Impulsivity and adolescent substance use: Rashly dismissed as “all-bad”?

doi:10.1016/j.neubiorev.2008.06.003

Neuroscience & Biobehavioral Reviews

Volume 32, Issue 8, October 2008, Pages 1507-1518

https://doi.org/10.1016/j.neubiorev.2008.06.003 Get rights and content

Abstract

The initial use of illicit drugs and alcohol typically occurs during adolescence. Individual differences in impulsivity and related constructs are consistently identified as key factors in the initiation and later problematic use of substances. Consequently, impulsivity is generally regarded as a negative trait; one that conveys only risk. However, what is often overlooked in addiction science is the positive role facets of trait impulsivity can play in everyday life and adaptive functioning. The following review aims to summarize recent advances in the psychobiology of impulsivity, including current perspectives on how it can convey risk for substance misuse. The review will also consider the importance of adolescence as a phase of life characterized by substantial neurodevelopment and natural increases in impulsivity. Uniquely, the review aims to reframe thinking on adolescent impulsivity to include the positive with the negative, and discuss how such thinking can benefit efforts for early intervention and future research.

Section snippets

A model of how impulsivity conveys risk for addiction

Dawe and Loxton (2004), in their review of the literature, concluded that impulsivity was better conceptualized as a two-dimensional trait. The first trait, labeled Reward Drive (RD), is argued to reflect individual differences in sensitivity to incentive motivation and engagement in appetitive behavior upon detection of reward cues (e.g., walking past a bar). The conceptualization of this trait was based on the Behavioral Approach/Activation System (BAS) proposed in Gray's Reinforcement

Impulsivity and adolescent substance misuse

It is well established that trait impulsivity conveys risk for the development of substance use problems in adolescents. However, it is important to note that the vast majority of studies examining this relationship measured impulsivity with scales that have since been shown to load on an RI-like factor. As a result, we will refer to the “impulsivity” examined in such studies as RI.

In addition to family (e.g., parental substance use, family dysfunction) and social factors (e.g., peer group,

Impulsivity and neurocognitive changes in adolescence

Across species, adolescence is a phase of life characterized by marked changes in the neuronal architecture and functioning of the brain (Spear, 2000). These changes are believed to play a significant role in the behavioral manifestations commonly thought to typify “the teenage years”; namely, sensation-seeking, poor judgment, and risk-taking (Steinberg, 2005). Indeed, it is difficult to underestimate the magnitude of transition taking place in the adolescent brain. Neurophysiological changes

Impulsivity: is it really all bad?

There is clear evidence that both impulsivity components play a role in addictive behavior. However, RD and RI are also related to certain adaptive behaviors that addiction scientists tend not to focus on. In this section, we review some of this research and follow it with a discussion of the importance of this trait to healthy behavior as well as how intervention approaches may be able to capitalize on high levels of RD and RI.

Reward Drive is a component of impulsivity that is measured, to

Implications for intervention

Traditionally, therapeutic interventions for substance use problems have focused on techniques aimed at enhancing restraint and avoidance of situations in which a person is likely to be tempted to use an abused substance. However, more recent approaches have begun to focus on “redirecting” approach behavior to healthier goals. Examples of this approach include contingency management (CM), which involves rewarding (e.g., with vouchers, cash, methadone) behaviors that are consistent with

Summary and way forward

The aim of the present article was to review recent theoretical and empirical developments in the neuropsychology of impulsivity and substance misuse. This began with a discussion of the current conceptualization of trait impulsivity as a multidimensional construct and how different components of this trait are believed to influence behaviors involved in the addictive process. This conceptualization is an attempt to synthesize data obtained from a large body of research that has focused on

