Naltrexone and Disulfiram Treatment Response in Veterans With Alcohol Dependence and Co-Occurring Problem-Gambling Features

Background: Disordered gambling behavior frequently co-occurs with alcohol dependence and other psychiatric conditions. Using data from a previously published trial, we conducted secondary analyses to examine the influence of problem-gambling features on treatment outcome for alcohol dependence or co-occurring psychopathology assessed via DSM-IV criteria.

Methods: Two hundred fifty-four patients with alcohol dependence and co-occurring psychiatric disorders were treated for 12 weeks in an outpatient medication study conducted at 3 Veterans Administration outpatient clinics from October 1998 to March 2002. Randomization included assignment to 1 of 4 groups: (1) naltrexone alone, (2) placebo alone, (3) (open-label) disulfiram and (blinded) naltrexone, or (4) (open-label) disulfiram and (blinded) placebo. One hundred seventy-four participants were evaluated for the diagnostic inclusionary criteria for pathological gambling using the Massachusetts Gambling Screen. Primary outcome and secondary outcome measures assessed alcohol use and psychiatric domains.

Results: Forty-five of 174 participants (25.9%) exhibited problem-gambling features (acknowledged 1 or more inclusionary criteria for pathological gambling). A gambling-group-by-disulfiram interaction was observed for abstinence, with problem-gambling features not associated with beneficial response to disulfiram (z = 6.58, P = .01). Participants with problem-gambling features reported significantly less improvement over time in general psychiatric functioning (z = 2.62, P = .01), specifically within somatization (z = 3.77, P < .01), phobic anxiety (z = 3.24, P < .01), interpersonal sensitivity (z = 2.61, P = .01), paranoid ideation (z = 2.32, P = .02), and anxiety (z = 2.10, P = .04) domains.

Conclusions: The association between problem-gambling features and poorer outcomes in alcohol and multiple nonsubstance psychiatric domains suggests the need for improved screening for gambling problems in dually diagnosed populations and for the development of empirically validated treatments for individuals with these disorders.