Neurobiology of Alcohol Dependence and Implications on Treatment.

The process of alcohol dependence has been conceptualized as a progress from controlled alcohol intake to compulsive alcohol consumption or a shift from alcohol intake for pleasure to compulsory alcohol seeking behavior. Hereditary and physical factors and the interaction of individuals with their environment, as well as permanent changes in the neurotransmitter and neurohormonal systems in the brain due to alcohol use, have an important role in the etiology of alcohol dependence. The effects of ethanol on the neurotransmitter, neuropeptide, and neuroendocrine systems not only account for its acute physiological and euphoric/reinforcing effects but also seem to be responsible for the development of dependence. While the motivation for alcohol use is mainly positive reinforcement in the earlier phases of alcohol consumption, both positive and negative reinforcements are involved in the process once dependence has developed. This event, termed allostasis, is caused by a neuroadaptive process due to chronic alcohol consumption. It seems that the most important neuroadaptive changes in progression from occasional alcohol intake to dependence are the: (1) down-regulation of the dopamine and gamma aminobutyric acid systems; (2) permanent upregulation in the glutamate system; and (3) dysregulation in the stress systems (corticotropin-releasing hormone and serotonin) of the brain. In this paper, we will review the adaptive changes caused by chronic alcohol consumption, which are important in the development of dependence, and address the potential therapeutic contributions of interventions to these changes in alcohol dependence. [ABSTRACT FROM AUTHOR]