What Causes Alcohol Cravings?

Alcohol cravings can strike at the strangest times, with little warning or logic. A photo, smell, song or familiar face can be all it takes to send a former alcoholic into an emotional uproar. What causes these alcohol cravings?
Like most addiction-related problems, alcohol cravings start in the brain. According to research from Medical University of South Carolina, viewing pictures of alcoholic beverages activates the prefrontal cortex and the anterior thalamus in alcoholics. This effect on the brain does not occur in moderate drinkers. Using fMRI (functional magnetic resonance imaging), the research team examined whether alcohol cues stimulate specific regions of the brain.

"The activated brain regions are known to be associated with attention and regulating emotion and are prominent components of working models of alcohol craving," said National Institute on Alcohol Abuse and Alcoholism Director Enoch Gordis, M.D. "Whether the activity in these areas accompanies craving or is in part responsible for it remains to be determined."

The following were the basic parameters for the study:

  • Study participants included eight male and two female alcoholics and an equal number of moderate drinkers (defined as those who drink no more than 14 alcoholic beverages per week). The alcoholics met DSM-IV criteria for alcohol dependence, drank an average of seven drinks per day, and drank on about 70 percent of days in the month before testing. They were not severe alcoholics or in alcohol rehab at the time of study.
  • While lying in an MRI scanner, participants viewed a series of photographs of alcoholic beverages followed by a series of nonalcoholic beverages  in random order. To heighten their responses to alcohol cues, the participants were given a sip of an alcoholic beverage before viewing the images. The researchers then compared images of brain activity, discovering several brain areas that showed unique activity in response to the alcohol-related images.

    "Our goals were to learn whether certain brain areas would be activated for the alcohol cues but not the neutral cues and whether brain areas in alcoholics would be activated differently than those of moderate drinkers," said Raymond F. Anton, M.D., a lead study author and Scientific Director of the NIAAA-funded MUSC Alcohol Research Center. "In fact, we saw clearly that certain brain regions in alcoholics activated in response to viewing pictures with alcohol-specific content. It appears that the alcoholics paid greater attention to the alcohol images."

    The researchers concluded that there is a significant biological and brain component to alcoholism, and that the brains of alcoholics respond differently to cues than nonalcoholics. Scientists hope to explore the impact on the brain of medications like naltrexone, which is believed to reduce alcohol cravings, and to eventually be able to predict risk for excessive drinking and relapse.

    Despite a number of studies about alcohol cravings, there is no consensus about the causes of these intense desires for alcohol. Most researchers agree that drug cravings involve  changes in brain cell function resulting from long-term alcohol consumption. The resulting  imbalance in brain activity may increase drinking or lead to relapse.  
    One of the complexities of understanding alcohol addiction is that alcohol cravings are experienced differently at different stages of alcohol addiction and differently among excessive drinkers  stage.


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