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An open-label trial of acamprosate in the treatment of pathological gambling

Donald W. Black, MD

Department of Psychiatry, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA

Dennis P. McNeilly, PsyD

Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, USA

William J. Burke, MD

Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, USA

Martha C. Shaw, BS

Department of Psychiatry, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA

Jeff Allen, PhD

Department of Psychiatry, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA

BACKGROUND: The efficacy and tolerability of acamprosate has been tested in the treatment of pathological gambling (PG). Acamprosate is known to reduce alcohol craving and use in persons with alcohol dependence, and it has been hypothesized that the drug would have a similar effect in individuals with PG.

METHODS: Participants with DSM-IV criteria for PG received acamprosate in an 8-week, open-label trial following a 2-week observation. The primary efficacy measure was the Yale-Brown Obsessive Compulsive Scale modified for PG (Y-BOCS-PG). Secondary efficacy measures included the Gambling Severity Assessment Scale (GSAS), the Clinical Global Impression (CGI) Improvement and Severity Scales, a patient self-rated global rating, the Hamilton Depression Rating Scale (HDRS), the Sheehan Disability Scale (SDS), and the Timeline Follow Back (TLFB). The study was conducted at 2 sites.

RESULTS: Twenty-six participants (11 men, 15 women) had at least 1 post-baseline visit and were included in the analysis. Twenty participants (77%) completed the protocol. Significant improvement was observed in Y-BOCS-PG and GSAS scores, both CGI scales, a patient self-rated global scale, all 3 SDS subscales, and number of gambling episodes. Seventeen participants (65%) were considered responders (ie, achieved “much” or “very much” improvement). Improvements on the HDRS, in money wagered, and in time spent gambling were not significant. Few adverse events were reported.

CONCLUSIONS: The results suggest that acamprosate is well tolerated and may be effective in the treatment of PG.

KEYWORDS: acamprosate, pathological gambling, impulse-control disorders

ANNALS OF CLINICAL PSYCHIATRY 2011;23(4):250–256

CORRESPONDENCE: Donald W. Black, MD, Psychiatry Research, 2-126B MEB, University of Iowa, Carver College of Medicine, Iowa City, IA 52242 USA, E-MAIL: donald-black@uiowa.edu
Annals of Clinical Psychiatry ©2011 Quadrant HealthCom Inc.

 
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