Роль импульсивности в патогенезе и клиническом течении алкогольной зависимости и других расстройств, связанных с употреблением алкоголя

Импульсивность представляет собой многомерный психологический и нейрокогнитивный конструкт, включающий как устойчивые личностные особенности, так и ситуативные поведенческие реакции, чувствительные к стрессу, контексту и действию психоактивных веществ. Она играет значимую роль в формировании, клиническом течении и рецидивирующем характере алкогольной зависимости и других расстройств, связанных с употреблением алкоголя (РУА). В настоящем обзоре импульсивность анализируется с позиций ее структурных субкомпонентов, включая импульсивный выбор (дисконтирование задержки, особенности принятия решений), негативную и позитивную срочность, поиск ощущений, дефицит планирования, моторную и ожидательную импульсивность. Показано, что различные субкомпоненты в различной степени ассоциированы с ранним дебютом употребления, эскалацией потребления, выраженностью аддиктивного влечения, нарушением приверженности терапии и повышенным риском рецидива. Отдельное внимание уделено нейробиологическим механизмам импульсивности, связанным с функционированием фронтостриарных, префронтальных, лимбических и интероцептивных сетей, а также влиянию острых и хронических эффектов алкоголя на системы эмоциональной регуляции и исполнительного контроля. Обсуждается концепция импульсивности как набора кандидатных эндофенотипов, отражающих наследуемую уязвимость к алкогольной зависимости и подтверждаемых данными о наследуемости отдельных субкомпонентов, семейной отягощенности и устойчивости некоторых показателей в разные фазы заболевания. Рассматриваются психосоциальные и биологические подходы к коррекции импульсивности, включая когнитивно-поведенческие и личностно-таргетированные программы, методы, основанные на осознанности, тренинги исполнительных функций и перспективные нейромодуляционные вмешательства. Подчеркивается необходимость стандартизации методов оценки импульсивности, унификации критериев рецидива и развития персонализированных профилактических и терапевтических стратегий при алкогольной зависимости и других РУА.

1. Автономов Д.А. Место импульсивности в клинике наркологии. Наркология. 2018;17(1):48-53.

2. Галкин С.А. Влияние когнитивной импульсивности у больных алкогольной зависимостью на продолжительность ремиссии. Consortium Psychiatricum. 2023;4(4).:29-38.

3. Трусова А.В., Березина А.А., Гвоздецкий А.Н., Климанова С.Г. Импульсивность, эмоциональная регуляция и влечение к алкоголю: модель опосредования. Вопросы наркологии. 2019;10(181):77-86.

4. Acheson A, Richard DM, Mathias CW, Dougherty DM. Adults with a family history of alcohol related problems are more impulsive on measures of response initiation and response inhibition. Drug Alcohol Depend. 2011;117(2-3):198-203. https://doi.org/10.1016/j.drugalcdep.2011.02.001.

5. Athamneh LN, Stein JS, Quisenberry AJ, Pope D, Bickel WK. The association between parental history and delay discounting among individuals in recovery from addiction. Drug Alcohol Depend. 2017;179:153-158. https://doi.org/10.1016/j.drugalcdep.2017.06.037.

6. Beckwith SW, Czachowski CL. Alcohol-Preferring P Rats Exhibit Elevated Motor Impulsivity Concomitant with Operant Responding and Self-Administration of Alcohol. Alcohol Clin Exp Res. 2016;40(5):1100-10. https://doi.org/10.1111/acer.13044.

7. Bickel WK, Jarmolowicz DP, Mueller ET, Gatchalian KM, McClure SM. Are executive function and impulsivity antipodes? A conceptual reconstruction with special reference to addiction. Psychopharmacology (Berl). 2012;221(3):361-87. https://doi.org/10.1007/s00213-012-2689-x.

8. Bozkurt M, Evren C. Impulsivity in alcohol use disorder: A multidimensional perspective. Addicta: The Turkish Journal on Addictions 2024;11(3):400-406. https://doi.org/10.5152/ADDICTA.2024.24256.

9. Castellanos-Ryan N, Brière FN, O’Leary-Barrett M, Banaschewski T, Bokde A, Bromberg U, Büchel C, Flor H, Frouin V, Gallinat J, Garavan H, Martinot JL, Nees F, Paus T, Pausova Z, Rietschel M, Smolka MN, Robbins TW, Whelan R, Schumann G, Conrod P; IMAGEN Consortium. The structure of psychopathology in adolescence and its common personality and cognitive correlates. J Abnorm Psychol. 2016;125(8):1039-1052. https://doi.org/10.1037/abn0000193.

