NEUROBEHAVIORAL ASPECTS OF THE PHARMACOTHERAPY OF ALCOHOL DEPENDENCE

A neurobehavioral basis for the pharmacologic treatment of alcoholism is beginning to emerge. Preclinical and clinical findings have provide d valuable information on which to build bridges of understanding rega rding the biological causes and treatment of alcoholism. Reinforcement and stress reduction are prominent in the initiation of alcohol use, while neuroadaptation to chronic alcohol exposure and Pavlovian condit ioning of alcohol-like effects appear to be involved in the developmen t of alcohol dependence. Impulsivity may play a crucial role in the ra pidity with which alcohol dependence develops. This article presents a model that attempts to integrate these neurobehavioral phenomena with neurochemical systems. The pharmacological agents that have been stud ied for the treatment of alcoholism are reviewed in the context of thi s model. While medications that affect the serotonin system have been the most widely studied for the treatment of alcoholism, their clinica l effects have been modest or inconsistent. Medications that affect do paminergic neurotransmission have received less research attention, an d their potential clinical utility may be limited by their side effect profile. The most efficacious agents for the treatment of alcoholism have been the opiate antagonists, including naltrexone. Naltrexone rec ently received approval from the U.S. Food and Drug Administration for relapse prevention in alcoholism. A number of recent clinical and ani mal studies suggest potential mechanisms of action for opiate antagoni sts in the treatment of alcoholism. Knowledge in this field is advanci ng rapidly. Developments in neurobiology, coupled with improvements in both animal models of alcohol self-administration and clinical trial methodology will surely further our understanding of the pathophysiolo gy and pharmacotherapy of alcohol dependence. (C) 1995 Wiley-Liss, Inc .