Treatments for Pathological Gambling and Other Impulse Control Disorders

Abstract

Several controlled outcome studies (Type 1 and Type 2) suggest that specific behavioral (e.g., cognitive-behavioral therapy [CBT]) and pharmacological (e.g., naltrexone, nalmefene, lithium) treatments significantly reduce the symptoms of pathological gambling in the short term compared with wait-list or placebo. Although long-term effects of manual-based CBT have been observed in several small studies, the long-term benefits of pharmacological treatment have not been adequately tested. No studies combining behavioral and pharmacological therapies have been published to date. Thus, the potential benefit of combining behavioral and drug treatments for pathological gambling remains to be investigated systematically. Although several studies (Type 1 and Type 2) suggest that CBT is effective for trichotillomania, pharmacological treatment studies for this disorder have shown mixed results. Similarly, controlled pharmacological studies (Type 1 and Type 2) of compulsive buying have demonstrated mixed results. Limited treatment studies exist for other impulse control disorders (kleptomania, intermittent explosive disorder), although various pharmacological and psychological treatments have shown promise in uncontrolled studies.