10. Chambers RA, Taylor JR, Potenza MN. Developmental neurocircuitry of motivation in adolescence: a critical period of addiction vulnerability. Am J Psychiatry. 2003;160(6):1041-52. https://doi.org/10.1176/appi.ajp.160.6.1041.

11. Coates JM, Gullo MJ, Feeney GFX, McD Young R, Dingle GA, Clark PJ, Connor JP. Craving mediates the effect of impulsivity on lapse-risk during alcohol use disorder treatment. Addict Behav. 2020;105:106286. https://doi.org/10.1016/j.addbeh.2019.106286.

12. Conrod PJ, O’Leary-Barrett M, Newton N, Topper L, Castellanos-Ryan N, Mackie C, Girard A. Effectiveness of a selective, personality-targeted prevention program for adolescent alcohol use and misuse: a cluster randomized controlled trial. JAMA Psychiatry. 2013;70(3):334-42. https://doi.org/10.1001/jamapsychiatry.2013.651.

13. Conrod PJ. Personality-Targeted Interventions for Substance Use and Misuse. Curr Addict Rep. 2016;3(4):426-436. https://doi.org/10.1007/s40429-016-0127-6.

14. Crews FT, Collins MA, Dlugos C, Littleton J, Wilkins L, Neafsey EJ, Pentney R, Snell LD, Tabakoff B, Zou J, Noronha A. Alcohol-induced neuro degeneration: when, where and why? Alcohol Clin Exp Res. 2004;28(2):350-64. https://doi.org/10.1097/01.alc.0000113416.65546.01.

15. Cservenka A, Brumback T. The Burden of Binge and Heavy Drinking on the Brain: Effects on Adolescent and Young Adult Neural Structure and Function. Front Psychol. 2017;8:1111. https://doi.org/10.3389/fpsyg.2017.01111.

16. Cyders MA, Coskunpinar A. Measurement of constructs using self-report and behavioral lab tasks: is there overlap in nomothetic span and construct representation for impulsivity? Clin Psychol Rev. 2011;31(6):965-82. https://doi.org/10.1016/j.cpr.2011.06.001.

17. D’Alberto N, Funnell M, Potter A, Garavan H. A split-brain case study on the hemispheric lateralization of inhibitory control. Neuropsychologia. 2017;99:24-29. https://doi.org/10.1016/j.neuropsychologia.2017.02.017.

18. Dalley JW, Everitt BJ, Robbins TW. Impulsivity, compulsivity, and top-down cognitive control. Neuron. 2011;69(4):680-94. https://doi.org/10.1016/j.neuron.2011.01.020.

19. de Wit H. Impulsivity as a determinant and con sequence of drug use: a review of underlying processes. Addict Biol. 2009;14(1):22-31. https://doi.org/10.1111/j.1369-1600.2008.00129.x.

20. Fernie G, Cole JC, Goudie AJ, Field M. Risk-taking but not response inhibition or delay discounting predict alcohol consumption in social drinkers. Drug Alcohol Depend. 2010 Nov 1;112(1-2):54-61. https://doi.org/10.1016/j.drugalcdep.2010.05.011.

21. Fernie G, Peeters M, Gullo MJ, Christiansen P, Cole JC, Sumnall H, Field M. Multiple behavioural impulsivity tasks predict prospective alcohol involvement in adolescents. Addiction. 2013;108(11):1916 23. https://doi.org/10.1111/add.12283.

22. Field M, Christiansen P, Cole J, Goudie A. Delay discounting and the alcohol Stroop in heavy drinking adolescents. Addiction. 2007;102(4):579-86. https://doi.org/10.1111/j.1360-0443.2007.01743.x

23. Fox HC, Bergquist KL, Peihua G, Rajita S. Interactive effects of cumulative stress and impulsivity on alcohol consumption. Alcohol Clin Exp Res. 2010;34(8):1376-1385. https://doi.org/10.1111/j.1530-0277.2010.01221.x.

24. Galandra C, Basso G, Cappa S, Canessa N. The alcoholic brain: neural bases of impaired re ward-based decision-making in alcohol use disorders. Neurol Sci. 2018;39(3):423-435. https://doi.org/10.1007/s10072-017-3205-1.

