Toward bridging the gap between biological, psychobiological and psychosocial models of alcohol craving

Urge to drink ("craving") has been a central focus of many theories and tre atments, but some researchers question the importance of urges during recov ery. Several studies assessed reactions to the presence of beverage alcohol (cue-reactivity) or to simulated high-risk situations (role plays). Higher urges in response to role plays predicted more drinking during the 6 month s after treatment. However, urges in response to beverage cues were inconsi stently predictive of outcome while measures of awareness or attention to c ues predicted less drinking. Urge to drink might re? ect a conflict between motivation to drink and awareness of danger. Whether urges predict increas ed risk of drinking should be a function of factors that affect motivation to drink, awareness of risk and effectiveness of coping. Cue-reactivity ass essment has recently been used to bridge the gap between psychosocial and b iomedical approaches in several ways: (1) salivation to cues predicts incre ased drinking independent of urge or attention, showing the value of includ ing both physiological and psychosocial measures; (2) naltrexone has been s hown to decrease cue-elicited urge to drink, illustrating the value of this assessment methodology for medications evaluation and (3) pre-pulse inhibi tion of startle response is being used to investigate the role of dopaminer gic pathways in cue-elicited urge. Thus, this laboratory based program of r esearch has the potential to add to knowledge of both biomedical and psycho social mechanisms involved in urge and relapse, leading to greater integrat ion of models.