A motivational model of alcohol use.

Abstract

The final, common pathway to alcohol use is motivational. A person decides consciously or uncon-sciously to consume or not to consume any particular drink of alcohol according to whether or nothe or she expects that the positive affective consequences of drinking will outweigh those of notdrinking. Various factors (e.g., past experiences with drinking, current life situation) help to formexpectations of affective change from drinking, these factors always modulated by a person's neuro-chemical reactivity to alcohol. Such major influences include the person's current nonchemicalincentives and the prospect of acquiring new positive incentives and removing current negative in-centives. Our motivational counseling technique uses nonchemical goals and incentives to help thealcoholic develop a satisfying life without the necessity of alcohol. The technique first assesses thealcoholic's motivational structure and then seeks to modify it through a multicomponent counselingprocedure. The counseling technique is one example of the heuristic value of the motiva-tional model.This article presents a motivational formulation of alcoholuse. The formulation is intended to incorporate advances madein understanding the inheritable constitutional factors (e.g.,Goodwin, in press; Schuckit, Li, Cloninger, & Deitrich, 1985)and the appetitive systems (T. B. Baker, Morse, & Sherman,1987) in alcohol-related behavior, and also the array of othermotivational factors that are increasingly recognized to play de-cisive roles in understanding and treating addictive behaviorpatterns (e.g., Klinger, 1977; Marlatt & Gordon, 1985; Miller,1985). The particular benefit of this formulation is to place al-coholic behavior in the context of contemporary theory of mo-tivation and emotion, as they relate both to alcohol use in thenarrow sense and to the life context in which the alcoholic con-tinually makes choices between drinking and alternative ac-tions. The formulation thereby suggests additional contributoryfactors, treatment strategies, and conceptual approaches.Despite the fact that there are multiple factors that influencedrinking, the final common pathway to alcohol use is, in ourview, motivational. The net motivation to drink, moreover, isclosely tied to people's incentives in other life areas and to theaffective changes that they derive from their incentives. We be-gin, therefore, by defining incentive motivation and affectivechange and showing how these two concepts are related to peo-ple's use of alcohol.