Drinking to Cope as a Vulnerability Factor for Alcohol Use Disorder: Evidence from Clinical and Preclinical Research

Alcohol use disorder (AUD) is a chronic condition in which the individual keeps drinking despite recognizing that such behavior is associated with a plethora of negative social, occupational, and health consequences. Several factors promote (e.g., a family history of AUD, exposure to aversive events, an early age of first alcohol use or intoxication) or deter (e.g., high levels of paternal monitoring and low levels of impulsivity-like personality traits) from risky drinking and AUD, and are thus referred to as vulnerability or protective factors, respectively. These factors can be described as distal factors that interact in increasingly complex manners and ultimately affect drinking behavior via more proximal factors, such as drinking motives, greater perception of alcohol-related cues or greater sensitivity to ethanol’s pharmacological effects. The present chapter puts forward the hypothesis that an anxiety-prone phenotype or the motivation of drinking to cope (DTC) with negative emotions is a common and proximal mediator of a wide range of vulnerability factors for AUD or risky drinking, ranging from personality traits to environmental exposure to aversive life events or early alcohol exposure. Specifically, we review preclinical studies indicating that rats or mice selectively bred for high alcohol drinking across several generations or exposed to ethanol during pregnancy or to experimental stress exhibit greater ethanol intake and preference. These behaviors are associated with reduced exploration of brightly lit environments or greater shelter seeking. We similarly describe clinical work indicating that drinking to cope (DTC) motives are a primary mechanism through which psychosocial constructs relate to problematic alcohol use and consequences.