Drugs Give Gamblers Relief From Impulse

TIMES HEALTH WRITER

Mike Ambrose, a computer systems analyst, often would spend 36 hours straight on weekends playing slot machines until his paycheck was gone. After blowing $15,000 to $20,000 a year on his habit for more than a decade, Ambrose, in desperation, volunteered as a patient in a clinical study to test a drug to control his gambling urge.

The medication, naltrexone, originally devised to combat heroin addiction and alcoholism, changed his life. Within two weeks, the Fridley, Minn., man noticed a "tremendous difference--suddenly, the urges stopped."

Three years later, Ambrose, 60, still takes a maintenance dose of the drug. "Even the few times I've gone to the casinos out of curiosity, I didn't enjoy it," he says. "Naltrexone takes all the excitement out of it, and I don't get the rush anymore."

The final results of this study conducted at the University of Minnesota were reported earlier this month in the journal Biological Psychiatry. The study found that people who took naltrexone reported that their gambling urges--once so powerful that they stole from their children and even turned to prostitution to pay gambling debts--either vanished or were diminished enough that they could resist temptation.

The Minnesota research is among a handful of recent studies suggesting that the gambling urge has its roots in biology, rather than human frailty. Researchers say that gambling may be, at least in part, sparked by a short circuit in the brain's wiring or an imbalance in key brain chemicals. And drugs such as naltrexone, which blocks the brain's pleasure pathways, are helping people control their impulses.

The findings offer new hope to the estimated 1% to 3% of the population that suffers from a gambling addiction, for which there is no standard treatment.

The University of Minnesota experiment, for example, involved 45 compulsive gamblers. For 11 weeks, 20 people received naltrexone, which dulls the sensation of pleasure that is associated with addictive cravings. The remainder were given a placebo, or dummy pill.

Each week, participants were interviewed about the severity of their symptoms, the frequency and duration of their urges, the time they were consumed with thoughts about gambling and the time they actually spent gambling.

Three-quarters of those on the medication reported substantial relief from the compulsion that had seriously disrupted their lives, contrasted with only one-fourth of the placebo group. "Their symptoms are under control, so they can have a normal life," says Dr. Suck Won Kim, a psychiatrist at the University of Minnesota Medical School in Minneapolis and co-author of the study. "The data shocked us. We got fantastic results."

Researchers studying gambling behavior at Rhode Island Hospital in Providence reported similar findings with another drug, Celexa, or citalopram, a type of antidepressant known as an SSRI. The study was, however, relatively small, involving just 15 compulsive gamblers, and lasted for just 12 weeks. (The study was funded by Forest Laboratories, which markets Celexa.)

Previous studies have suggested that people with obsessive-compulsive behavior disorders, such as pathological gambling, suffer from a deficiency of serotonin, a brain chemical that may be involved in the ability to delay or prevent acting on impulses. The class of drugs known as SSRIs (or serotonin reuptake inhibitors) prevent serotonin from being removed from the synapses in the brain.

In the Rhode Island research, 13 out of 15 of the study participants reported significant improvements in all gambling measures, including the number of days gambled and their preoccupation with gambling. The amount of money participants lost dropped from an average of $1,900 in the two weeks prior to the study to $145 in the final two weeks.

"Individuals who are struggling to get a handle on this devastating problem should be aware of the possible treatment options," said Dr. Mark Zimmerman, director of outpatient psychiatry at Rhode Island Hospital and the study's lead author.

However, the Food and Drug Administration has not yet approved these medications for use in curbing gambling urges. Still, these studies suggest that medications that compensate for deficits in brain chemistry may hold the key to controlling impulses.

Researchers at Massachusetts General Hospital in Boston, writing in the May issue of the journal Neuron, reported that the same pathways in the brain that are stimulated by cocaine also became activated in the anticipation and experience of winning at gambling.

And researchers at the University of Cambridge in England found in another recent study that impulsive behavior, which is a feature of addictions such as pathological gambling, may be caused by a defect in a region of the brain known as the nucleus accumbens.

"Impulse disorders like gambling are likely the result of genetic vulnerabilities that cause abnormalities in the brain circuits," said Dr. Eric Hollander, a professor of psychiatry and director of the Compulsive, Impulsive and Anxiety Disorder program at Mt. Sinai Medical School in New York. "These treatments may help people put the brakes on their impulses."

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How You Can Tell When Gambling Controls You

There's nothing wrong with a day at the racetrack. But for some people, gambling can cross the line to become a pathological disorder. The American Psychiatric Assn. says that anyone who exhibits five or more of the following behaviors may need medical help:

* Needs to gamble with increasing amounts of money in order to achieve the desired excitement.

* After losing money gambling, often returns another day to get even.

* Is restless or irritable when attempting to cut down or stop gambling.

* Has repeated unsuccessful efforts to control, cut back or stop gambling.

* Gambles as a way of escaping from problems or of relieving depression.

* Is preoccupied with gambling.

* Lies to family members, therapist or others to conceal the extent of involvement with gambling.

* Has committed illegal acts such as forgery, fraud theft, or embezzlement to finance gambling.

* Has jeopardized or lost a significant relationship, job, or educational opportunity because of gambling.

* Relies on others to provide money to relieve a desperate financial situation caused by gambling.

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