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01-03-2017 | Original Paper

Topiramate Combined with Cognitive Restructuring for the Treatment of Gambling Disorder: A Two-Center, Randomized, Double-Blind Clinical Trial

Authors: Antonio Marcelo Cabrita de Brito, Moema Galindo de Almeida Pinto, Gabriel Bronstein, Elizabeth Carneiro, Daniela Faertes, Viviane Fukugawa, Angela Duque, Fatima Vasconcellos, Hermano Tavares

Published in: Journal of Gambling Studies | Issue 1/2017

Abstract

Gambling disorder (GD) is a prevalent condition for which no pharmacological treatment has yet been approved, although there is evidence that topiramate can reduce impulsivity in GD and craving in various addictive behaviors. The goal of this study was to investigate the effectiveness of topiramate combined with cognitive restructuring for GD in a two-center, randomized, double-blind clinical trial. Participants were individuals seeking outpatient treatment for GD (n = 30), treated with either topiramate or placebo combined with a brief cognitive intervention, over a 12-week period, the dose of topiramate being tapered up during the first 8 weeks. The main outcome measures were gambling craving, behavior, and cognitive distortions; impulsivity; depression and social adjustment. Topiramate proved superior to placebo in reducing gambling craving (P = 0.017); time and money spent gambling (P = 0.007 and P = 0.047, respectively); cognitive distortions related to gambling (P = 0.003); and social adjustment (P = 0.040). We found no significant effects on impulsivity or depression. These findings are in contrast with data from a previous clinical trial with topiramate for GD. In the current study, we found that topiramate affects features specifically related to gambling addiction and had no significant effect on associated phenomena such as impulsiveness and depression. We believe that this response could be due to synergistic interaction between topiramate and the cognitive intervention.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders DSM-5 (5th ed.). Washington: American Psychiatric Association.CrossRef

Amorim, P. (2000). Mini international neuropsychiatric interview (mini): Validation of brief interview for diagnosing mental disorders. Revista Brasileira de Psiquiatria, 22(3), 106–115.CrossRef

Anderson, C., Cowlishaw, S., Dowling, N., Jackson, A., Lorains, F., Merkouris, S., et al. (2011). Pharmacological interventions for the treatment of pathological and problem gambling (Protocol). The Cochrane Library, 1, CD008936.

Anthenelli, R. M., Blom, T. J., McElroy, S. L., & Keck, P. E, Jr. (2008). Preliminary evidence for gender-specific effects of topiramate as a potential aid to smoking cessation. Addiction, 103(4), 687–694.CrossRefPubMed

Arnone, D. (2005). Review of the use of topiramate for treatment of psychiatric disorders. Annals of General Psychiatry, 4(1), 5.CrossRefPubMedPubMedCentral

Association, New York Heart. (1964). The criteria committee of the New York Heart Association Inc.: Diseases of the heart and blood vessels, nomenclature and criteria for diagnosis (6th ed.). Boston, DC: Little Brown.

Babor, T. F., Brown, J., & del Boca, F. K. (1990). Validity of self-reports in applied research on addictive behaviours: Fact or fiction? Behavioural Assessment, 12(1), 5–31.

Beck, A. T., Steer, R. A., & Carbin, M. G. (1988). Psychometric properties of the beck depression inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8(1), 77–100.CrossRef

Berlin, H. A., Braun, A., Simeon, D., Koran, L. M., Potenza, M. N., McElroy, S. L., et al. (2013). A double-blind, placebo-controlled trial of topiramate for pathological gambling. World Journal of Biological Psychiatry, 14(2), 121–128.CrossRefPubMed

Claudino, A. M., de Oliveira, I. R., Appolinario, J. C., Cordás, T. A., Duchesne, M., Sichieri, R., et al. (2007). Double-blind, randomized, placebo-controlled trial of topiramate plus cognitive-behaviour therapy in binge-eating disorder. Journal of Clinical Psychiatry, 68(9), 1324–1332.CrossRefPubMed

Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155–159.CrossRefPubMed

Cowlishaw, S., Merkouris, S., Dowling, N., Anderson, C., Jackson, A., & Thomas, S. (2012). Psychological therapies for pathological and problem gambling. Cochrane Database of Systematic Reviews, 11, CD008937.PubMed

de Oliveira, I. R. (2011). Kafka’s trial dilemma: Proposal of a practical solution to Joseph K.’s unknown accusation. Medical Hypotheses, 77(1), 5–6.CrossRefPubMed

Dickson-Swift, V. A., James, E. L., & Kippin, S. (2005). The experience of living with a problem gambler: Spouses and partners speak out. Journal of Gambling Issues, 13, 1–22.CrossRef

Gorenstein, C., Moreno, R. A., Bernik, M. A., Carvalho, S. C., Nicastri, S., Cord á s, T., et al. (2002). Validation of the Portuguese version of the Social Adjustment Scale on Brazilian samples. Journal of Affective Disorders, 69(1–3), 167–175.CrossRefPubMed

Grant, J. E., Kim, S. W., & Hartman, B. K. (2008). A double-blind, placebo-controlled study of the opiate antagonist naltrexone in the treatment of pathological gambling urges. Journal of Clinical Psychiatry, 69(5), 783–789.CrossRefPubMed

