The Intersection of Sex, Drugs and Impulsivity

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Humans are determined reward-seekers. It’s a built-in motivation that keeps us on the hunt for food, water, sex and nurturing — things that keep us alive and thriving.

We also universally prefer those rewards to come sooner rather than later. In some people, however, that preference is more pronounced than in others. And we have a word for it: impulsivity.

In large part, impulsivity is a reward deficiency — a tendency to value immediate gratification over future rewards, even when it’s not in the person’s best interests. Researchers have a name for it: delay discounting. An impulsive person, for example, might drive off the lot with a car they’ve fallen in love with even though they could save money by waiting a couple of months for a promised sale.

This heat of the moment mindset can spice up life in small doses, but it can also bring serious downsides. Impulsivity has been linked to addiction, for example, and it’s not hard to see why. A person who has trouble valuing future rewards over immediate ones is going to find it tougher to say no to another drink, for example, or to walk away from a slot machine before all their money is gone. Impulsive people also try drugs and alcohol at a younger age, which is known to elevate addiction risk.

Complicating the picture, substance abuse can change the brain in ways that increase impulsivity, so each issue can make the other worse.

Impulsivity also fuels risky sexual behavior. Substance use does as well. Put the three together and problems escalate. A study of 3,000 high students found, for example, that those who scored high on impulsivity reported that they used alcohol or marijuana before sex, had five or more sexual partners, and “never refused unsafe sex” at much higher rates than those who scored low on impulsivity.

In time, impulsivity, sex and addiction can get tangled up in one another, elevating the negatives and causing problems to snowball.

Following the Reward Pathways

A growing body of research, especially research using brain imaging technology, has helped increase our insights into these interconnections.

When a person encounters a reward, or even when anticipating a reward, the brain releases the chemical dopamine along reward pathways. The brains of those who score high on impulsivity scales, however, show disproportionately more dopamine activity in response to an immediate reward and less dopamine activity when presented with a delayed reward. The greater the dopamine drop-off over time, the more impulsive the person.

Drug use boosts dopamine transmission, reinforcing the thrill of the immediate reward and making impulsivity worse. With repeated use, the substances begin to alter the brain circuitry that assigns importance to stimuli. This increases the person’s craving for the drug, as well as increasing the motivation to obtain natural rewards such as sex. Chronic drug use also causes chemical and physical brain changes that increase sensitivity to dopamine, another spur to impulsivity. Rewards that have to be waited for begin to seem less and less worth the effort. All this makes relapse more likely for those trying to control their substance use.

Research in Parkinson’s disease has also taught us much about impulsivity. The disorder’s bodily tremors and rigidity are thought to be the result of damage to dopamine neurons. Medications that compensate for that lost dopamine were found to have an unexpected side effect for a significant percentage of people: an increase in problems with issues such as gambling, sex, eating and spending. Dopamine release, this reaction made clear, is directly related to behaviors and can trigger problems with impulse control.

Treating Impulsivity

So for those who recognize impulsivity in themselves and fear where it might lead or who are already struggling with its effects, what can be done to lessen that tendency to make counterproductive choices?

Impulsivity’s delayed discounting is thought to be about 40% genetics, but it is also believed to be connected to deficits in the brain’s memory systems. After all, you can’t value a future reward if you can’t remember what it’s worth.

That means that working on memory through simple memory training exercises can help. Research has shown, for example, that memory training decreases impulsivity in newly sober amphetamine addicts.

Another treatment for impulsivity is a technique called prospection. This is a type of mental time travel in which the person projects themselves into the future and thinks about the rewards that might await. For example, a person who wants to stop drinking might visualize waking up sober, rested and ready to take on the day rather than feeling hung over and miserable. In time, the brain learns to assign value to what might be rather than only seeing reward in immediate gratification.

Interestingly, both techniques are built into the framework of Alcoholics Anonymous and are believed to explain part of its success in helping many with addictions maintain their sobriety. The repetition and practice that comes with learning and living the 12 steps improves memory, while the story sharing that is a hallmark of the group helps participants imagine a better future and learn to want what those who are successful in their recovery have created for themselves.

Memory training and prospection are techniques that don’t give results overnight. (The impulsive person must learn to delay gratification here as well.) But the brain, as research now makes clear, is capable of great neurochemical and even physical change. And it’s encouraging to know that where impulsivity is concerned, simply dreaming of a better future might help you achieve it.