Outcome Measuresįollowing the recommendations of the Banff, Alberta Consensus (Walker et al. Additionally, authors of relevant articles were contacted to ask for unpublished papers suitable for inclusion in the meta-analysis. Subsequently, we conducted a thorough examination of the reference lists of review articles, meta-analyses, and original studies retrieved from the databases. The search covered all relevant publications from the first available year until Apusing the following disorder-related search terms: “pathological gambling OR gambl* OR ludomania” combined with the intervention-related key words treatment “open-label OR placebo-controlled OR random* OR trial OR pilot”. We conducted a multilevel literature search using the databases PsycINFO, Medline, PubMed, Psyndex, the Cochrane Central Register of Clinical Trials, ProQuest Digital Dissertations, and the web search engine Google Scholar. Information Sources and Literature Search Studies were excluded if (1) the study was a single case study (2) disordered gambling was secondary to Parkinson`s disease or to other medical conditions (3) the study sample overlapped completely with the sample of another study included in the meta-analysis, or (4) no abstract or full text of the study was available. Studies were considered for inclusion if they (1) employed pharmacological, or combined treatments (e.g., pharmacological and psychological treatments applied at the same time) (2) used within-group, randomized, or quasi-randomized controlled study designs including a placebo intervention (3) measured at least one of the outcome variables (i.e., global severity, frequency or financial loss) and (4) reported sufficient statistical data for effect size calculations. Moreover, future studies need to monitor concurrent psychosocial treatments, the type of comorbidity, use equivalent measurement tools, include outcome variables according to the Banff, Alberta Consensus, and provide follow-up data in order to broaden the knowledge about the efficacy of pharmacological treatments for this disabling condition. However, more rigorously designed, large-scale randomized controlled trials with extended placebo lead-in periods are necessary. Of the placebo controlled studies, results showed that opioid antagonists and mood stabilizers, particularly the glutamatergic agent topiramate combined with a cognitive intervention and lithium for gamblers with bipolar disorders demonstrated promising results. In general, medication classes yielded comparable effect sizes independent of predictors of treatment outcome. ![]() The controlled effect sizes for the outcome variables were significantly smaller (Hedges’s g: 0.41, 0.11, 0.22), but robust for the reduction of global severity at short-term. Pharmacological treatments were associated with large and medium pre-post reductions in global severity, frequency, and financial loss (Hedges’s g: 1.35, 1.22, 0.80, respectively). ![]() A multilevel literature search yielded 34 studies including open-label and placebo-controlled trials totaling 1340 participants to provide a comprehensive evaluation of the short- and long-term efficacies of pharmacological and combined treatments. Only recently, glutamatergic agents and combined pharmacological and psychological treatments have been examined appearing promising options for the management of gambling disorder. ![]() Currently, opioid antagonists are considered the first-line treatments to reduce symptoms of uncontrolled gambling. Disordered gambling is a public health concern associated with detrimental consequences for affected individuals and social costs.
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