This chapter explores the complex relationship between stress, impulsivity, and substance use disorders (SUDs). A representative sample of individual impulse control disorders is reviewed to include pathological gambling (PG), trichotillomania (TTM), and intermittent explosive disorder (IED), and categorized as problems of reward seeking (PG), habit (TTM), and a lack of premeditation (IED). Factors that mediate the disorders include tension reduction and affective regulation and can be further complicated by, and hold many similarities to, SUDs. Individuals with impulse control disorders can engage in the problem behavior as a means to immediately reduce tension or urge intensity and also seek to regulate affective states, particularly negative states (e.g., depression, boredom, and anxiety), which there is low tolerance for. Individuals with impulse control disorders suffer numerous negative psychosocial stressors as a result of their acting on the impulses. Impulsivity, aggression, and sensation seeking are common features of SUD and impulse control disorders (PG and IED) leading to problems in managing either comorbid disorders. Treatment of the differing impulse control problems requires multimodal approaches (psychosocial, behavioral, and pharmacological) in order to address unique qualities of each problem. Promising psychological treatment approaches include components of cognitive behavioral therapy (CBT) such as cognitive retraining, behavioral modification, cue exposure, and self-control training.
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