A biobehavioral research perspective on alcohol abuse and alcoholism.

An empirical biobehavioral research approach to the conditions generally identified as alcohol abuse and alcoholism emphasizes the temporal ordering of participating biochemical, physiological, and behavioral events that provide an operational basis for characterizing the functional aspects of this complex disorder and identifying distinguishable features of the alcohol abuse and dependence process. The available evidence suggests that alcoholism is a condition determined by a host of continuous variables rather than an entity possessing static qualities that imply intractability. The challenge for biobehavioral research is to determine the details of how chronic and excessive alcohol drinking is generated as well as the conditions under which such overindulgence can be attenuated and prevented. Environmental context, for example, can dramatically alter the frequency and amount of alcohol intake. Such contextual malleability is suggested as an important key to at least some of the inconsistencies in the literature with regard to the conditions under which chronic and excessive alcohol intake occurs. Excessive and chronic alcohol ingestion would seem most parsimoniously viewed as a set of behaviors for which others might have been substituted, and intermittently do, rather than as a highly specific disorder or disease. Though current etiological, preventive, and therapeutic orientations emphasize the role of physical dependence and favor genetic influences as strong determinants of alcohol-related disorders, it is important to recognize that troubled drinking is malleable, waxing and then entering periods of remission, with alcohol drinking even in severely dependent individuals remaining susceptible to control by both antecedent and consequating environmental events.