Rewarding, stimulant, and sedative alcohol responses and relationship to future binge drinking

Arch Gen Psychiatry. 2011 Apr;68(4):389-99. doi: 10.1001/archgenpsychiatry.2011.26.


Context: Excessive consumption of alcohol is a major problem in the United States and abroad. Despite many years of study, it is unclear why some individuals drink alcohol excessively while others do not. It has been postulated that either lower or greater acute responses to alcohol, or both, depending on the limb of the breath alcohol concentration curve, contribute to propensity for alcohol misuse.

Objective: To prospectively assess the relationship of acute alcohol responses to future binge drinking.

Design: Within-subject, double-blind, placebo-controlled, multidose laboratory alcohol challenge study with intensive follow-up. Each participant completed 3 randomized sessions examining responses to a high (0.8 g/kg) and low (0.4 g/kg) alcohol dose and placebo, followed by quarterly assessments for 2 years examining drinking behaviors and alcohol diagnoses.

Setting: Participants recruited from the community.

Participants: High-risk heavy social drinkers aged 21 to 35 years who habitually engage in weekly binge drinking (n = 104) and light drinker controls (n = 86).

Intervention: We conducted 570 laboratory sessions with a subsequent 99.1% follow-up (1506 of 1520).

Main outcome measures: Biphasic Alcohol Effects Scale, Drug Effects Questionnaire, cortisol response, Timeline Follow-Back, Drinker Inventory of Consequences-Recent, and DSM-IV alcohol abuse and dependence.

Results: Alcohol produced greater stimulant and rewarding (liking and wanting) responses and lower sedative and cortisol responses in heavy vs light drinkers. Among the heavy drinkers, greater positive effects and lower sedative effects after alcohol consumption predicted increased binge drinking frequency during follow-up. In turn, greater frequency of binge drinking during follow-up was associated with greater likelihood of meeting diagnostic criteria for alcohol abuse and dependence.

Conclusions: The widely held low level response theory and differentiator model should be revised: in high-risk drinkers, stimulant and rewarding alcohol responses even at peak breath alcohol concentrations are important predictors of future alcohol problems.

Trial registration: Identifier: NCT00961792.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Alcohol Drinking / metabolism*
  • Alcohol Drinking / psychology*
  • Alcoholism / diagnosis*
  • Alcoholism / metabolism
  • Alcoholism / psychology
  • Breath Tests / methods
  • Ethanol / adverse effects*
  • Ethanol / pharmacology
  • Female
  • Humans
  • Hydrocortisone / analysis
  • Hypnotics and Sedatives / pharmacology*
  • Male
  • Reward*
  • Saliva / chemistry


  • Hypnotics and Sedatives
  • Ethanol
  • Hydrocortisone

Associated data