The aripiprazole and gambling link, and why this particular study is weak evidence for it
Swedish national registers found an odds ratio of 3.4. They could not show which came first.
Reasonable evidence with real limitations. how we score evidence
Caveat on this rating: One author holds a position at Lund University funded by AB Svenska Spel, the state-owned Swedish gambling operator, as part of its responsible-gambling policy, and reports research funding from the same source alongside public research councils. The conflict is with the outcome being studied rather than with the drug, and it is disclosed in full in the paper. It is repeated here because a reader deciding how much weight to give a gambling finding should know who funds the chair that produced it.
Aripiprazole acts on dopamine differently from other antipsychotics, and reports of new compulsive gambling on it have accumulated for years. Swedish researchers took every person in the country diagnosed with pathological gambling between 2005 and 2019 — 3,689 people — matched each to two people of the same age and sex from the general population, and looked at what had been prescribed to all 11,067.
Within the subgroup who had schizophrenia or a related psychotic disorder, an aripiprazole prescription was associated with a gambling diagnosis at an odds ratio of 3.4. Dopamine agonists like pramipexole and ropinirole showed a similar pattern, at 3.2.
Now the reasons to hold this loosely. The study has no time dimension: it can see that a person had both a prescription and a diagnosis, but not which came first, so it cannot show the medication preceded the gambling. The raw percentages in the paper look alarming — 88.8% against 71.2% — but that is an artefact of how the sample was built, since a third of it has gambling disorder by design; the odds ratio is the number that means something. And the subgroup the aripiprazole result comes from is small and heavily selected.
This is a signal, consistent with a lot of case reports and with the drug's pharmacology. It is not proof, and the study design is the reason why.
Worth asking
Has anything about my spending, gambling, shopping or sexual behaviour changed since I started this, and is that something we should be tracking.
What it is FDA approved for
Read off the label. Trial duration and approval year are shown only where they were recorded — never inferred.
- Schizophrenia (adults and adolescents 13-17)
- Bipolar I disorder, acute and maintenance treatment of manic and mixed episodes, monotherapy or adjunct to lithium/valproate (adults and ages 10-17)
- Adjunctive treatment of major depressive disorder (adults)
- Irritability associated with autistic disorder (ages 6-17)
- Tourette's disorder (ages 6-18)
- Agitation associated with schizophrenia or bipolar mania (injection, adults)
Source
Increased risk for developing gambling disorder under the treatment with pramipexole, ropinirole, and aripiprazole: A nationwide register study in Sweden — Wolfschlag M, Håkansson A (2021)
Indexed peer-reviewed journal
Read the source: https://doi.org/10.1371/journal.pone.0252516
DOI: 10.1371/journal.pone.0252516
How this was scored
- Study design
- Cross-sectional study / survey
- Funding
- No external funding
- Published in
- Indexed peer-reviewed journal
- Sample size
- 11,067
- Preregistered
- No
- Conflicts disclosed
- Yes
- Independent of proponent
- Yes
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published August 5, 2026. Last verified August 19, 2026.
Questions
How strong is the evidence behind this?
Resolv rates this source "moderate evidence". Reasonable evidence with real limitations. It scores 64 out of 100 on our published rubric. One caveat travels with that badge: One author holds a position at Lund University funded by AB Svenska Spel, the state-owned Swedish gambling operator, as part of its responsible-gambling policy, and reports research funding from the same source alongside public research councils. The conflict is with the outcome being studied rather than with the drug, and it is disclosed in full in the paper. It is repeated here because a reader deciding how much weight to give a gambling finding should know who funds the chair that produced it. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Increased risk for developing gambling disorder under the treatment with pramipexole, ropinirole, and aripiprazole: A nationwide register study in Sweden — Wolfschlag M, Håkansson A (2021). Published in: Indexed peer-reviewed journal. DOI: 10.1371/journal.pone.0252516. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Cross-sectional study / survey. Funding: No external funding. The researchers were independent of whoever benefits from the result. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is aripiprazole (Abilify) FDA approved?
Yes — FDA approved for Schizophrenia (adults and adolescents 13-17), Bipolar I disorder, acute and maintenance treatment of manic and mixed episodes, monotherapy or adjunct to lithium/valproate (adults and ages 10-17), Adjunctive treatment of major depressive disorder (adults), Irritability associated with autistic disorder (ages 6-17), Tourette's disorder (ages 6-18), Agitation associated with schizophrenia or bipolar mania (injection, adults). Approval is for a specific indication, not for everything the drug is prescribed for.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.