Given the preliminary nature of these results, future studies should systematically investigate and report the types and rates of co-occurring disorders in order to identify subgroups of gamblers, and to determine the impact of comorbidity on treatment outcomes Dowling et al. Similarly, we found no advantage of any medication class over the other in reducing symptoms of disordered gambling across both study designs see also Bartley and Bloch ; Pallesen et al. This novel antidepressant that promotes the resynchronization of circadian rhythms by acting on melatonin and 5-HT 2c receptors Le Strat and Gorwood produced promising results in the treatment of mood, anxiety, and a range of other disorders for a review see De Berardis et al.
Since our findings were based on a single trial including a small number of participants Egorov , further research is required to substantiate the efficacy of agomelatine for the treatment of disordered gambling. The particularly large effect size of this study and the beneficial gains of recently published treatments on topiramate De Brito et al. Although a slight advantage for flexible dosage was found for the remaining outcome variables, results should be interpreted with caution and warrant further research. Also in line with the current state of knowledge emphasizing opioid antagonists as the most supported drug treatment for gambling disorder Bartley and Bloch ; Bullock and Potenza , we ascertained a significant and medium advantage of opioid antagonists over placebo for the reduction of global severity.
In contrast to Bartley and Bloch , however, who found substantial heterogeneity across the studies and an effect size being flawed by the type of data analysis and the year of publication, our analyses revealed between-study homogeneity with no moderators impacting the effect size for opioid antagonists. These differences may be based on the fact that Bartley and Bloch pooled effect sizes across scales with different contents i. Therefore, future studies and meta-analyses are encouraged to select equivalent response measures and differentiate between distinct aspects of gambling behaviors as recommended by the Banff, Alberta Consensus Walker et al.
Besides opioid antagonists which proved effective not only for the treatment of alcohol dependence e. It should be noted, however, that these results were driven by single trials which produced strong effects including either gamblers with bipolar disorders treated with lithium Hollander et al.
In addition to topiramate, other glutamatergic agents such as N -acetylcysteine and acamprosate which are favorable treatment options for substance use disorders Guglielmo et al. Since medications targeting glutamatergic pathways not only appear to reduce symptoms of craving, but may also enhance cognitive flexibility as demonstrated by the use of memantine Grant et al. Relative to placebo, antidepressants reduced the global symptom severity to a similar level compared to that of the remaining drugs. The lack to obtain a significant effect, however, may be due to the heterogeneity across the studies caused by a single trial that determined the magnitude of the treatment response and differed from the others by yielding a large effect size and including a high percentage of female participants Kim et al.
Even though a variety of gender-specific differences were ascertained in clinical trials e. Nevertheless, some limitations and implications for further research should be mentioned: First and foremost, our meta-analysis covered a small number of studies.
However, the short-term within-group effect sizes, and the overall controlled effect size for the reduction of global severity were robust. Second, as is true for most meta-analytic reviews, the included studies differed in their methodological quality, although when addressed statistically, we did not observe a systematic bias in the effect sizes due to differences in the quality of the studies. It should be noted that none of the studies achieved the highest rating reflecting limited quality of evidence with respect to selection bias, high dropout rates, and—particularly regarding within-group study designs—to the identification and control of confounders, and blinding.
As a result, rigorously designed, large-scale RCTs are necessary including extended placebo lead-in periods, the monitoring of additional psychosocial support, the type of comorbidity, the use of equivalent measurement tools, the reporting of outcome variables according to the Banff, Alberta Consensus Walker et al. Although the amount of drug dosage has demonstrated to impact treatment outcome e. Furthermore, when this information was provided, the dosage often varied depending on the type of medication, complicating these analyses, which would have resulted in insufficient test power.
Moreover, the dosage within each drug class usually showed little variation, further complicating these analyses Thompson and Higgins Therefore, additional studies will be necessary to examine the impact of dosage on treatment outcome within the different drug classes. Moreover, separate data should be reported for participants who receive low, moderate or high doses of the relevant medication facilitating the comparability of dosage within each drug class.
Despite these limitations, the results of the present meta-analysis suggest that a variety of medications are effective for the management of gambling behaviors. Focusing placebo controlled designs, opioid antagonists and mood stabilizers, particularly the glutamatergic agent topiramate combined with a cognitive intervention and lithium for gamblers with bipolar disorders demonstrated preliminary evidence for reducing the global gambling severity.