25. Gottesman II, Gould TD. The endophenotype concept in psychiatry: etymology and strategic intentions. Am J Psychiatry. 2003;160(4):636-645. https://doi.org/10.1176/appi.ajp.160.4.636.

26. Herman AM, Duka T. Facets of impulsivity and alcohol use: What role do emotions play? Neurosci Biobehav Rev. 2019;106:202-216. https://doi.org/10.1016/j.neubiorev.2018.08.011.

27. Herman AM. Interoception Within the Context of Impulsivity and Addiction. Curr Addict Rep. 2023;10(2):97-106. https://doi.org/10.1007/s40429-023-00482-7.

28. Hoffman WF, Schwartz DL, Huckans MS, McFar land BH, Meiri G, Stevens AA, Mitchell SH. Cortical activation during delay discounting in abstinent methamphetamine dependent individuals. Psychopharmacology (Berl). 2008;201(2):183-193. https://doi.org/10.1007/s00213-008-1261-1.

29. Houben K, Wiers RW, Jansen A. Getting a grip on drinking behavior: training working memory to reduce alcohol abuse. Psychol Sci. 2011;22(7):968 975. https://doi.org/10.1177/0956797611412392.

30. Jones CB, Meier MH, Corbin WE, Chassin L. Adolescent executive cognitive functioning and trait impulsivity as predictors of young-adult risky drinking and alcohol-related problems. Psychol Addict Behav. 2021;35(2):187-198. https://doi.org/10.1037/adb0000636.

31. Kocka A, Gagnon J. Definition of Impulsivity and Related Terms Following Traumatic Brain Injury: A Review of the Different Concepts and Measures Used to Assess Impulsivity, Disinhibition and other Related Concepts. Behav Sci (Basel). 2014;4(4):352-70. https://doi.org/10.3390/bs4040352.

32. Kollins SH. Delay discounting is associated with substance use in college students. Addict Behav. 2003;28(6):1167-73. https://doi.org/10.1016/s0306-4603(02)00220-4.

33. Kozak K, Lucatch AM, Lowe DJE, Balodis IM, MacKillop J, George TP. The neurobiology of impulsivity and substance use disorders: implications for treatment. Ann N Y Acad Sci. 2019;1451(1):71-91. https://doi.org/10.1111/nyas.13977.

34. Martinez-Loredo V, Fernandez-Hermida JR, De La Torre-Luque A, Fernandez-Artamendi S. Trajectories of impulsivity by sex predict substance use and heavy drinking. Addict Behav. 2018;85:164-172. https://doi.org/10.1016/j.addbeh.2018.06.011.

35. McCloskey MS, New AS, Siever LJ, Goodman M, Koenigsberg HW, Flory JD, Coccaro EF. Evaluation of behavioral impulsivity and aggression tasks as endophenotypes for borderline personality disorder. J Psychiatr Res. 2009;43(12):1036-1048. doi: 10.1016/j.jpsychires.2009.01.002.

36. Mischel W, Shoda Y, Rodriguez MI. Delay of gratification in children. Science. 1989;244(4907):933-8. https://doi.org/10.1126/science.2658056.

37. Mitchell MR, Potenza MN. Addictions and Personality Traits: Impulsivity and Related Constructs. Curr Behav Neurosci Rep. 2014;1(1):1-12. https://doi.org/10.1007/s40473-013-0001-y.

38. Moeller FG, Barratt ES, Dougherty DM, Schmitz JM, Swann AC. Psychiatric aspects of impulsivity. Am J Psychiatry. 2001;158(11):1783-1793. https://doi.org/10.1176/appi.ajp.158.11.1783.

39. Morris LS, Kundu P, Baek K, Irvine MA, Mechelmans DJ, Wood J, Harrison NA, Robbins TW, Bullmore ET, Voon V. Jumping the Gun: Mapping Neural Correlates of Waiting Impulsivity and Relevance Across Alcohol Misuse. Biol Psychiatry. 2016;79(6):499-507. https://doi.org/10.1016/j.biopsych.2015.06.009.

40. Nigg JT, Glass JM, Wong MM, Poon E, Jester JM, Fitzgerald HE, Puttler LI, Adams KM, Zucker RA. Neuropsychological executive functioning in children at elevated risk for alcoholism: findings in early adolescence. J Abnorm Psychol. 2004;113(2):302-314. https://doi.org/10.1037/0021-843X.113.2.302.

