Intermittent Explosive Disorder and Substance Use Disorder: Analysis of the National Comorbidity Survey Replication Sample
Open accessAbstract
OBJECTIVE: A relationship between aggression and substance use has been debated for many years. While substance use increases the risk of aggressive behavior, no studies have reported on the relationship between impulsive aggression and substance use/disorder, specifically. METHODS: We analyzed data from the community-based National Comorbidity Survey Replication (N = 9,282 subjects) in order to examine the relationship between current DSM-5 intermittent explosive disorder (IED), a disorder of impulsive aggression, and current substance use disorders (SUDs), overall, and with regard to alcohol, tobacco, and cannabis use disorders and nondisordered use. RESULTS: Occurrence of current SUD was elevated in current IED versus non-IED adult subjects, and onset of IED preceded that of SUD in 92.5% of comorbid IED + SUD cases. This relationship was not due to the presence, or absence, of current depressive or anxiety disorders. Examination of the severity of IED and of SUD revealed that the presence of IED increases SUD severity but that the presence of SUD does not increase IED severity. CONCLUSIONS: Subjects with IED are at increased risk of developing SUD, compared with those without IED. This suggests that history of recurrent, problematic, impulsive aggression is a risk factor for the later development of SUD rather than the reverse. If so, effective treatment of impulsive aggression, before the onset of substance misuse, may prevent, or delay, the development of SUD in young people.
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Men perpetrate most alcohol-related violent offenses, including homicide and domestic violence, linked to chronic misuse, impulsivity, and intermittent explosive behaviors.
“In line with these premises, alcohol-related aggression and violence similarly display notable sex differences: men perpetrate most alcohol-related violent offenses, including homicide and domestic violence, linked to chronic misuse, impulsivity, and intermittent explosive behaviors (Dobash And Dobash 2011; Graham et al. 2011; Coccaro et al. 2017; Puhalla et al. 2020; Sontate et al. 2021).”
From Decoding the bidirectional links between alcohol misuse and aggression: toward a unified translational framework (2026) · cites this paper as Coccaro et al. 2017
The Introduction (page unavailable in our copy) says alcohol can increase aggressive behavior and describes intermittent explosive disorder as involving impulsive aggression. It does not say that men perpetrate most alcohol-related violent offenses or discuss homicide or domestic violence as outcomes. (LLM, conf=0.87)
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Flagged first, then by citations
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Russell, N. M., Frier, M. D., Bortolato, M., & Mangieri, R. A. (2026) · Psychopharmacology · doi:10.1007/s00213-025-06938-0 · Cited by 3 · see citing works
- Authors
- Coccaro, E. F., Fanning, J. R., & Lee, R.
- Affiliations
- University of Chicago (US)
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2017-06-28
- Volume
- 78
- Issue
- 06
- Pages
- 697-702
- ISSN
- 0160-6689 (ISSN-L)
- PMC
- PMC6128355
- OpenAlex
- W2592014168
- Semantic Scholar
- a4db921df8967ecd3fa61fdac0a41bc46d01875d
- Cited by
- 38
- References
- 27
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 3 · 2021: 4 · 2020: 4 · 2019: 9 · 2018: 4 · 2017: 2 · 2016: 5
- FWCI
- 4.07
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R21MH099393, K23MH109824)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Social Psychology › Bullying, Victimization, and Aggression
- Keywords
- intermittent explosive disorder, substance use disorders, impulsive aggression, comorbidities, alcoholism, tobacco use disorder, cannabis use disorder, disorder severity, risk factors, National Comorbidity Survey Replication
- MeSH terms
- Adolescent, Adult, Aggression, Female, Humans, Disruptive, Impulse Control, and Conduct Disorders, Male, Middle Aged, Risk, Severity of Illness Index, Comorbidity, Substance-Related Disorders, Young Adult
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