Impulsivity is a well-documented trait associated with the development and perpetuation of substance use disorders [1, 2]. Impulsivity is defined as a predisposition towards rapid, unplanned reaction to internal and external stimuli without regard to the negative consequences of these reactions. It comprises of attention, behavioural and cognitive components. It is characterized by a tendency to act without adequate for thought, which can exacerbate the risk of substance use by leading individuals to engage in risky behaviours [3, 4]. While impulsivity is recognized as a significant factor in substance use, existing research predominantly focuses on its relationship with substance use disorder in general rather than making direct comparisons between different types of substance use disorders [5, 6]. Alcohol and cannabis are two commonly abused substances, each with distinct pharmacological effects and potential impacts on behaviour [7, 8]. Understanding how impulsivity varies between these substances is crucial, as it can provide insights into the differential treatment needs and therapeutic approaches for individuals with these specific addictions. Although heavy drinking is arguably the most direct risk factor for adverse alcohol-related outcomes, research indicates that other substance use also carries some risk. Cannabis is the most often used psychoactive substance in the United States, aside from alcohol [9], and its usage has grown dramatically over the last 20 years [10]. A substantial proportion of cannabis users report drinking [11], and a sizable proportion of alcohol users report using cannabis [12], a term referred to as alcohol and cannabis co-use (i.e., use of both substances during a given time period, but not necessarily on the same occasion;) [13].

Aim and Objective: To asses Impulsivity in patient with Alcohol and Cannabis Dependence Syndrome and to compare the levels of impulsivity between individuals with alcohol and cannabis dependence syndrome.

Study Design: A Single centre, Hospital based Cross-sectional Study.

Study Setting: Department of Psychiatry, Chirayu Medical College, Bhopal.

Duration of Study: 3 months

Sample Size: 64 participants (32 in each group)

Tool used: Barratt Impulsiveness Scale (BIS-11) used to measure impulsivity

Inclusion Criteria:

Male patient between the age group of 18-50 years who will be diagnosed as a case of Alcohol and Cannabis Dependence Syndrome as per ICD10

Exclusion Criteria:

• Patient having multiple Drug dependence
• Pre-existing psychiatric illness.
• Patient with other chronic medical conditions which affect psychiatric illness
• Patient with alcoholic hallucinosis
• Patient with head injury
• Patient in acute withdrawal symptoms

Study participants were randomly divided into two groups: alcohol addiction group and cannabis addiction group (32 participants in each group).

All data were collected and compared between these two groups

Statistical analysis:  SPSS version 22 software was used to do the statistical analysis. For the relevant variables, the mean and median were determined. Multivariate analysis was used to compare variables that were significant in univariate analysis. P<0.05 was considered statistically significant.

All participants in this study were male. The mean age of individuals was 29.5 years (SD = 5.2), with ages ranging from 22 to 38 years. The average duration of addiction for the alcohol group was 3.1 years (SD = 1.4), spanning from 1 to 5 years. The cannabis group had a slightly shorter mean duration of 2.8 years (SD = 1.3), with a range from 1 to 4.5 years. Regarding the frequency of use, individuals in the alcohol addiction group reported consuming alcohol on average 5.6 days per week (SD = 1.2), while the cannabis addiction group used cannabis on average 4.8 days per week (SD = 1.3). The alcohol dependence patient had a mean impulsivity score of 64.9 (SD=9.3), with scores ranging from 42 to 84. Conversely, the cannabis dependence patient had a mean impulsivity score of 59.25 (SD=8.7), with scores ranging from 45 to 77. An independent samples t-test indicated that the mean impulsivity score was significantly higher in the alcohol dependence patient compared to the cannabis dependence patient [t (62) = 2.61, p = 0.0087]. For the alcohol Dependence group, impulsivity scores showed a positive correlation with the duration of use. Specifically, individuals with a longer duration of alcohol use exhibited higher levels of impulsivity.

Table 1: Comparison of data between the alcohol addiction and cannabis addiction group

Similarly, impulsivity scores were positively associated with the frequency of alcohol use. Participants who consumed alcohol more frequently displayed greater impulsivity. In contrast, for the cannabis dependence group, impulsivity did not show a significant variation with the duration of use. However, a positive correlation was observed between impulsivity and the frequency of cannabis use. Those who used cannabis more often tended to have higher impulsivity scores, although the variation was less pronounced compared to the alcohol dependence group.

This study investigated impulsivity levels among individuals with alcohol and cannabis dependence syndrome, using the Barratt Impulsiveness Scale (BIS-11) [14]. The findings revealed that individuals in the alcohol dependence group exhibited significantly higher impulsivity scores than those in the cannabis dependence group. This suggests that alcohol dependence may be associated with greater impulsivity compared to cannabis dependence. The results also showed that impulsivity varied significantly with both the duration and frequency of use, similar observation seen in a study done by Wagner MF, et al [15].

In the alcohol dependence group, longer duration and higher frequency of use were associated with increased impulsivity, indicating that chronic alcohol use may exacerbate impulsive behaviour [16].

For cannabis users, while impulsivity correlated with the frequency of use, the impact of the duration of use on impulsivity was less clear [17].