Although further neurobiological and neuroimaging studies should promote a better understanding in the mechanisms underlying problematic gambling behavior e. Open access funding provided by Paris Lodron University of Salzburg. The authors wish to thank Dr. Tuuli Lahti and Professor Arun Ravindran for providing additional data. This research did not receive direct financial support from any funding agencies in the public, commercial, or not-for-profit sectors. Martina Goslar declares that she has no conflict of interest.
Max Leibetseder declares that he has no conflict of interest. Hannah M. Muench declares that she has no conflict of interest. He also receives royalties and payments for his editorial work from various publishers. Anton-Rupert Laireiter declares that he has no conflict of interest.
Pharmacological Treatments for Disordered Gambling: A Meta-analysis
This article does not contain any studies with human participants or animals performed by any of the authors. Skip to main content Skip to sections. Advertisement Hide. Download PDF. Open Access. First Online: 20 December Methods Eligibility Criteria Studies were considered for inclusion if they 1 employed pharmacological, or combined treatments e. Study Selection Study selection was performed by two independent reviewers the first and the second authors, MG and ML , and supervised by the last author of this paper AL.
Data Collection Process and Data Extraction We generated a structured data extraction form that we refined and modified after pilot testing a sample of 10 studies. Moderator Analysis To explain heterogeneity among effect sizes, we determined the following categorical moderators: type of treatment pharmacological vs. Study Selection A total of 39 studies including 43 treatment conditions were identified for inclusion in this meta-analysis.
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We excluded two studies assessed in recent reviews Lupi et al. The flow diagram of the study selection process is illustrated in Fig. Open image in new window. A total of participants across all studies were analyzed. Of those, were assigned to treatment conditions, individuals to control groups.
Results of the within-group and controlled effect sizes and their forest plots are presented in Fig. Only if moderator analyses on the medication-specific effect sizes differed from those on the overall effect sizes, results were reported separately A anxiety, AD antidepressants, CO completers, EPHPP effective public health practice project quality assessment tool for quantitative studies , FR frequency, FL financial loss, GS global severity, ITT intention-to-treat analysis, MD mood disorders, MST mood stabilizers, NA not available, NDRI norepinephrine-dopamine reuptake inhibitor, OA opioid antagonists, Q bet homogeneity statistic for differences between subgroups, SSRI serotonin reuptake inhibitor, SNDRI serotonin-norepinephrine-dopamine reuptake inhibitor a The study of Black was excluded, because no information regarding the data analysis was available b Only studies which reported the type of gambling were included in the analyses.
Funding This research did not receive direct financial support from any funding agencies in the public, commercial, or not-for-profit sectors. Ethical Approval This article does not contain any studies with human participants or animals performed by any of the authors. References marked with an asterisk indicate studies included in the meta-anaylsis. American Psychiatric Association. Diagnostic and statistical manual of mental disorders 5th ed. Washington, DC: Author. CrossRef Google Scholar. Bartley, C. Meta-analysis: Pharmacological treatment of pathological gambling.
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Annals of Clinical Psychiatry, 26 3 , — A proof of concept study of tolcapone for pathological gambling: Relationships with COMT genotype and brain activation. European Neuropsychopharmacology. A randomized, placebo-controlled trial of N-acetylcysteine plus imaginal desensitization for nicotine-dependent pathological gamblers. Journal of Clinical Psychiatry. Nalmefene in the treatment of pathological gambling: Multicentre, double-blind, placebo-controlled study. The British Journal of Psychiatry. Pharmacological treatments in pathological gambling. British Journal of Clinical Pharmacology.
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Leucht, S. Putting the efficacy of psychiatric and general medicine medication into perspective: Review of meta-analyses. Arbitrage betting is a combination of the ancient art of arbitrage trading and gambling, which has been made possible by the large numbers of bookmakers in the marketplace, creating occasional opportunities for arbitrage. One can also bet with another person that a statement is true or false, or that a specified event will happen a "back bet" or will not happen a "lay bet" within a specified time. This occurs in particular when two people have opposing but strongly held views on truth or events.
