The relationship between substance use disorders, impulse control disorders, and pathological aggression

The authors examine the relationship between substance use disorders, impulse control disorders (ICDs), and pathological aggression. Phenomenologic evidence, neurobiologic evidence, and comorbidity data, as well as evidence from the pharmacotherapy of aggression and impulse control and substance use disorders, suggest links between substance use, impulsivity, and pathologic aggression. There also is evidence suggesting that dysfunction in common neurotransmitter systems, particularly the serotonin and GABAergic systems, may be involved in both disorders. Serotonergic agents have been explored in the treatment of ICDs, pathological aggression and substance use disorders. Mood-stabilizing anticonvulsant agents such as sodium valproate and carbamazepine, which have GABAergic activity have received preliminary exploration in the treatment of ICDs and aggression in a number of psychiatric disorders. There is also evidence that these agents may be useful in subgroups of individuals with substance use disorders.