Impulse Control Disorder (ICD) and Substance Abuse

Substance abuse and impulse control disorders share many of the same traits, but recent research has found that they are not the same thing. Knowing the difference between the two and how to manage a co-occurring disorder could help save you or a loved one’s life.

Impulse control disorders (ICDs) and substance abuse are linked in two primary ways. First, ICDs—or behavioral addictions—share many characteristics with substance-abuse traits, according to the National Center for Biotechnology Information.

Some of these commonalities include:

  • Phenomenology, referring to “urges,” cravings, intoxication (getting “high”), and withdrawal.
  • Natural history, or a person’s chronic behavior or substance use, often resulting in relapse and/or an increase in, and higher incidence of, use or behavior.
  • Tolerance, resulting in an increase in use or behavior.
  • Response to treatment, with similar response rates and tendencies to failure or relapse.
  • Nature and nurture, which includes environment and family history, including family substance abuse, physical abuse and genetic factors.

Second, people with ICDs very often suffer from substance abuse, although disagreement exists as to the cause-and-effect order (i.e., are substance abusers more likely to develop ICDs, or are behavioral disorders the cause of substance abuse?). Conversely, then, many people who are substance abusers present with various forms of ICDs. Twenty to 50 percent of people suffering from ICDs also abuse drugs, according to Frontiers in Psychiatry.

A 2017 report by the UCLA Dual Diagnosis Program (citing a 2012 University of Cambridge study) actually was titled “Which Comes First: Addiction Or Impaired Impulse Control?” The article concluded that,

“Although this study does not definitively answer the question as to which comes first – and obviously not all people with impaired impulse control become addicts – diagnosing these abnormal brain patterns at an early age may fa(c)ilitate education and intervention that could prevent or decrease the incidence of addiction.”

The National Center for Biotechnology Information concluded that evidence exists to support three separate theories of the relationship between drug abuse and impulse-control problems, including: 1) increased levels of impulsivity lead to drug abuse; 2) drug abuse increases impulsivity; and 3) impulsivity and drug abuse often are associated with a common third factor (such as family history).

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What Are Impulse Control Disorders?

Although no consensus exists as to what constitutes an ICD, some agreement has been reached on some common behavioral impulse conditions.

Some common traits among ICDs include:

  • Repetitive behavior, even in the face of repeated and severe negative consequences.
  • Loss of, or diminished control over, impulsive and problematic behavior.
  • The sensation of urges or cravings prior to the impulsive actions.
  • Pleasure, often euphoric, experienced while participating in, and following, impulsive behavior.

These traits exist independent of any substance-abuse issues, although the similarities between the ICD behavior and drug abuse are evident.

As far as the types of conditions that constitute an ICD, there again is disagreement, usually regarding the severity of impulsive behaviors and the amount of research that has been conducted.

The Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) recognizes the following conditions as meeting criteria for ICD behavior:

  • Gambling—Referring to pathological gambling, men engage in this behavior much more frequently than women and begin at a younger age. Alcohol abuse is commonly associated with pathological gambling, although research indicates that the ICD behavior is more frequently the cause, rather than the result, of alcohol use. Pathological gambling is by far the most researched of ICDs.
  • Kleptomania—This impulsive “need” to steal is divorced from any real “need,” but is associated with an impulsive, uncontrollable urge to do so, usually for no tangible reason like stealing food because a person’s hungry. As many as 75 percent of kleptomaniacs are female.
  • Trichotillomania—Although relatively rare—occurring in only about 0.5 to 3.9 percent of the U.S. population—trichotillomania refers to repetitive hair-pulling, usually resulting in significant hair loss. Females account for more than 90 percent of cases. Fifteen to 20 percent of trichotillomania sufferers also abuse drugs or alcohol.
  • Intermittent Explosive Disorder (IED)—Characterized by outbursts, often violent, these episodes are out of all proportion to the triggering device, such as road rage. Usually referred to as “temper tantrums” in children, intermittent explosive disorders in adults can often be predicted in childhood, although there is no guarantee that children displaying such behavior will necessarily develop a corresponding adult ICD. A high correlation exists between IED behavior and substance abuse, as high as 50 percent in men.
  • Pyromania—Intentional fire-setting is more common among men, typically beginning in childhood, and is accompanied by substance abuse in one-third of cases.

The DSM doesn’t officially recognize other conditions put forth by some health professionals as ICDs, although research is inchoate and ongoing. These include pathological skin picking, compulsive buying, love addiction, excessive tanning, and compulsive sexual behavior.

Root Causes

As discussed previously, impulse control disorders and substance abuse share common traits, but root causes may or may not co-exist. Again, the exploring the chicken-and-egg syndrome is paramount when diagnosing and treating ICDs, substance abuse, or co-occurring disorders. At one point, substance abuse itself was considered a type of impulse control disorder, although that theory has been debunked in favor of the disease model.

A convincing argument that ICDs are biological or genetic in nature are studies conducted on subjects who have no history of substance abuse yet present behavior problems. Most of these studies necessarily involve young people or children, although studies involving adult non-users have been performed. For example, in a study cited by the National Institute on Drug Abuse, it was reported that “the fact that siblings without drug problems also had impaired self-control offers strong evidence that these brain abnormalities are inherited, but not deterministic.”

The Journal of Neuroscience, in a 2016 article, concluded that, “Impairments in cognitive control underlie extreme forms of sensation seeking, impulsivity, and substance use in patient populations.” Although the article focused on relationships between impulse control, sensation seeking and the cortical thickness of the brain (especially the reduction in cortical thickness), it summarized that, “the relations between sensation seeking and brain structure were evident in participants without a history of alcohol or tobacco use, suggesting that observed associations with anatomy are not solely a consequence of substance use. These results demonstrate that individual differences in the tendency to seek stimulation, act on impulse, and engage in substance use are correlated with the anatomical structure of cognitive control circuitry.”

Of course, this conclusion does not negate the possibility that substance abuse in adults can and does result in impaired impulse control, as well as physiological changes that mimic what otherwise would be identified as genetic or biological in nature. In other words, in adults suffering from both ICD behavior and substance-abuse problems, it’s difficult to determine which is the cause and which is the effect (if any such distinction exists). Such a determination can only be reached if a subject is studied from childhood (pre-drug use) through adulthood (present- or post-drug use).

Despite the chicken-and-egg conundrum, the co-existence of ICDs and substance abuse may lead to increased risks and complications for both disorders.

Don’t Wait If You Think You Need Help

If you think you’re suffering from either an ICD or a substance-abuse problem—or perhaps from both—don’t hesitate to contact us. We’re here at to help you navigate your way through the treatment and recovery process. Contact us today.

National Center for Biotechnology Information - The role of impulsive behavior in drug abuse

Frontiers in Psychiatry - Impulse Control Disorders: Updated Review of Clinical Characteristics and Pharmacological Management

UCLA Dual Diagnosis Program - Which Comes First: Addiction Or Impaired Impulse Control?

National Institute on Drug Abuse - Self-Control Deficits Linked to Drug Abuse Precede Drug Exposure

The Journal of Neuroscience - Individual Differences in Cognitive Control Circuit Anatomy Link Sensation Seeking, Impulsivity, and Substance Use

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