Mental Disorders; Disruptive, Impulse Control, and Conduct Disorders; Gambling; Harm Reduction; Humans; Naloxone; Naltrexone; Narcotic Antagonists; Neurosciences; Public Health

Gambling disorder (GD) is a global phenomenon affecting millions of people. GD can result in severe social and financial difficulties and efficacious treatments are warranted. Psychosocial treatments form the basis of treatment. Opioid antagonists (OAs) have however shown promise in previous studies. In a recent imaging study intranasal naloxone was found to rapidly and fully occupy brain μ-opioid receptors. This trial investigates the effect and safety of as needed naloxone in the treatment of gambling disorder.. This was a 12-week double blind, randomised control trial comparing intranasal naloxone to placebo. The primary endpoint was gambling urge measured by the Gambling symptom Assessment Scale (G-SAS). Secondary outcome measures were gambling severity measures (PGSI) as well as quality of life (WHO:EUROHIS-8), alcohol consumption (AUDIT), depression (MARDS) and internet use (IDS-9SF). In addition, safety of treatment was assessed. Both treatment groups received psychosocial support.. 126 participants were randomised to treatment groups in a 1:1 ratio. 106 patients completed the study. Gambling urge (GSAS) and other gambling related measured improved in both groups, but no statistically significant difference could be found. Intranasal naloxone was well tolerated, no subjects discontinued the study due to adverse events. No serious adverse drug reactions were observed.. This study found no difference between the as-needed administration of intranasal naloxone and placebo in reducing gambling urge in persons with GD. Intranasal naloxone was safe and well tolerated.

Topics: Administration, Intranasal; Double-Blind Method; Gambling; Humans; Naloxone; Narcotic Antagonists; Quality of Life

There is growing interest in the use of medication-assisted treatments for gambling disorder (GD). Opioid receptor antagonists are hypothesised to blunt the craving associated with gambling. This study was designed to assess the feasibility of using an intranasal naloxone spray to treat GD.. An 8-week, open-label, uncontrolled pilot study.. A single study site in the capital region of Finland.. Twenty problem gamblers (nine men) were randomised into two groups. Group A (n=10) took one dose into one nostril (2 mg naloxone), as needed, with a maximum of 4 doses/day (max. 8 mg/day). Group B (n=10) took one dose into each nostril (4 mg naloxone) as needed, with a maximum of 4 doses/day (max. 16 mg/day).. Naloxone hydrochloride nasal spray.. Acceptability and feasibility of the intervention were assessed. Use of study medication, adverse events, gambling frequency and gambling expenditure were recorded in a mobile diary. Problem gambling: South Oaks Gambling Screen (SOGS), depressive symptoms: Beck Depression Inventory (BDI) and alcohol use: Alcohol Use Disorders Identification Test were recorded.. Study completion rate was 90%. Acceptability and feasibility scores were high. Group B used intranasal naloxone more frequently than group A, and consequently used more naloxone. No serious adverse events were reported. The postintervention SOGS scores were lower (median=4 (IQR=3.75) versus preintervention scores (median=12 (IQR=4.75)). Depressive symptoms were reduced during the trial (preintervention BDI median=9, IQR=9 vs postintervention BDI median=6, IQR=6).. The acceptability and feasibility of using intranasal naloxone were high, and no serious adverse events were reported. Preliminary results suggest mixed results in terms of gambling behaviour (ie, reduced frequency but not expenditure) and decreased depressive symptoms.. EudraCT2016-001828-56.

Topics: Administration, Intranasal; Adolescent; Adult; Aged; Feasibility Studies; Gambling; Humans; Middle Aged; Naloxone; Patient Acceptance of Health Care; Pilot Projects; Psychiatric Status Rating Scales; Treatment Outcome; Young Adult

We explored the efficacy of the opiate antagonist, naltrexone, as a treatment for pathological gambling. Treatment seeking pathological gamblers (n = 39) (according to both South Oaks Gambling Screen and a screen based on the Diagnostic and Statistical Manual of Mental Disorders) participated into our treatment study during 2009. The subjects were instructed to use 50 mg of naltrexone before gambling or when feeling craving towards gambling. The protocol contained one initial doctor visit with motivational brief intervention. During period that were free of gambling, the subjects were instructed to practice other healthy behavioral alternatives to gambling. The primary outcome measure was the Yale Brown Obsessive Compulsive Scale adapted for Pathological Gambling. The other outcome measurements were the EQ-5D quality of life survey, the Alcohol Use Disorders Identification Test, and the Beck Depression Inventory. The average age of the subjects was 39 years; 80% were men. Highly significant (p < 0.01) decreases in reported obsessive-compulsive gambling and depressive symptoms and increases in the subjective quality of life developed in the study. These positive changes suggest that this simple, inexpensive treatment helps pathological gamblers. The role of naltrexone in the treatment effect, however, needs to be determined with a larger, placebo-controlled study.

Topics: Adult; Aged; Combined Modality Therapy; Depression; Female; Finland; Gambling; Humans; Male; Middle Aged; Motivation; Naloxone; Narcotic Antagonists; Pilot Projects; Psychiatric Status Rating Scales; Psychotherapy, Brief; Quality of Life; Surveys and Questionnaires; Treatment Outcome; Young Adult

Topics: Blood Pressure; Body Temperature; Compulsive Behavior; Cyclazocine; Discrimination Learning; Endorphins; Ethylketocyclazocine; Euphoria; Gambling; Glucose; Heart Rate; Humans; Morphine; Naloxone; Nicotine; Perception; Respiration; Substance-Related Disorders; Time Factors