Grant, J. E., Odlaug, B. L., & Schreiber, L. R. (2014). Pharmacological treatments in pathological gambling. British Journal of Clinical Pharmacology, 77(2), 375–381.CrossRefPubMedPubMedCentral

Hodgins, D. C. (2005). Implications of a brief intervention trial for problem gambling for future outcome research. Journal of Gambling Studies, 21(1), 13–19.CrossRefPubMed

Johnson, B. A. (2004). Topiramate-induced neuromodulation of cortico-mesolimbic dopamine function: A new vista for the treatment of comorbid alcohol and nicotine dependence? Addictive Behaviours, 29(7), 1465–1479.CrossRef

Johnson, B. A., Ait-Daoud, N., Bowden, C. L., DiClemente, C. C., Roache, J. D., Lawson, K., et al. (2003). Oral topiramate for treatment of alcohol dependence: A randomised controlled trial. Lancet, 361(9370), 1677–1685.CrossRefPubMed

Johnson, B. A., Rosenthal, N., Capece, J. A., Wiegand, F., Mao, L., Beyers, K., et al. (2007). Topiramate for treating alcohol dependence: A randomized controlled trial. The Journal of the American Medical Association, 298(14), 1641–1651.CrossRefPubMed

Johnson, B. A., Rosenthal, N., Capece, J. A., Wiegand, F., Mao, L., Beyers, K., et al. (2008). Improvement of physical health and quality of life of alcohol-dependent individuals with topiramate treatment: US multisite randomized controlled trial. Archives of Internal Medicine, 168(11), 1188–1199.CrossRefPubMed

Kim, S. W., Grant, J. E., Adson, D. E., & Shin, Y. C. (2001). Double-blind naltrexone and placebo comparison study in the treatment of pathological gambling. Biological Psychiatry, 49(11), 914–921.CrossRefPubMed

Koob, G. F. (2000). Neurobiology of addiction: Toward the development of new therapies. Annals of the New York Academy of Sciences, 909, 170–185.CrossRefPubMed

Ladouceur, R., Sylvain, C., Boutin, C., Lachance, S., Doucet, C., Leblond, J., et al. (2001). Cognitive treatment of pathological gambling. Journal of Nervous and Mental Disease, 189(11), 774–780.CrossRefPubMed

Larimer, M. E., Neighbors, C., Lostutter, T. W., Whiteside, U., Cronce, J. M., Kaysen, D., et al. (2012). Brief motivational feedback and cognitive behavioural interventions for prevention of disordered gambling: A randomized clinical trial. Addiction, 107(6), 1148–1158.CrossRefPubMedPubMedCentral

Lesieur, H. R. (1984). The chase: Career of the compulsive gambler (2nd ed.). Rochester, DC: Schenkman Books.

Lingjaerde, O., Ahlfors, U. G., Bech, P., Dencker, S. J., & Elgen, K. (1987). The UKU side effect rating scale. A new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients. Acta Psychiatrica Scandinavica. Supplementum, 334, 1–100.CrossRefPubMed

Mariani, J. J., Pavlicova, M., Bisaga, A., Nunes, E. V., Brooks, D. J., & Levin, F. R. (2012). Extended-release mixed amphetamine salts and topiramate for cocaine dependence: A randomized controlled trial. Biological Psychiatry, 72(11), 950–956.CrossRefPubMedPubMedCentral

Muelleman, R. L., DenOtter, T., Wadman, M. C., Tran, T. P., & Anderson, J. (2002). Problem gambling in the partner of the emergency department patient as a risk factor for intimate partner violence. Journal of Emergency Medicine, 23(3), 307–312.CrossRefPubMed

Pallanti, S., Baldini Rossi, N., Sood, E., & Hollander, E. (2002). Nefazodone treatment of pathological gambling: A prospective open-label controlled trial. Journal of Clinical Psychiatry, 63(11), 1034–1039.CrossRefPubMed

Pallesen, S., Mitsem, M., Kvale, G., Johnsen, B. H., & Molde, H. (2005). Outcome of psychological treatments of pathological gambling: A review and meta-analysis. Addiction, 100(10), 1412–1422.CrossRefPubMed

Pallesen, S., Molde, H., Arnestad, H. M., Laberg, J. C., Skutle, A., Iversen, E., et al. (2007). Outcome of pharmacological treatments of pathological gambling: A review and meta-analysis. Journal of Clinical Psychopharmacology, 27(4), 357–364.CrossRefPubMed

Park, S., Cho, M. J., Jeon, H. J., Lee, H. W., Bae, J. N., Park, J. I., et al. (2010). Prevalence, clinical correlations, comorbidities, and suicidal tendencies in pathological Korean gamblers: Results from the Korean Epidemiologic Catchment Area Study. Social Psychiatry and Psychiatric Epidemiology, 45(6), 621–629.CrossRefPubMed

Patton, J. H., Stanford, M. S., & Barratt, E. S. (1995). Factor structure of the Barratt impulsiveness scale. Journal of Clinical Psychology, 51(6), 768–774.CrossRefPubMed

Petry, N. (2005). Stages of change in treatment-seeking pathological gamblers. Journal of Consulting and Clinical Psychology, 73(2), 312–322.CrossRefPubMed

Petry, N. M., Stinson, F. S., & Grant, B. F. (2005). Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 66(5), 564–574.CrossRefPubMed

Reis, A. D., Castro, L. A., Faria, R., & Laranjeira, R. (2008). Craving decrease with topiramate in outpatient treatment for cocaine dependence: An open label trial. Revista Brasileira de Psiquiatria, 30(2), 132–135.CrossRefPubMed

Rosner, B. (2000). Fundamentals of biostatistics (5th ed.). California, DC: Duxbury Press.

