2010 Conference - Toward a Treatment Standard for Pathological Gambling (Grant)

4 6 8 10

2 4

6 8

10

12

Visit

PG

-YB

OC

S U

rges

Placebo 20mg 40mg

p=.027

Days

84 70 56 42 28 14 0

1.0

.9

.8

.7

.6

.5

.4

.3

.2

.1 0.0

Naltrexone / Asp40 Allele (A/G, G/G)

Naltrexone Asn40 Allele (A/A) Placebo / Asp40 Allele (A/G, G/G) Placebo / Asn40 Allele (A/Al)

Days

84 70 56 42 28 14 0

1.0

.9

.8

.7

.6

.5

.4

.3

.2

.1 0.0

Naltrexone / Asp40 Allele (A/G, G/G)

Naltrexone Asn40 Allele (A/A) Placebo / Asp40 Allele (A/G, G/G) Placebo / Asn40 Allele (A/Al)

Days

84 70 56 42 28 14 0

1.0

.9

.8

.7

.6

.5

.4

.3

.2

.1 0.0

Naltrexone / Asp40 Allele (A/G, G/G)

Naltrexone Asn40 Allele (A/A) Placebo / Asp40 Allele (A/G, G/G) Placebo / Asn40 Allele (A/Al)

Prop

ortio

n N

onre

laps

ed

Analysis of Maximum Likelihood Estimates (N=282)

Variable Parameter Estimate

Standard Error

Chi-Square

Pr>ChiSq Hazard Ratio

FH-AUD 0.55 0.24 7.53 0.006 1.74

Baseline urges were significantly associated with response to higher doses of opiate antagonists (i.e. nalmefene 50mg or 100mg or naltrexone 100mg or 150mg) (parameter estimate = 1.77; SE= 0.84; Wald χ2 =4.41; p= .036; HR= 5.86; HR 95% CI=1.12-30.6

56% reduction in urges; 57% reduction in total gambling symptoms

N-Acetyl Cysteine: 12-Week Open-Label

Visit 1 Visit 6 p-value

PG-YBOCS total score 21.8 8.9 <.001

Responder, n (%) n/a 18 (62.1)

<.001

Dollars lost per week 743 309 <.001

Hours gambled per week 10.4 4.0 <.001

PG B v E PG B v C PG E v C

T P t p t p

IDED total errors 2.20 0.037 2.09 0.041 1.06 0.294

Lexapro Treatment of Anxious Gamblers

Hollander et al, 2002

* *

*

* p<.05