A sense of urgency: Trait impulsivity in co-occurring bipolar and alcohol use disorder

BackgroundBipolar disorder (BD) and alcohol use disorder (AUD) often co-occur, with BD + AUD characterized by higher levels of impulsivity relative to either disorder alone. Emotional facets of impulsivity (e.g., "urgency," measured by the UPPS-P), however, remain underexplored in this population and could have distinct associations with clinical correlates.MethodsThis cross-sectional study used a two-by-two (BDxAD) factorial design, including groups with BD + AD (n = 28), BD (n = 29), AD (n = 28), and healthy controls (HC) (n = 27), to identify between-group differences among the five subscales of the UPPS-P. Associations of UPPS-P subscales with Barratt Impulsiveness Scale (BIS) total scores and clinical variables of interest were also examined.ResultsBD + AD had the highest scores for every UPPS-P subscale but Sensation Seeking, with the Positive and Negative Urgency subscales having the largest main effects for both BD and AD. BIS-11 total scores were most correlated with the urgency subscales of the UPPS-P. Negative Urgency was found to be uniquely relevant to clinical measures in the BD + AD group. Rapid cycling was associated with both urgency subscales and BIS-11 scores, and the Alcohol Dependence Scale was most correlated with the Premeditation subscale.LimitationsCross sectional design and predominantly white sample.ConclusionsUnlike the BIS-11, UPPS-P is able to distinguish emotional from nonemotional facets of impulsivity, something especially relevant to people with co-occurring BD + AD, where fluid emotionality is a key part of symptom presentation. For this reason, the UPPS-P should be utilized in future studies and clinical settings measuring trait impulsivity in this population. Trait impulsivity, namely Positive and Negative Urgency (i.e., emotion-triggered impulsivity), was evaluated in co-occurring bipolar and alcohol use disorder (BD + AD) following a two-by-two (BD x AD) factorial design. BD and AD had significant additive, but not multiplicative, effects on both Positive and Negative Urgency. In turn, specifically among individuals with BD + AD, Negative Urgency was associated with rapid cycling and scores on the ADS. Interventions targeting emotion dysregulation may be especially useful for clinicians working with this historically difficult-to-treat population.image