41. Nigg JT, Wong MM, Martel MM, Jester JM, Puttler LI, Glass JM, Adams KM, Fitzgerald HE, Zucker RA. Poor response inhibition as a predictor of problem drinking and illicit drug use in adolescents at risk for alcoholism and other substance use disorders. J Am Acad Child Adolesc Psychiatry. 2006;45(4):468-475. https://doi.org/10.1097/01.chi.0000199028.76452.a9

42. Norman AL, Pulido C, Squeglia LM, Spadoni AD, Paulus MP, Tapert SF. Neural activation during inhibition predicts initiation of substance use in adolescence. Drug Alcohol Depend. 2011;119(3):216 223. https://doi.org/10.1016/j.drugalcdep.2011.06.019.

43. O’Leary-Barrett M, Castellanos-Ryan N, Pihl RO, Conrod PJ. Mechanisms of personality-targeted intervention effects on adolescent alcohol misuse, internalizing and externalizing symptoms. J Consult Clin Psychol. 2016;84(5):438-452. https://doi.org/10.1037/ccp0000082.

44. O’Leary-Barrett M, Topper L, Al-Khudhairy N, Pihl RO, Castellanos-Ryan N, Mackie CJ, Conrod PJ. Two-year impact of personality-targeted, teacher-delivered interventions on youth internalizing and externalizing problems: a cluster-randomized trial. J Am Acad Child Adolesc Psychiatry. 2013;52(9):911-920. https://doi.org/10.1016/j.jaac.2013.05.020.

45. Ortal S, van de Glind G, Johan F, Itai B, Nir Y, Iliyan I, van den Brink W. The Role of Different Aspects of Impulsivity as Independent Risk Factors for Substance Use Disorders in Patients with ADHD: A Review. Curr Drug Abuse Rev. 2015;8(2):119-133. https://doi.org/10.2174/1874473708666150916112913.

46. Poulton A, Hester R. Transition to substance use disorders: impulsivity for reward and learning from reward. Soc Cogn Affect Neurosci. 2020;15(10):1182-1191. https://doi.org/10.1093/scan/nsz077.

47. Reyes-Huerta HE, Dos Santos C, Martínez K. Impulsive mechanisms influencing relapse in alcohol drinking. Med Hypotheses. 2018;112:27-29. https://doi.org/10.1016/j.mehy.2018.01.007.

48. Rømer Thomsen K, Callesen MB, Hesse M, Kvamme TL, Pedersen MM, Pedersen MU, Voon V. Impulsivity traits and addiction-related behaviors in youth. J Behav Addict. 2018;7(2):317-330. https://doi.org/10.1556/2006.7.2018.22.

49. Rubia K, Russell T, Overmeyer S, Brammer MJ, Bullmore ET, Sharma T, Simmons A, Williams SC, Giampietro V, Andrew CM, Taylor E. Mapping motor inhibition: conjunctive brain activations across different versions of go/no-go and stop tasks. Neuroimage. 2001;13(2):250-61. https://doi.org/10.1006/nimg.2000.0685.

50. Rubio G, Jiménez M, Rodríguez-Jiménez R, Martínez I, Avila C, Ferre F, Jiménez-Arriero MA, Ponce G, Palomo T. The role of behavioral impulsivity in the development of alcohol dependence: a 4-year follow-up study. Alcohol Clin Exp Res. 2008 Sep;32(9):1681-7. doi: 10.1111/j.1530-0277.2008.00746.x.

51. Sanchez-Roige S, Stephens DN, Duka T. Heightened Impulsivity: Associated with Family History of Alcohol Misuse, and a Consequence of Alcohol Intake. Alcohol Clin Exp Res. 2016t;40(10):2208 2217. https://doi.org/10.1111/acer.13184.

52. Seigneurie AS, Guérin Langlois C, Limosin F. Cognitive vulnerability to alcohol dependence: related neuroanatomic endophenotypes. Encephale. 2013;39(5):320-5. https://doi.org/10.1016/j.encep.2012.11.007.

53. Sliedrecht W, Roozen HG, Witkiewitz K, de Waart R, Dom G. The Association Between Impulsivity and Relapse in Patients With Alcohol Use Dis order: A Literature Review. Alcohol Alcohol. 2021;56(6):637-650. https://doi.org/10.1093/alcalc/agaa132.

