Good for alcoholics, maybe for gamblers, too

By Liz Benston

Friday, Sept. 21, 2007 | 7:06 a.m.

Researchers at the University of Minnesota have found promising help for problem gamblers through a combination of drugs and therapy similar to those used to fight alcoholism.

The findings of a team headed by Dr. Jon Grant, co-director of the Impulse Control Disorders Clinic at the university's Medical Center in Minneapolis, run counter to the approach to problem gambling currently popular in the growing field of addiction research.

Research paid for by the gaming industry, the primary source of research money, is devoted to studying the brain to find the underlying causes of problem gambling before turning to methods of treatment.

The Minnesota research seeks effective treatments first. "If we waited until we knew everything about the brain before we started treatment, we wouldn't be treating any mental illness," said Grant, an associate professor of psychiatry. "You can treat people beautifully without knowing what's going on in the brain."

For example, he said, researchers do not know the underlying causes of depression or alcoholism, yet they have found ways to treat those afflictions. Conversely, "we understand cocaine addiction better than any of them but have the hardest time treating it," Grant said.

Grant's research began in the late 1990s. That was years before Nevada would devote state money to fight problem gambling and when public awareness of the disorder was low.

He studied naltrexone, a drug that is FDA approved to treat alcoholism and heroin addiction. His findings, expected to be published by year's end, echo the results of a 2001 study that found a significant decline in gambling cravings through treatment with the drug.

Also, in 2003, Grant led a study with a similar drug, nalmefene, that blocks a part of the brain that makes some activities pleasurable. These studies involved hundreds of research subjects across the country, including in Las Vegas.

The National Center for Responsible Gaming, a charity affiliated with the casino industry, pays for problem gambling research through the Institute for Research on Pathological Gambling and Related Disorders at Harvard Medical School's Division on Addictions.

"The neuroscience is needed to get to a certain point before experimenting with treatment methods," said Christine Reilly, executive director of the Harvard institute.

A little over half of the center's roughly $2 million annual budget goes to the institute, which uses an expert panel to pay for peer-reviewed research.

Grant questions that approach. Studying treatment methods, he says, is ultimately more important than brain research. Yet many researchers have dropped treatment studies in favor of brain research, which historically has been better funded.

"The more we know about the brain, the more sophisticated we can be in our therapy, but we also need better treatment," he said. "We can't wait while there are lots of people standing at the door suffering."

At a recent meeting of the National Center for Responsible Gaming in Las Vegas, Reilly conceded the point. She said her group will seek more treatment studies in the future because neurological research has reached a critical mass and can better inform treatment research.

The industry has raised more than $15 million for the National Center for Responsible Gaming since the nonprofit was founded in 1996. The group has helped publicize and fund Grant's research and has attracted more researchers and government money to the field.

Still, other hurdles stand between Grant's research and a widely available drug for problem gamblers.

Drug companies spend millions of dollars getting FDA approval for treatment methods only if they stand to make money. Given that Grant's approach is not widely known, pharmaceutical companies are reluctant to invest.

That leaves Grant and others scrambling to find money, especially to pay for studies on a scale required by the FDA.

Grant said despite a decade that has yielded dozens of studies of problem gambling, doctors remain largely unaware of the latest addiction research or treatment options, leaving gamblers in the difficult position of figuring things out on their own.

That's also true for alcoholism, even though that more widespread disorder has undergone many more years of research.

The most widely used outlet for gambling addicts in the Las Vegas Valley, Gamblers Anonymous, has historically been skeptical of drug treatments. As other 12-step programs do , Gamblers Anonymous thinks people should rely on a support network and individual willpower - rather than pills - to kick their habit.

Robert Hunter, director of the Problem Gambling Center, a nonprofit outpatient clinic in Las Vegas, says he isn't convinced that drugs can work for hard-core gamblers.

"My patients gamble the way a junkie shoots heroin," Hunter said. "The studies I've seen so far haven't made the case that there's a drug that can help."