At No Fallen Heroes we are concerned about substance abuse in veterans for its own sake and because it is a predisposing factor in veteran suicides. People who become addicted to drugs or alcohol generally know that these substances are not good for them, at least in the quantities they are using. With all good intentions, an alcoholic makes little decisions that lead to the bar or buying a six pack at the grocery store when getting groceries for the family. Poor impulse control appears to be part of why those with substance abuse problems repeatedly “fall off the wagon” when they are trying to quit. But it also appears that the drugs themselves have effects that reduce impulse control as well.
Is Poor Impulse Control First or Is Addiction?
As noted in a British study, there are genetic predispositions to poor impulse control. They scanned the brains of thirty pairs of siblings, one of whom was addicted to cocaine and one of whom was not. In both cases there were similar connections between lower and higher brain functions that related to control of impulses before they bypassed conscious or intentional thought. In other words, the cocaine addicted siblings were genetically predisposed to poor impulse control which could lead to drug use but the “defect” in the brain connection did not condemn everyone with the problem to become addicted to cocaine.
On the other hand we know that anyone who is drunk will typically have poor control of their impulses as a direct effect of the alcohol (or a drug). The prefrontal cortex is the part of the brain where people make rational and sound decisions. It is where judgment intervenes and helps us control urges and impulses. This area of the brain is weakened by drugs and alcohol allowing impulses to use drugs and alcohol to get through. The continued use of addictive substances became ingrained behavior and the control exercised by the prefrontal cortex becomes weaker and weaker
Thus drug-using behavior that may have been facilitated by a genetic predisposition to poor impulse control is further strengthened by the weakening of the higher centers of the brain than normally work to override impulsive and poor decision making.
Depression and Impulse Control Issues
One of the major risk factors for suicide attempts in veterans is depression. Depressed people often engage in impulsive behaviors which temporarily relieve their depression by giving them a surge of the neurotransmitter dopamine in their brain. Impulsive behavior can act as a form of self-medication for some individuals. Drinking, drug use, overeating, impulsive spending or other impulsive acts become habitual because they serve to temporarily relieve depression.
Depression Treatment With Psychedelic Medicines
Sadly, depressed individuals who engage in impulsive behaviors are also at risk for impulsive suicide attempts. As such, effective treatment of depression and the “need” to self-medicate with impulsive acts is important. What appears to be the most effective treatment for suicide is a combination of psychedelic medicine and psychotherapy or coaching. Although the psychedelics MDMA and psilocybin are in FDA testing phases they are likely to be OKed for standard use within a year or two. These medicines have been shown to relieve depression for years with just one or two doses coupled with coaching sessions. This is unlike treatment with standard antidepressants that require one more pills every day for weeks, months, or even years.
Impulse Control Issues and Suicide
Depressed individuals can come to the point where they believe life has no meaning, pain will never cease, they have no individual self-worth, or there is simply no point in going on. Some individuals will plan to take their own lives and others will not. Unfortunately, the ones who do not resort to making plans may choose impulsively to end their lives when a personal crisis emerges, their symptoms take a turn for the worse, or pain from a chronic ailment becomes unbearable. When this happens impulse control or the lack of it becomes critical. This is why depression coupled with substance abuse is so dangerous because both conditions tend to cause poor impulse control and predispose the suicidal thought processes at the same time.
