NEWS: Problem gamblers, alcoholics may get same drug - SMH - 21.12.11

[Mr Blonde]

GAMBLING addicts will be given the same medication as alcoholics and heroin addicts under a radical new plan being explored by the Greens senator and public-health doctor Richard Di Natale.
The Greens will today release a discussion paper on problem gambling, which calls for a trial of the drug Naltrexone - now on the Pharmaceutical Benefits Scheme to help alcoholics - to help problem gamblers.
It is also registered for use in Australia for heroin treatment, although uncommon.
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Australians are the world's most prolific punters, with an estimated $19 billion gambled a year - $12 billion of that on the pokies, the Productivity Commission has found.
Senator Di Natale, who worked as a doctor specialising in public health and alcohol and drug dependence before entering politics, said problem gambling needed to be a public-health issue, not just one of harm minimisation.
''There are clear parallels between addiction to gambling and addiction to other substances,'' the paper says.
Pokies reform is a condition of the independent MP Andrew Wilkie's support for the Gillard government, with a plan to force punters to preset how much they are willing to lose. The Greens have proposed a $1 maximum bet on all pokies as an alternative.
''You've got to address problem gambling right across: at the level of government, at the level of health professionals and at the level of individuals, so individuals know there are potential options - counselling and potentially Naltrexone available if they need help,'' Senator Di Natale told the Herald.
The paper says there is a growing number of small studies, including those in Australia, Canada and the United States, which found Naltrexone was efficient in reducing addiction.
It is thought that the drug, an opioid antagonist, treats addiction by blocking the dopamine-driven reward pathway that releases positive feelings when gambling and is responsible for feelings of craving.
In alcoholics it reduces the pleasures of binge drinking, Senator Di Natale said.
The paper recommends ''a trial into the use of Naltrexone as a treatment for gambling addiction, with a view to establishing cost effectiveness for inclusion on the PBS for treatment of this condition''.
The 12-page discussion paper also calls for GPs to be trained to identify problem gamblers.
''Because GPs are in a unique position to identify problem gamblers who may not otherwise seek treatment, it is likely to be cost-effective to invest in developing education and tools to support this work.''
To this end, the paper also recommends that identifying problem gamblers be included in undergraduate and postgraduate medical education.


Read more: http://www.smh.com.au/national/health/problem-gamblers-alcoholics-may-get-same-drug-20111220-1p41s.html#ixzz1h6xoKxxm

Heard this on Radio National a few weeks back, and now it's in the newspaper. Interesting story.

 

[footscrazy]

Hmm yeah, interesting. I do find naltrexone effective for reducing alcohol cravings, I can't remember what I felt about gambling at that time though. I'm def a problem gambler when I hit the pokies or the casino so I wish I could remember how I felt about it when I was taking naltrexone regularly.

It is thought that the drug, an opioid antagonist, treats addiction by blocking the dopamine-driven reward pathway that releases positive feelings when gambling and is responsible for feelings of craving.

This doesn't really make much sense to me, and as far as I knew, how naltrexone actually works in blocking cravings isn't really understood. From what I'd read I thought naltrexone blocked the opioid effect of alcohol, blocking the pleasurable aspect, rather than affecting the dopamine pathway.

Actually, I just found an article talking about a link -

Alcohol’s effects on endogenous opioids and the mesolimbic dopamine system. The activity of the dopamine-releasing (i.e., dopaminergic) neurons in the ventral tegmental area (VTA) is controlled by γ−aminobutyric acid (GABA)-releasing (i.e., GABAergic) neurons. When these GABA neurons are activated (e.g., through the actions of the excitatory neuro-transmitter glutamate), their signals decrease the firing of dopaminergic neurons. Endogenous opioids, however, can act on µ receptors on the GABAergic neurons, thereby inhibiting GABA transmission, and ultimately leading to increased dopamine release.

It's got a useful diagram as well, here.

 

[thestudent14]

Yeah it's definitely an interesting read, my mum had a serious gambling problem, not the type a family recovers from.

I wish there was an easy fix in this sort. But my understanding of problem gambling isn't really about the enjoyment of it, it's a very unique addiction. I imagine it works in similar ways to videogame and internet addiction. In the sense where people feel a genuine need to do it, even if the enjoyment is negligable.

I wonder how well a placebo affect of a drug works on problem gamblers. I imagine it probably has a lot more affect then it would then most addictions although this is all just speculation from how I see my mother.
I think if she believed a drug was helping her to stop it may have given her a psychological edge over her addiction and my family wouldn't have a life long debt that we will never get through.
Makes ya think.

 

[Divine Moments]

I think it would be a great step if it could indeed be used to treat problem gambling. This would suggest that it's acting on a pathway common to many/all addictive processes and would have wide applications, as opposed to it's currently only being indicated as an 'Adjunct in treatment of alcohol dependence' or 'Adjunct in maintenance of abstinence from opioids after opioid detoxification'. I'm skeptical though...

 

[jaurk]

Gambling is almost just as bad as a drug addiction, my mother gambles all of our money away.
I'd love to see what comes of this.

...another empty Christmas

 

[footscrazy]

I wonder how well a placebo affect of a drug works on problem gamblers. I imagine it probably has a lot more affect then it would then most addictions although this is all just speculation from how I see my mother.
I think if she believed a drug was helping her to stop it may have given her a psychological edge over her addiction and my family wouldn't have a life long debt that we will never get through.
Makes ya think.

I reckon this might be the main benefit of it as well, that placebo effect. Just feeling like you're taking something that helps you beat it, even if it has little neurological benefit.

When I took naltrexone I didn't find it had any effect on my meth cravings, only alcohol. I remember thinking in terms of alcohol, that it removed cravings I didn't even know I had, until they were gone! I think though that gambling has more in common with meth addiction than alcohol, just in that intense dopamine reward, so I'm not sure how effective naltrexone will be for gambling, for me anyway.

 

[thestudent14]

. I remember thinking in terms of alcohol, that it removed cravings I didn't even know I had, until they were gone!

haha sounds like when i first tried MDMA. Like my brain had flushed out all this garbarge in my head I didn't even know I had