Effects of the Atypical Stimulant Modafinil on a Brief Gambling Episode in Pathological Gamblers With High vs. Low Impulsivity

J Psychopharmacol. 2009 Aug;23(6):660-71. doi: 10.1177/0269881108091072. Epub 2008 Jun 26.

Abstract

Pathological gambling (PG) is a serious psychiatric disorder afflicting 1-3% of the general population. Experimental evidence indicates shared neurochemical substrates for PG and psychostimulant addiction. Impulsivity characterizes one key subtype of PG. Therefore, medications that ameliorate psychostimulant addiction and impulsive syndromes might also benefit impulsive PG subjects. The atypical stimulant, modafinil reduces cocaine abuse and impulsivity in patients with ADHD. The present study sought to determine if modafinil (200 mg) would reduce the reinforcing effects of slot machine gambling in PG subjects, and if this effect was stronger in high (H-I) vs. low (L-I) impulsivity subjects (N = 20). A placebo-controlled, double-blind, counterbalanced, repeated measures design was employed. Apart from bet size, which declined uniformly in both groups under drug, modafinil had bi-directional effects in the two groups. In H-I subjects, the drug decreased desire to gamble, salience of Gambling words, disinhibition and risky decision-making. In L-I subjects, modafinil increased scores on these indices. Modafinil also differentially affected blood pressure response to the game in the two groups. These findings for modafinil appear to fit well with a growing literature demonstrating bi-directional effects of D2 agonists as a function of trait impulsivity. Impulsivity could critically moderate medication response in PG.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Benzhydryl Compounds / adverse effects
  • Benzhydryl Compounds / therapeutic use*
  • Central Nervous System Stimulants / adverse effects
  • Central Nervous System Stimulants / therapeutic use*
  • Double-Blind Method
  • Female
  • Gambling / psychology*
  • Humans
  • Impulsive Behavior / drug therapy*
  • Impulsive Behavior / psychology*
  • Male
  • Modafinil
  • Motivation
  • Neuropsychological Tests
  • Psychiatric Status Rating Scales
  • Reaction Time / drug effects
  • Reproducibility of Results

Substances

  • Benzhydryl Compounds
  • Central Nervous System Stimulants
  • Modafinil