A controversial anti-addiction medicine that has successfully been used on alcoholics will now to be trialled on problem gamblers, part of a mental health reclassification of gambling addiction, writes Andy Park.
Half a million Australians are at risk of becoming, or already are, problem gamblers, according government figures.
It's a vexing social issue, which costs the community $4.7 billion a year.
But a controversial drug is about to be trialled in Melbourne in a clinical experiment described as the first of its kind: a pill that researchers hope will cure problem gamblers.
'GAMBLING NO DIFFERENT TO SUBSTANCE ADDICTION'
In the US, gambling addiction is expected to be clinically re-classified next year by the influential American Psychiatric Association.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification of mental disorders used by the US healthcare system and the fifth edition in expected to be released in May 2013.
The DSM-5 is expected to broaden the definition of addiction to include gambling for the first time, making it almost no different to drug or alcohol addictions.
More importantly, addiction-medicine experts believe this means that treatment approaches for addiction will merge.
Leading the way are researchers from the University of Melbourne and St Vincent's Hospital Melbourne, who are about to conduct a clinical trial which they hope will prove a drug can help problem gamblers to make better decisions.
WHAT IS NALTREXONE?
Naltrexone is designed to dull the euphoria of opiates and therefore lessen cravings for those with addictive behaviours.
The Australian Drug Foundation describes Naltrexone as a prescribed drug which may be used:
• to help people who have withdrawn (detoxified) from opioids such as heroin, to stay off those drugs.
• to help people with alcohol dependence, not to drink alcohol.
• as an experimental treatment during rapid withdrawal from opioids.
Naltrexone is classed as an opioid antagonist which blocks the opioid receptors in the brain, therefore blocking the effects of heroin and other opioids, the foundation says.
It can assist in keeping people off heroin because they will be aware that they cannot achieve a "high" from using heroin, it says.
The drug does not directly stop a person wanting to use heroin, although it may reduce or prevent cravings in some people.
'A WORLD FIRST STUDY'
There have been previous studies into Naltrexone tolerance in problem gamblers, but this study will be the first to measure effectiveness.
Nine problem gamblers will be administered low-dosage Naltrexone tablets and then given a range of MRI, brain and blood pressure scans to observe the effects of the brain under Naltrexone while they carry out decision-making tasks similar to those when gambling.
Leading the study is problem gambling expert from The University of Melbourne, Darren Christensen.
"This is a world first, we are giving problem gamblers Naltrexone and scanning their brains pre and post treatment and looking at their urges to gamble and their gambling behaviour," he said.
Neuro-imaging specialist from St Vincent's Hospital, Simon Vogrin, is adapting MRI and brain imaging technology that is often used in epilepsy research to measure brain activity in problem gamblers.
"By recording the electrical activity from the brain we are really trying to see which parts of the brain are active during decision-making tasks," he says.
"The real interest here is to understand how the Naltrexone treatment will be able to improve our participants' control over those functions, more akin to what we see in patients who don't necessarily suffer from problems with gambling."
WHY IS NALTREXONE CONTROVERSIAL?
Earlier this year, a Coronial inquest in Sydney investigated three deaths following the use of Naltrexone implants as a substance abuse treatment by a Sydney detox clinic.
Delivering a slow release of Naltrexone, the implants were used as part of a detox technique known as Rapid Opiate Detoxification.
The National Health and Medical Research Council says Naltrexone implants "have not been approved for human use in Australia due to a lack of results from clinical trials demonstrating their pharmaceutical quality, safety and efficacy".
Unlike Naltrexone implants, low-dose Naltrexone tablets have been approved by the Therapeutic Goods Administration.
Addiction medicine expert Professor Jon Currie, who is working on the Melbourne trial, defends the oral use of the drug in the study.
"We have hundreds of patients being treated for alcohol dependence and for heroin dependence using Naltrexone, but we use it wisely and we use it correctly,” he said.
“The problems with how it's administered are perhaps giving Naltrexone a bad name, it's not Naltrexone that has a bad name, it's the actual way it's used and perhaps how it can be misused."
"We have to remember that Naltrexone is an absolutely TGA-approved treatment in its tablet form for alcohol and for heroin dependency, so it's fully approved by the Australian government for the treatment.”
But advocates of counselling methods to treat gambling addiction, like Tom Simpson of Oakdene House in Western Sydney, say Naltrexone doesn't address its root causes such as childhood trauma, abuse or other potential psychological causes.
“I guess we're living in a quick fix society now, get fit - take a pill, stop smoking - take a pill, don't have a bet - take a pill. In reality it's not like that," he said.
STACY'S STORY: GAMBLING LED ME TO PROSTITUTION
Once a corporate high-flyer, Stacy* says compulsive gambling led her to prostitution, drug addiction and even attempts at suicide.
"Because I crossed those boundaries I escaped through gambling to deal with the emotions, I was able to cross more and more boundaries cause I would just go and escape again. It ruined my life, it took everything away from me,"
Stacy says she once gambled away $15,000 in one month.
She says that addressing the issues that drove her to gamble was key, and that a pill alone can't address the social isolation that many problem gamblers feel.
“I don't believe that a pill can fix that, and actually I won't swap the experience I've had for a quick pill to help me stop gambling."
She says that talking about the pain her addiction has caused loved ones is still the best medicine in her continued recovery.
"My mother and I... that's a very sore subject," she said.
*name changed on request
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