How does impulsivity change during addiction treatment and what impact does it have on treatment outcomes?

Share this:

By Emily Levitt


  • People who experience addiction often also report high levels of impulsivity, but less is known about how impulsivity relates to other important treatment outcomes.
  • This study examined whether impulsivity changed among patients who completed an inpatient addiction treatment program and how these changes related to changes alcohol/drug cravings, as well as symptoms of depression, anxiety and PTSD.  
  • Results showed that impulsivity decreased over treatment and those who became less impulsive exhibited greater reductions in cravings and improvements in mental health.
  • The findings suggest that specifically focusing on impulsivity during treatment may have an even greater impact on treatment outcomes.


Impulsivity, briefly defined as acting without thinking, can be a problem for people living with substance use disorders. However, there is limited research on how impulsivity changes during treatment. This is complicated by the fact that impulsivity can be measured in several different ways.

This study explored whether impulsive decision making (i.e., a preference for small, more immediate rewards over larger, delayed rewards) and impulsive personality traits (i.e., self-reported impulsivity related to five specific traits) change over time among individuals in an inpatient addiction treatment program. In addition, HRI researchers explored whether these changes were linked to changes in other important clinical outcomes, including cravings for alcohol/drugs and symptoms of depression, anxiety, and PTSD. In other words, this study sought to understand if people become less impulsive during treatment and whether this reduction in impulsivity is connected to improvements in other important aspects of their mental health.


Researchers analyzed data collected from 817 patients who completed an inpatient addiction treatment program between April 2018 and December 2019 at Homewood Health Centre in Guelph, Ontario. Data were collected as part of routine care at admission and discharge, and included measures of impulsive decision making (5-Choice Effective Delay 50), impulsive personality traits (the UPPS-P Brief Impulsive Behaviour Scale), alcohol/drug craving (Aggregated Drug Craving Scale), depression, (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and PTSD (Post-Traumatic Stress Disorder Checklist-5).

The researchers then conducted analyses to determine whether impulsivity changed from admission to discharge and whether these changes were associated with changes in alcohol/drug craving, as well as symptoms of depression, anxiety, and PTSD.


The researchers found patients’ ratings of impulsive personality traits decreased significantly over the course of treatment; however, impulsive decision making did not change. Importantly, changes in most of the impulsive personality traits were associated with changes in other clinical outcomes (i.e., alcohol/drug craving and symptoms of depression, anxiety and PTSD). This means that as people became less impulsive, they also experienced fewer alcohol/drug cravings, as well as improvements in their mental health. Future studies in this field should continue to explore whether specifically targeting impulsivity in treatment could lead to even greater improvements in clinical outcomes.


This study revealed that impulsive personality traits can change over the course of addiction treatment and that these changes are related to changes in other important clinical outcomes. Interestingly, these traits decreased without specifically targeting them during treatment. Focusing on specific impulsive personality traits may have an even greater impact on treatment outcomes. By enhancing care in this way, it may be possible to further improve the effectiveness of addiction treatment and ultimately benefit patients’ overall well-being.


Emily E. Levitt, BA., PhD Candidate1 and Research Trainee2,

Sarah Sousa MSc., Senior Research Associate2

Jean Costello PhD., Director of Research and Evaluation2

Onawa LaBelle, PhD., Director, Positive Psychology, Recovery, and Relationships Lab3, and Collaborating Scientist2

Brian Rush PhD, Scientist Emeritus4, and Senior Scientist2

James MacKillop, PhD, Director, Peter Boris Centre for Addictions Research1 and Senior Scientist2

1Peter Boris Centre for Addiction Research, McMaster University & St. Joseph’s Healthcare (Hamilton, ON)

2Homewood Research Institute (Guelph, ON)

3University of Windsor, Windsor, Ontario, Canada

4Centre for Addiction and Mental Health (Toronto, ON)

Hershberger, A. R., Um, M., & Cyders, M. A. (2017). The relationship between the UPPS-P impulsive personality traits and substance use psychotherapy outcomes: A meta-analysis. Drug and Alcohol Dependence178, 408-416.

Littlefield, A. K., Stevens, A. K., Cunningham, S., Jones, R. E., King, K. M., Schumacher, J. A., & Coffey, S. F. (2015). Stability and change in multi-method measures of impulsivity across residential addictions treatment. Addictive Behaviors42, 126-129.

Loree, A. M., Lundahl, L. H., & Ledgerwood, D. M. (2015). Impulsivity as a predictor of treatment outcome in substance use disorders: Review and synthesis. Drug and Alcohol Review, 34(2), 119-134.

Petker, T., Yanke, C., Rahman, L., Whalen, L., Demaline, K., Whitelaw, K., & MacKillop, J. (2021). Naturalistic Evaluation of an Adjunctive Yoga Program for Women with Substance Use Disorders in Inpatient Treatment: Within-Treatment Effects on Cravings, Self-efficacy, Psychiatric Symptoms, Impulsivity, and Mindfulness. Substance Abuse: Research and Treatment15, 11782218211026651.