DRUGS SHOW PROMISE IN TREATMENT OF GAMBLING ADDICTION

Mike Ambrose, a computer systems analyst, often would spend 36 hours
straight on weekends playing slot machines until his paycheck was
gone. After blowing $15,000 to $20,000 a year on his habit for more
than a decade, Ambrose, in desperation, volunteered as a patient in a
clinical study to test a drug to control his gambling urge.

The medication, naltrexone, originally devised to combat heroin
addiction and alcoholism, changed his life. Within two weeks, the
Fridley, Minn., man noticed a "tremendous difference -- suddenly, the
urges stopped."

Three years later, Ambrose, 60, still takes a maintenance dose of the
drug. "Even the few times I've gone to the casinos out of curiosity,
I didn't enjoy it," he says. "Naltrexone takes all the excitement out
of it, and I don't get the rush anymore."

The final results of this study conducted at the University of
Minnesota were reported earlier this month in the journal Biological
Psychiatry. The study found that people who took naltrexone reported
that their gambling urges -- once so powerful that they stole from
their children and even turned to prostitution to pay gambling debts
- -- either vanished or were diminished enough that they could resist
temptation.

The Minnesota research is among a handful of recent studies
suggesting that the gambling urge has its roots in biology, rather
than human frailty. Researchers say that gambling may be, at least in
part, sparked by a short circuit in the brain's wiring or an
imbalance in key brain chemicals. And drugs such as naltrexone, which
blocks the brain's pleasure pathways, are helping people control
their impulses.

The findings offer new hope to the estimated 1 percent to 3 percent
of the population that suffers from a gambling addiction, for which
there is no standard treatment.

The University of Minnesota experiment, for example, involved 45
compulsive gamblers. For 11 weeks, 20 people received naltrexone,
which dulls the sensation of pleasure that is associated with
addictive cravings. The remainder were given a placebo, or dummy pill.

Each week, participants were interviewed about the severity of their
symptoms, the frequency and duration of their urges, the time they
were consumed with thoughts about gambling and the time they actually
spent gambling.

Three-quarters of those on the medication reported substantial relief
from the compulsion that had seriously disrupted their lives,
contrasted with only one-fourth of the placebo group. "Their symptoms
are under control, so they can have a normal life," says Suck Won
Kim, a psychiatrist at the University of Minnesota Medical School in
Minneapolis and co-author of the study. "The data shocked us. We got
fantastic results."

Researchers studying gambling behavior at Rhode Island Hospital in
Providence reported similar findings with another drug, Celexa, or
citalopram, a type of antidepressant known as an SSRI. The study was,
however, relatively small, involving just 15 compulsive gamblers, and
lasted for just 12 weeks. (The study was funded by Forest
Laboratories, which markets Celexa.)

Previous studies have suggested that people with obsessive-compulsive
behavior disorders, such as pathological gambling, suffer from a
deficiency of serotonin, a brain chemical that may be involved in the
ability to delay or prevent acting on impulses. The class of drugs
known as SSRIs (or serotonin reuptake inhibitors) prevent serotonin
from being removed from the synapses in the brain.

In the Rhode Island research, 13 of the 15 study participants
reported significant improvements in all gambling measures, including
the number of days gambled and their preoccupation with gambling. The
amount of money participants lost dropped from an average of $1,900
in the two weeks prior to the study to $145 in the final two weeks.

"Individuals who are struggling to get a handle on this devastating
problem should be aware of the possible treatment options," says Mark
Zimmerman, director of outpatient psychiatry at Rhode Island Hospital
and the study's lead author.

However, the Food and Drug Administration has not yet approved these
medications for use in curbing gambling urges. Still, these studies
suggest that medications that compensate for deficits in brain
chemistry may hold the key to controlling impulses.

Researchers at Massachusetts General Hospital in Boston, writing in
the May issue of the journal Neuron, reported that the same pathways
in the brain that are stimulated by cocaine also became activated in
the anticipation and experience of winning at gambling.

And researchers at the University of Cambridge in England found in
another recent study that impulsive behavior, which is a feature of
addictions such as pathological gambling, may be caused by a defect
in a region of the brain known as the nucleus accumbens.

"Impulse disorders like gambling are likely the result of genetic
vulnerabilities that cause abnormalities in the brain circuits," says
Eric Hollander, a professor of psychiatry and director of the
Compulsive, Impulsive and Anxiety Disorder program at Mt. Sinai
Medical School in New York. "These treatments may help people put the
brakes on their impulses."