1 National Problem Gambling Clinic, Central and North West London NHS Foundation Trust , London, UK.
2 Institute of Medical and Biomedical Education, St. George's University of London , London, UK.
J Behav Addict. 2018 Sep 1;7(3):827-833. doi: 10.1556/2006.7.2018.89. Epub 2018 Sep 21.
To investigate the potential indications and adverse effects of using the opioid antagonist naltrexone to treat problem gamblers.
The files of the 1,192 patients who were referred to the National Problem Gambling Clinic between January 2015 and June 2016 were audited. Seventeen patients were considered appropriate for treatment with naltrexone, having attended and failed to respond to psychological therapies at the clinic. Fourteen patients were placed on a regimen of 50 mg/day naltrexone.
Of the 14 patients who were treated with naltrexone, there were 10 for whom sufficient follow-up existed to analyze the treatment efficacy and side effects of naltrexone. Patients showed significant decreases in their craving to gamble and the majority (60%) were able to abstain completely from gambling in the treatment period, with a further 20% reducing their gambling to almost nothing. The reported side effects from the naltrexone included: loss of appetite, gastrointestinal pain, headaches, sedation, dizziness, and vivid dreams. Two patients with concurrent alcohol-use disorder relapsed during the treatment. One patient relapsed after the treatment period.
The study showed significant outcomes in reducing gambling cravings for the sample set. Given the design of the study as a case series, there was no control group, and a number of patients were on other psychotropic medications. We recommend care when prescribing to those suffering from concurrent alcohol-use disorder.
研究使用阿片受体拮抗剂纳曲酮治疗问题赌徒的潜在适应证和不良反应。
对 2015 年 1 月至 2016 年 6 月间被转介到国家问题赌博诊所的 1192 名患者的档案进行了审核。17 名患者被认为适合使用纳曲酮治疗，他们已经参加过诊所的心理治疗，但没有反应。14 名患者接受了 50mg/天纳曲酮的治疗方案。
在接受纳曲酮治疗的 14 名患者中，有 10 名患者有足够的随访数据来分析纳曲酮的治疗效果和不良反应。患者的赌博欲望显著下降，大多数（60%）在治疗期间完全戒赌，另有 20%的患者将赌博减少到几乎没有。纳曲酮的不良反应包括：食欲不振、胃肠道疼痛、头痛、镇静、头晕和生动的梦境。两名同时患有酒精使用障碍的患者在治疗期间复发。一名患者在治疗期后复发。
该研究表明，对于样本集，减少赌博欲望的效果显著。鉴于研究的设计为病例系列，没有对照组，且许多患者还在服用其他精神药物。我们建议在为同时患有酒精使用障碍的患者开处方时要谨慎。
