Craving: what can be done to bring the insights of neuroscience, behavioral science and clinical science into synchrony

Alcohol self-administration behavior is the common thread that is necessary to bring the insights of neuroscience, behavioral science and clinical sci ence into synchrony around the concept of craving. Animal models should add ress the molecular and cellular changes that take place in behaviorally rel evant brain regions of rats consequent to chronic self-administration of et hanol. Animal models can focus on the biology of the anticipatory state in alcohol preferring/consuming rats, as well as studies of the effects of pos sible medications on this state in the animal model, on actual alcohol cons uming behavior, and on the residual effects of chronic alcohol on the non-h uman mammalian brain. In human studies of craving, cue-reactivity in the ab sence of the opportunity to drink alcohol does not have the same salience a s cue-reactivity in which drinking is possible. Moreover, actual drinking b ehavior serves to validate self-reports of craving. Studies of limited alco hol self-administration in the laboratory are an essential element in scree ning new medications for the treatment of alcoholism. Studies to date sugge st no adverse reaction to the participation of alcoholic subjects in limite d alcohol self-administration studies, but the research community should co ntinue to monitor carefully the outcomes of alcohol-dependent subjects who participate in this type of research, and efforts should always be made to encourage these subjects to enter active treatment. In outpatient clinical trials of new treatments for alcoholism, the assessment of craving should i nclude queries regarding symptoms and signs of protracted abstinence such a s sleep disturbances, as well as questions regarding situational craving. F ield observations of alcoholics in their favorite drinking environments wou ld contribute greatly to our understanding of the real-world phenomenology of craving.