Impulse Control Disorder & Substance Abuse

An impulse control disorder can show up as any number of different behaviors, such as pathological gambling, explosive anger, or chronic shopping. These behaviors often do not feel like a choice, and the results can be devastating.[2] 

To manage stress, those who live with an ICD may turn to substances. This can cause further problems if use becomes impulsive. 

When both disorders are present, comprehensive treatment for co-occurring disorders is needed. 

What Causes Impulse Control Disorder?

There isn’t a single cause of impulse control disorder. In most cases, a combination of factors contribute to the problem, such as these:

Genetic Factors

There are a handful of genes that have been identified as being linked to impulsivity.[3,4] While impulsivity in and of itself is not a sign of a disorder since it can be helpful in situations that require fast decisions, it can be maladaptive as is the case with ICD.

Brain Structure & Function

Neurobiological factors could play a role in the ability or inability to manage impulsive decision-making. Specifically, abnormalities in specific brain regions and imbalances of neurotransmitter levels (such as serotonin or dopamine) can be problematic.[5]

Psychological Factors

Experiences of trauma especially during childhood may have a huge effect on one’s ability to control impulsive behaviors.[6] People who have endured abuse or neglect may develop maladaptive coping mechanisms, leading to impulse control issues.

Personality Traits

People who often seek out high-adrenaline or high-risk activities may be more likely to develop an impulse control disorder. This personality trait of “sensation seeking” is often seen in adolescents who also struggle with controlling impulsive behaviors.[7] 

Environmental Factors

Certain environmental stressors — such as chronic anxiety, financial difficulties, or high-stress living arrangements that create a sense of instability — may intensify impulse control issues in some people. In fact, any high-stress environment may contribute to difficulties managing impulses. 

Substance Abuse

Substance abuse, particularly long-term use of certain substances, can impair judgment and lead to impulsive behaviors. When the result of those behaviors is higher stress levels, the person may turn to substances to feel better. This can then again trigger the impulsive behaviors that cause stress, creating an ongoing cycle of substance abuse and further problems. 

Neurological Disorders

Certain neurological conditions and injuries to the brain can make it harder to manage impulse control. Frontal traumatic brain injury (TBI) or other lesions in the brain can alter brain functioning in such a way that the person may be more likely to follow their impulses and engage in harmful behaviors.[8]

Types of Impulse Control Disorder 

Impulse control disorders are mental health conditions that are characterized by the inability to resist the urge to engage in a behavior that could harm oneself or others.[2] 

There are many different types of ICDs, including these:[2,9]

Intermittent Explosive Disorder (IED)

Individuals with IED experience episodes of impulsive aggression, which manifest as verbal or physical outbursts that are disproportionate to the provocation, and ultimately result in harm to themselves, others, or property. For example, someone with IED may respond to someone accidentally bumping into them by screaming at them and starting a physical altercation.

Kleptomania

Kleptomania refers to the inability to resist impulses to steal items that do not serve a personal need or are of little or no financial worth, often without premeditation and for no tangible gain. The theft occurs through impulse — that is, without thinking through the possible consequences.

Pyromania

Pyromania, also known as fire-starting compulsions or episodes, involves starting fires deliberately to relieve tension, gain pleasure, or provide an emotional release. This does not include those who set fires for financial gain, revenge, or political ideology.

Pathological Gambling

Pathological gambling also referred to as gambling disorder, refers to persistent problematic gambling behaviors that cannot be managed despite causing serious personal, social, or financial ramifications.

Hair Pulling Disorder

Trichotillomania involves compulsively pulling out one’s hair. It’s a problem that becomes so extreme that it causes noticeable hair loss. While pulling out hair may help relieve anxiety or tension, this act often creates great distress for the person living with the disorder.

Skin Picking Disorder

Excoriation disorder, also known as skin picking disorder, involves repetitive picking at the skin despite knowing that it will lead to lesions or wounds that won’t heal or scarring.

Compulsive Shopping 

Compulsive shopping, also called oniomania, is defined as an uncontrollable urge to spend money excessively and acquire items that are not necessary. The act leads to extreme financial problems and emotional strain despite a brief emotional release experienced initially.

Understanding the Connection Between Substance Abuse & Impulse Control Disorder

The relationship between SUD and ICD is complex. Individuals with substance abuse issues may exhibit impulsivity, but not all individuals with substance abuse problems have a diagnosed impulse control disorder. 

