Transition to alcohol dependence: Clinical and neurobiological considerations

The transition to alcohol dependence is supposed to occur during a critical period that begins with increased drinking and ends with a loss of control . This process may last about 3 to 4 years, and is modified by gender and a ccelerated by premorbid traits (e.g.. novelty-seeking) and comorbid disorde rs (e,g., dissocial personality disorders according to ICD-10). Genetic dis position, environmental influences (:e.g., stress), and sensitization by ex posure are factors implicated in dependence that alter brain functions, som e possibly in an irreversible way. Underlying neurobiological mechanisms th at may have different time patterns are beginning to be characterized on a systemic, cellular, and molecular level. Repeated free choices of the rewar ding compound seem to be necessary for the transition to dependence. Copyri ght (C) 2000 by W.B. Saunders Company.