The Difference Between Alcoholism and Impulse Control Disorder

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The Difference Between Alcoholism and Impulse Control Disorder

By Brian Whitney 12/13/15

For many alcoholics, it's the booze itself that they depend on. Others have a different sort of drinking problem, one that isn’t quite so easy to figure out.

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It goes without saying that there are those who have drinking problems who are dependent on alcohol. Whether psychologically or physically dependent, the issue at hand is the booze itself. You know you are an alcoholic, and so does everyone else in your life.

Others have a different sort of drinking problem, one that isn’t quite so easy to figure out. They might only drink once a month, or maybe even just a couple of times a year. But when they drink, everyone better look out. They say they are going out for a couple of drinks, but instead they end up having ten. They tell you they are going to be home by seven, but they come home at two in the morning, if at all. They become reckless or argumentative. Some even become violent. There seems to be nothing these people won't do when drinking. They fight, they argue, they cheat on their spouse, they get behind the wheel and drive when they are hammered. Pretty much every decision they make when drinking is in the opposite of their, and society's, best interest.

Basically, being one of these people, or being around these people, is a bad time. Things are going great, all is cool, a good time is being had by all. Then, all of a sudden, the person you have been having a few beers with turns into a werewolf. 

Some of these people are just plain old bad drinkers who can’t handle any amount of alcohol well, but many are afflicted with impulse control disorder. I know a fair amount about this because I have it myself. I also know that if I throw a lot of booze in the mix (and I do mean a lot) I can become a lunatic completely lacking in morals and will make bad decisions all night long.

There is often that moment during a night out when a certain type of man thinks something like, “Well I would really like nothing better than to get really drunk tonight and have sex with that woman over there, and then just not go home to my wife. Now that I think of it, I am not going to go to work tomorrow either. I hate my job. I am so tired of all of this. Time to blow it up.” But at some point, even when drinking, most people will think, “But I might get fired if I don’t go to work, and my wife will kick me out if I don’t go home, and you know I kind of need a job and a place to live.” Most people think that, but if you have ICD and you are drinking…it’s on.

There is a pretty common cycle that people go through when they are afflicted with ICD. There is often a feeling of tension that builds up prior to the impulsive behavior. Then once the behavior occurs, comes a feeling of pleasure and gratification, followed by guilt and an enormous amount of shame. Then comes the next day, and the thought, “Oh my god, did I really do that?”

Of course, impulsive behavior has long been linked with alcohol consumption as well as drug use. The two go hand in hand. One has to fight the initial urge to drink and do drugs in the first place. Then once you get clean, the impulse to pick up again is going to come up, again and again. Of course, the average Joe is just going to say the person with ICD has a lack of willpower. In one way, he might be correct. But it isn’t a moral issue. It is one that has to do with brain chemistry.

Impulse control disorders are loosely defined by urges and behaviors that are excessive and/or harmful to oneself or others, and cause significant impairment in social and occupational functioning, as well as legal and financial difficulties. If you are unable to resist doing things that are excessive and could harm yourself or others, you might have ICD. In the addiction world, there is a high prevalence of ICD in both gambling addicts and sex addicts. And of course, substance abuse also arises as part of a pattern of impulsive behavior.  

A recent study suggests that a gene mutation may play a role in why people become reckless when drinking. The people in the study who had the genetic variation were more likely to be aggressive, to get in fights and engage in impulsive behavior while drinking alcohol. They were also more likely to get behind the wheel and drive drunk. The researchers claim these people were not alcoholics, but bad drunks that would often lose control of their behavior when drinking.

I spoke to Dr. George Koob, who is Director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) about ICD. He related to me that the problem is usually caused by damage or decreased blood flow in areas of the cerebral cortex, which controls higher reasoning and judgment. He said that people who have ICD are often deficient in the areas of the brain that control decision-making, planning, and impulse control.

Dr. Koob said, “People that are missing those frontal lobe connections or have a weaker connection usually have problems throughout their lifespan. They often have multiple job losses, have numerous relationship problems and multiple divorces. They often also have numerous problems with the law.”

And what if you have ICD and then drink a lot as well? Dr. Koob said, “Alcohol can be a real problem for those with ICD because alcohol is a disinhibitor to begin with. People with ICD often don’t have that ability to not have that next drink or to not get behind the wheel after becoming intoxicated.”

Dr. Koob also talked about the “Marshmallow Test,” which was a study on delayed gratification done back in the 60s and 70s. The researchers would offer a child a marshmallow that they could have right now, or they could wait for 15 minutes or so and have two marshmallows. In follow-up studies, the kids who took the first marshmallow without waiting had way more life issues with work, relationships, finances, and the criminal justice system over their lifespan than the kids who waited. So basically, booze and drugs in this instance just represent one big marshmallow.

Dr. Koob also said this issue has been a bit understudied. There is still no concrete way for professionals to deal with this issue. Cognitive behavioral therapy is often used. And while medications are often prescribed, there are no FDA-approved medications for ICD.

It can be confusing if you're this type of drinker. I could, and still can, easily go weeks or months without touching a drop of booze, and not even miss it. To someone with ICD, it can be a pretty easy thing to say they don’t have a problem with drinking. I mean sure, there was that time six months ago when you got hammered and you got in a fight, or that time last year when you got drunk and ended up taking that girl home when your wife was out of town, and every time you go out drinking you end up driving home wasted—but still, you aren’t an alcoholic. You can take it or leave it.

I mean, who knows. Maybe you aren’t an alcoholic. Maybe you have ICD and you just shouldn’t drink.

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