The Connection Between Intermittent Explosive Disorder and Substance Abuse

From domestic violence to road rage, the symptoms of intermittent explosive disorder (IED) have a devastating – and sometimes life-threatening – impact on the lives touched by it. It’s a complicated psychiatric condition that is often made worse by alcohol and drug addiction. If you or a loved one lives with IED, which is estimated to affect anywhere from 11million to 16 million Americans [1], it’s essential to understand the connection between this condition and substance abuse.

The Alcohol Link

Research suggests that people with this impulse-control disorder, marked by episodes of severe rage, increased energy, racing thoughts, and palpitations, are predisposed to struggle with other mental health conditions, including substance abuse [2]. It’s estimated about one-third of IED patients also have a major depressive disorder or substance abuse disorder [3]. Experts still don’t have a clear picture of how exactly substance abuse and IED are linked. The connection is strong enough that a history of substance abuse is one of the risk factors for intermittent explosive disorder.

One theory may provide some insight. The emotional aftereffects of a rage episode may contribute to some cases of alcohol and drug addiction. The sudden onset and severity of the rages can result in violent words, property damage, and physical harm. When the episode has passed, the person with intermittent explosive disorder may feel depressed, anxious, or guilty over their behavior. In one study, 52% of IED patients reported they regretted their explosive episodes [4]. Those emotions may make it more likely for a person with this mental health condition to turn to alcohol or drugs as a coping mechanism.

The Danger of IED and Substance Abuse

Each of these mental health disorders on its own has serious consequences for those who suffer from them and for those around them. When combined the conditions have the potential for increasing the risk of harm. Consider that in one study men who were more aggressive (although they did not necessarily have IED) showed higher rates of alcohol-related aggression [5].

In addition, the combination of intermittent explosive disorder and alcohol or drug addiction can produce a higher risk for suicide. Substance abuse itself has been linked to depression and suicide risk. People with IED also have a higher risk of self-aggression and suicide. Sixteen percent of IED patients in one study reported they had been aggressive toward themselves and about 13% reported suicide attempts. [6].

Treating IED and Substance Abuse

• Get professional help. A person living with intermittent explosive disorder and alcohol or drug addiction is unlikely to get better without professional treatment. In fact, fewer than 20% of people with IED will seek treatment, and those who do often only do so after a serious violent episode [7]. Because each condition can complicate the treatment of the other any treatment plan must address the addiction as well as the psychiatric disorder. If you or someone you love is dealing with these problems, get help now.
• Make an emergency plan. If your loved one lives with IED and alcohol abuse or drug addiction, make a plan to get yourself and others – especially children or elderly parents – away and out of danger if and when necessary. Contact a domestic violence shelter for advice and assistance now – before the next outburst occurs.
• Re-learn how to deal with anger. If you have IED, you can re-learn how to deal with angry emotions by working with an experienced therapist. Cognitive-behavioral therapy (CBT) will give you the internal resources to recognize the triggers that set you off. Researchers found that IED patients who received 12 sessions of CBT were significantly less angry and aggressive as well as less depressed than those who did not [8].
• Develop practical strategies for avoiding outbursts. It’s a fact of human nature that you will get angry. Work with a professional therapist to identify and practice ways for getting out of angry situations in a safe and socially acceptable way. You may also learn techniques such as deep breathing exercises to reduce the body’s physical response to anger.
• Avoid alcohol and other substances. Alcohol and drugs increase the chance you’ll act aggressively. Additionally, alcohol can interact with medications, like antidepressants, sometimes used to decrease symptoms of intermittent explosive disorder [9]. The combination of alcohol and antidepressants may worsen symptoms, alter judgment, raise blood pressure, or cause death. The best strategy is to avoid substances entirely.When intermittent explosive disorder is complicated by alcohol or drug addiction the effects are serious. It can result in physical harm and property damage, but it can also fracture relationships, make it hard to hold a job, trigger financial problems, and spur trouble with legal authorities. Don’t wait until it’s too late. Seek help from a skilled mental health professional.