Here’s how these two conditions can be connected:[1,5]

Impulsivity

Both substance abuse and impulse control disorders involve impulsivity or acting on urges or desires without consideration of the long-term potential negative consequences. With substance abuse, impulsivity translates into spontaneous abuse of drugs or alcohol despite known risks.

Co-Occurrence & Comorbidity

It is common for people who are living with a substance use disorder to also struggle with an impulse control disorder. Not only do they tend to compulsively use drugs or alcohol, but they are also more likely to engage in compulsive acts of aggression, gambling, binge eating, shopping, and other behaviors. 

Shared Neurological Factors

Neurological components that promote impulsivity and impair decision-making can be seen both in substance use and impulse control disorders. An imbalanced regulation of neurotransmitters such as dopamine is commonly present with both conditions, leading to reward processing delays as well as impulsive behaviors. 

Shared Treatment Approaches

Cognitive behavioral therapies and treatments that address impulse control issues may prove helpful for people who want to overcome the compulsive use of substances drugs and alcohol. Both conditions benefit from learning better-coping mechanisms and promoting positive lifestyle changes.

Most Common Drugs Abused by Those With Impulse Control Disorder

People living with an impulse control disorder may use any number of substances based on their preferences and what is available to them. However, some common substances of abuse for people with ICD include the following:[3,10-12] 

Alcohol

Alcohol is one of the most commonly abused substances in the U.S. due to its prevalence in our culture and ease of availability. For many, alcohol is incorporated into the impulsive behavior. For example, those who struggle with problem gambling generally have alcohol available to them at casinos or parties where they gamble.

Stimulants

Stimulants, like cocaine or meth, can fuel impulsive behaviors. These drugs can also worsen episodes of anger that occur with ICD.  

Opioids

Opioids produce feelings of euphoria and emotional numbing that often intensely appeal to those dealing with impulse control.

Marijuana

Marijuana can temporarily relieve stress and anxiety, providing a sense of relaxation. Additionally, it may be a part of the ritual for those engaging in impulsive behaviors like shopping or gambling.

Benzodiazepines 

Similar to opioids and marijuana, the use of sedatives or benzodiazepines like Xanax or Valium can offer relaxation to those dealing with stress related to impulsive control issues.

Treatment for Impulse Control Disorder 

Treatment for an impulse control disorder should involve a combination of elements, including therapy, medication, lifestyle modifications, and long-term support. The specifics will vary depending on the individual’s triggers, co-occurring disorders, and personal variables.

These are some of the most common treatments for ICD:[2,9,13-15]

Psychotherapy

Many forms of psychotherapy can be beneficial for ICD. These two often work best:

Cognitive Behavioral Therapy 

Cognitive behavioral therapy (CBT) can be highly effective for individuals living with ICD. This approach helps people to recognize and alter negative thought patterns that lead to impulsive choices.

Dialectical Behavior Therapy (DBT)

Dialectical behavior therapy (DBT) can be especially helpful for individuals struggling to regulate emotions and control impulses.

Medication

Because mood can play a large role in triggers for impulsive behavior, SSRIs like fluoxetine and sertraline may help by controlling serotonin levels within the brain.

Similarly, mood-stabilizing medications may help to smooth extreme ups and downs, which can limit acts of impulsivity in some individuals. Antipsychotic medicines like aripiprazole or risperidone may be prescribed to lessen aggressive or impulsive behaviors in some situations.

Skills Training

Teaching individuals specific tools to manage the urge to engage in a problematic behavior as well as the thoughts and emotions that may trigger those choices is a key factor in a comprehensive ICD treatment program. Such techniques may include teaching anger management strategies, problem-solving abilities, communication techniques, and mindfulness practices.

Support Groups

Support groups that focus on impulse control and related issues can provide both community support and additional coping mechanisms as well as a safe space to work through challenges.

Lifestyle Changes

Prioritizing self-care can improve mental health and emotional wellness, which can decrease the feelings of discomfort that may trigger impulsive behaviors. Focus on getting daily exercise, a balanced diet, and sufficient sleep.

Substance Abuse Treatment

Addressing co-occurring substance abuse is of utmost importance for people living with an ICD, as substance use generally exacerbates impulsive behavior. If you have both a substance use disorder and an ICD, treatment for co-occurring disorders is needed. Both disorders are treated simultaneously to ensure recovery on both fronts.