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R Spanagel

Publications and source records attributed to R Spanagel.

At least 55 records · Page 3Linked to original sources

Discriminative stimulus effects of glutamate release inhibitors in rats trained to discriminate ethanol.

In a drug discrimination paradigm with rats trained to discriminate ethanol (1 g/kg IP) from saline we studied two substances, lamotrigine and riluzole, which are regarded as glutamate release inhibitors concerning their ability to substitute for ethanol. Both substances have been shown to act primarily on voltage-gated sodium channels; however, Lamotrigine dose dependently generalized to the ethanol cue, whereas riluzole did not. These results reflect the different high-dose effects of both sustances at voltage-gated calcium channels, where lamotrigine has inhibitory effects, but not riluzole, and provide further evidence for a role of voltage-gated calcium channels in the mediation of the effects of ethanol.

Animals↗

Enhanced morphine-induced behavioural effects and dopamine release in the nucleus accumbens in a transgenic mouse model of impaired glucocorticoid (type II) receptor function: influence of long-term treatment with the antidepressant moclobemide.

In vivo microdialysis experiments were conducted in transgenic mice with impaired glucocorticoid receptor function resulting from expression of antisense directed against glucocorticoid receptor messenger RNA. Basal corticosterone and serotonin levels in the nucleus accumbens of untreated transgenic mice were enhanced compared to control mice (B6C3F1). Following a systemic morphine injection (15 mg/kg) mesolimbic dopamine and serotonin release was markedly increased in transgenic mice compared to control mice and in parallel enhanced behavioural stimulation was observed in these animals. After pretreatment with the antidepressant moclobemide over a time period of eight weeks (15 mg/kg/day) elevated basal levels of both corticosterone and serotonin were normalized in transgenic mice. Furthermore, morphine-induced dopamine and serotonin release as well as behavioral stimulation were suppressed in transgenic mice and similar to that in control mice. The results indicate that impaired glucocorticoid receptor function influences the basal release of serotonin in the nucleus accumbens. This alteration has no effect on basal but on morphine-stimulated release of dopamine in the mesolimbic system. An enhanced sensitivity to the effects of morphine is apparently related to elevated brain corticosterone and serotonin levels and can be normalized by long-term antidepressant treatment.

Animals↗

Impaired stress response and reduced anxiety in mice lacking a functional corticotropin-releasing hormone receptor 1.

Corticotropin-releasing hormone (CRH) is a potent mediator of endocrine, autonomic, behavioural and immune responses to stress, and has been implicated in the stress-like and other aversive consequences of drug abuse, such as withdrawal from alcohol. Two CRH receptors, Crhr1 and Crhr2, have been identified in the mouse. Crhr1 is highly expressed in the anterior pituitary, neocortex, hippocampus, amygdala and cerebellum, and activation of this receptor stimulates adenylate cyclase. Here we show that in mice lacking Crhr1, the medulla of the adrenal gland is atrophied and stress-induced release of adrenocorticotropic hormone (ACTH) and corticosterone is reduced. The homozygous mutants exhibit increased exploratory activity and reduced anxiety-related behaviour under both basal conditions and following alcohol withdrawal. Our results demonstrate a key role of the Crhr1 receptor in mediating the stress response and anxiety-related behaviour.

Adrenocorticotropic Hormone↗

Repeated administration of the neurotensin receptor antagonist SR 48692 differentially regulates mesocortical and mesolimbic dopaminergic systems.

The purpose of the present study was to investigate the effects of repeated administration of the neurotensin receptor antagonist, SR 48692, on the activity of the mesocortical and mesolimbic dopaminergic (DA) systems. We showed that daily administration of SR 48692 for 15 days (1 mg/kg i.p.) to Wistar rats increased the expression of tyrosine hydroxylase mRNA and protein in the ventral mesencephalon. Simultaneous in vivo microdialysis in the shell part of the nucleus accumbens (AcbSh) and the medial prefrontal cortex (mPFC) revealed that blockade of neurotensin receptors for 15 days decreased basal extracellular levels of DA (approximately 50%) and its metabolites in the AcbSh, whereas no modification in DA levels was observed in the mPFC. In animals submitted to a forced swimming stress, which preferentially enhanced extracellular DA levels in the mPFC, treatment with SR 48692 failed to affect the stress-induced increase in DA. Moreover, given that glucocorticoids can modulate the activity of mesencephalic DA neurons, we examined the effect of the same SR 48692 treatment on corticosterone levels in dialysates from the AcbSh. We found that repeated SR 48692 did not affect the basal levels of free corticosterone, but significantly reduced the increase induced by forced swimming stress. The present results demonstrate that repeated treatment with SR 48692 modulates selectively the DA mesolimbic system when compared with the mesocortical pathway. These findings suggest that long-term treatment with selective neurotensin receptor antagonists could have potential clinical utility in the treatment of neuropsychiatric disorders associated with hyperactivity of the mesolimbic DA systems or the hypothalamic-pituitary-adrenal axis.

