What pharmacologic treatments can be used to reduce cravings for video gaming?

Pharmacologic Treatment for Video Gaming Disorder

Primary Recommendation

Naltrexone (50-100 mg daily) is the medication with the strongest evidence for reducing cravings and urges in gaming disorder, but it must always be prescribed alongside cognitive behavioral therapy—never as monotherapy. 1, 2

Critical Treatment Framework

Medication Selection and Dosing

• Naltrexone is the first-line pharmacologic agent for gaming disorder based on its robust evidence in behavioral addictions that share neurobiological substrates with gaming disorder, specifically targeting dopaminergic reward pathways in the nucleus accumbens. 1, 2

• Start naltrexone at 50 mg daily orally, with dosing flexibility up to 100 mg daily depending on response. 1

• An alternative regimen of 100 mg on Mondays and Wednesdays plus 150 mg on Fridays can be used for improved adherence. 1

• Monthly injectable naltrexone 380 mg (Vivitrol) is available when oral therapy adherence is problematic. 1

• Naltrexone works by blocking opioid receptors, thereby reducing dopamine release in reward circuits that sustain gaming behaviors and cravings. 1, 2

Mandatory Concurrent Behavioral Treatment

Pharmacotherapy alone is inadequate and will fail—naltrexone must be combined with structured cognitive behavioral therapy from treatment initiation. 1, 2

• CBT has the strongest evidence base for gaming disorder and targets gaming-specific cognitive distortions that maintain the addictive behavior. 2, 3

• Add motivational interviewing to CBT when patients show ambivalence about reducing gaming, which is common in this population. 2, 3

• The combination approach addresses both neurobiological dysregulation (via naltrexone) and maladaptive thought patterns (via CBT), with CBT improving responses that plateau with medication alone. 1, 3

Safety Monitoring Requirements

• Obtain baseline liver function tests before starting naltrexone and repeat every 3-6 months, as hepatotoxicity can occur at supratherapeutic doses. 1

• Do not prescribe naltrexone to patients requiring opioid analgesics, as it will completely block opioid-mediated pain relief. 1

• Screen for current opioid use before initiating therapy to avoid precipitating withdrawal. 1

Systematic Comorbidity Management

Gaming disorder rarely occurs in isolation—address psychiatric comorbidities as they directly impact treatment outcomes. 1, 2, 3

• Screen for and treat ADHD, impulse control disorders, obsessive-compulsive symptoms, depression, anxiety, and substance use disorders, as these frequently co-occur with gaming disorder. 1, 2, 3

• The shared neurobiology involves dysregulated striatal reward circuitry and diminished prefrontal cortical control over impulses, explaining the high comorbidity rates. 1

• Recent meta-analysis shows that comorbidity does not moderate treatment outcomes, so proceed with standard treatment even in complex cases. 4

Special Population Considerations

• Exercise extreme caution in Parkinson's disease patients on dopaminergic medications, as they have markedly elevated risk of developing gaming disorder and impulse control problems. 1, 2, 3

• In this population, consider adjusting dopaminergic regimens rather than adding naltrexone. 1

Treatment Algorithm

1. Initiate naltrexone 50 mg daily (titrate from 25-50 mg if needed for tolerability) with baseline liver function testing. 1

2. Simultaneously begin structured CBT targeting gaming-specific cognitive distortions and behavioral patterns. 1, 2

3. Add motivational interviewing if patient demonstrates ambivalence about treatment engagement or reducing gaming time. 1, 3

4. Screen comprehensively for psychiatric comorbidities (ADHD, mood disorders, anxiety, impulse control problems, substance use) and treat concurrently. 1, 2

5. Monitor liver function every 3-6 months throughout naltrexone treatment. 1

6. Assess treatment response at 90 days, as sustained benefits for gaming symptoms and time reduction are demonstrated at this interval. 4

Evidence Strength and Limitations

• Gaming disorder shares neurobiological substrates with gambling disorder and substance use disorders, including abnormal reward processing in the striatum and orbitofrontal cortex, plus diminished executive functioning related to DLPFC and anterior cingulate cortex dysfunction. 5

• While gaming disorder was placed in DSM-5 Appendix requiring more research, it is now recognized in ICD-11 within disorders due to addictive behaviors. 5

• The pharmacotherapy evidence base for gaming disorder specifically is limited—naltrexone's recommendation is extrapolated from robust data in gambling disorder and other behavioral addictions with shared neurobiology. 1, 2, 4

• A 2025 systematic review found that pharmacological interventions for gaming disorder require further study, either alone or combined with psychological therapies, highlighting the current evidence gap. 4

• Treatment effects are larger in adolescents compared to adults, suggesting age-specific neuroplasticity may enhance treatment response. 4

Common Pitfalls to Avoid

• Never prescribe naltrexone without concurrent behavioral therapy—monotherapy has poor outcomes and wastes the opportunity for synergistic treatment effects. 1, 2

• Do not focus solely on abstinence rather than harm reduction, particularly early in treatment when patients may be ambivalent. 1

• Avoid missing comorbid conditions that will undermine treatment if left unaddressed. 1, 2

• Do not overlook the need for family involvement, as gaming disorder significantly impacts family and social functioning. 6