Overall, these findings suggest that individuals with the CT genotype may carry a genetic vulnerability that affects CB1 receptor levels in the mesocorticolimbic structures that underlie the rewarding effects of alcohol and the attribution of incentive salience to alcohol cues. The neuroimaging data, specifically the correlations between blood oxygenation level–dependent activation and alcohol use problems, suggest that the increased reactivity of these structures in response to alcohol cues may play an important role in the pathogenesis of alcohol dependence for these individuals. For individuals without a genetic load for increased reactivity to cues, other factors may be more influential in the pathogenesis of alcohol dependence. Likewise, the treatment study is consistent with the notion that individuals with this genetic risk may benefit most from a treatment that targets mesocorticolimbic reactivity, whereas individuals without this genetic risk may benefit minimally from this type of treatment.
