The rewarding (pleasurable or stimulating) effects of alcohol are mediated by the release of dopamine in the mesolimbic dopamine system, which projects to the orbitofrontal and prefrontal cortices, areas of the brain that regulate motivation and cognitive control.28 Alcohol also affects neurotransmitter systems involving GABA, endogenous opioids, glutamate, cannabinoids, norepinephrine, and serotonin,29 and neuroendocrine systems, including the hypothalamic-pituitary-adrenal (HPA) axis.30 These systems interact with the mesolimbic dopamine reward system. Evidence that alcohol-related reward has a neurobiological basis underscores the potential utility of medications to reduce heavy alcohol use and treat AUD.
