PHARMACOLOGICAL TREATMENT OF BEHAVIORAL ADDICTIONS: A SYSTEMATIC REVIEW WITH NARRATIVE SYNTHESIS

Abstract

Introduction: Behavioral addictions represent a heterogeneous group of conditions characterized by repetitive reward-seeking behaviors, impaired control, craving, persistence despite harm, and significant psychosocial dysfunction. Gambling disorder and gaming disorder are formally recognized within ICD-11, whereas compulsive buying-shopping disorder (CBSD), compulsive sexual behaviors disorder (CSBD), problematic pornography use, internet-related addictions, and food addiction remain diagnostically debated or variably classified. Although psychosocial interventions remain the first-line treatment, pharmacological approaches have increasingly been explored, particularly in severe, treatment-resistant, impulsive-compulsive, or comorbid presentations. Aims and Objectives: To systematically review and narratively synthesize available evidence regarding pharmacological interventions for behavioral addictions as mentioned in background Materials and Methods: A PubMed/MEDLINE-based literature search identified 104 potentially relevant records related to behavioral addictions and pharmacological therapy. Out of these, 24 human studies focusing exclusively on pharmacotherapy, including randomized controlled trials (RCTs), open-label studies, observational studies, retrospective studies, case reports/series, systematic reviews, and treatment guidelines were evaluated. Owing to substantial heterogeneity in diagnostic criteria, interventions, outcome measures, and study methodologies, findings were synthesized narratively rather than quantitatively. Results: The strongest evidence was identified for gambling disorder, particularly for opioid antagonists. CSBD demonstrated limited but clinically meaningful evidence for selective serotonin reuptake inhibitors (SSRIs) and naltrexone, especially in patients with obsessive-compulsive, anxiety-related, or reward-driven symptom profiles. In gaming disorder and internet-related addictions, bupropion showed the most consistent benefit. Evidence for other disorders remain weak or mixed. Conclusion: Pharmacological agents may provide adjunctive benefit in selected patients with severe craving, impulsivity, compulsivity, psychiatric comorbidity, or relapse despite psychotherapy. Larger, well-designed RCTs using standardized diagnostic frameworks and longer follow-up periods are required to clarify the role of pharmacotherapy across behavioral addictions.