“Addictions and Impulse Control Disorders”
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What is an Addiction or Impulse Control Disorder?
When someone has an Impulse Control Disorder (ICD) it means that they experience irresistible urges to carry out a particular behaviour which will result in feelings of relief or pleasure.
Afterwards they may experience a period of guilt or remorse.
Common behaviours include abusing drugs or alcohol, gambling, stealing, excessive anger and setting things alight.
When these behaviours become part of day to day life despite the consequences, they also become known as addictions.
Drugs and Alcohol (also toxic substances eg glue, solvents)
The most common symptoms are that of craving continual use despite the side effects, such as increased tolerance and withdrawal symptoms.
To be considered dependent there must be evidence of taking excessive amounts despite already being intoxicated.
The individual may want to cut down or have attempted to do so several times. Most activities will be centred on the substance. There is an inability to stop despite awareness of the damage being done.
The signs associated with a person abusing drugs and/or alcohol (DA) are listed below:-
Significant impairment or distress resulting from use
Failure to fulfil roles at work, home, or school
Persistent use in physically hazardous situations
Ongoing legal problems related to use
Continued use despite interpersonal problems
DA abuse may or may not involve physiological dependence or tolerance. The symptoms that do indicate dependency or addiction are as follows:-
Compulsion and preoccupation with obtaining a drug or drugs
Loss of control over use or DA-induced behaviour
Continued use despite negative consequences
Tendency for relapse after period of abstinence
The main symptom is increased tolerance and withdrawal. This means the same amount of the drug or alcohol has less effect, the person can tolerate greater amounts without feeling the effects.
Withdrawal symptoms occur after physiological dependence has been established and the person cannot acquire the drug or alcohol, or stops taking it for some reason.
Substance abuse is not measured by how much, how many, or what substance a person uses, but by how the substance affects their life and the lives of those around them.
A number of treatment options exist. These differ in their aims and methods. Some aim for the user to achieve a drug and/or alcohol-free lifestyle, while others aim to stabilise the DA user at a reduced, safer level of use.
Some employ individual counselling techniques, others use group therapy, while still others use chemical agents to assist with withdrawal and maintenance.
Gambling
Pathological gambling is one of the most common disorders. It affects 1-3% of the adult population and typically begins in adolescence. The process to addiction is slow and is likely to increase during times of stress and anxiety.
These people have a preoccupation with gambling to the extent that family life and work are affected. They are excited by the thrill more than the financial gain.
These individuals can be restless and irritated if attempts are made to cut down. They will often lie to family members about debt and may steal or extort money.
The personalities of these people are competitive, easily bored, energetic, approval seekers, workaholic or binge workers (working at the last minute to meet deadlines). The typical pathological gambler is affable, self-centered, and often likeable.
Most are male, and many have committed illegal acts to support their habits. The signs associated with a person with a gambling addiction are as follows:-
Preoccupation with gambling,
Necessity to gamble with increasing amounts of money to experience the original thrill
Failed attempts to cut back
Restless when not gambling
Lies to all concerned about the gambling
Loss of a relationship, job, and/or money
Reliance on others to get out of trouble
Individual cures are extremely difficult to come by. Gamblers Anonymous (GA), patterned after Alcoholics Anonymous, offers some hope, and Gam-Anon offers support for families of Pathological Gamblers.
Few who only enter GA actually quit gambling, but if they enter GA and go to an inpatient treatment facility, recovery rates approach 50% for those who complete the program. Families of pathological gamblers may have a better chance of adapting to the problems than the gambler has of stopping the creation of the problems.
Kleptomania (impulsive stealing)
This is when a person will shoplift or steal from others even though the goods may be of little value or are unneeded. They steal for the thrill of stealing and they don't want to get caught. It is also done to relieve tension.
Items may be hoarded or taken back secretly. They may feel guilty and worried about being caught. To be diagnosed, a person must have the typical pattern that involves having recurrent tension leading to the behaviour, which leads to relief or pleasure after performing the behaviour.
This disorder may be associated with depression and/or bulimia. It is rare overall but is more common in females than in males.
The stealing is not accounted for by hunger or poverty or vengeance, or accounted for better by another disorder of which stealing is a part (for example, Antisocial Personality Disorder or a manic episode).
It is difficult to document the precise number of people with Kleptomania. People with Kleptomania often have another psychiatric disorder, often a mood disorder.
reatment is largely untested, and the disorder often persists despite many convictions of shoplifting. It may decrease as the individual ages, however.
Intermittent Explosive Disorder (IED)
This aptly named disorder is diagnosed if an individual manifests several obviously excessive and unjustified outbursts of anger that result in significant property damage or injury to others.
Care must be taken in diagnosis to ensure that the outbursts cannot be better accounted for by another diagnosis or be substance-induced or the result of a medical condition. Voluntary acts for gain also do not qualify.
The disorder does not necessarily interfere with aspects of the individual's life, although it obviously interferes with the lives of others.
Some investigators believe that this disorder is a version of bipolar disorder, and have had some success treating the disorder with medication.
However, it is fair to say that relatively little is certain about treatment of people with IED. Left untreated, symptoms of the disorder are certainly likely to recur.
