Betting on a Cure

This summer, two scientists are making a risky bet: that they can treat gambling addiction solely by administering drugs. Both researchers have just begun small trials of pharmacotherapies traditionally used for treating alcoholism. They hypothesize that gambling releases the same kind of feel-good chemicals that alcohol does, and that the drugs may tamp down the thrill of betting just enough to help "problem gamblers" resist the allure.

So far, the early results are encouraging—and that's saying something, given that the trials recruited patients for the express purpose of taking the drugs and then exposing themselves to temptation. But doctors have been trying to treat gamblers with similar therapies for years, with mixed results at best. Can these researchers succeed where past attempts have failed? Or are they still a few cards short of a good hand?

The first of this summer's two trials is the brainchild of Judy Grisel, a psychologist at Furman University in Greenville, S.C. The legwork for it began several years ago, when Grisel sent a student into video gambling parlors along the northwestern border of South Carolina. ("She smelled like smoke for three straight months," Grisel says.) The student gave 60 of the regulars at the gaming parlors $50 in exchange for letting her watch while they played a game called Shamrock 7s—a variation of video poker that is "a very repetitive, mind-numbing game, with no strategy," says Grisel. Half of the gamblers took a placebo. The other half took a drug called Naltrexone, which is approved for treating alcoholism and drug addiction.

"People who take the drug tend to drink more slowly and leave bars earlier," says Grisel. "They say things like, 'Well, I've got a lot going on tomorrow,' or 'I had a long week.' They don't seem to enjoy drinking as much." Naltrexone works by blocking opiate receptors—a crucial step in the pathway for processing dopamine, the pleasure neurotransmitter that activates the brain's sense of reward. Essentially, the drug is designed to keep people from enjoying addictive behaviors as much as they normally might.

Sure enough, Grisel and her student found that those gamblers who took Naltrexone weren't nearly as active in the parlors as the control group was. "They bet about half as much money," she says. "It wasn't a knock-your-socks-off effect, but it was significant." Alas, any hopes for identical follow-up tests were thwarted: Shortly after the experiment, South Carolina outlawed video gambling parlors. So this summer, Grisel and another student will try to replicate the results with Naltrexone in the lab. Her second student has designed a computer-based card game and will watch to see whether gamblers taking Naltrexone are less willing to risk large amounts of money while playing.

Meanwhile, a similar trial is getting under way across the country at the University of Nebraska Medical Center. Dennis McNeilly, a psychiatrist at the UNMC, has built his experiment around Acamprosate, which has a different mechanism of action than Naltrexone but is also designed to decrease cravings for alcohol. A recent small study found that it could also cut back on behaviors tied to problems of impulse control, such as compulsive eating, in some patients.