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New Research Challenges Existing Beliefs About Tolerance in Alcohol Dependence


This blog post is excerpted from a report by Alison Caldwell in UChicago News 

Andrea King, a professor of psychiatry and behavioral neuroscience at the University of Chicago Medicine, has published the first-ever study of how an individual’s acute response to alcohol could predict their risk for developing alcoholism.  In a new study, published on Jan. 5 in the American Journal of Psychiatry, King reports on results of testing 190 non-alcoholic young adults in a laboratory-based binge-drinking scenario at three regular intervals over the course of 10 years.

The study showed that those reporting the highest pleasurable and rewarding effects of alcohol at the start of the trial were more likely to develop an alcohol use disorder.  Further, when retested on their responses 10 years later, those who became alcoholics retained the highest levels of alcohol stimulation, liking, and wanting—and these thoughts/feelings were heightened compared to their initial testing with no signs of tolerance to these pleasurable effects.

These results suggest that individuals developing an alcohol use disorder are more likely to experience a stronger positive response rather than becoming tolerant. In these individuals, alcohol was less sedating for them from the beginning and this did not change over time.

These pleasurable alcohol effects grow in intensity over time, and do not dissipate, in people progressing in excessive drinking,” said King. “This tells us that having a higher sensitivity to the rewarding effects of alcohol in the brain puts such individuals at higher risk for developing an addiction.”

“Alcoholics have been thought to need to drink more to finally get their desired effect when they drink, (tolerance) but these well-controlled data do not support that contention. The subjects in this study get the desirable alcohol effect early in the drinking bout and that seems to fuel wanting more alcohol.”

King’s study is based on over 10 years of effort from the research team.  By building relationships with their participants, they were able to follow nearly all of the 190 participants from beginning to end. The participants were regular light or heavy social drinkers in their mid-20s at the start of the trial between 2004 and 2006. They were brought back for repeated testing of alcohol responses in the laboratory five and 10 years later as they approached middle adulthood. In between testing periods, participants were interviewed at near-annual intervals to track their drinking patterns and symptoms of alcohol use disorder over time.

King also points out that the results can help to develop better treatments for alcohol use disorders and inform earlier interventions for individuals who may be at high risk for developing an addiction.

I’m already using this information to inform how I talk about addiction with my therapy clients,” King said. “It can be frustrating for them to see other people who can have a couple of drinks and just stop there. They can’t understand why they repeatedly seem unable to do that, too, and I tell them, it may be because your brain responds differently to alcohol which makes it harder to stop drinking once you start. Knowing that information can empower a person to make different decisions.”

Based on this research, King sees the potential for a sort of “personalized medicine” approach for treating alcohol use disorders, describing how sharing an individual’s “thumbprint” response to alcohol can make a difference in how they think about their consumption.

“This could be an opportunity for early intervention, comparable to how someone may get their cholesterol tested and then may be more motivated to change their diet, exercise more, or start a medication to rein it in. Similarly, knowing one’s acute response to alcohol and how it may indicate a person’s future risk for drinking problems, one may decide to change their drinking on their own or seek help to avoid the progression to addiction.”

 Citation: “Subjective Responses to Alcohol in the Development and Maintenance of Alcohol Use Disorder.” King et al., American Journal of Psychiatry, Jan. 5, 2021.  2021.   Funding: National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse