Higher Sensitivity to Pleasurable Effects of Alcohol Can Predict Alcohol Use Disorder

In the United States, 14.1 million adults had alcohol use disorder in 2019, according to the National Institute on Alcohol Abuse and Alcoholism.

Alcohol use disorder encompasses the behaviors of both alcohol abuse and alcohol dependence, defined as "a chronic relapsing brain disease characterized by an impaired ability to stop or control alcohol use despite social, occupational, or health consequences."

A new study conducted by the University of Chicago Medicine showed that individuals with a higher sensitivity to the rewarding and euphoric effects of alcohol are more likely to develop alcohol use disorder through their 20s and 30s.

While these findings might appear to be a no-brainer, the study results don't actually align with current prediction theories,and could help in the development of better treatments for alcohol use disorder.

The Study

The study, published in the American Journal of Psychiatry, followed 190 young adult drinkers for 10 years. Over the course of the decade, the cohort participated in laboratory-based binge-drinking scenarios at three regular intervals.

Participants who reported the highest pleasurable alcohol stimulation at the outset were most likely to have developed alcohol use disorder 10 years later. At the end of that decade, 21% of participants met criteria for past-year alcohol use disorder.

The length of this study is significant in that its findings demonstrate changes in subjective responses to alcohol over time.

"Alcohol use disorder takes time to develop, so to really understand the risk factors that can lead to problematic alcohol use, it's ideal to be able to monitor drinking patterns and consequences over an extended period of time," says Andrea King, PhD, lead researcher and professor of psychiatry and behavioral neuroscience at the University of Chicago.

King continues, "Our study accomplished this with a great deal of dedication and enthusiasm from both the research team and study participants."

The data shows that not only is greater sensitivity to the rewarding effects of alcohol a risk factor for developing alcoholism, but the pleasurable effects of alcohol don't diminish a person's progression of excessive drinking. It's important to note these findings diverge from current prediction theories.

King mentions two theories in the camp of predictions today—incentive-sensitization theory and allostasis, which involve increased alcohol liking and removal of negative feelings, respectively.

"Both theories are based on neuroscience studies in animals, where pleasurable or aversive responses to alcohol are inferred based on brain changes caused by chronic exposure to alcohol," King says. "However, in clinical research, we have the advantage of directly asking our participants specifically about the effects that they are experiencing while under the influence of alcohol."

The Future of Treatment

With these findings, not only can health professionals gain a better understanding of alcohol use disorder and treatment, but so can the individuals trying to overcome it, as well. A better understanding creates a more accessible path toward recovery.

King points out that the goal of any approach to treatment is to provide people with accurate, evidence-based information that empowers them to make the lifestyle changes necessary for a healthy existence.

"These findings can help persons dealing with alcoholism understand that their positive responses to alcohol, and their persistence and even magnification over time, that may help explain why it may be challenging for them to stop drinking once they start," King says.

Reassessing One's Relationship With Alchohol

Part of that challenge is that high-functioning alcoholics regularly romanticize their relationship with alcohol, says psychologist Sal Raichbach, PsyD, director of clinical services at Ambrosia Treatment Center.

"Alcohol impacts the way the brain forms and retains memories..." Raichbach says. "This lust for alcohol will oftentimes manifest into the mind, developing an obsession with alcohol or associated behaviors and activities. So you'll see the mind of an alcoholic, who isn't even drinking at that moment, telling them that they should be. This is a preoccupation with only the good or fun times, euphoria, they've had while drinking."

This aligns with King's study findings. By overriding run-ins with or experiences that involve alcohol's negative effects, individuals are at greater risk of developing a habit.

"The positive responses and euphoria mentioned in the study can be very telling for future AUD and alcoholism," Raichbach says. "These individuals are essentially misremembering their relationship with alcohol, so the study's findings that those who have greater reward responses to alcohol's effects should be cautious for future addictive behavior seems wise to me."

Focusing on this aspect of an individual's experience could provide them a better chance at recovery. King hopes the study can inform prevention and education initiatives, particularly those geared toward adolescents and young adults.

"This may be an opportunity for early intervention, as educating a patient on how their responses to alcohol may present a risk for future problematic drinking may motivate them to change their behavior early on," King says.