title: Reward craving and withdrawal relief craving: assessment of different motivational pathways to alcohol intake.
abstract: OBJECTIVE
  Craving for the rewarding effects of alcohol may be evoked by conditioned alcohol-like effects whereas conditioned compensatory responses may induce withdrawal relief craving. We tested the hypothesis that drinking in positive emotional states is associated with appetitive reactions to alcohol-associated cues and contributes to reward craving, while conditioned withdrawal is associated with drinking in negative situations and distressful, obsessive preoccupations with alcohol.
  
  
  METHODS
  In 38 detoxified alcoholics, the Obsessive Compulsive Drinking Scale was used to assess the craving factors 'impaired control', 'interference with social functioning' and 'obsession'. Affective responses to alcohol-associated visual stimuli were measured with the affect-modulated eyeblink startle reflex, positive and negative drinking situations with the Inventory of Drinking Situations (IDS) and withdrawal-like symptoms preceding alcohol intake with the revised Clinical Institute Assessment for Alcohol Scale (CIWA-Ar).
  
  
  RESULTS
  Appetitive reactions to alcohol-associated cues correlated positively with drinking in positive situations and contributed significantly to the craving factor 'interference' with social and work functioning. The severity of withdrawal-like symptoms preceding alcohol intake contributed to the craving factor 'obsession'; however, contrary to our hypothesis, this measure of conditioned withdrawal correlated with drinking not only in negative but also in positive situations.
  
  
  CONCLUSIONS
  Drinking in positive and negative situations, appetitive reactions to alcohol and withdrawal-like symptoms contributed differentially to the craving factors 'obsession' and 'interference', supporting the notion of different craving factors with separate underlying mechanisms.
authors.affiliation: Department of Addictive Behaviour and Addiction Medicine, Humboldt University, Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Heinz
authors.forename: Sabine
authors.initials: S
authors.lastname: Löber
authors.forename: Alexander
authors.initials: A
authors.lastname: Georgi
authors.forename: Jana
authors.initials: J
authors.lastname: Wrase
authors.forename: Derik
authors.initials: D
authors.lastname: Hermann
authors.forename: Eibe-R
authors.initials: ER
authors.lastname: Rey
authors.forename: Stefan
authors.initials: S
authors.lastname: Wellek
authors.forename: Karl
authors.initials: K
authors.lastname: Mann
mesh_terms: D000328:Adult; D000339:Affect; D000428:Alcohol Drinking / Q000523:psychology*; D000430:Alcohol Withdrawal Delirium / Q000523:psychology*; D000437:Alcoholism / Q000523:psychology / Q000534:rehabilitation*; D001767:Blinking; D003214:Conditioning, Classical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009770:Obsessive Behavior / Q000523:psychology; D010555:Personality Inventory; D013216:Reflex, Startle; D012201:Reward; D012932:Social Facilitation; D013695:Temperance / Q000523:psychology