Could Ketamine Help Tackle Gambling Addiction?

Recruitment is now underway for a first-of-its-kind study investigating the potential of ketamine to fight gambling addiction.

The new research will look to explore whether ketamine’s effect on human memory might be leveraged to break down the “superstitious thinking” that is common in gambling addiction, as well as lessen the general habit or compulsive urge to gamble.

Conducted by the biotechnology company Awakn Life Sciences, the study will be led by the internationally respected ketamine researcher Celia Morgan, a professor of psychopharmacology at the University of Exeter and Awakn’s head of ketamine-assisted psychotherapy for addiction.

The difference between behavioral addictions and drug addiction

While substance addiction and behavioral addictions may appear to be two sides of the same coin, each comes with its own set of complications that can complicate treatment.

“We know that the dopaminergic system is involved in both and we get the same kind of changes, but there’s not the effects of these substances on the brain as well [with behavioral addiction],” Morgan explained. “Drugs and alcohol actually change your brain function by the chemicals themselves. That doesn’t happen with behavioral addictions, but we do get similar brain changes in things like dopamine transmission.”

Perhaps because of the highly stigmatized nature of substance addictions in society, behavioral addictions such as gambling addiction have largely flown under the radar. Sex addiction and food addiction are not yet recognized by World Health Organization diagnostic criteria, and so they can be very difficult to recognize and treat. The prevalence of food, sex, and money at a societal level can also massively complicate the road to abstinence.

To add to this, gambling addiction specifically comes with its own set of behaviors that can be challenging to treat with psychotherapy alone.

“Something that we’re really interested in tackling in gambling addiction is a kind of superstitious thinking which we particularly think ketamine might work on, which is where gamblers come to associate certain cues and they’ve got to overlearn the association between a cue and winning. They enter into very superstitious behaviors, which is quite unique to gambling,” said Morgan.

First study examining ketamine for gambling addiction now recruiting

Ketamine’s effect on memory has already shown promise as a potential treatment avenue in tackling alcohol use disorder, with one study suggesting that ketamine may result in a meaningful reduction in drinking by rewriting the maladaptive reward memories that contribute to substance misuse and addiction. In a similar vein, the new Awakn study will look to see whether ketamine’s effects on memory might also benefit people with gambling addictions by altering how the brain handles the reward memories associated with past gambling.

“We are using one of the capacities of the ketamine which is to block a process of re-stabilization of memory. In the study that we’re doing, we’re going to reactivate gambling memories. We’ll be showing people, depending on what their modality of gambling is, a roulette wheel or slot machines or horses, and this reactivates the memory,” Morgan explained.

“Normally in memory, this means that this memory becomes active and you’re able to update it. Then it’s restabilized – saved again, in computer terms – and is laid down more strongly. If you give ketamine during this time of reactivation, what’s been found particularly in animals is that this can weaken the memory trace. That’s what we’re looking at in this study.”

The Awakn study has received approval from the relevant ethics committee and is now actively recruiting participants. Those taking part in the trial will have the strength of their maladaptive reward memories measured before undergoing a supervised ketamine infusion session. Importantly, the ketamine infusion session will not be accompanied by any kind of directed psychotherapy, so that the fundamental drug effects of the ketamine remain the central focus of the study. The strength of these reward memories will then be reassessed after the session, with additional follow-up assessments one week and one month after treatment to examine any longer-term changes that might occur.

“This isn’t a treatment study, that’s important to emphasize,” said Morgan. “This is just a study looking at mechanistic action. That is a subtle distinction, but it means it’s not a clinical trial.”

Changing how we think about addiction

Previously, to be considered as having an addiction, a patient would need to show prominent physical withdrawal symptoms such as shivering, vomiting, or insomnia. With substance addictions this was relatively straightforward, as the biological withdrawal symptoms associated with the lack of substance in a person’s system would normally produce some visible physical side effects. But now this school of thought is on the way out, and scientists tend to focus more on the impact a certain behavior may have on a person’s quality of life to determine whether they might have an addiction.

“Now we very much think what constitutes an addiction is the impacts, the use of something, whatever it is, be it a behavior or a drug has on your life and your relationships and your ability to function. That’s somewhat of a paradigm shift in the way we think about addiction and that has allowed people to start recognizing these addictions,” said Morgan.

Psychological therapy is not an effective treatment for all people struggling with addiction, but there are no pharmacological therapies approved for treating gambling addiction – a fact that is perhaps unsurprising given the past lack of recognition for this type of addiction. This new study is just one aspect of a wider research strategy from Awakn that aims to develop and deliver new proprietary therapeutics for both substance and behavioral addictions using psychedelic medicine.

“Hopefully, increasingly as we acknowledge the distress and the huge impact this has on people’s relationships, their work, their daily functioning, we will start to recognize these [behavioral addictions] as disorders that are worthy of treatment and healthcare. There’s a lot of stigma around them as well – particularly sex and food addiction,” Morgan said.

“I’m hopeful that we’ll be able to find some new treatments. I’m very pleased that Awakn has backed this approach.”