Drug treatment for addiction
1. Why do you need medication
Correction of neurotransmitter balance disorders. With ludomania, the imbalance of the dopamine system increases - drugs help reduce the "thirst for gain."
Mitigation of associated symptoms. Anxiety, depression and intrusive thoughts often require pharmacological support for psychotherapy to be effective.
Prevention of relapses. With a properly selected scheme, the drug reduces the intensity of game impulses and increases the likelihood of a non-jerk period.
2. Indication
1. Severe and moderate gaming addiction, when without therapy it is not possible to stop betting.
2. Concomitant mood disorders (depression, dysthymia) or anxiety (GAD, panic attacks).
3. Pronounced autonomic reactions when not playing: tremor, tachycardia, insomnia.
3. Main drug groups
4. Prescribing and dosage standards
1. SSRIS:
Correction of neurotransmitter balance disorders. With ludomania, the imbalance of the dopamine system increases - drugs help reduce the "thirst for gain."
Mitigation of associated symptoms. Anxiety, depression and intrusive thoughts often require pharmacological support for psychotherapy to be effective.
Prevention of relapses. With a properly selected scheme, the drug reduces the intensity of game impulses and increases the likelihood of a non-jerk period.
2. Indication
1. Severe and moderate gaming addiction, when without therapy it is not possible to stop betting.
2. Concomitant mood disorders (depression, dysthymia) or anxiety (GAD, panic attacks).
3. Pronounced autonomic reactions when not playing: tremor, tachycardia, insomnia.
3. Main drug groups
| Drug Group | Examples | Mechanism of Action |
|---|---|---|
| Selective serotonin reuptake inhibitors (SSRIs) | Fluoxetine, sertraline, paroxetine | Increase serotonin levels, reduce anxiety and compulsions |
| Dopamine receptor antagonists | Naltrexone | Blocks the "encouraging" effect of dopamine at stakes |
| Normotimics and mood stabilizers | Lithium, valproates | Smooth emotional fluctuations |
| Anxiolytics (short course) | Benzodiazepines (lorapam, alprazolam) | Rapid relaxation in acute anxiety attacks (course up to 2-3 weeks) |
| Atypical antipsychotics | Quetiapine, risperidone | In severe impulsivity and psychotic reactions |
4. Prescribing and dosage standards
1. SSRIS:
- Fluoxetine 20 mg/day, paroxetine 20 mg/day, sertraline 50-100 mg/day.
- The effect is achieved after 4-6 weeks of stable intake. 2. Naltrexone:
- 50 mg/day, if well tolerated, can be increased to 100 mg/day.
- Monitoring of liver function before and during therapy. 3. Lithium:
- 600-900 mg/day in 2-3 doses, maintaining a serum level of 0.6-1.2 mmol/l. 4. Benzodiazepines:
- Lorapam 0.5-1 mg as needed, no longer than 2-3 weeks. 5. Quetiapine:
- 25-50 mg overnight, up to 150 mg if needed.
5. Treatment regimen and monitoring
Initial consultation with a psychiatrist: history collection, laboratory tests (liver, kidney tests).
Starting phase (1-2 weeks): low doses, careful monitoring of side effects.
Maintenance phase (3-12 weeks): achievement of therapeutic doses, regular visits every 2-4 weeks.
Stabilization phase (3-6 months): maintenance of the achieved effect, gradual dose reduction as clinically indicated.
6. Possible side effects and interactions
SSRIs: nausea, headache, insomnia or drowsiness, decreased libido.
Naltrexone: dyspepsia, dizziness, transaminases increased.
Lithium: tremor, polydipsia, polyuria, risk of nephrotoxicity in overdose.
Benzodiazepines: drowsiness, dependence with prolonged use, cognitive impairment.
Antipsychotics: metabolic changes, weight gain, sedation.
7. Combination with psychotherapy and other methods
Cognitive behavioural therapy (CBT): Medication reduces the severity of impulses - the psychotherapist is trained to manage the remaining cravings.
Mutual Aid Groups: Pharmacotherapy improves the chances of successful integration into GA and SMART Recovery.
Breathing and relaxation practices: Anxiolytics facilitate training in self-regulation techniques.
8. Discontinuation and replacement
Smooth withdrawal: 10-25% dose reduction every 1-2 weeks to avoid withdrawal syndrome.
Regimen adjustment: in case of relapse - return to higher doses or drug change.
Long-term support: at the risk of relapse, sometimes the admission is extended for a year or more under supervision.
9. Performance monitoring
Subjective scale "craving for the game" (0-10) - daily or weekly measurements.
Gambling Severity Index - every 4-6 weeks.
Data on failures (frequency, sum of bets) - analysis and correction of therapy.
Functional state: sleep, appetite, anxiety level, participation in social life.
10. Conclusion
Drug therapy for ludomania is an important component of complex treatment. Proper selection of drugs, strict monitoring and combination with psychotherapy create conditions for a steady rejection of gambling, reduce the risk of relapse and improve the quality of life.
