Integrating research and clinical care

by Scott Turner

About 1.5 percent of adult Americans will suffer from pathological gambling some time in their lives. A 1999 report, Pathological Gambling: A Critical Review, from the congressionally chartered National Academy Press, cited a "lack of national attention to the treatment of pathological gambling" and called for "expanded clinical research into the condition."

Indeed, research on the illness of pathological gambling is in its infancy, said Mark Zimmerman, M.D. To build a better profile of compulsive gambling, he and colleagues in the Rhode Island Hospital Gambling Treatment Program combine data gathering with clinical care.

For example, each introductory therapy session lasts up to four hours. "This allows us to collect data on what pathological gambling looks like and to learn as much as possible about a patient so that we enter therapy running," Zimmerman said.

The researchers are developing a questionnaire to better measure and track outcomes, illness severity, and relapse triggers. In addition, they are studying factors strongly associated with pathological gambling, such as alcoholism and substance abuse, and the value of group therapy in treatment. The researchers are also considering a special treatment track just for women or machine gamblers.

At a scientific meeting last spring, Zimmerman presented a pilot study that found 13 of 15 compulsive gamblers treated for 12 weeks with the anti-depressant Celexa, were rated "much improved" or "very much improved" on a clinical rating scale for pathological gambling.

The drug worked equally well for depressed and non-depressed gamblers. Study participants also experienced a nearly 13-fold decrease in the amount of money lost during a two-week interval before treatment and at the end of treatment.

The small, open-label trial employed no control group, so its findings are tentative. Celexa is an SSRI, or selective serotonin reuptake inhibitor. SSRI’s are a potential tool for treating pathological gambling because they help ease irresistible impulses. With further studies, Celexa may well be a useful therapeutic tool, Zimmerman said.

"People with gambling problems and their loved ones are often devastated by the impact it has on their daily lives and their families," said Valerie C. Lorenz, executive director of the Compulsive Gambling Center in Baltimore. "We are encouraged about the results of this study and the hope that it provides for thousands of people who suffer from this disorder." — Scott J. Turner