In a long-running, prospective cohort study among people seeking help for alcohol-related problems, those with poor impulse control had an increased risk of dying, according to Daniel Blonigen, PhD, and colleagues at the Palo Alto Veterans Affairs Medical Center in Palo Alto, Calif.

The effect was independent of the risk associated with alcohol use disorders, Blonigen and colleagues reported online in Alcoholism: Clinical and Experimental Research.

Both impulsivity and alcohol use disorders are known to increase the risk of premature death, the researchers noted, and alcohol use increases impulsive behavior. But there has been no research on how poor impulse control affects mortality risk among people who also have problems with alcohol, they added.

“This is a surprising omission, given that impulsivity is a well-established risk factor for alcohol misuse,” Blonigen and colleagues wrote.

To help clarify the issue, they studied a cohort of 628 people who had sought help for alcohol-related problems and who were followed for 16 years.

The researchers used data on a set of variables collected when participants entered the study and a year later to predict the 15-year probability of death from years one through 16 of the study.

The researchers found:

•Among the 515 participants who remained in the study for the year one assessment, 93 were known to have died in the subsequent 15 years.

•After controlling for age, sex, and marital status, higher impulsivity at baseline was linked to an increased risk of death from years one to 16. A standard deviation increase yielded a hazard ratio (HR) for death of 1.38 with a 95% confidence interval (CI) from 1.10 to 1.74.

•But further adjustment for the severity of alcohol use at baseline accounted for the association, rendering it non-significant.

•However, impulsivity at year one — after treatment for alcohol use disorders — remained a significant predictor for death, with each standard deviation increase yielding an HR of 1.35 with a 95% CI from 1.06 to 1.72.

•That was similar to the risk imposed by alcohol use in the fully adjusted model — an HR of 1.34 with a 95% CI from 1.02 to 1.77.

On the positive side, Blonigen and colleagues reported, a supplemental analysis suggested that a supportive network of peers and friends can moderate the effect of high impulsivity.

The study was not designed to look at why poor impulse control might contribute to an increased risk of death among those with alcohol problems, Blonigen and colleagues noted, but several factors might play a role.

“Impulsivity is linked to a wide range of health-risk behaviors beyond excessive alcohol use,” they noted, including “violent crime, risky driving and sexual practices, (and) illicit drug abuse.”


The researchers cautioned that the study didn’t look closely at other risky activities, such as smoking. Also, they noted, assessment of risk factors was based on self-reporting and impulsivity was measured using a brief 10-item scale.


By Michael Smith, North American Correspondent, MedPage Today

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