These findings underscore the need for tailored treatment approaches that address impulsivity, particularly for individuals with alcohol dependence. Understanding the relationship between impulsivity and substance use patterns can inform more effective intervention strategies, aiming to mitigate the impact of impulsivity on substance use disorders. Further research can be done to explore these relationships in broader populations and to develop targeted therapies that address impulsivity across different types of substance addictions.

Cannabis and alcohol use are associated with increases in impulsivity (both), hostility (cannabis), and positive affect (alcohol) in daily life, and these effects are part of separate processes that operate on different time scales

1. De Wit H. Impulsivity as a determinant and consequence of drug use: a review of underlying processes. Addict Biol. 2009 Jan; 14(1):22-31. doi: 10.1111/j.1369-1600.2008.00129.x. Epub2008 Oct 9. PMID: 18855805; PMCID: PMC3640851.
2. Poulton A, Hester R. Transition to substance use disorders: impulsivity for reward and learning from reward. Soc Cogn Affect Neurosci. 2020 Nov 10; 15(10):1182-1191. doi: 10.1093/scan/nsz077. PMID: 31848627; PMCID: PMC7657456.
3. Mitchell, M.R., Potenza, M.N. Addictions and Personality Traits: Impulsivity and Related Constructs. Curr Behav Neurosci Rep1, 1–12 (2014). https://doi.org/10.1007/s40473-013-0001-y
4. Bornovalova MA, Lejuez CW, Daughters SB, Zachary Rosenthal M, Lynch TR. Impulsivity as a common process across borderline personality and substance use disorders. Clin Psychol Rev. 2005 Sep; 25(6):790-812. doi: 10.1016/j.cpr.2005.05.005. PMID: 16005556.
5. Moeller FG, Barratt ES, Dougherty DM, Schmitz JM, Swann AC. Psychiatric aspects of impulsivity. Am J Psychiatry. 2001 Nov; 158(11):1783-93. doi: 10.1176/appi.ajp.158.11.1783. PMID: 11691682.
6. Potenza MN, de Wit H. Control yourself: alcohol and impulsivity. Alcohol Clin Exp Res. 2010 Aug; 34(8):1303-5. doi: 10.1111/j.1530-0277.2010.01214.x. Epub2010 May 14. PMID: 20491735; PMCID: PMC3822522.
7. McDonald J, Schleifer L, Richards JB, de Wit H. Effects of THC on behaviour almeasures of impulsivity in humans. Neuropsychopharmacology. 2003 Jul; 28(7):1356-65. doi: 10.1038/sj.npp.1300176. Epub2003 Apr 30. PMID: 12784123.
8. 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 AcadSci. 2019 Sep; 1451(1):71-91. doi: 10.1111/nyas.13977. Epub2018 Oct 5. PMID: 30291624; PMCID: PMC6450787.
9. National Institute on Drug Abuse (NIDA), 2020. What Is the Scope of Marijuana Use in the United States?
10. Hasin DS, 2018. US epidemiology of cannabis use and associated problems. Neuropsychopharmacology 43, 195–212. [PubMed: 28853439]
11. Suerken CK, Reboussin BA, Sutfin EL, Wagoner KG, Spangler J, Wolfson M, 2014. Prevalence of marijuana use at college entry and risk factors for initiation during freshman year. Addict. Behav 39, 302–307. [PubMed: 24455784]
12. Patrick ME, Kloska DD, Terry-McElrath YM, Lee CM, O’Malley PM, Johnston LD, 2018. Patterns of simultaneous and concurrent alcohol and marijuana use among adolescents. Am. J. Drug Alcohol Abuse 44, 441–451. [PubMed: 29261344]
13. Gunn RL, Norris AL, Sokolovsky A, Micalizzi L, Merrill JE, Barnett NP, 2018. Marijuana use is associated with alcohol use and consequences across the first 2 years of college. Psychol. Addict. Behav 32, 885. [PubMed: 30359046]
14. Tsatali M, Moraitou D, Papantoniou G, Foutsitzi E, Bonti E, Kougioumtzis G, Ntritsos G, Sofologi M, Tsolaki M. Measuring Impulsivity in Greek Adults: Psychometric Properties of the Barratt Impulsiveness Scale (BIS-11) and Impulsive Behavior Scale (Short Version of UPPS-P). Brain Sci. 2021 Jul 29; 11(8):1007. doi: 10.3390/brainsci11081007.
15. Wagner MF, Oliveira CR, Paloski LH. Levels of impulsivity in individuals with cannabis use disorder. Trends Psychiatry Psychother.2022;44(Suppl 1):e20210449. http://dx.doi.org/10.47626/2237-6089-2021-0449
16. Johannes Wrege, André Schmidt, Anna Walter1, Renata Smieskova, Kerstin Bendfeldt, Ernst-Wilhelm Radue, Undine E. Lang and Stefan Borgward, Effects of Cannabis on Impulsivity: A Systematic Review of Neuroimaging Findings, Current Pharmaceutical Design, 2014, 20, 2126-2137
17. Timothy J. Trull, Andrea M. Wycoff, Sean P. Lane, Ryan W. Carpenter, and Whitney C. Brown, Cannabis and Alcohol Use, Affect, and Impulsivity in Psychiatric Outpatients’ Daily Lives, Addiction. 2016 November ; 111(11): 2052–2059. doi:10.1111/add.13471