Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician
11.6 Major clinical issues with gambling and stimulant (including methamphetamine) use
- Stimulant users are frequently affected by problem gambling.
- MAO-Is (either irreversible or reversible) are contraindicated in people using amphetamines or MDMA. Deaths have been associated with concurrent use of moclobemide and MDMA.
11.6.1 Effects of stimulants on problem gambling
- Rates of stimulant use are higher in people with problem gambling than the general population(488). Stimulant users are frequently affected by problem gambling(439).
- Stimulants may increase risk taking and impulsivity(338, 339) and are therefore likely to adversely affect people with problem gambling.
- Stimulants are amongst the most commonly used illicit substances by people with problem gambling(432, 464).
11.6.2 Interactions between stimulants and therapeutic agents for problem gambling
- Stimulant drugs are likely to exacerbate the effects of SSRI and SNRI antidepressants, in particular (and vice versa), and may result in serotonin syndrome (Appendix 1)x(127, 179, 180). Patients should be warned of signs of serotonin syndrome and be monitored.
- MAO-Is (either irreversible or reversible) are contraindicated in people using amphetamines or MDMA. Deaths have been associated with concurrent use of moclobemide and MDMAxxx(181, 182).
- Fluoxetine, norfluoxetine, paroxetine and sertraline are potential inhibitors of CYP 2D6 which metabolises MDMA and methamphetamine. This may result in elevated plasma concentrations leading to toxicityx.
11.6.3 Management approaches to comorbid problem gambling and stimulant use
- Formal drug detoxification should be considered if the person is dependent on stimulants.
- CBT is effective in reducing stimulant use***(49, 183) as well as problem gambling****(441-443) and an approach that integrates treatments for both conditions may be more effective in managing comorbid stimulant use and problem gambling. This is yet to be investigated.