Alcoholism: the role of different motivational systems.

Individuals use and misuse alcohol (and other drugs) because of the pharmacologically mediated effects these substances have on the operation of 4 psychobiological systems, mediating response to motivationally relevant unconditioned and conditioned stimuli. These 4 systems have unique neuroanatomical structure, biochemical modes of operation, association with affect, behavior and cognition, and responsiveness to drugs of abuse. Individual variation in the operation of these systems determines individual susceptibility to initiation and maintenance of drug use and abuse. Sources of such variation differ, in a vitally important fashion, in various specific populations of individuals at heightened risk for drug abuse. Nonalcoholic sons of male alcoholics, with multigenerational family histories of male alcoholism, appear to be at heightened risk for the development of alcohol abuse because alcohol eliminates their heightened response to threat, and because they are hypersensitive to ethanol's psychomotor stimulant effects. Anxiety-sensitive individuals also appear attracted to alcohol for its anxiolytic properties. Many other important sources of idiosyncratic variability exist. Detailed analysis of such sources may lead to the development of more effective prevention and treatment programs.