Heavy Alcohol Use in Emerging
Adults Is Due to Impulsivity Alone: True or False?

According to Hall (1904), adolescence
is a time of “storm and stress” as children transit to adulthood. A common stereotype
has labelled adolescence as the difficult age of impulsivity (Chan, et al., 2012), which refers to the
tendency to engage in behaviors rapidly without considering potential negative
consequences. This stereotype may be formed based on the predominant traits
found within adolescents (Fishman, 1956),
such as facing the highest risk for initiation and alcohol use (Kandel & Logan, 1984). The frequency of
heavy alcohol use is also found to reach the peak during emerging adulthood (Windle, Mun, & Windle, 2005). However, the
relevance of these characteristics may also be exaggerated or faulty
assumptions towards adolescents and emerging adults (Banaji, Hardin, & Rothman, 1993). Therefore, this paper serves
to examine whether heavy alcohol use in emerging adults, age 18 to 25 (Arnett, 2000), is due to impulsivity alone.

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The Role of Impulsivity in Alcohol Use

Several studies have considered impulsivity as a single construct and found
that impulsivity is positively related to alcohol use, however, few studies
focused on the relationship between different impulsivity traits and alcohol
use in emerging adulthood. Thus, Shin et al. (2012)
examined how four aspects of impulsivity based on the Five Factor Model of
personality: (a) urgency, (b) premeditation, (c) perseverance, and (d) sensation
seeking, are related to different alcohol use outcomes: (a) frequency of
alcohol use, (b) alcohol-related problems, (c) binge drinking, and (d) alcohol
use disorders (AUDs), after controlling for age, gender, socio-economic status,
psychological distress, peer alcohol use and parental alcoholism. This study
serves to aid in the development of personality-targeted interventions on prevention
and treatment. In relation to past findings, urgency and sensation seeking are
associated to AUDs, while sensation seeking are related to the frequency of
alcohol use. There is no prediction of any relationships between the remaining
factors.

Methodology

            Participants.

190 individuals aged 18 to 25, without major medical conditions, were recruited
through advertisements. Among the participants, 61% were females, 56% were
college students, and 65.8% were white. 25.2% had less than enough, 50% had
enough, while 24.8% had more than enough money for family needs.

            Impulsivity. The Urgency, Premeditation, Perseverance, and Sensation Seeking (UPPS)
Impulsive Behavior Scale (Whiteside & Lynam,
2001) was used to measure the four impulsivity traits mentioned above.

            Alcohol Use. The frequency of alcohol was determined by the number of days one
consumed alcohol per month in the past year. Past year alcohol-related problems
were assessed using the Rutgers Alcohol Problem Index (White & Labouvie, 1989). Binge drinking was measured by the
number of days one had five or more drinks continuously for males, or four or
more drinks continuously for females, at least two to three days per month in
the past year (Wechsler, Davenport, Dowdall,
Moeykens, & Castillo, 1994). AUDs were evaluated using alcohol
section in the Composite International Diagnostic Interview (Cottler, et al., 1991).

Psychological distress was assessed by the Brief Symptom Inventory 18 (Derogatis, 1993). Peer alcohol use
was determined by the number of friends who drink currently. Parental
alcoholism was measured by the 6-item Children of Alcoholics Screening Test (Hodgins, Maticka-Tyndale, El-Guebaly, & West,
1993, 1995).

Results

Analysis for the four impulsivity traits was done using the Poisson
regression on the frequency of alcohol use and alcohol-related problems, as
well as the logistic regression analysis on binge drinking and alcohol use
disorders. It was found that participants with higher scores on urgency and
sensation seeking, scored higher on all four constructs of alcohol use. Those who
scored lower on premeditation also had higher frequency alcohol use. No
relationship was found between perseverance and the constructs of alcohol use.

Discussion

            Different impulsivity traits, specifically
urgency, sensation seeking, and premeditation, are related to alcohol use
during emerging adulthood. Individuals with high urgency may be motivated to
consume alcohol to relieve negative emotions, which may escalate to long-term alcohol
dependency due to the negative reinforcement. As for individuals with high
sensation seeking, initial alcohol use may serve as an exploration of adult
identity, which may be a confusing process (Arnett, 2005) that leads to alcohol
dependency. This may also be due to the inability to control stimulating
behaviors that generates positive emotions (Castellanos-Ryan,
Rubia, & Conrod, 2011). Furthermore, individuals lacking
premeditation tend to fail in taking into account for the negative consequences
of alcohol use. Overall, the four impulsivity traits have varying effects on the
different alcohol outcomes in emerging adults.

