What medications are used to treat gambling addiction?

Medication for Gambling Addiction

Naltrexone is the medication with the strongest evidence for treating gambling disorder, targeting reward pathways to reduce gambling urges and behavior, and should be offered as first-line pharmacotherapy when medication is indicated. 1

First-Line Pharmacological Treatment

Naltrexone (opioid antagonist) should be the initial medication choice based on the most consistent evidence across multiple studies showing reduction in gambling urges and behavior. 1, 2, 3, 4

• Typical dosing ranges from 50-150 mg/day, though optimal dosing requires further study 3
• Works by blocking opioid receptors involved in reward processing and the "high" associated with gambling 2
• Nalmefene (another opioid antagonist) also shows promise but has less robust data than naltrexone 3

Critical Treatment Framework

Pharmacotherapy must always be delivered as an adjunct to behavioral treatment, never as monotherapy. 1

• Cognitive Behavioral Therapy (CBT) has the strongest evidence base and should be the initial treatment approach, targeting gambling-specific cognitive distortions 1
• Motivational Interviewing should be combined with CBT, particularly for patients ambivalent about change 1
• Medication alone has lower retention rates compared to combined pharmacotherapy and psychotherapy 4

Alternative Pharmacological Options

When naltrexone is contraindicated or ineffective, consider these alternatives with weaker but emerging evidence:

Mood stabilizers:

• Topiramate showed some benefit in small trials but requires larger studies 3, 5
• Lithium and carbamazepine have limited data 3, 5

Glutamatergic agents:

• N-acetylcysteine (NAC) shows preliminary promise but needs more research 3
• Acamprosate and memantine have minimal data specific to gambling disorder 3

SSRIs (fluvoxamine, paroxetine, sertraline):

• Evidence is mixed and inconsistent across studies 2, 3, 4, 5
• May be considered when significant comorbid depression or anxiety is present 2

Essential Clinical Considerations

Address comorbidities systematically, as gambling disorder frequently co-occurs with:

• ADHD and impulse control problems 1
• Substance use disorders 1, 4
• Depression and anxiety 2
• Treatment must address these co-occurring conditions for optimal outcomes 4

Special population alert:

• Be vigilant for gambling disorder development in Parkinson's disease patients on dopaminergic medications, as there is evidence of comorbid overlap 1

Common Pitfalls to Avoid

• Do not use antipsychotics (olanzapine, haloperidol) as primary treatment—evidence is extremely limited and they carry significant side effect burden 3, 5
• Do not rely on SSRIs alone—they have shown inconsistent results and should not be first-line unless treating comorbid depression 3, 4, 5
• Do not prescribe medication without concurrent behavioral therapy—this significantly reduces treatment effectiveness and retention 1, 4
• Do not expect rapid response—treatment trials should be adequate in duration (typically 8-16 weeks minimum) before declaring failure 2

Evidence Limitations

The current evidence base has significant gaps:

• Small sample sizes across most studies 3, 4
• High placebo response rates complicate interpretation 3
• Limited long-term follow-up data 3
• Lack of diversity in study populations 3, 4
• Few studies examining treatment of dually diagnosed patients 4

Despite these limitations, naltrexone remains the most evidence-supported medication, but always combined with structured CBT for optimal outcomes. 1, 3, 4