Animals↗

Release and accumulation of neurotransmitters in the rat brain: acute effects of ethanol in vitro and effects of long-term voluntary ethanol intake.

Release from and accumulation in tissue slices of some neurotransmitters under acute ethanol in naive rats and in long-term voluntarily ethanol drinking rats were investigated. Slices of the rat caudatoputamen were prelabeled with [3H]choline and release of [3H]acetylcholine was stimulated through either N-methyl-D-aspartate (NMDA) receptors or strychnine-sensitive glycine receptors. Ethanol in vitro at 2 per thousand, 4 per thousand, and 6 per thousand (34 mM, 68 mM, and 102 mM, respectively) concentration-dependently depressed the maximum effect of the concentration-response curve of NMDA in naive rats. In contrast, voluntary ethanol consumption over months led to a significantly enhanced NMDA receptor response characterized by an increase in the maximum effect of the concentration-response curve. The glycine receptor-mediated release of [3H]acetylcholine, which is inhibited by acute ethanol in a competitive-like fashion, was not changed in animals that ingested ethanol over months. Electrically evoked release of [3H]noradrenaline ([3H]NA) and its presynaptic modulation by morphine through mu-opioid receptors in neocortical slices of the rat, preloaded with [3H]NA, was nearly identical in both ethanol-naive rats and in ethanol drinking rats. The accumulation of [3H]gamma-aminobutyric acid in rat cerebellum tissue was neither affected by acute ethanol in vitro nor after chronic ethanol consumption. In summary, long-term voluntary ethanol intake caused a significant increase in NMDA receptor function in the rat caudatoputamen, but did not result in changes in glycine-evoked [3H]acetylcholine release of electrically evoked [3H]NA release modulated by morphine or cerebellar [3H]gamma-aminobutyric acid accumulation.

Acetylcholine↗

Long-term ethanol self-administration with repeated ethanol deprivation episodes changes ethanol drinking pattern and increases anxiety-related behaviour during ethanol deprivation in rats.

In order to study the dynamics of ethanol drinking behaviour, male Wistar rats were given the free choice between tap water, and 5, 10 and 20% ethanol solutions. After 8 weeks of continuous access, the animals were repeatedly deprived of the ethanol solutions for 3 days every 4 weeks. In the first experiment, drinking patterns were recorded for 24 h with an electronic drinkometer device, at different time-points of ethanol experience and after an ethanol deprivation episode. The preference for more highly concentrated ethanol solutions as well as ethanol consumption increased with continuing ethanol experience. Furthermore, after the ethanol deprivation episode, the animals immediately and preferentially drank from the 20% ethanol solution, the most highly concentrated ethanol solution offered. Additionally, the number of drinking bouts, particularly at the 10 and 20% ethanol solutions, was increased during the first hour after ethanol re-presentation. In a second experiment, the effects of repeated ethanol deprivation experience, inherent in this self-administration paradigm, on anxiety-related behaviour were tested on the elevated plus-maze. Repeated ethanol deprivation proved to be more anxiogenic than the first deprivation experience. Taken together, these findings suggest that ethanol deprivation is anxiogenic in long-term voluntarily ethanol-drinking rats, which is increased by repeated ethanol deprivation experience. The possibility that anxiety during ethanol deprivation might contribute to the 'relapse'-like drinking behaviour is discussed.

Alcohol Drinking↗

Centrally administered oligodeoxynucleotides in rats: occurrence of non-specific effects.

We studied the effects of various intracerebroventricularly administered oligodeoxynucleotides on body temperature, locomotor activity, food intake and water consumption in rats during a 24 h period with a radio-telemetric system. Both complete phosphorothioate oligodeoxynucleotides and end-inverted oligodeoxynucleotides dose-dependently elevated body temperature, suppressed food and fluid intake and inhibited nighttime activity. Apparently these effects do not depend on the nucleotide sequence because antisense and sense arginine vasopressin and oxytocin oligodeoxynucleotides, as well as a missense oligodeoxynucleotide produced comparable changes in the autonomous and behavioral parameters. In control experiments neither contaminants from the chemical synthesis nor endotoxins produced such effects, whereas native DNA from salmon sperm did. Fever and sickness-like behavior in response to missense phosphorothioate oligodeoxynucleotides were accompanied by elevated concentrations of circulating corticosterone and by a marked increase in interleukin 6 mRNA in brain and spleen, indicating that centrally administered oligodeoxynucleotides stimulate the production of pyrogenic inflammatory mediators in both central nervous system and peripheral tissues. Our results indicate that centrally administered oligodeoxynucleotides produce beside their intended sequence-specific effects also transient and sequence-independent effects due to their nucleic acid structure.

Animals↗

Infusions of tyrosine hydroxylase antisense oligodeoxynucleotide into substantia nigra of the rat: effects on tyrosine hydroxylase mRNA and protein content, striatal dopamine release and behaviour.

Modulation of the transcriptional message of tyrosine hydroxylase was investigated in vivo in the rat nigrostriatal dopamine system with unmodified antisense oligodeoxynucleotide, mismatch oligodeoxynucleotide or vehicle controls. Oligodeoxynucleotide was infused (0.5 microgram/0.5 microliter/h) unilaterally into the substantia nigra by an osmotic minipump system over 14 days. The presence of oligodeoxynucleotide in the brain was verified by in situ hybridization and fluorescence labelling. Animals treated with unmodified antisense oligodeoxynucleotide showed ipsilateral turning behaviour when challenged systemically with the indirect dopamine agonist amphetamine, whereas mismatch- and vehicle-infused rats showed no such behavioural asymmetries. In the substantia nigra, antisense treatment had no effects on tyrosine hydroxylase mRNA, but it led to a reduction in tyrosine hydroxylase protein content. Tissue levels of dopamine, measured in postmortem tissue punches of the neostriatum and substantia nigra, were reduced in the oligodeoxynucleotide-treated hemisphere. Furthermore, basal extracellular levels of dopamine, monitored by in vivo microdialysis, were also lower in the neostriatum ipsilateral to antisense infusion and showed a weaker response to an amphetamine challenge when compared with the contralateral side. These effects were not observed after infusion of mismatch oligodeoxynucleotide or vehicle into the substantia nigra. Finally, the GABAergic enzyme glutamate decarboxylase was not affected in the antisense-treated substantia nigra, indicating that non-specific damage in this area was not caused by this treatment. Our results indicate that antisense oligodeoxynucleotide treatment against tyrosine hydroxylase in the substantia nigra has behavioural and neurochemical effects that are comparable with known actions of dopamine neurotoxins, which are conventional pharmacological tools for the depletion of dopamine. Furthermore, our data show the potential of antisense targetting to reveal new relationships between neurotransmitter-related enzymes and behavioural parameters, because the possibility of selectively and discretely manipulating tyrosine hydroxylase function is likely to produce new insights into the physiological and behavioural functions of the dopaminergic nigrostriatal system.

Animals↗

Anti-craving compounds for ethanol: new pharmacological tools to study addictive processes.

Anti-craving compounds have recently been registered for relapse prophylaxis in weaned alcoholics in various European countries (acamprosate), and in the United States (naltrexone). Acamprosate, the Ca(2+)-salt of N-acetyl-homotaurinate, interacts with NMDA receptor-mediated glutamatergic neurotransmission in various brain regions and reduces Ca2+ fluxes through voltage-operated channels. The opioid receptor antagonist naltrexone most likely interferes with alcohol-induced reinforcement via the block of opioid receptors. In this article Rainer Spanagel and Walter Zieglgänsberger discuss the pivotal role of incremental neuroadaptation to alcohol and alcohol-associated stimuli for craving, and the possible mechanisms of action underlying the anti-craving properties of acamprosate and naltrexone.

Acamprosate↗

Time course of acamprosate action on operant ethanol self-administration after ethanol deprivation.