Sobell, L. C., & Sobell, M. B. (1992). Timeline follow-back: A technique for assessing self-report alcohol consumption. In R. Litten & J. Allen (Eds.), Measuring alcohol consumption: Psychosocial and biochemical methods (pp. 41–72). Totowa, WJ: Humana Press.CrossRef

Sobell, L. C., Sobell, M. B., Leo, G. I., & Cancilla, A. (1988). Reliability of a timeline method: Assessing normal drinkers’ reports of recent drinking and a comparative evaluation across several populations. British Journal of Addiction, 83(4), 393–402.CrossRefPubMed

Sood, E. D., Pallanti, S., & Hollander, E. (2003). Diagnosis and treatment of pathologic gambling. Current Psychiatry Reports, 5(1), 9–15.CrossRefPubMed

Stahl, S. M. (2012). Psychotherapy as an epigenetic ‘drug’: Psychiatric therapeutics target symptoms linked to malfunctioning brain circuits with psychotherapy as well as with drugs. Journal of Clinical Pharmacy and Therapeutics, 37(3), 249–253.CrossRefPubMed

Steenbergh, T. A., Meyers, A. W., May, R. K., & Whelan, J. P. (2002). Development and validation of the Gamblers’ Beliefs Questionnaire. Psychology of Addictive Behaviours, 16(2), 143–149.CrossRef

Tamada, R. S., Amaral, J. A., Issler, C. K., & Lafer, B. (2006). Treatment emergent affective switch with topiramate. Revista Brasileira de Psiquiatria, 28(2), 158.CrossRefPubMed

Tavares, H. (2014). Gambling in Brazil: A call for an open debate. Addiction, 109(12), 1972–1976.CrossRefPubMed

Tavares, H., Carneiro, E., Sanches, M., Pinsky, I., Caetano, R., Zaleski, M., et al. (2010). Gambling in Brazil: Lifetime prevalences and socio-demographic correlates. Psychiatry Research, 180(1), 35–41.CrossRefPubMed

Tavares, H., & Gentil, V. (2007). Pathological gambling and obsessive-compulsive disorder: Towards a spectrum of disorders of volition. Revista Brasileira de Psiquiatria, 29(2), 107–117.CrossRefPubMed

Thorens, G., Billieux, J., Manghi, R., Khan, R., Khazaal, Y., & Zullino, D. F. (2011). The potential interest of topiramate in addiction. Current Pharmaceutical Design, 17(14), 1410–1415.CrossRefPubMed

Toneatto, T. (1999). Cognitive psychopathology of problem gambling. Substance Use and Misuse, 34(11), 1593–1604.CrossRefPubMed

Walker, M., Toneatto, T., Potenza, M. N., Petry, N., Ladouceur, R., Hodgins, D. C., et al. (2006). A framework for reporting outcomes in problem gambling treatment research: The Banff, Alberta, Consensus. Addiction, 101(4), 504–511.CrossRefPubMed

Weissman, M. M., & Bothwell, S. (1976). Assessment of social adjustment by patient self-report. Archives of General Psychiatry, 33(9), 1111–1115.CrossRefPubMed

Welte, J., Barnes, G., Wieczorek, W., Tidwell, M. C., & Parker, J. (2001). Alcohol and gambling pathology among U.S. adults: Prevalence, demographic patterns and comorbidity. Journal of Studies on Alcohol, 62(5), 706–712.CrossRefPubMed

Zeger, S. L., Liang, K. Y., & Albert, P. S. (1988). Models for longitudinal data: A generalized estimating equation approach. Biometrics, 44(4), 1049–1060.CrossRefPubMed

Title: Topiramate Combined with Cognitive Restructuring for the Treatment of Gambling Disorder: A Two-Center, Randomized, Double-Blind Clinical Trial
Authors: Antonio Marcelo Cabrita de Brito
Moema Galindo de Almeida Pinto
Gabriel Bronstein
Elizabeth Carneiro
Daniela Faertes
Viviane Fukugawa
Angela Duque
Fatima Vasconcellos
Hermano Tavares
Publication date: 01-03-2017
Publisher: Springer US
Published in: Journal of Gambling Studies / Issue 1/2017
Electronic ISSN: 1573-3602
DOI: https://doi.org/10.1007/s10899-016-9620-z

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Topiramate Combined with Cognitive Restructuring for the Treatment of Gambling Disorder: A Two-Center, Randomized, Double-Blind Clinical Trial

Abstract

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