Alcoholism and the Loss of Willpower: A Neurocognitive Perspective

Like other addictions, alcoholism reflects the continuation of alcohol use despite negative consequences (e.g., an ulcer or family problems made worse by alcohol consumption). Recent cognitive theories suggest that optimal information processing related to the capacity to make decisions under uncertainty conditions is impaired either prior to the initiation of alcohol use, or it is related to the consequence of its repeated utilization. In this paper, we suggest that alcoholism may be the product of an imbalance between two separate, but interacting, cognitive registers that contribute to decision making: a reactive/automatic attentional and memory system for signaling the presence of alcohol cues in the environment and for attributing to such cues pleasure and/or excitement; and a reflective/nonautomatic system for regulating the dominant reactive/automatic response. Hyperactivity within the reactive system can override the reflective system and brain/cognitive changes induced by ethanol could lead to the disruption of self-regulation. We finally develop the idea that different patterns of imbalance between reactive and reflective systems could lead to distinct patterns of clinical impulsivity involved in the vulnerability to, the development of, and the relapse into alcoholism.