The diagnosis of alcoholism requires the continuing engagement in dangerous or risky drinking in the face of recurring negative consequences of the drinking behavior in the social, physical, work, or family domains. This propensity toward continued hazardous drinking despite continuing consequences suggests that the short-term appetitive outcomes of drinking (e.g. intoxication, disinhibition) have greater control over behavior than do the potential short-term and long-term negative consequences of drinking (e.g., drunk driving arrests, liver disease, loss of family or job, etc.). From a neurobiological perspective this pattern implies weak “top-down” executive control over impulsive and compulsive urges to consume alcohol, and a strong “bottom-up” appetitive drive to impulsively and compulsively consume alcohol.
