Alcohol and Alcoholism, Vol 34, 197-222, Copyright © 1999 by Medical Council on Alcoholism
R Verheul, W Van den Brink and P Geerlings
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
ARTICLES
A three-pathway psychobiological model of craving for alcohol
Amsterdam Institute for Addiction Research, Academical Medical Center, University of Amsterdam (Department of Psychiatry) and De Jellinek Center, Amsterdam, The Netherlands; Corresponding author at: Amsterdam Institute for Addiction Research, Jacob Obrechtstraat 92, 1071 KR Amsterdam, The Netherlands
-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.
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