Presents a case report of a 58-year old man with alcohol dependence in remission, depression, and a 4-year history of pathological gambling presented to a clinic for the treatment of gambling. His gambling started after the initiation of pramipexole to control leg spasm and restless leg syndrome. He took pramipexole more than prescribed as it significantly reduced his physical symptoms. This led to more gambling and adversely affected his business, self-esteem, family relationships, and finances. Clonazepam was switched back to pramipexole, which was more effective for restless leg syndrome. He abstained from gambling during the next 12 months of follow-up while receiving monthly injectable naltrexone and taking pramipexole. He abstained from alcohol during the treatment, and his depression, treated with citalopram, remained relatively stable. This case indicates that injectable naltrexone may successfully control gambling cravings and behaviors.