According to researchers at the University of Chicago Medical Center, patients with intermittent explosive disorder (IED) are much more likely to become substance abusers compared to those who do not display frequent aggressive behavior.
The study examined data from more than 9,200 subjects in the in the National Comorbidity Survey, a national survey of mental health in the United States.
Aggression Linked to Substance AbuseThe investigators found that as the severity of aggressive behavior increases so do levels of daily and weekly substance abuse. A history of frequent, aggressive behavior is a predictor of later substance abuse, they concluded.
IED is a condition marked by frequent physical or verbal outburts and affects an estimated 16 million people in the United States -- more than bipolar disorder and schizophrenia combined. It is typically diagnosed in adolescents, some as young as 11, long before substance abuse problems develop.
The condition runs in families and is generally treated as a social-behavior issue rather than a true neurobiological disorder with significant genetic components, said Emil Coccaro, MD.
More Than Simply Bad Behavior
"People don't see this as a medical problem. They think of it as simply bad behavior they have developed over the course of their lives, but it isn't. It has significant biology and neuroscience behind it," said Coccaro.
The Chicago study found no relationship between IED and the presences of other psychiatric disorders, as has been implied by previous research.
Although excessive alcohol use can clearly worsen aggressive behavior, Coccaro and colleagues found that IED diagnosis almost always precedes the development of chronic substance abuse. In cases where subjects were diagnosed with both disorders, IED preceded substance abuse in 92.5% of the cases.
Early Treatment Is Effective
The good news is if intermittent explosive disorder and aggression is treated early it can delay or even prevent substance abuse later in life. "Early psychological intervention, medication and cognitive therapy are the most effective treatments to prevent, or at least delay, substance abuse problems in adolescents diagnosed with IED," Coccaro said.
Source: Coccaro EF, et al. "Intermittent Explosive Disorder and Substance Use Disorder: Analysis of the National Comorbidity Survey Replication Sample." Journal of Clinical Psychiatry Feb. 28, 2017