Alcohol and alcoholism : international journal of the Medical Council on Alcoholism
-
Increasing evidence suggests that craving may play a central role in the mechanisms of addiction. The experience of craving is largely characterized by obsessional thoughts about drugs, triggering compulsive drug-seeking and drug-taking behaviour. In the present article the possible involvement of brain 5-hydroxytryptamine (5-HT) in the mechanisms of craving and relapse is discussed by integrating the results of basic research with those obtained in human studies. Based on studies suggesting that the brain serotonergic system plays a central role in the regulation of impulse-control mechanisms, it is proposed that 5-HT deficiency may contribute to the loss of control over drug-taking, which is a crucial factor for the maintenance of addictive behaviour.
-
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. ⋯ 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.