Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

312 IV. SPECIAL POPULATIONSreceiving high dose (range = 50–250 mg/day; mean dose of 157 mg/day)(Grant, Kim, & Potenza, 2003). A larger double-blind study using a meannaltrexone dose of 188 mg/day confirmed these earlier findings (Kim, Grant,Adson, & Shin, 2001). In particular, individuals reporting higher intensitygambling urges responded preferentially to treatment (Kim et al., 2001).Mood StabilizersA recent double-blind study found sustained-release lithium carbonate superiorto placebo in 29 bipolar-spectrum pathological gamblers over 10 weeks (Hollander,Pallanti, & Baldini-Rossi, 2005). Bipolar spectrum disorders weredefined as including DSM-IV diagnoses of bipolar II disorder, bipolar disordernot otherwise specified (NOS), and cyclothymia, and mood swings thatoccurred at times unrelated to gambling urges/behavior.Atypical AntipsychoticsAtypical antipsychotics have been explored as augmenting agents in the treatmentof nonpsychotic disorders and behaviors, including OCD. Olanzapine wasnot found to be superior to placebo in the treatment of video poker pathologicalgamblers (Potenza & Hollander, 2002). A case report described symptomimprovement following the initiation of olanzapine at 10 mg/day in the treatmentof a woman with PG and schizophrenia (Grant, Kim, & Potenza, 2003).Further systematic investigation of the potential of atypical antipsychotics, particularlyin treating individuals with co-occurring psychotic disorders and PG,seems indicated.PsychotherapyMultiple behavioral treatments have been investigated (Petry & Roll, 2001).Cognitive therapy focuses on changing the patient’s beliefs regarding perceivedcontrol over randomly determined events. Case reports have demonstrated successwith cognitive therapy (Petry & Roll, 2001), and further support is derivedfrom two randomized trials. In the first, individual cognitive therapy resulted inreduced gambling frequency and increased perceived self-control over gamblingwhen compared with a wait-list control group (Sylvain, Ladouceur, & Boisvert,1997). A second trial that included relapse prevention also produced improvementin gambling symptoms compared to a wait-list group (Ladouceur et al.,2001).Cognitive-behavioral therapy has also been used to treat pathologicalgambling, including one published randomized trial (Echeburua, Baez, &Fernandez-Montalvo, 1996). In this study, four groups were compared: (1) individualstimulus control and in vivo exposure with response prevention, (2) group