Disorders of Impulse Control

Abstract

Reviewed in this chapter are the research and theory concerning conditions that have in common deficits in impulse control, or disinhibitory psychopathology. Emphasized in particular are the substance use disorders and pathological gambling. Disorders of impulse control are prevalent in all societies and place high costs on the affected individuals, as well as their friends, family members, and often the rest of society. Because they often co‐occur within the same individuals, it is useful clinically and conceptually to understand their psychopathology from a common theoretical perspective. For each of the specific variants of disinhibitory psychopathology, there appears to be multiple etiological mechanisms that convey risk for their development. We have termed these mechanisms positive affect regulation, negative affect regulation, pharmacological vulnerability (in the case of substance use disorders), and deviance proneness. It seems likely that attention to these underlying mechanisms will permit a refinement of diagnosis and provide starting points for new approaches to prevention and treatment. Considered as well are pathologies and etiologies recognized within the research and clinical literature to be specific to individual substance use and pathological gambling disorders.

Religion/spirituality, risk, and the development of alcohol dependence in female twins.

“…All significant risk factors accelerated onset; these included parental divorce or separation, psychiatric disorders (ADHD, CD, MDD, PTSD), and trauma. These findings are consistent with the general alcoholism literature (Zucker et al, 1995), and are specifically documented in the alcohol use onset literature (Maggs & Schulenberg, 2006; McGue, Iacono, Legrand, & Elkins, 2001; McGue, Iacono, Legrand, Malone et al, 2001), and the alcoholism etiology literature (Sher, Slutske, Stricker, Widiger, & Weiner, 2003; Zucker & Gomberg, 1986). Concerning R/S, the strongest effect was for religious attendance, which robustly delayed the age of first drink.…”

‘Being sick a lot, often on each other': students’ alcohol-related provocation

“…Indeed, taken together our findings suggest that these ongoing and normalised environmental influences on medical students to consume alcohol when they otherwise might not and to drink more than they would normally do could place some people more at risk of developing a dependency on alcohol during their student years, particularly if they are light to moderate drinkers 53 and experience a positive reinforcement for their drinking behaviour. 54 Further longitudinal studies are needed to shed light onto whether this is an issue.…”

Alcohol Milestones, Risk Factors, and Religion/Spirituality in Young Adult Women

“…The goal of the current study was to more precisely characterize the relationship between R/S variables and risk factors identifi ed in current models of alcoholism etiology (Sher, 1991;Sher and Slutske, 2003) and their impact on the prevalence of fi ve alcohol use milestones. First examined was the relationship between alcoholism risk factors (four diagnoses: ADHD, ODD, CD, MDD; and four stressful life events: personal trauma, parental inconsistency in applying family rules, parent-child arguments, and marital separation or divorce) and alcohol outcomes in terms of fi ve key milestones (fi rst full drink, intoxication, regular drinking, heavy drinking, and alcohol dependence).…”

“…Furthermore, (a) "religiosity has a stronger relationship with substance use and abuse than with current or lifetime psychiatric symptoms or disorders" (Kendler et al, 1997, p. 327), (b) outcome research shows recovery to be sustained by ongoing R/S involvement (Booth and Martin, 1998), and (c) clinical treatment studies confi rm the effi cacy of alcoholism treatment programs with a spirituality component (such as the 12-step program) (Project MATCH Research Group, 1997). Of particular interest here is that a substantial literature shows R/S to be inversely associated with adolescent drinking; alcohol use disorders; drug use, abuse and dependence; and delinquency (e.g., Booth and Martin, 1998;Galanter, 2006;Jessor and Jessor, 1977).Adolescence and young adulthood include both the initial emergence of alcohol behaviors and the period of highest alcohol risk (Galanter, 2006), and the alcoholism etiology literature (Sher and Slutske, 2003;Sher et al, 2005) indicates that psychiatric conditions, trauma, and diffi cult family relations are key contributors to alcohol behavior etiology (Windle and Windle, 2006). Although R/S has been shown to be inversely associated with alcohol behavior and its risk factors, some have argued that R/S effects are largely indirect effects through other factors (Mason and Windle, 2002).…”