More adolescents are gambling—with addiction

No medications are FDA-approved for pathological gambling, and no studies have examined medication use for adolescent gamblers. Controlled trials with adults suggest some medications may reduce urges and cravings or decrease gambling behaviors. These include:

• selective serotonin reuptake inhibitors
  
• opioid antagonists such as naltrexone or its analogue nalmefene
  
• or mood stabilizers such as lithium, divalproex sodium, or possibly topiramate.²³
  

Adult dosages do not need to be adjusted for adolescents with pathological gambling and comorbid psychiatric disorders.^1,24 Psychotropics could potentially increase pathological gambling behaviors, so monitor for changes.

Working with families. Many parents are aware of the destructive potential of substance abuse but not of gambling. They may feel shame that they did not recognize their teen’s gambling problem or “control” their child’s behavior. The adolescent may feel remorse for having bet with the parents’ money.

Even when the family recognizes the teen’s problem, denial or enabling can perpetuate the behavior. For teens such as Matt who learned to gamble at a home, advise the parents to abstain from gambling as well. Consider screening the parents for pathological gambling, given its high rate of heritability.

Address guilt and shame by acknowledging that pathological gambling is a psychiatric disease caused by biological, psychological, and social factors—not dysfunctional family relations. Emphasize that treatment works. Because gambling is easily hidden, educate families about relapse signs, such as preoccupation with money, personality changes, or failing to fulfill family responsibilities.²⁵

Related resources

• Wiebe JM, Cox BJ, Mehmel BG. The South Oaks Gambling Screen Revised for Adolescents (SOGS-RA): further psychometric findings from a community sample. J Gambl Stud 2000;16(2-3):275-88.
  
• Gamblers Anonymous. www.gamblersanonymous.org.
  
• National Council on Problem Gambling. www.ncpgambling.org.
  
• International Centre for Youth Gambling Problems and High-Risk Behaviors. www.youthgambling.com.
  

Drug brand names

• Nalmefene • Revex
  
• Naltrexone • ReVia
  
• Lithium • Lithobid, others
  
• Divalproex sodium • Depakote, others
  
• Topiramate • Topamax
  

Disclosures

Dr. Fong receives grant/research support from Ortho McNeil Pharmaceutical and Somaxon Pharmaceuticals and is a speaker for Forest Pharmaceuticals.