The effects of the new alcohol anticraving compound acamprosate on the alcohol deprivation effect were tested in an operant two-lever free choice paradigm with concurrent water. Two groups of rats were tested after long-term voluntary ethanol self-administration: the "continuous access" group consisting of animals that had continuous access to ethanol before operant testing; and the "limited access" group that was tested only after ethanol deprivation. The limited access group exhibited a strong alcohol deprivation effect with immediate high ethanol consumption and preference. Acamprosate (100, 200, or 400 mg/kg) dose-dependently reduced lever pressing for ethanol and, accordingly, ethanol consumption in both groups in a 23-hr session. The consumption-reducing effect was still evident at the end of the session. Ethanol preference was dose-dependently reduced during the first hour of the session, but returned to basal levels before the end of the 23-hr session in both groups. Thus, the time course of preference reduction was not identical with that of the reduction of ethanol consumption. Surprisingly, preference reduction was observed only after a considerable amount of ethanol had been consumed. These results suggest that the specific effect of preference reduction depended on the simultaneous presence of sufficient levels of acamprosate and ethanol, and that the longer-lasting reduction of ethanol consumption was the consequence of this experience.

Acamprosate↗

The anti-craving drug acamprosate reduces c-fos expression in rats undergoing ethanol withdrawal.

Acamprosate (Ca salt of N-acetylhomotaurine) is a novel anti-craving substance which a double-blind placebo-controlled study has proven to be therapeutically useful in the prevention of relapses in weaned alcoholics. In the present study the expression of the immediate-early gene c-fos in rat hippocampal and cerebellar neurons was used to monitor the modulatory effect of acamprosate on neuronal excitability during ethanol withdrawal. Several hybridization techniques were employed to investigate the effect of acamprosate on c-fos expression. Acamprosate (200 mg/kg; intraperitoneally) reduced the elevated c-fos mRNA levels in the hippocampus and the cerebellum following 24 h of ethanol withdrawal, or the application of the convulsant pentylenetetrazole. The effect of ethanol withdrawal on c-fos expression was more pronounced in the cerebellum than in the hippocampus. In the hippocampus (CA1) and the cerebellum acamprosate alone induced a significant increase in c-fos expression in drug-naive animals. Only in the hippocampus did co-administration of pentylenetetrazole during ethanol withdrawal induce a further increase in c-fos expression. The present findings support the notion that acamprosate elicits its preventive effect on relapse by reducing the hyperexcitability of central neurons during withdrawal, following long-term ethanol consumption.

Acamprosate↗

Evidence for alcohol anti-craving properties of memantine.

Rats consuming alcohol voluntarily for a long time show increased alcohol consumption after a phase of alcohol deprivation and this might reflect increased craving for alcohol. Administration of memantine (1-amino-3,5-dimethyl-adamantane), a clinically used uncompetitive NDMA receptor antagonist, resulted in a significant reduction of the alcohol deprivation effect without any sedative, dysphoric or stimulant side-effects. The dose of memantine used (4.8 mg/day) resulted in serum levels close to the therapeutic range in humans. These results indicate that memantine may have therapeutical potential as an anti-craving drug for alcohol.

Alcoholism↗

Acamprosate and alcohol: I. Effects on alcohol intake following alcohol deprivation in the rat.

Acamprosate (calcium-acetyl homotaurinate) is a new compound in the treatment of alcoholism. Its efficacy has been proven in several clinical trials and registration is now pending in most European countries. The basic mechanisms by which acamprosate elicits its anti-craving action, thereby leading to reduced relapse rates, is not known at the moment. In the present study we describe a rat model of long-term alcohol-drinking which mimics relapse behavior in human alcoholics. The effect of acamprosate was studied in this model. Wistar rats had a free choice between water and alcohol solutions of different concentrations (5, 10, 20% v/v). After two months of continuous alcohol access, rats were deprived of alcohol for three days. Following this deprivation phase, all alcohol solutions were presented again. This procedure was repeated monthly for the following six months. The rats consumed 3.5 +/- 0.3 g/kg alcohol a day. After alcohol deprivation, alcohol intake rose to 5.2 +/- 0.3 g/kg per day resulting in blood alcohol levels of 30 +/- 6 mg/dl. Interestingly, the addition of quinine to the alcohol solutions or the additional presentation of a 5% sucrose solution did not affect the alcohol-deprivation effect after eight months of this intermittent alcohol exposure. However, when acamprosate (50-200 mg/kg i.p.) was administered twice daily, alcohol-drinking following an alcohol-deprivation phase was decreased dose dependently. Given at the highest dose alcohol intake even dropped significantly below baseline drinking. Together, these results show that acamprosate effectively diminishes the alcohol-deprivation effect. Furthermore, the described model seems to be a suitable animal model to screen compounds for their anti-relapse properties and subsequently for their anti-craving action.