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Dual-pathway models suggest that poor self-regulation (immature regulatory combined with strong reactive processes) is an important factor underlying addictive behaviors among adolescents. This study examined whether there are different self-regulation profiles among community adolescents, and how these profiles are related to the presence, severity and comorbidity of different addictive behaviors. A community sample of 341 adolescents (54.5% female; 13–17 years) was recruited. Participants self-reported on regulatory (inhibitory control) and reactive (reward and punishment sensitivity) processes, as well as on different addictive behaviors (binge eating, tobacco-, cannabis- and alcohol use, gaming, gambling and pathological buying). A model-based clustering analysis found evidence for three meaningful profiles: ‘impulsive/under-controlled’, ‘anxious’ and ‘protective’. The ‘impulsive/under-controlled’ profile was characterized by the highest prevalence and severity of cannabis use and the most severe alcohol use. The ‘impulsive/under-controlled’ and ‘protective’ profiles demonstrated the highest prevalence and severity of tobacco use, whereas the ‘impulsive/under-controlled’ and ‘anxious’ profiles showed the highest binge eating scores. Adolescents who reported more than three types of addictive behaviors generally belonged to the ‘impulsive/under-controlled’ profile. The profiles did not differ for gaming, gambling and pathological buying. The ‘impulsive/under-controlled’ profile emerged as the most vulnerable profile in the context of addictive behaviors (especially for binge eating and substance use).
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Reward Drive Moderates the Effect of Depression-Related Cognitive Mechanisms on Risk of Prescription Opioid Misuse Among Patients With Chronic Non-Cancer Pain
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Depression, a prognostic factor for prescription opioid misuse commonly occurs in people with chronic non-cancer pain (CNCP). However, the mechanisms linking depression and prescription opioid misuse remain unclear. This study examined the potential mediating role of pain catastrophizing in the association between depressive symptoms and prescription opioid misuse risk, and impulsivity traits as possible moderators of these relationships. Individuals (N = 198; 77% women) with CNCP using prescription opioids participated in a cross-sectional online survey with validated measures of depression, pain catastrophizing, rash impulsiveness, reward drive, anxiety, pain severity and prescription opioid misuse. Meditation analyses with percentile-based bootstrapping examined pathways to prescription opioid use, controlling for age, sex, pain severity, and anxiety symptoms. Partial moderated mediation of the indirect effect of depressive symptoms on prescription opioid misuse risk through pain catastrophizing by rash impulsiveness and reward drive were estimated. Pain catastrophizing mediated depressive symptoms and prescription opioid misuse risk. Indirect effects were stronger when moderate to high levels of reward drive were included in the model. Findings suggest the risk of prescription opioid misuse in those experiencing depressive symptoms and pain catastrophizing is particularly higher for those higher in reward drive. Treatments targeting these mechanisms may reduce opioid misuse risk.
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ReviewImpulsivity and adolescent substance use: Rashly dismissed as “all-bad”?

Abstract

Section snippets

A model of how impulsivity conveys risk for addiction

Impulsivity and adolescent substance misuse

Impulsivity and neurocognitive changes in adolescence

Impulsivity: is it really all bad?

Implications for intervention

Summary and way forward

Brain and Cognition

Neuropsychologia

Neuropsychologia

Neuropsychologia

Addictive Behaviors

Personality and Individual Differences

Trends in Cognitive Sciences

Personality and Individual Differences

Personality and Individual Differences

Neuroscience and Biobehavioral Reviews

Addictive Behaviors

Neuropsychopharmacology

Neuroimage

Neuropsychologia

Personality and Individual Differences

Personality and Individual Differences

Personality and Individual Differences

Journal of Adolescent Health

Neuropsychologia

Drug and Alcohol Dependence

Personality and Individual Differences

Neuropsychopharmacology

Neuropsychopharmacology

Personality and Individual Differences

Neuroscience and Biobehavioral Reviews

Personality and Individual Differences

Drug and Alcohol Dependence

Behavioural Processes

Who attains social status? Effects of personality and physical attractiveness in social groups

Journal of Personality and Social Psychology

Distinguishing BIS-mediated and BAS-mediated disinhibition mechanisms: a comparison of disinhibition models of Gray (1981, 1987) and of Patterson and Newman (1993)

Journal of Personality and Social Psychology

Individual differences in reward drive predict neural responses to images of food

Journal of Neuroscience

Deciding advantageously before knowing the advantageous strategy

Science

Dissociation of working memory from decision making within the human prefrontal cortex

Journal of Neuroscience

Theoretical and empirical foundations of contingency management treatments for drug abuse

Personality and transformational and transactional leadership: a meta-analysis

Journal of Applied Psychology

Conflict monitoring and cognitive control

Psychological Review

The onset of marijuana use from preadolescence and early adolescence to young adulthood

Development and Psychopathology

Targeting behavioral therapies to enhance naltrexone treatment of opioid dependence—efficacy of contingency management and significant other involvement

Archives of General Psychiatry

The use of contingency management and motivational/skills-building therapy to treat young adults with marijuana dependence

Journal of Consulting and Clinical Psychology

Behavioral inhibition, behavioral activation and affective responses to impending reward and punishment: the BIS/BAS scales

Journal of Personality and Social Psychology

The child is father of the man: personality continuities from childhood to adulthood

Journal of Personality and Social Psychology

Alcohol, psychological dysregulation, and adolescent brain development

Alcoholism-Clinical and Experimental Research

A systematic method for clinical description and classification of personality variants: a proposal

Archives of General Psychiatry

The Tridimensional Personality Questionnaire

Reinforcement Sensitivity Theory (RST) introduction

Revised NEO Personality Inventory (NEO PI-R) and NEO Five-Factor Inventory (NEO-FFI)

Dual determinants of drug use in humans: reward and impulsivity

Neurobiology of the structure of personality: dopamine, facilitation of incentive motivation, and extraversion

Behavioral and Brain Sciences

Review
Impulsivity and adolescent substance use: Rashly dismissed as “all-bad”?