54. Sousa SS, Sampaio A, Marques P, Gonçalves ÓF, Crego A. Gray Matter Abnormalities in the Inhibitory Circuitry of Young Binge Drinkers: A Voxel-Based Morphometry Study. Front Psychol. 2017;8:1567. https://doi.org/10.3389/fpsyg.2017.01567.

55. Stautz K, Cooper A. Impulsivity-related personality traits and adolescent alcohol use: a meta-analytic review. Clin Psychol Rev. 2013;33(4):574-92. https://doi.org/10.1016/j.cpr.2013.03.003.

56. Tunney RJ, Raybould JN. Thinking about neither death nor poverty affects delay discounting, but episodic foresight does: Three replications of the effects of priming on time preferences. Q J Exp Psychol (Hove). 2023 Apr;76(4):838-849. doi: 10.1177/17470218221097047.

57. VanderVeen JD, Plawecki MH, Millward JB, Hays J, Kareken DA, O’Connor S, Cyders MA. Negative urgency, mood induction, and alcohol seeking behaviors. Drug Alcohol Depend. 2016;165:151-8. https://doi.org/10.1016/j.drugalcdep.2016.05.026.

58. Vassileva J, Conrod PJ. Impulsivities and addictions: a multidimensional integrative framework informing assessment and interventions for sub stance use disorders. Philos Trans R Soc Lond B Biol Sci. 2019;374(1766):20180137. https://doi.org/10.1098/rstb.2018.0137.

59. Verdejo-Garcia A, Albein-Urios N. Impulsivity traits and neurocognitive mechanisms conferring vulnerability to substance use disorders. Neuro pharmacology. 2021;183:108402. https://doi.org/10.1016/j.neuropharm.2020.108402.

60. Verdejo-García A, Lawrence AJ, Clark L. Impulsivity as a vulnerability marker for substance-use dis orders: review of findings from high-risk research, problem gamblers and genetic association studies. Neurosci Biobehav Rev. 2008;32(4):777-810. https://doi.org/10.1016/j.neubiorev.2007.11.003.

61. Westman JG, Bujarski S, Ray LA. Impulsivity Moderates Subjective Responses to Alcohol in Alcohol-Dependent Individuals. Alcohol Alcohol. 2017;52(2):249-255. https://doi.org/10.1093/alcalc/agw096.

62. Whelan R, Watts R, Orr CA, Althoff RR, Artiges E, Banaschewski T, Barker GJ, Bokde AL, Büchel C, Carvalho FM, Conrod PJ, Flor H, Fauth-Bühler M, Frouin V, Gallinat J, Gan G, Gowland P, Heinz A, Ittermann B, Lawrence C, Mann K, Martinot JL, Nees F, Ortiz N, Paillère-Martinot ML, Paus T, Pausova Z, Rietschel M, Robbins TW, Smolka MN, Ströhle A, Schumann G, Garavan H; IMAGEN Consortium. Neuropsychosocial profiles of current and future adolescent alcohol misusers. Nature. 2014;512(7513):185-9. https://doi.org/10.1038/nature13402.

63. Wilson S, Malone SM, Thomas KM, Iacono WG. Adolescent drinking and brain morphometry: A co-twin control analysis. Dev Cogn Neurosci. 2015;16:130-138. https://doi.org/10.1016/j.dcn.2015.07.005.

64. Witkiewitz K, Lustyk MKB, Bowen S. Retraining the addicted brain: a review of hypothesized neuro biological mechanisms of mindfulness-based relapse prevention. Psychol Addict Behav. 2013;27(2):351 365. https://doi.org/10.1037/a0029258.

65. Yücel M, Oldenhof E, Ahmed SH, Belin D, Billieux J, Bowden-Jones H, Carter A, Chamberlain SR, Clark L, Connor J, Daglish M, Dom G, Dannon P, Duka T, Fernandez-Serrano MJ, Field M, Franken I, Goldstein RZ, Gonzalez R, Goudriaan AE, Grant JE, Gullo MJ, Hester R, Hodgins DC, Le Foll B, Lee RSC, Lingford-Hughes A, Lorenzetti V, Moeller SJ, Munafò MR, Odlaug B, Potenza MN, Segrave R, Sjoerds Z, Solowij N, van den Brink W, van Holst RJ, Voon V, Wiers R, Fontenelle LF, Verdejo-Garcia A. A transdiagnostic dimensional approach towards a neuropsychological assessment for addiction: an international Delphi consensus study. Addiction. 2019;114(6):1095-1109. https://doi.org/10.1111/add.14424.