Impulse Control Disorder
How it Relates to Substance Abuse
To live comfortably in our society, we have to exercise a certain level of control over our behavior. This means refraining from activities that that are dangerous to ourselves or others, like heavy drinking, drug abuse, uncontrolled gambling, violent outbursts and theft.
Although these behaviors may provide some form of pleasure or release, pursuing them will harm us on a physical, mental and social level. We could suffer legal or financial problems, lose our most important relationships and lose our jobs.
Impulse control disorders interfere with the ability to resist certain urges. The American Journal of Psychiatry has identified a number of disorders that fall into this category:
- Pathological gambling: an addictive attachment to games that involve money
- Intermittent explosive disorder: a pattern of violent, uncontrolled episodes
- Pyromania: an obsession with starting or observing fires
- Kleptomania: compulsive theft of others’ belongings
- Trichotillomania: compulsive hair-pulling
Sex addiction, compulsive shopping and Internet addiction have been added more recently to the list of common impulse control disorders, or ICDs. ICDs often go hand in hand with other psychiatric conditions, such as substance use disorders, attention deficit hyperactivity disorder (ADHD) and anxiety disorders.
The Dangers of Substance Abuse
Substance abuse is a common problem among people with ICDs, who have trouble resisting the desire to harm themselves or others. Impulsivity itself is a sign of addiction, which is characterized by a loss of control over a self-destructive behavior. Some people who suffer from ICD use alcohol or drugs in order to manage destructive impulses. A person with sex addiction, for instance, may numb her compulsive desire with alcohol or tranquilizers in order to avoid behavior that she perceives as more harmful. Substance abuse also arises as part of a pattern of impulsive behavior. A pathological gambler might develop an alcohol problem as a result of drinking heavily at casinos or bars. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the incidence of co-occurring pathological gambling and alcohol abuse may be as high as 44 percent. No matter how substance abuse begins, drinking and drug abuse almost always make impulsive behavior worse. Although drugs and alcohol may initially make an impulse seem more manageable, these substances actually lower your inhibitions and weaken your judgment, making it even harder to practice effective coping skills in high-risk situations. In some cases, the combination of substance abuse and impulsivity can be tragic. According to the Mayo Clinic, people with substance use disorders have a higher risk of intermittent explosive disorder, a condition that causes episodes of aggression that are out of proportion to the circumstances. When drugs or alcohol fuels these episodes, the results can be devastating, even fatal. Like substance abusers, people with intermittent explosive disorder often have a history of being physically or sexually abused in childhood.
More on Impulsive Disorders
The Stages of Impulsivity
By definition, impulsive behavior seems fast, careless and uncontrolled. When you’re in the grip of an impulse, you may feel powerless to stop the urge to do something risky. But the Journal of Neuropsychiatry emphasizes that impulsivity actually has five behavioral stages:
- The impulse arises
- Internal tension increases
- Action on the impulse brings pleasure
- A sense of relief follows
- Guilt or remorse replace pleasure and relief
Not everyone who acts on an impulse experiences stage 5: guilt and remorse. Some people with an ICD feel nothing but a sense of release after they’ve carried out their desire. Others may try repeatedly to stop the behavior, only to relapse again and again. In this sense, impulsivity and addiction are identical. Addiction is defined as a disease of relapse, in which the victim tries many times to quit without success.
Breaking down impulsive behavior into stages makes the impulsive drive seem more manageable. Therapeutic strategies like cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) address the problem of impulse control by helping the individual manage destructive urges in their early stages. Practices like mindful thought and meditation are used today in some of the top drug rehab programs to help addicts respond constructively to their cravings and control the urge to drink or use.
Impulsivity, Addiction and the Brain
A study of impulsivity and addiction reveals that people with impulse control disorder share certain traits with chronic substance abusers. Biochemical Pharmacology proposes that there is a relationship between impulsivity, addiction and the brain’s production of dopamine, a neurotransmitter that controls feelings of pleasure and satisfaction. Low levels of dopamine may increase the risk of impulsive, high-risk behavior like gambling, drinking, anonymous sex and drug abuse. Other neurotransmitters that affect pleasure and impulse control, including GABA and serotonin, have been linked to impulsive behavior, as well. Because chemical imbalances in the brain have a genetic component, there may be a hereditary relationship between impulse control disorders and substance abuse. Neurological studies of individuals with pathological gambling disorder show deficiencies in the areas of the brain that control decision making, planning and impulse control. People with substance abuse disorders and ICDs typically do poorly on tests that measure the ability to delay gratification. This may be related to damage or decreased blood flow in areas of the cerebral cortex, which controls higher reasoning and judgment.
Help for Impulse Control Disorders
Impulse control disorders can have a negative impact on your quality of life. Pathological gambling, compulsive shopping and sex addiction can be emotionally and financially devastating. Intermittent explosive disorder, kleptomania and pyromania can lead to a host of legal and interpersonal problems. Because substance abuse is so often a factor in impulsive behaviors, individuals with impulse control disorders are vulnerable to the health risks of addiction:
- Heart disease
- Heart attack
- Respiratory disease
- Liver disease
- Certain forms of cancer
An ICD combined with substance abuse can increase the risk of suicide attempts, accidental injuries and death by homicide.
The U.S. Food and Drug Administration (FDA) has not approved any specific psychiatric medications for the treatment of impulse control disorders. However, the Psychiatric Times notes that antidepressants that affect serotonin transmission may be effective at treating these disorders. Minnesota Medicine adds that naltrexone, a drug used to help opioid addicts manage their cravings, has been used effectively to help pathological gamblers control their urges. Anti-seizure medications, anti-anxiety drugs and mood-stabilizing medications have been used in the treatment of intermittent explosive disorder. Along with psychiatric medications, other strategies used to treat ICDs include talk therapy, group therapy and behavioral modification. Cognitive behavioral therapy and dialectical behavioral therapy, which emphasize the individual’s ability to manage impulses, have been used successfully in treatment. When an impulse control disorder and a substance use disorder occur at the same time — a condition called a dual diagnosis — special treatment is needed to address both illnesses. Integrated treatment programs involve intensive drug or alcohol rehab combined with therapy for a co-existing psychiatric disorder.
At Futures of Palm Beach, we provide a full range of rehabilitation services, with an emphasis on treating dual diagnosis clients. Our services include detoxification, intensive psychotherapy, group therapy, psychosocial education, family counseling and recovery coaching. We also provide complementary therapies such as biofeedback, hypnotherapy and physical training. After completing our program, you’ll be supported in your recovery through our comprehensive aftercare plan. To learn more about our fully integrated treatment plans, call our supportive admissions counselors for a confidential consultation.