The Association Between Impulsivity and Relapse in Patients With Alcohol Use Disorder: A Literature Review

Abstract

Aim Impulsivity has been identified as a key relapse risk factor in patients with alcohol use disorder (AUD); however, the inherent characteristics of this relationship have been largely understudied. The heterogeneity of AUD and variation in impulsivity constructs require careful consideration to inform future work examining the relationship. This study sought to review empirical findings examining facets of impulsivity and AUD relapse. Methods A systematic search strategy was employed to capture studies on impulsivity measures related to AUD relapse. Impulsivity measures were qualitatively organized in terms of ‘trait impulsivity’—typically measured by self-report questionnaires—and ‘behavioural impulsivity’, i.e. ‘motor impulsivity’, ‘impulsive choice’ and ‘reflection impulsivity, assessed with cognitive–behavioural tasks. Results Seventeen peer-reviewed papers were identified. Relapse outcomes varied substantially in relation to impulsivity measures. Twelve papers included aspects of ‘trait impulsivity’, and nine studies included ‘behavioural impulsivity’ measures, from which five studies dealt with the ‘impulsive choice’ subcategory. The Barratt Impulsivity Scale was the self-report questionnaire that was most frequently used. Conclusions All three included facets of impulsivity (‘trait-, motor- and impulsive choice impulsivity’) were associated with AUD relapse, but none seemed to be superior to another. This study confirmed that research on the relation between impulsivity and AUD relapse is relatively scarce. Future research and treatment options are proposed.

Association of impulsivity with quality of life and well‐being after alcohol withdrawal treatment

“…One factor that has repeatedly been associated with lower rates of abstinence (Sliedrecht et al, 2020)— and, thus, might be an important leverage point for treatments—is self‐reported impulsivity. Self‐reported impulsivity seems to be a multidimensional construct (MacKillop et al, 2016), including a) immediate, thoughtless reactions to cues, b) not being able to stay focused on a (complex) task, and c) not considering potential consequences or planning‐ahead, especially in light of emotional experience.…”

“…From a neurobiological perspective, impulsivity is often ascribed to a hyperactivity of the bottom-up network evoking reflexive responses (e.g., automated approaching to substance cues in expectation of reward) and the antagonistic hypoactivity of the top-down network responsible for reflective processes (e.g., considering longitudinal consequences, inhibiting automated responses; see e.g., Kozak et al, 2019). These processes may result in a lack of inhibition of substance-seeking behavior and may, thus, account for the relation of impulsivity to craving (Coates et al, 2020), relapse (Sliedrecht et al, 2020(Sliedrecht et al, , 2019, and substance use (Hershberger et al, 2017). Excessive substance use, in turn, may increase the imbalance of bottomup and top-down processes described above (Volkow et al, 2019).…”

Desire thinking as an underlying mechanism in alcohol use disorder and nicotine dependence

“…Evidence has also shown that inducing negative affect increases alcohol craving (Bresin et al, 2018). Impulsivity, which is defined as a behaviour engaged in without thinking and planning, is also a core component of AUD and nicotine dependence (Kale et al, 2018; Szczypiński et al, 2021) and is strongly associated with both alcohol and nicotine craving (Billieux et al, 2007; Coates et al, 2020) so that it impairs cognitive control (Zaso et al, 2021) and leads to relapse (Pettiford et al, 2007; Sliedrecht et al, 2021). Importantly, individuals with increased impulsivity tend to use alcohol and nicotine to cope with negative affect (Herman & Duka, 2019; Spillane et al, 2013).…”

Impulsivity and alexithymia predict early versus subsequent relapse in patients with alcohol use disorder: A 1‐year longitudinal study

“…Several features, such as alcohol use severity, high levels of craving, comorbid substance use and psychiatric disorders, and co-existing medical conditions have been related to relapse in the first months after treatment [3,4]. Additionally, certain psychopathological traits, such as impulsivity (a predisposition towards rapid, unplanned reactions to stimuli despite negative consequences), alexithymia (the difficulty in identifying and describing feelings) and dissociation (described as a discontinuity in the normal integration of consciousness), are common in AUD patients and contribute to detrimental outcomes [4]. However, possible variations over time of the impact of these predictors on the risk of relapse are still unclear.…”