January 26, 2021
by Patricia Tomasi
A new study published in the American Journal of Psychiatry looked at subjective responses to alcohol in the development and maintenance of alcohol use disorder.
“There are heuristic scientific models as well as common folklore surrounding the issue of responses to alcohol in those who are at risk for, and who do become addicted,” study author Dr. Andrea King told us. “These notions came from animal models or ad-hoc comments from patients entering treatment. I was hoping to find out, in empirical research, whether individuals who develop alcoholism (vs. those who do not) are different in how they acutely respond to alcohol over time.”
Dr. King was testing incentive-sensitization theory, based on neuroscience that wanting alcohol is mediated by different neurochemical pathways than those underlying liking alcohol. The theory purports that wanting increases over time in addiction but liking may not increase. The other theory, allostasis, also based on neuroscience models in rodents, states that addiction is characterized by a transition from drinking for positive reinforcement (pleasurable effects) to negative reinforcement (removing negative feelings).
“I have been working in addictions for decades now, both in research and in treating patients, and keenly interested in improving our understanding of the disorder for better prevention, early intervention, and treatments,” Dr. King told us.
Dr. King examined 190 young adults and followed them for ten years. They were directly tested on their response to alcohol vs. placebo beverage in initial testing sessions and then they returned five and ten years later to our laboratory in Chicago to undergo identical re-examination testing.
“We flew people in from all over the country (and the world) to come back for their returning sessions,” Dr. King told us. “We also conducted regular follow-up interviews semi-annually in that period. I am grateful the participants were so connected to the study, as 99% of those still living continued to participate over the decade.”
Study results showed that having more sensitivity in young adulthood to alcohol’s stimulant and rewarding effects increased the chances of becoming alcoholic in middle age. Those effects persisted and were magnified in persons with the more severe addiction. Contrary to common theory, the positive effects of alcohol did not wane in these individuals with excessive drinking patterns. They did show lesser response, in terms of alcohol’s effects on sedation and fatigue, but those effects were evident initially and remained low over time.
“I was surprised initially as the prevailing theory and folklore about lower responses to alcohol in persons developing addiction is so pervasive in the research field,” Dr. King told us. “Nearly a decade ago, we countered that notion by showing that at initial testing, the at-risk drinkers did not show a low level response to the enjoyable effects of alcohol. When we completed our five-year re-examination phase, I took a step back and thought, wow, this positive alcohol response is not going away over time, it actually persists.”
With the ten-year re-examination data, Dr. King and the research team are now showing these stimulating and motivationally rewarding effects of alcohol increased in magnitude, with liking persisting at high levels, in those developing alcohol use disorder.
“My thought is that people need to know this,” Dr. King told us. “We need to consider the positive reinforcement phase of addiction lasts much longer in humans than was originally conceived. We need to understand that the euphoric effects of alcohol persist and grow in magnitude in persons with excessive drinking. Prevention, education and treatments should include this information to best guide and help patients. Knowledge is power.”
Dr. King believes that now, more than ever, a solid science base is needed to understand how it is that some people are vulnerable to addiction and what adaptations occur in that process. Targeting this positive-like response to alcohol may help people to make the changes they need to lead a healthy life without alcohol controlling them.
About the Author
Patricia Tomasi is a mom, maternal mental health advocate, journalist, and speaker. She writes regularly for the Huffington Post Canada, focusing primarily on maternal mental health after suffering from severe postpartum anxiety twice. You can find her Huffington Post biography here. Patricia is also a Patient Expert Advisor for the North American-based, Maternal Mental Health Research Collective and is the founder of the online peer support group - Facebook Postpartum Depression & Anxiety Support Group - with over 1500 members worldwide. Blog: www.patriciatomasiblog.wordpress.com