The neurobiology of impulsivity and substance use disorders: implications for treatment

Abstract

Impulsivity is strongly associated with substance use disorders (SUDs). Our review discusses impulsivity as an underlying vulnerability marker for SUDs, and treatment of co-occurring impulsivity in SUDs. Three factors should be considered for the complex relationship between impulsivity and a SUD: (1) the trait effect of impulsivity, centering on decreased cognitive and response inhibition, (2) the state effect resulting from either acute or chronic substance use on brain structure and function, and (3) the genetic and environmental factors (e.g., age and sex) may influence impulsive behavior associated with SUDs. Both subjective and objective measures are used to assess impulsivity. Together, treatment developments (pharmacological, behavioral, and neurophysiological) should consider these clinically relevant dimensions assessed by a variety of measures, which have implications for treatment matching in individuals with SUD. Despite its heterogeneity, impulsivity is a marker associated with SUDs and may be understood as an imbalance of bottom-up and top-down neural systems. Further investigation of these relationships may lead to more effective SUD treatments.

Keywords: alcohol; cannabis; impulsivity; substance use disorders; tobacco; treatment.

Conflict of interest statement

Competing interests

The authors declare no competing interests

© 2018 New York Academy of Sciences.

Figures

Figure 1.

Brain diagram to illustrate pathways leading to impulsive behaviors (adapted from Ref. 57). Three neurobiological systems including the control/regulatory, reward, and threat systems, mediated by the medial and ventral prefrontal cortices, the ventral striatum and midbrain dopaminergic system, and the amygdala, respectively, provide an overlapping pathway linking brain circuitries and neurotransmitter systems associated with addiction risk and impulsivity.

Figure 2.

Transdiagnostic model for addiction risk and targets for treatments. The interrelationship between trait effects, state effects and other environmental and genetic factors, as well as implicated neurotransmitter levels, influencing the initiation and progression of impulsivity and substance use disorders.