Acamprosate↗

Acamprosate and alcohol: II. Effects on alcohol withdrawal in the rat.

The suppressing effect of acamprosate (calcium-acetyl homotaurinate) on alcohol drinking is well established; however, little is known about its effects upon the alcohol-induced withdrawal syndrome. Male Wistar rats received as a sole drinking fluid a 20% (v/v) alcohol solution for one week. Animals consumed on average 5.3 +/- 0.3 g/kg per day alcohol, which resulted in blood alcohol levels of 38 +/- 14 mg/dl. For the quantification of alcohol withdrawal we used a new radio-telemetric system which enabled us to monitor body temperature, locomotor activity, food and water intake patterns constantly during alcohol withdrawal. Although alcohol intake and the resulting blood alcohol levels were low, clear signs of withdrawal could be observed. Thus, hyperthermia and hyperlocomotion occurred 18 h after the termination of forced alcohol drinking. Food intake was initially enhanced but dropped significantly below basal food intake in control animals one day after the termination of forced alcohol drinking. Acamprosate given twice a day (200 mg/kg, i.p., 8 a.m. and 8 p.m.) reduced hyperlocomotion and food intake significantly in the alcohol withdrawal animals, however, it did not change withdrawal-induced hyperthermia. When acamprosate was given to alcohol-naive animals, it increased locomotor activity and body temperature transiently, in particular during the rats' active night phase. In summary, (i) the radio-telemetric system used in the present study proved to be a very sensitive method for quantifying alcohol-induced withdrawal symptoms; (ii) acamprosate reduced alcohol-induced physical signs of withdrawal, however, this effect could not be observed for all parameters measured, which might be explained by the fact that (iii) acamprosate exerts a slight, transient psychomotor stimulant effects by itself.

Acamprosate↗

Acamprosate and alcohol: III. Effects on alcohol discrimination in the rat.

It has been shown that acamprosate (calcium-acetyl homotaurinate) decreases voluntary ethanol drinking in laboratory animals as well as relapse behaviour in human alcoholics. Although glutamatergic mechanisms have been implicated in several recent studies in the action of acamprosate, the basic mechanism remains unknown. In order to gain more insight into possible mechanisms underlying the ethanol intake-suppressing effects of acamprosate, we investigated this compound in an ethanol discrimination test. Male Wistar rats were trained in a two-lever operant drug discrimination paradigm to make differential responses for food following ethanol (1 g/kg i.p.; 12% v/v ethanol solution) or saline vehicle injections with a fixed ratio schedule of food reinforcement (FR 10) and a post-administration interval of 10 min. Once rats had acquired the discrimination, the criterion for stimulus control was set as at least 90% ethanol- or vehicle appropriate responding during ten consecutive sessions, an ethanol dose-response test (0.25-1.5 g/kg i.p.) was conducted. The effects of acamprosate on the discrimination were assessed in two ways: (i) Generalization test: acamprosate (25-250 mg/kg i.p.) was given either 30 or 120 min before the animals were put in the operant chambers. (ii) Antagonism test: acamprosate (25-250 mg/kg i.p.) was given 120 min before the animals were injected with ethanol, 10 min later the animals were tested. Data obtained in the dose-response test showed a dose-dependent effect with an ED50 of 0.53 g/kg ethanol. The results of generalization testing revealed that acamprosate failed to substitute for the ethanol cue, whereas, in comparison, dizocilpine (0.01-0.2 mg/kg i.p.) completely generalized for the ethanol cue (ED50 = 0.05 mg/kg). Acamprosate also had no effect when tested as an antagonist. Thus, neither the ethanol nor the saline discrimination was altered by acamprosate pretreatment. Furthermore, acamprosate had no effect on response latencies at all doses tested. In conclusion, acamprosate does not generalize for the ethanol cue, suggesting that it is not a substitution drug. Further, acamprosate does not seem to act via the dizocilpine binding site of the N-methyl-D-aspartic acid (NMDA) channel.