Not only do the parties hope to gain from the bet, they place the bet also to demonstrate their certainty about the issue. Some means of determining the issue at stake must exist. Sometimes the amount bet remains nominal, demonstrating the outcome as one of principle rather than of financial importance. Betting exchanges allow consumers to both back and lay at odds of their choice. Similar in some ways to a stock exchange, a bettor may want to back a horse hoping it will win or lay a horse hoping it will lose, effectively acting as bookmaker.
Spread betting allows gamblers to wagering on the outcome of an event where the pay-off is based on the accuracy of the wager, rather than a simple "win or lose" outcome. For example, a wager can be based on the when a point is scored in the game in minutes and each minute away from the prediction increases or reduces the payout. Many betting systems have been created in an attempt to "beat the house" but no system can make a mathematically unprofitable bet in terms of expected value profitable over time.
Widely used systems include:. Many risk-return choices are sometimes referred to colloquially as "gambling. Investments are also usually not considered gambling, although some investments can involve significant risk. Examples of investments include stocks , bonds and real estate. Starting a business can also be considered a form of investment.
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Investments are generally not considered gambling when they meet the following criteria:. Some speculative investment activities are particularly risky, but are sometimes perceived to be different from gambling:. Studies show that though many people participate in gambling as a form of recreation or even as a means to gain an income, gambling, like any behavior that involves variation in brain chemistry , can become a harmful, behavioral addiction.
Behavioral addiction can occur with all the negative consequences in a person's life minus the physical issues faced by people who compulsively engage in drug and alcohol abuse. Late or missed payments would result in visits and threats from such crime family members. The Russian writer and problem gambler Fyodor Dostoevsky portrays in his novella The Gambler the psychological implications of gambling and how gambling can affect gamblers. He also associates gambling and the idea of " getting rich quick ", suggesting that Russians may have a particular affinity for gambling. Dostoevsky shows the effect of betting money for the chance of gaining more in 19th-century Europe.
The association between Russians and gambling has fed legends of the origins of Russian roulette. There are many symptoms and reasons for gambling. Gamblers gamble more money to try and win back money that they have lost and some gamble to relieve feelings of helplessness and anxiety. The Advertising Standards Authority has censured several betting firms for advertisements disguised as news articles suggesting falsely a person had cleared debts and paid for medical expenses by online gambling. The firms face possible fines.
Gamblers exhibit a number of cognitive and motivational biases that distort the perceived odds of events and that influence their preferences for gambles. For example, gamblers exhibit a costly aversion to betting against their favorite team or political candidate. From Wikipedia, the free encyclopedia. For other uses, see Gamble disambiguation and Betting disambiguation. Main article: Gambling in the United States. Main article: Gambling law. Main article: Table game. Main article: Fixed-odds betting. Main article: Parimutuel betting.
Main article: Sports betting. Main article: Virtual sports. Main article: Arbitrage betting. Main article: Betting strategy. This section possibly contains original research. Please improve it by verifying the claims made and adding inline citations.
Statements consisting only of original research should be removed. August Learn how and when to remove this template message. Main article: Problem gambling. Nelson; Loeb, Robert A. Blackjack and the Law 1st ed. Retrieved 22 September The Economist. Winchester Books. A History of Japan. London: Psychology Press published Retrieved 6 April Many Japanese are naturally prone to gambling; in the old Kyoto court the vice was rife, and in the fourteenth and fifteenth centuries samurai would often stake their arms, armour, and horse trappings on a cast of the dice, even on the eve of a battle, and so have to go into action in incomplete panoplies, and sometimes with no armour at all.
In Tokugawa times the vice did not reach this extent among the samurai, but it became common in Yedo and continued to be so throughout the history of the city. Sports and Games of Medieval Cultures. Ashgate Publishing, Ltd. Retrieved 17 August Manchester UP, Manchester U. Press, Gambling in California. California State Library. March Archived from the original on 8 October VII, Sec. Retrieved 5 September Concept Publishing Company. Archived from the original on 16 June Retrieved 20 July Cass To settle your conscience a layman's guide to Catholic moral theology.
Our Sunday Visitor. Retrieved 30 May Catholic Courier. Archived from the original on 11 June Palgrave Macmillan. Evangelical Wesleyan Church. Intellectual Reserve, Inc.