Reader’s Question

I recently read an article on impulse control disorder. I am a compulsive gambler. I go gambling approximately once a month and spend around $1000. Trust me, I don’t have the money. If I lose, I feel this unstoppable need to steal something. It’s always small, but nonetheless, it’s stealing.

I have recently attained my bachelor’s in social work. I wanted to go on for my master’s in counseling, but I fear if I can’t help myself, I won’t be able to help others. I also have problems keeping a job. My anxiety overtakes me. I truly want to be able to help others.

Can you tell me what I can do for this disorder and what medications work the best?

Our Clinical Psychologist’s Reply

If an individual has an impulse control disorder, they experience an irresistible urge to engage in an act that is potentially quite harmful to themselves or others. Despite knowing the risks of engaging in the behavior, the person feels increasing tension, anxiety, and arousal before committing the act and then a sense of relief or release once the act is performed. Sometimes, they feel regret or remorse, especially if the act results in some damage, but despite this recurring urges to engage in the act persist. Kleptomania (recurring urge to steal) and Compulsive Gambling are two of the more common impulse control disorders.

Some medications such as the selective serotonin reuptake inhibitors (SSRIs) and the mood-stabilizing medications such as Depakote have proven helpful at times assisting persons gain better control over such disturbing impulses. Behavior therapy is also very helpful in both minimizing the degree of pre-act anxiety and arousal as well as post-act relief and release. Removing the pleasurable or reinforcing aspects of the problem behavior is a most important part of helping a person gain better control over their impulses. Cognitive-Behavioral Therapy (CBT) adds a cognitive component to behavior therapy by examining the distorted beliefs (e.g., “I can stop this if I really want to”), challenging those beliefs, and replacing the beliefs that foster continued uncontrolled conduct with thoughts and beliefs that foster increased impulse control.

Individual and family counseling can help bolster other therapeutic measures as can participation in self-help groups and programs.

It is best to seek advice from a specialist in the area of impulse control and addictive behavior disorders and to develop a multifaceted plan of attack. The added payoff for re-establishing control over one’s impulses is an increased sense of self-efficacy and worth.