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By Austin Taylor · Founder, Cope CompassLast updated October 17, 2026

Medication for Gambling Addiction: What the Research Shows

If you've gone looking for a pill that stops the urge to gamble, here's the honest answer: none has FDA approval, and none works on its own. But one drug, naltrexone, now has enough trial evidence behind it that England's national guideline body tells doctors to consider it when therapy alone hasn't worked. Here's what the research found, including the trials that came up empty.

No approved drug, but a real candidate

Gambling disorder sits alongside substance use disorders in the DSM-5 (here are the nine criteria), yet no drug carries an FDA label for it. "There is no FDA-approved pharmacotherapy for the treatment of GD," the Division on Addiction at Cambridge Health Alliance wrote in its February 2026 guide for providers.

So anything prescribed for gambling is off-label, which is legal: the FDA says providers "generally may prescribe the drug for an unapproved use when they judge that it is medically appropriate."

Naltrexone is FDA-approved for alcohol dependence and for blocking the effects of opioids. Nalmefene, another opioid blocker, is approved in the European Union for use in alcohol dependence, but in the US only as an emergency opioid-overdose reversal drug, so the daily pill used in gambling trials isn't available here.

Both block opioid receptors, and the theory the trials tested is that this blunts the dopamine surge in the brain's reward circuit. Gambling disorder runs on cue reactivity, where an app alert sets off a craving, and on intermittent reinforcement, the unpredictable payouts that make the habit so hard to extinguish. The goal of medication is narrow: turn down the urge so the skills you're building in therapy and meetings have room to work.

What the trials found

Most of these trials were small, and several lost many participants before the end.

Naltrexone, 2001. The first controlled trial, by Kim, Grant and colleagues, enrolled 83 people and analyzed data from 45, with doses up to 250 mg a day. After 11 weeks, 75% on naltrexone were rated much or very much improved, versus 24% on placebo. Four participants, all also taking pain relievers, had elevated liver enzymes. The authors urged caution until other studies confirmed the findings.

75% vs 24%rated much or very much improved on naltrexone vs placebo in the first controlled trial (Kim et al., Biological Psychiatry, 2001)

Nalmefene, 2006. Across 15 US outpatient centers, 207 people were randomized to one of three doses or placebo for 16 weeks. At 25 mg a day, 59.2% were rated much or very much improved, versus 34.0% on placebo. Higher doses caused what the authors called "intolerable side effects."

Naltrexone, 2008. In an 18-week trial of 77 adults, naltrexone significantly reduced gambling urges and behavior, and 50 mg a day, the standard label dose for alcohol dependence, appeared to work as well as 100 or 150 mg.

The trials that came up empty. A 2009 trial of 52 people with both alcohol use disorder and gambling problems found naltrexone no better than placebo. A 2010 nalmefene trial of 233 people missed its primary outcome. A 2016 trial of 101 people taking naltrexone only as needed, rather than daily, found no significant difference.

The honest shape of it: a real signal, built on small studies, with some failures to replicate.

What the big reviews say

Cochrane, 2022. Across four studies and 562 people, opioid antagonists showed "a medium beneficial effect" on gambling severity versus placebo. The reviewers rated the evidence "very low to low" certainty and called it "preliminary support."

Network meta-analysis, 2025. Pooling 16 trials and 977 people in Comprehensive Psychiatry, the authors found moderate-confidence evidence that nalmefene reduced gambling severity. Naltrexone came next, but the statistical range for its effect on severity crossed zero, so that result isn't certain. Both improved quality of life, and both had far more side-effect dropouts than placebo.

Systematic review, 2026. Dutch researchers reviewed 24 double-blind trials with 1,547 patients. Four of seven opioid-antagonist trials beat placebo. Their conclusion: consider opioid antagonists only for people who don't respond to psychotherapy; for other drugs, "there is currently insufficient evidence."

4 of 7opioid-antagonist trials beat placebo in a 2026 systematic review of 24 randomized trials (Neven et al., Tijdschrift voor Psychiatrie)

In January 2025, England's National Institute for Health and Care Excellence (NICE) acted on it. Its guideline NG248 says to consider naltrexone if psychological therapy hasn't achieved the desired outcomes after an appropriate course, or if relapses keep happening. A qualified specialist should start or supervise it after checking liver and kidney function and confirming the person isn't taking opioids, and NICE suggests 25 mg a day for three days, then 50 mg a day for four to six months.

SSRIs, mood stabilizers, NAC, and what's next

Antidepressants. A 2002 trial of 45 people favored paroxetine, but a larger 2003 multicenter trial of 76 found no significant advantage, and placebo-controlled fluvoxamine (2002) and sertraline (2005) trials also fell short. Cochrane found antidepressants "no more effective than placebo." Treating co-occurring depression or anxiety still matters: the Division on Addiction notes it "may help relieve GD symptoms."

Mood stabilizers. As a group, no better than placebo in the Cochrane review; the 2025 analysis found the same for topiramate. The exception is bipolar-spectrum symptoms: in a 2005 trial of 40 such patients, 10 of 12 who finished on sustained-release lithium responded, versus 5 of 17 on placebo.

N-acetylcysteine (NAC). NAC works on glutamate, a different brain system. In a 2007 pilot, 16 of 27 people responded on open-label NAC. In the blinded phase that followed, 83.3% of those kept on it still met response criteria, versus 28.6% switched to placebo. A 2014 trial of 28 people with gambling disorder and nicotine dependence, all in behavioral therapy, found an added benefit on gambling severity at three-month follow-up. Both are small. NAC is sold as a dietary supplement, which the FDA doesn't approve before sale, so a bottle bought online isn't what was tested.

