Characterizing the role of impaired control over alcohol in associations of impulsive personality traits with alcohol use as a function of depressive disorder

•Relations among impulsivity, impaired control, and drinking differ by depression.•Negative urgency linked to failed control and drinking in those with depression.•Positive urgency linked to failed control and drinking in absence of depression.•Results suggest heterogeneity in antecedents to drinking within clinical samples. Impulsive personality traits have well-documented associations with at-risk drinking, although the role of impaired control over alcohol in these associations requires further study. Additionally, it remains unknown whether such relationships differ in the context of concurrent depressive disorder, which is a priority due to the high rates of mood dysregulation particularly in clinical samples. This project examined associations of impulsivity, impaired control over alcohol, and alcohol use within 201 adult general outpatients recruited from specialty mental health and addictions clinics at a psychiatric hospital. Outpatients completed the Structured Clinical Interview for DSM-IV Patient version (SCID) and assessments of impulsivity, impaired control over alcohol, and alcohol use. Over 35% of outpatients met criteria for a current depressive disorder. Path models supported associations of impulsivity with impaired control over alcohol and, in turn, at-risk drinking that differed significantly as a function of current depression. Among individuals with current depression, greater tendency to act rashly when experiencing negative affect (negative urgency) was associated with more frequent failures to control drinking (failed control) and, in turn, more at-risk drinking. In contrast, among individuals without current depression, greater positive urgency and lower sensation seeking were associated with greater failed control and, in turn, more at-risk drinking. Findings represent an important step toward clarifying the role of impaired control over alcohol in impulsivity and alcohol use associations and suggest divergent associations of negative urgency, positive urgency, and sensation seeking with at-risk drinking across clinical presentations.