![]() The literature demonstrates a higher treatment efficacy with opioid antagonists ( Grant, Kim, & Odlaug, 2007). Antidepressants, mood stabilizers, and atypical antipsychotics have shown mixed results, and there is no evidence to recommend their use as a treatment protocol in PG. ( 2014) reviewed 18 randomized control trials across five drug classes in the treatment of PG. The body of literature on the pharmacological treatment of PG is supportive of the use of opioid antagonists as a treatment of “last resort” once psychological interventions have failed. A systematic review of the use of naltrexone in diverse behavioral addictions showed consistent efficacy of the drug ( Aboujaoude & Salame, 2016). A case series looking at compulsive buying found that high-dose naltrexone led to partial or complete remission of urges to shop ( Grant, 2003). In a randomized controlled trial on kleptomania, it was found that subjects randomized to receive naltrexone reported significant reductions in urges in stealing and stealing behavior ( Grant, Kim, & Odlaug, 2009). Indeed, this is the basis of its use in behavioral addictions more broadly ( Grant, Schreiber, & Odlaug, 2013). The suggested role of gambling in the stimulation of the endogenous opioid system forms the clinical basis for using opioid antagonists in the treatment of PG ( Grant, Odlaug, & Schreiber, 2014). In preclinical data, naltrexone is advocated to help treat addictions more diversely by blocking binding of endogenous opioids. Naltrexone is a US Food and Drug Administration (FDA)- and National Institute for Health and Care Excellence (NICE)-approved treatment for alcohol and opiate dependence ( Center for Substance Abuse Treatment, 2009). It is one of the aims of this study to help in guiding such policy. Framing National Health Service (NHS) treatment policy is particularly important, provided the risks of this vulnerable group and the ease of accessing gambling online. ![]() However, these young gamblers are almost twice as likely to be a problem gambler, with 1.1% estimated to be so. Those in the 18- to 24-year-old-age group are least likely to gamble, with 33% reporting having participated in the past 4 weeks, versus 54% for the highest participant group (45–54 years old people). The commission reported that 0.7% of respondents identified as problem gamblers, amounting to there being around 300,000 problem gamblers in the UK at any one time. The UK Gambling Commission ( 2017) reported that, as of December 2016, 48% of people had participated in gambling in the past 4 weeks, an increase from 43% in December 2015. Attempted or completed suicide is not uncommon ( Ledgerwood & Petry, 2004). ![]() There is a significant relationship between PG and comorbid psychiatric disorders, where they are likely to have a mutually reinforcing effect on the sufferer. PG is known to have a negative impact on physical and mental health, occupation, financial matters, and interpersonal relationships ( Grant & Kim, 2001). ![]() There is a lack of remission in PG, despite psychological intervention. Sufferers tend to become increasingly involved in terms of time and financial commitment, continuing to gamble regardless of the impact on their personal, social, and financial well-being ( Hodgins, Stea, & Grant, 2011). Pathological and problem gambling (PG) is a psychiatric disorder characterized by persistent and recurrent gambling behavior leading to clinically significant impairment or distress ( American Psychiatric Association, 2013). ![]()
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