A three-pathway psychobiological model of craving for alcohol.

Abstract

In this article, by reviewing the psychological, psychophysiological, neurobiological, and psychopharmacological literature on craving for alcohol, it is argued that converging evidence from several disciplines suggests a three-pathway psychobiological model of craving. Essential to this model is the appreciation of the role of individual differences in affect regulation strategies or personality styles, conditionability, sensitivity to alcohol's effects, and related dysregulations in distinct neural circuitries or neurotransmitter systems. These factors are of crucial importance to a proper understanding of the nature of craving, its underlying mechanisms and different manifestations. As a first pathway, it is suggested that reward craving or desire for the rewarding, stimulating and/or enhancing effects of alcohol might result from either dopaminergic/opioidergic dysregulation or a personality style characterized by reward seeking or a combination of both. As a second pathway, it is suggested that relief craving or desire for the reduction of tension or arousal might result from either gamma-aminobutyric acid (GABA)ergic/glutamatergic dysregulation or a personality style characterized by stress reactivity or a combination of both. Obsessive craving, the result of the third pathway, can be defined as lack of control over intrusive thoughts about drinking resulting in impaired functioning. This type of craving might result either from a serotonin deficiency or a personality style characterized by low constraint or disinhibition or a combination of both. The putative implications of this three-pathway model for the assessment of alcohol craving, diagnosis and treatment of alcoholism, and future research on craving, are discussed.

Negative affect is associated with alcohol, but not cigarette use in heavy drinking smokers

“…It is also possible that tension reduction mechanisms depend upon a host of factors beyond the pharmacological effects of alcohol (e.g., response to alcohol cues, social context), which were suppressed in the intravenous alcohol administration paradigm. Furthermore, drinkers, even alcohol dependent drinkers are known to differ in terms of relief drinking (Verheul et al, 1999).…”

Effect of a Single Dose of Levodopa on Sexual Response in Men and Women

“…T reflex modulation showed to be sensitive to changes in reward processing due to dopaminergic influences. Disorders in appetitive motivation, like substance addiction, are supposed to be related to dysregulation or sensitization of the mesolimbic dopaminergic system (Robinson and Berridge, 2001;Verheul et al, 1999). T reflex modulation may offer a sensitive tool to investigate reward signaling and the instigation of action tendencies in disorders in appetitive motivation, for example in substance addiction and hyper-and hypoactive sexual desire disorder.…”

Event-related potentials indicate motivational relevance of cocaine cues in abstinent cocaine addicts

“…These systems imply that dopaminergic projections of the ventral tegmental area to the nucleus accumbens, amygdala, hippocampus, anterior cingulate cortex and prefrontal cortex play a major role in the motivational and rewarding effects of addictive drugs (Wise 1996;Verheul et al 1999). According to Goldstein and Volkow (2002), the mesolimbic system is involved in the reinforcing effects of drugs and conditioned responses during craving, whilst this system is also responsible for emotional and motivational changes during withdrawal.…”