This study attempts to explicate some of the major determinants of relapse in alcoholics by manipulating craving and alcohol acquisition behavior through appropriate interoceptive and exteroceptive stimulation. Subjective, behavioral, physiological, and neurophysiological measures were used with 24 chronic alcoholics, randomly assigned to one of two groups—label (L) and nonlabel (NL). In the L situation, exteroceptive cues—such as the clear sight and smell of alcohol—were conducive to appropriate "cognitive labeling." Alcoholic subjects in each group were administered either a placebo (P), high (Hi), or low dose (Lo) of alcohol.
Consistent with the conditioning theory proposed, the results generally indicated that craving and alcohol acquisition behavior, as well as conversion from abstinence to alcohol acquisition, were a function of the combination of appropriate interoceptive and exteroceptive cues, with the Lo (L) group condition producing the greatest effects. It appeared that a sufficient amount of alcohol, administered in the context of explicit drinking cues, could act much like hors d'oeuvres and thereby contribute to the "first drink" relapse phenomenon.
Ludwig AM, Wikler A, Stark LH. The First DrinkPsychobiological Aspects of Craving. Arch Gen Psychiatry. 1974;30(4):539-547. doi:10.1001/archpsyc.1974.01760100093015