The Role of Impulsivity in the Pathogenesis and Clinical Course of Alcohol Dependence and Other Alcohol Use Disorders

Impulsivity is a multidimensional psychological and neurocognitive construct encompassing both stable personality traits and context-dependent behavioral tendencies sensitive to stress, emotional states, and the acute or chronic effects of psychoactive substances. It plays a critical role in the onset, progression, and recurrent course of alcohol dependence and other alcohol use disorders (AUDs). This review examines impulsivity through its principal structural components, including impulsive choice (delay discounting and decision-making deficits), negative and positive urgency, sensation seeking, lack of premeditation, and motor and anticipatory impulsivity. Evidence indicates that distinct subcomponents differentially contribute to early initiation of alcohol use, escalation of consumption, craving intensity, treatment non-adherence, and increased relapse risk. Special attention is given to the neurobiological mechanisms underlying impulsivity, involving dysregulation within frontostriatal, prefrontal, limbic, and interoceptive networks, as well as the modulatory effects of acute and chronic alcohol exposure on executive control and emotional regulation systems. The review also discusses the conceptualization of impulsivity as a set of candidate endophenotypes reflecting heritable vulnerability to alcohol dependence, supported by findings on the heritability of distinct impulsivity domains, their presence in unaffected relatives, and the relative stability of certain indices across clinical states. Therapeutic approaches targeting impulsivity are examined across psychosocial, cognitive, and biological domains, including cognitive-behavioral and personality-targeted interventions, mindfulness-based methods, executive-function training, and emerging neuromodulation strategies. The review highlights the need for standardized impulsivity assessment tools, harmonized relapse definitions, and the development of personalized preventive and therapeutic strategies for alcohol dependence and other AUDs.

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