Limitations and Future Directions

            This was a cross-sectional study that
was unable to cover the changes in impulsivity traits over time due to
development or alcohol use (Quinn, Stappenbeck, & Fromme,
2011). Hence,
longitudinal studies can be employed to determine the causal relationship and
temporal order of impulsivity and alcohol use from adolescence into emerging
adulthood. Additionally, self-report measures for alcohol use in this study may
be subjected to recall bias, social desirability bias, and acquiescence bias.

Interaction
Between Impulsivity and Stress on Alcohol Use

            On the other hand, alcoholism may
not be related to the effects of impulsivity alone. Studies have shown that
stress is also related to alcohol use, yet few have explored its interaction
with impulsivity in influencing alcoholism. Hence, Fox et al. (2010) examined how cumulative
stress and impulsivity influence alcohol use and alcohol-related problems. This
study also served to assist the development of preventive interventions on
alcohol abuse. Based on past findings, recent life stress
(Rutledge & Sher, 2001),
cumulative traumatic stress (Lloyd & Turner, 2008), and traumatic life experiences
(Reed, Anthony, & Breslau, 2007), are positively related to varying
increments of alcohol use. Inability to delay gratification and inhibitory
control are also related to compulsive alcoholism (Rubio,
et al., 2007). Genetic
research has also identified common genetic markers between alcohol use and stress
(Covault, et al., 2007), as well as impulsivity (Wagner,
Baskaya, Lieb, Dahmen, & Tasi? André, 2009).

Methodology

            Participants.

130 individuals
aged 18 to 50, without major medical conditions,
DSM-IVTR psychiatric disorders, or drug dependence, excluding nicotine and
alcohol, were recruited through advertisements. 58% of the participants were
females.

            Stress. Cumulative stress was
assessed using the Cumulative Stress/Adversity Checklist (CSC, Turner
& Wheaton, 1995), including recent life stress, major life stress,
traumatic stress, and chronic stress.

Impulsivity. Impulsivity was measured using
the Barratt Impulsiveness Scale (BIS-11; Patton, Stanford, & Barratt,
1995) by summing the scores for attentional impulsivity, motor impulsivity, and
non-planning impulsivity.  

Alcohol Use. The Alcohol Use Disorders
Identification Test (AUDIT; Babor, Higgins-Biddle, Saunders,
& Monteiro, 2001)
was used to measure alcohol consumption and its negative consequences.

Results

            Multiple regressions were used to
determine the individual and interaction effects of cumulative stress and
impulsivity, as well as their specific components on alcohol use. This study
found that recent life stress, traumatic stress, overall impulsivity,
attentional impulsivity, motor impulsivity, and non-planning impulsivity were
related to AUDIT scores, and the strongest relationship was with traumatic
stress. An interaction was found between high cumulative stress and high
impulsivity in predicting high AUDIT scores.

Discussion

            This study showed that different
components of stress and impulsivity are associated with alcohol use. Additionally,
high stressful events and moderate to high impulsivity may be related to the
escalation of alcohol use over time, leading to long-term alcohol dependency. This
may be because stress, especially traumatic stress, may weaken the physiological
processes of the brain (McEwen, 2007) and its cognitive
mechanisms, such as decreasing self-regulation (Muraven
& Baumeister, 2000),
thereby increasing impulsive behaviors.

Limitations and Future Directions

This
was also a cross-sectional study which was unable to cover the changes in
stress, impulsivity, and alcohol use over time. Thus, longitudinal research is
required to assess the temporal directionality of the relationship between
these three variables, especially the influence of early traumatic life events
in the development of impulsivity. In addition to the self-report measures used
in this study, further studies could also employ comparative subjective,
biological, and behavioral markers of stress and impulsivity.

Conclusion

            Overall, these two studies provided different
perspectives on whether heavy alcohol use in emerging adults is due to
impulsivity alone, or due to the interaction effect of impulsivity with other
factors, such as stress.