Leung KS, Cottler LB.

Epidemiology and Prevention Research Group, Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA. Curr Opin Psychiatry. 2009 Jan;22(1):69-74.

PURPOSE OF REVIEW: This paper highlights the development of pharmacological and nonpharmacological treatments for pathological gambling and is based on a review of the literature published in the past 12 months.

RECENT FINDINGS: The efficacy of naltrexone treatment for pathological gambling has been replicated in a double-blind, placebo-controlled, confirmatory study. For mood stabilizers, whereas carbamazepine and topiramate continued to produce positive results, olanzapine failed to show superior outcomes compared with placebo control. Two new pharmacological agents for pathological gambling, N-acetyl cysteine and modafinil, produced significant improvement for pathological gamblers. Several studies examined the outcomes of nonpharmacological treatments. Recent studies showed that cognitive-behavioral therapy failed to produce superior outcomes compared with other less costly methods such as brief interventions. Two new nonpharmacological treatment methods have been reported, including the use of videoconferencing in delivering ongoing supervisions after exposure therapy and the congruence couple therapy, which aims to heal the person as a system whole.

SUMMARY: Recent treatment outcomes studies address not only the effectiveness, but also the efficacy of different treatment approaches. Results of two meta-analysis studies showed that nonpharmacological treatments have a larger overall effect size than pharmacological treatments; however, owing to the diversity in study designs, it is unclear whether nonpharmacological treatments are more effective than pharmacological treatments at this point.