Impulse control problems are common among people who abuse alcohol. When someone struggles with impulse control, they are unable to resist engaging in behaviors that cause them, or others, harm. Impulse control disorder (ICD) is a newly defined type of personality disorder.
ICD often co-occurs with alcohol abuse. An ICD called “intermittent explosive disorder” features bouts of rage, but there are other types of impulse control issues that might also be present in alcoholics. These might include compulsive gambling, pyromania, or kleptomania. But the ICD most present in people with an alcohol use disorder (AUD) is intermittent explosive disorder.
A study looking at patients who were enrolled in alcohol detox showed that 38% had a co-occurring ICD. Of those, 2/3 had intermittent explosive disorder. The next most common ICD in these study participants was a compulsive gambling. Drinking also involves compulsive behaviors, and the two disorders often coexist.
What is Impulse Control Disorder?
Impulse control disorder is a mental health disorder that features a problem with controlling behaviors. Early signs of the disorder may first emerge in childhood or the teen years with conduct disorder, ADHD, or oppositional defiant disorder. These show up as antisocial type behaviors that cause problems in school or with authority figures. About 10.5% of adults have an ICD. The disorder follows a cycle. There are increased urges or cravings that build up of tension when anticipating the act. This is followed by the impulsive act itself, and then a feeling of relief after the act is completed.
Types of ICDs include:
- Intermittent explosive disorder. This involves angry outburst against people, animals, or property. The person may have had a problem with a neighbor, family member, or stranger that triggers severe rage. The outbursts are short-lived, only lasting about thirty minutes.
- Compulsive gambling. Gambling becomes an ICD when the person cannot control the urge to keep gambling even when they want to quit. Compulsive gambling can cause severe problems in someone’s life. Alcohol abuse is common among males who engage in compulsive gambling.
- Pyromania. This is the act of repeatedly setting fires on purpose. The person is obsessed with fire and fire setting, and set fires as a way of releasing tension.
- Kleptomania. This involves compulsive stealing of items for no reason. The person may steal things from stores, and have no need or use for the items. They end up throwing it away or giving the item to others.
Treatment for an ICD is mainly focused on behavior-based therapies along with antidepressants.
Impulse Control and Co-Occurring Alcohol Abuse
Although impulse control and alcohol abuse are separate disorders, they do share common features. They are called co-occurring disorders, or the presence of both an SUD and a mental health issue like ICD. Data supports that many people with an ICD also suffer from substance abuse… with numbers as high as 50%.
As with other dual diagnoses, it is hard to pinpoint which disorder emerged first. Was it the SUD that led to the ICD or the other way around? Of course, not all who have an SUD have an ICD. Just as true is the fact that not all people with impulse control issues have an SUD.
When Alcohol Abuse Crosses Into an Alcohol Use Disorder
There is a risk of alcohol abuse morphing into a severe AUD when paired with ICD. The ICD itself, whether it is the sudden bouts of rage or constant gambling, may be relieved somewhat by drinking. As the cycle goes on, the risk increases that the person becomes dependent on alcohol.
Someone with an impulse control problem might find themselves facing harsh effects of their ICD. If it is coupled with an AUD then the problems are even more intense. These include:
- Legal problems. Setting fires on purpose, stealing goods from stores, or raging towards others can often result in a criminal offense.
- Money issues. Compulsive gambling can destroy someone’s finances.
- Relationship problems. Angry outbursts can harm a marriage and lead to divorce.
There are some telltale signs that an AUD is present. People that become dependent on alcohol will display warning signs of the drinking problem. These include:
- Obsessed about drinking and having alcohol on hand.
- Try to quit drinking and cannot.
- Increased tolerance.
- Withdraw from friends and family.
- Lose interest in activities once enjoyed.
- Drinking more and more as tolerance increases.
- Mood swings.
- Lie about how much is being consumed.
- Decline in hygiene.
- Problems with concentrating.
- Sleep disturbance.
- Alcohol cravings.
- When not drinking withdrawal symptoms emerge.
Clearly, the more AUD signs present, the more severe the AUD is.
Dual Diagnosis Treatment
Someone struggling with both an AUD and ICD will need a program that provides dual diagnosis treatment. This means that mental health support is offered as well as the treatment for an AUD. Treatment for a dual diagnosis is complex, and includes these elements:
- Detox support. Before treatment can proceed, the person must first complete alcohol detox.
- Psychotherapy. Evidence-based therapies are a core treatment element for a dual diagnosis. Therapies that help both the ICD and the AUD include CBT, DBT, and CM.
- Group therapy. Group support is central to the rehab program. These small group sessions offer peers to bond while in treatment through sharing with each other.
- Medication. SSRIs may be prescribed for managing the symptoms of the ICD.
- Recovery meetings. 12-step or SMART Recovery meetings are a source of social support and also learning from others.
- Psycho-social skills. Treatment for a dual diagnosis includes preparing the client to manage stressors. Classes teach them how to better manage their mood states, how to resolve conflicts, and how to tamp down anger.
- Complementary activities. A holistic approach to dual diagnosis treatment includes experiential activities such as mindfulness meditation, art and music therapy, therapeutic massage, acupuncture, and yoga.
Bodhi Addiction Treatment and Wellness for Dual Diagnosis
Bodhi Addiction Treatment is a recovery program that helps people overcome alcohol use disorder with a mental health issue such as impulse control. Our program is a holistic one, helping clients achieve both sobriety and mental wellness. For more details about our program, please reach out today at (877) 328-1968.