Antipsychotics. Cochrane read a possible benefit for olanzapine on very low certainty evidence, but both of its trials were reported as negative, and the 2025 analysis found it no better than placebo. One antipsychotic, aripiprazole, points the other way: it's among the medications that can trigger compulsive gambling.

What's next. As of October 2026, ClinicalTrials.gov lists a phase 3 nalmefene trial in France and a small psilocybin-assisted therapy pilot, but no trials of GLP-1 drugs like semaglutide for gambling disorder. Claims that they treat it are ahead of the evidence.

Who gets offered medication, and why

Medication tends to come up in a few situations:

  • Therapy alone hasn't been enough. That's NICE's threshold.
  • Strong, intrusive urges. Urges fell significantly in the 2008 naltrexone trial, and a 2008 analysis of 284 people from two trials found stronger urges tracked with better response on higher doses, at a trend level.
  • A family history of alcohol use disorder. The same analysis found this was the clinical factor most strongly associated with responding to an opioid antagonist. It's an association, not a guarantee.
  • Co-occurring conditions. Someone with alcohol use disorder may already be offered naltrexone for drinking, though the 2009 trial found no gambling benefit in that group. Bipolar symptoms may point toward lithium.

Side effects, and the liver caveat

Nausea is the most common side effect on naltrexone's current US label, at 10%, followed by headache, dizziness, nervousness, and fatigue. In the 2001 gambling trial, nausea was common in the first week.

Naltrexone's boxed warning for liver toxicity was removed in 2013, but the label still warns of "cases of hepatitis and clinically significant liver dysfunction." That's why NICE advises checking liver function before starting.

For many people the bigger issue is opioids. Naltrexone blocks opioid pain medicine and can trigger sudden withdrawal in anyone dependent on opioids; the label recommends at least 7 to 10 days opioid-free after dependence on short-acting opioids. Trying to override the blockade "may lead to life-threatening opioid intoxication or fatal overdose." The label also advises carrying identification and telling any treating doctor you take it, in case you need surgery or emergency care.

The label notes postmarketing reports of depression, suicidal thinking, and suicide attempts, and NICE cautions that a relapse after improvement can be distressing and may lead to self-harm or suicide. Tell your prescriber how your mood is, and if it changes. One reassurance: per the label, naltrexone "does not lead to physical or psychological dependence."

Medication supports the plan. It isn't the plan.

Every guideline and review above treats medication as an adjunct. NICE places naltrexone after therapy, not instead of it.

A pill may soften the pull of a cue. It can't close a betting account, pay down a credit card, or rebuild trust. It doesn't correct the gambler's fallacy, the belief that a cold streak means you're "due." Loss chasing, the drive to get even, is as much a thinking pattern as a craving, and that's what cognitive behavioral therapy targets. (Here's how the therapy side works.)

Lasting recovery stacks layers: therapy, peer support like Gamblers Anonymous, barriers like self-exclusion, and honest people around you. Medication can be one. If it quiets the urges enough that you get to a meeting and stay in the room, it's doing its job. The goal is still to stop gambling, and recovery is more common than people assume.

How to bring it up with a prescriber

Naltrexone isn't a controlled substance, so any licensed prescriber can write it. The question is who knows this use well:

  • Addiction medicine physicians prescribe naltrexone for alcohol and opioid use disorders, so the opioid screening and labs are familiar ground.
  • Psychiatrists fit best if you also have depression, anxiety, ADHD, or possible bipolar symptoms.
  • Primary care clinicians are easiest to reach and can order baseline labs, but this use may be new to them, so come prepared.
If you see a gambling therapist, ask them first; they may have a prescriber they refer to. (Peers, sponsors, and therapists do different jobs.)

A simple opener: "I'm dealing with gambling disorder. I'm in therapy, and the urges are still strong. I've read naltrexone is used off-label for this. Could it make sense for me?"

Ask which labs they want, what happens if you need pain medication, and how you'll both judge whether it's helping. Tell them every medication and supplement you take, any opioid use, how much you drink, any liver history, your mood, and whether the gambling started after a new prescription.

What to do this week

  1. Track your urges for seven days: when, how strong from 0 to 10, and what set each one off. Here's how to catch an urge early.
  2. Take the self-assessment.
  3. Book one appointment with your therapist, your primary care clinician, or a gambling-informed provider through Cope Compass. If cost is a barrier, check state-funded options.
  4. Keep the other layers going. Get to one GA meeting or another recovery meeting, and set up self-exclusion if you haven't.
  5. Don't self-source. No online pharmacies, borrowed pills, or supplement experiments.
Our urgent help page lists who to call or text and what to do in the next hour, free and private, and you can find treatment and meetings at Cope Compass. If you're thinking about suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline. Written by Austin Taylor. This article is educational, not medical advice, and not a recommendation to start, stop, or avoid any medication. Decisions about medication belong to you and your prescriber. Trial figures were checked against each study's published abstract as of October 17, 2026.

Sources

Questions people ask

Is there an FDA-approved medication for gambling addiction?

No. As of October 2026, no medication is FDA-approved for gambling disorder, so any drug prescribed for it is used off-label. Naltrexone, which is approved for alcohol dependence and for blocking opioids, has the most research behind it.

Does naltrexone work for gambling addiction?

In several randomized trials naltrexone reduced gambling urges and behavior more than placebo, but other trials found no difference, and a 2022 Cochrane review rated the evidence for opioid antagonists as very low to low certainty. England's NICE recommends considering it when a course of psychological therapy hasn't worked.

Can medication replace therapy or Gamblers Anonymous?

No. Every major guideline and review treats medication as an add-on to therapy and peer support, not a replacement. Whether it fits your recovery plan is a decision for you and your prescriber.

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