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. Phenome nologic evidence, neurobiologic evidence, and comorbidity data, as wel l as evidence from the pharmacotherapy of aggression and impulse contr ol and substance use disorders, suggest links between substance use, i mpulsivity, and pathologic aggression. There also is evidence suggesti ng that dysfunction in common neurotransmitter systems, particularly t he serotonin and GABAergic systems, may be involved in both disorders. Serotonergic agents have been explored in the treatment of ICDs, path ological aggression and substance use disorders. Mood-stabilizing anti convulsant agents such as sodium valproate and carbamazepine, which ha ve GABAergic activity have received preliminary exploration in the tre atment of ICDs and aggression in a number of psychiatric disorders. Th ere is also evidence that these agents may be useful in subgroups of i ndividuals with substance use disorders.