Acamprosate↗

The influence of opioid antagonists on the discriminative stimulus effects of ethanol.

The aim of the present study was to investigate the role of different endogenous opioid systems in the expression of ethanol's discriminative stimulus effects in a two-lever operant drug discrimination paradigm. Wistar rats trained to make differential responses following the administration of ethanol (1 g/kg, i.p.) or saline. The correct response (fixed-ratio schedule; FR10) resulted in the presentation of food. Once rats had acquired the discrimination an ethanol dose-response test was conducted. The effects of opioid antagonists on the discrimination were assessed by administering the mu-opioid receptor antagonists naloxone (0.5-20 mg/kg s.c.) and cyprodime (5-100 mg/kg s.c.) and the delta-opioid receptor antagonist naltrindole (0.1-25 mg/kg s.c.) 15-30 min before the discrimination test. Furthermore, the selective kappa-opioid antagonist nor-binaltorphimine (5 mg/kg s.c.) given 24 h before the test session was examined. Results of generalization testing demonstrate that ethanol discrimination was dose dependent. Pretreatment with naloxone produced only at the highest dose a partial, but significant, antagonism, whereas cyprodime failed to alter the ethanol cue. This suggested the involvement of other opioid receptor subtypes. However, neither naltrindole nor nor-binaltorphimine had any effect on the ethanol-saline discrimination. These results demonstrate that the expression of the ethanol cue is only partly dependent on the function of endogenous opioid systems.

Animals↗

Strain differences in the rewarding and dopamine-releasing effects of morphine in rats.

Studies examining differential sensitivity to psychoactive drugs in mice suggest that genotype may play a critical role. Furthermore, an involvement of genotype in mediating individual differences in sensitivity to the rewarding effects of several drugs of abuse has also been postulated. The aim of this study was to examine the conditioned rewarding and dopamine-releasing effects of morphine in two outbred rat strains commonly used in addiction research. Additionally, the behavioural and neuroendocrine responses of these strains to the stress of novelty were also examined. Basal locomotor activity was higher in Wistar rats than Sprague-Dawley following exposure to a novel environment. In contrast, elevations in plasma corticosteroid levels following novelty exposure did not differ between the two strains. In a counterbalanced place preference conditioning procedure, increasing doses of morphine (1.0-10.0 mg/kg SC) produced significant conditioned place preferences (CPP) in both Wistar and Sprague-Dawley strains. However, Wistar rats required a significantly larger dose of morphine (5.0 mg/kg) to produce a significant CPP than the Sprague-Dawley rats. In the latter strain, CPP occurred with doses of 3.0 mg/kg and greater. In parallel microdialysis experiments, both strains showed significant dose-related increases in dopamine release in the nucleus accumbens following acute morphine challenge (1.0-10.0 mg/kg SC). Again in Wistar rats, a larger dose of morphine was necessary to produce a significant increase in comparison to Sprague-Dawley rats. These results show that genetically distinct rat strains can show differential sensitivity to opioids, more specifically to drug-seeking responses.

Animals↗

Anxiety: a potential predictor of vulnerability to the initiation of ethanol self-administration in rats.

Anxiolytic effects of ethanol have been proposed to be important factors in the initiation of ethanol consumption. To examine this hypothesis, drug-naive Wistar rats were tested in the elevated plus-maze to determine their initial level of anxiety. Based on their response, we separated the animals into anxious and non-anxious groups. After that, animals went through an oral ethanol self-administration procedure. Rats that were initially classified as anxious showed a significantly (P < 0.01) higher intake and preference for ethanol during the initiation phase of the voluntary drinking procedure than non-anxious animals. In another experiment, intraperitoneal (IP) injections of ethanol (0.5-1.5 g/kg) produced dose-dependent anxiolytic effects in rats when tested in the elevated plus-maze procedure. Blood ethanol levels following IP injections during the plus-maze test were similar to those reached during the oral ethanol self-administration procedure, which shows that the rats indeed drank sufficient amounts of ethanol to experience its anxiolytic effects. These findings indicate that the basal level of anxiety plays an important role in vulnerability to alcohol drinking.

Alcohol Drinking↗