Pyromania (compulsive fire-setting)
Pyromania involves more planning than most of the impulse control disorders, so it is actually more compulsive than impulsive. It requires that the person set more than one deliberate fire (not in a barbecue or fireplace) that is also a destructive fire.
It follows the usual impulse disorder sequence, which consists of a strong arousal before and pleasure or tension reduction after the act. People usually have a fascination, obsession or attraction to fire and objects, people, or situations around fire.
The fire setting is not done for monetary gain or an expression of anger, vengeance, personal gain, or psychosis, unless they meet the criteria above and the fire setting must not be accounted for by another diagnosis.
Trichotillomania (compulsive pulling out of hair)
Trichotillomania (T) has the usual features of impulse control disorders – that is relief after the behaviour, and usually a build up of tension before, at least when the individual is attempting to control the behaviour. T was thought to be rare, but earlier estimates may have been too low because victims are usually secretive about the behaviour.
Frequently, a stressful event can be associated with the onset, such as a change of schools, abuse, family conflict, or the death of a parent. The symptoms also may be triggered by pubertal hormonal changes.
Most cases of hair pulling don't qualify as T, and many cases remit over time. Others continue indefinitely. In behavioural therapy, people learn a structured method of keeping track of the symptoms and associated behaviours, increasing awareness of pulling, substituting incompatible behaviours and several other techniques aimed at reversing the "habit" of pulling. However, different treatments work for different people.
What are the causes?
The causes of ICDs and addiction are numerous. Some people may have a genetic predisposition to it, which would make them particularly prone to developing the behaviour. For example Trichotillomania may be a neurological disorder not just a bad habit.
Biological and physiological explanations are also given whereby behaviours are the result of chemical reactions in the body. Upbringing, a developmental disorder or learning disability may also be responsible.
These factors together with any number of social and environmental features and significant life events can all have an impact on the occurrence of an ICD or addiction.
What is the treatment?
Counselling and psychotherapy involves working with a therapist on developing inner strengths, capabilities, resources and potential.
Cognitive-behaviour therapy that focuses on:
The introduction of a 'reward' scheme to provide a greater incentive to discontinue the behaviour, or towards increasing positive behaviours such as attending support groups and making steps to find employment.
Working to resolve ambivalence and help people to recognise the greater benefits in changing behaviour as opposed to the benefits in maintaining old behaviour patterns. It focuses on increasing the use of internal resources.
Learning to recognise personal 'high-risk' situations and applying specific coping skills and strategies to avoid continuing the behaviour. Self-efficacy and confidence are boosted as a result.
It is well understood how the environment can affect a person's desire to continue negative behaviour patterns thus individual environments can be assessed and modified to minimise this desire and make it more rewarding to maintain abstinence.
Joining a self-help group. This enables individuals to talk to each other about their experiences and provide mutual support.
Enlisting and using the support of family and friends
For Help (AUSTRALIAN RESIDENTS)
Mental Health Association NSW Inc ph (02) 9816 5688 or ph 1800 674 200 (outside Sydney Metro) for services in your area
Make an appointment with your GP.
Contact your Local Health Centre, Mental Health Team, or Drug and Alcohol Team (See ‘Emergency, Health and Help’ section of the White Pages)
Lifeline ph 13 11 14
Contact a counsellor or psychologist either through the Australian Psychological Society ph 1800 333 497 or through the Yellow Pages
Alcohol and Drug Information Service ph 1800 422 599/ 9361 8000
Al-anon (a twelve step programme with support groups and literature) ph 9663 1206.
Narcotics Anonymous ph 9212 3444.
Gam-Anon (for partners, friends and family) ph 9564 1594.
G-Line ph 1800 633 635
For more information
General information on Impulse Control Disorder – www.healthinmind.com
Articles on ICDs - www.psychnet-uk.com
Controlling your anger by the American Psychological Association -www.apa.org
Shoplifters anonymous – www.shopliftersanonymous.com
Reading list
Kleptomania: the compulsion to steal- what can be done
By Marcus J. Goldman MD published by new horizon press ISBN 088282158X 1997
Will power’s not enough: understanding and recovering from addictions of every kind by Arnold Washton, Donn Boundy published by Harpercollins 1990 ISBN 0060919698
The addictive personality: understanding the addictive process and compulsive behaviour by craig nakken published by hazelden information education ISBN 1568381298 1996
Impulsivity by Christopher Webster(ed) Margaret A. Jackson (ed) ISBN 1572302259 1997
Best possible odds: contemporary treatment strategies for gambling disorders by Linda L. Chamberlain, William G. McGowan published by John Wiley & sons ISBN 0471189693
Workbook for Overcoming Addictions by A. Thomas Horvath, Reid K. Hester, G. Alan Marlatt
Disclaimer The information provided is to be used for educational purposes only. It should not be used as a substitute for seeking professional care in the diagnosis and treatment of mental health disorders. Information may be reproduced with an acknowledgement to the Mental Health Association NSW. This, and other fact sheets are available for download from www.mentalhealth.asn.au. This fact sheet was last updated in Autumn, 2002.
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