ALCOHOL-WITHDRAWAL AND LIMBIC KINDLING A HYPOTHESIS OF RELAPSE

In this concept paper, the authors review the arguments and evidence f or the hypothesized link between the alcohol withdrawal syndrome and t he anxiety and craving that occurs during abstinence in alcohol-depend ent patients. This hypothetical construct suggests that the repeated e xperience of alcohol withdrawal and its associated limbic-neuronal dis charge induces a permanent state of limbic hyperexcitability. This phe nomenon has been referred to as ''kindling.'' Subsequent episodes of l imbic discharge may then be precipitated during abstinence by alcohol- related cues or may even occur spontaneously. Subjectively experienced as anxiety or craving, such a neuronal discharge could provoke relaps e to drinking in vulnearable subjects. The clinical, neurochemical, an d electrophysiologic rationale for this hypothesis will be presented, along with implications for treatment and suggested future studies.