Quitting Alcohol Does Not Always Reduce Cravings: Scientists Identify Changes in the Brain

Scientists have identified a possible mechanism in the brain that may help explain why some people face an increased risk of returning to alcohol use after a period of abstinence. The findings were published in the journal Molecular Psychiatry.

The researchers studied mice that had long-term free access to alcohol and were then forced to abstain completely for a period of time. After the abstinence period, some of the animals developed particularly strong cravings for alcohol. They continued drinking even when the beverage had been made unpleasantly bitter by adding quinine.

Moreover, mice that had undergone a period of abstinence later consumed more bitter alcohol than animals that had not experienced such a break. According to the researchers, this suggests that changes may occur in the brain during abstinence that could increase vulnerability to relapse.

The scientists focused on the bed nucleus of the stria terminalis (BNST), a small brain region involved in stress responses, anxiety, and other processes relevant to alcohol dependence.

When mice were returned to an environment where alcohol had previously been available, they began attempting to drink even when only water was present in the drinking bottle. These attempts were accompanied by increased activity in the BNST.

In animals that were willing to drink even highly bitter alcohol after abstinence, activity in this brain region was more than twice as high as in mice that had not undergone forced abstinence.

Particularly important was the finding that increased BNST activity occurred before the animals were given access to alcohol again. This led the researchers to suggest that activity in this brain region could potentially serve as a marker of increased relapse risk in the future.

However, these findings currently come only from animal experiments. It is not known whether the BNST plays the same role in humans or whether its activity can reliably predict a return to alcohol use.

As a next step, the researchers want to determine which specific BNST cells are responsible for the observed response and what triggers the increased activity in this region. In parallel, another research group is studying BNST activity in people with alcohol use disorder who are in the early stages of abstinence.

If similar changes are found in humans, scientists may be able to determine whether this measure could be useful for clinical screening and early identification of people at high risk of relapse.

The authors emphasize an important distinction: the findings do not mean that giving up alcohol is harmful or that abstinence itself increases the risk of addiction. Rather, the results suggest that in people who are already vulnerable to alcohol dependence, the brain and body may respond to a period of abstinence in ways that increase the likelihood of subsequent relapse.

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