The field of problem gambling research has expanded dramatically in recent years thanks in good measure to the National Center for Responsible Gaming (NCRG), the only funding source in the United States dedicated exclusively to peer-reviewed scientific research on gambling disorders. As the field matures, we are moving closer to building a body of knowledge that eventually will result in effective prevention and treatment.
Two recently completed neuroscience projects supported by the NCRG reveal some important advances in scientific research on pathological gambling. The University of Minnesota conducted a clinical trial of the drug naltrexone as a treatment strategy for pathological gamblers. A Massachusetts General Hospital study used neuroimaging to study how the brain responds to the anticipation and reward of money.
The University of Minnesota study found that naltrexone significantly reduced gambling urges and behaviors among pathological gamblers. The clinical trial revealed that 75 percent of the patients receiving naltrexone (an opiod antagonist) improved in terms of their urges to gamble. Because of naltrexone's actions in the brain areas that process pleasure and urges, the study's lead investigator, Suck Won Kim, M.D., had theorized that this drug, usually used to treat narcotics and alcohol dependence, would be useful for treating pathological gambling. It should be noted that Kim's findings are preliminary, and that no one therapy will be the silver bullet for pathological gambling. There is broad consensus that a "cocktail" approach is the most responsible and effective treatment strategy. Such an approach may draw on a continuum of care that includes self-help programs (e.g., Gamblers Anonymous), psychotherapy and counseling (group, family and individual), cognitive behavioral treatments and psycho-educational activities (e.g., finance, transitional work, etc.), and pharmacology.
The research team at Massachusetts General Hospital (MGH), led by Hans Breiter, M.D., co-director of the Motivation and Emotion Neuroscience Center at MGH, used the neuroimaging process called functional magnetic resonance imaging (fMRI) to monitor the brain activity of volunteers participating in a game of chance. The subjects were given $50 and told they could lose it all or keep their potential winnings. Each subject played the game with one of three spinners: a "good spinner" offered them the chance to earn $10, $2.50 or nothing; an intermediate spinner offered $2.50, $0 or -$1.50; and a "bad spinner" let them win nothing or lose $1.50 or $6. The researchers measured each subject's brain activity using the fMRI both during six-second spins. The scientists found that depending on whether subjects played the game with the good, intermediate or bad spinner, they showed strong, moderate or low activation levels in certain key brain regions. "The results showed that an incentive unique to humans-money-produced patterns of brain activity that closely resembled patterns seen previously in response to other types of rewards," Breiter says. "This similarity suggests that common brain circuitry is used for various types of rewards."
In addition to supporting the notion that problem gambling has biological roots, Breiter's study has implications for how to treat gambling disorders. "Identifying these regions of the brain and mapping the neural pathways that process the anticipation and 'rewards' associated with drug abuse would be a tremendous boost to the development of medications or interventions that could block these circuits and provide other treatment approaches," says Dr. Alan I. Leshner, director, National Institute on Drug Abuse, which also funded Breiter's study.