1 - Journey from responsible alcohol drinking to alcoholism

Abstract

Alcoholic beverages are socially accepted around the world and consumed mostly to socialize, celebrate, and relax. The pleasant effects of alcohol are attributed to (i) an increase in GABAergic (inhibitory signals), OPergic, and 5HTergic (euphoric effects) neuronal activities and (ii) a decrease in DAergic (“want” signal or craving), Gluergic (excitatory signals), and NEergic (stress signals) neuronal and the HPA axis (stress hormones) activities. If alcohol drinking continues, the receptors are sensitized, resulting in the development of tolerance when alcohol drinking must be increased to achieve the desired effects. In genetically/environmentally predisposed subjects, chronic alcohol drinking results in the development of addiction, characterized by a condition when alcohol caseation results in a rapid onset of withdrawal symptoms including, but not limited to, alcohol craving and moderate to severe discomfort. Because pharmacotherapy alone or in combination with behavioral approaches are only modestly effective in treating alcoholism symptoms, there is an urgent need for the development of effective and safe therapies. At present, a lack of clear understanding of the mechanisms underlying addiction hinders possible development of new treatment strategies. Therefore, this chapter aims to discuss the mechanisms underlying (i) the euphoric, relaxing, and adverse effects of alcohol drinking and (ii) addiction and the withdrawal symptoms.