Robin wanted another screwdriver. Newly arrived at a Western North Carolina college from her small hometown, she’d just had her first two alcoholic drinks ever, at a dinner party. “I asked for a screwdriver because the person right before me asked for one,” she says. “Later, they offered a second drink, and I took one. I spent the rest of the evening wondering when they were going to offer a third.”

Maybe she was smitten with the drinks because they seemed grown-up, part of her new, sophisticated college life. But Robin doesn’t think so. She didn’t get drunk that night, but she vividly remembers feeling a physical craving for more alcohol. Over the next few years, she began to think of alcohol as her best friend.

Robin didn’t get drunk until the third time she drank. It was scotch, straight.

“That first time I got high, I remember thinking, `This is how normal people must feel,’” she says. “Booze made me feel alive. For me, whatever had been wrong up until that point, alcohol fixed it.”

Robin describes herself as a brain, a loner, never the life of the party. She tried to drink just enough to reach “that particular spot where I felt a sense of belonging, felt right with the world.” But more and more, she found herself overshooting that spot. She often got drunk when she’d intended to have only one or two drinks. On weekends, she typically drank about a case of beer a day.

“I believe today that I was an alcoholic before I left college,” she says.

Even so, Robin graduated magna cum laude. She went on to Harvard and earned a master’s degree while drinking every day. Though she was drinking more and more, she still felt that alcohol helped her. She often agonized about writing papers, she says, but when she’d been drinking, the words would just flow.

Robin did well at Harvard, but she was very unhappy. For her Ph.D. work, she transferred to Carolina. But then she started drinking alone more and more, and caring less about her appearance when she did go out. Eventually she dropped out of school. Now, she rarely left her apartment—except to buy beer.

She drank about a case every day and found herself eating almost nothing. “I didn’t mean to stop eating, but somehow it just happened,” she says. “I meant to take out the trash, but it just didn’t get taken out.” After living this way for about six weeks, she finally called her parents, who took her to the hospital.

What caused Robin to lose control over her drinking isn’t well understood. Personality, environment, and culture play a role, along with biology and heredity. Robin’s father was an alcoholic, though she never knew it growing up—he drank only periodically and kept it hidden.

Alexei Kampov, research fellow at Carolina’s Skipper-Bowles Center for Alcohol Studies, is a physician who has worked with alcoholics. In his experience, Robin’s feeling that alcohol “fixed” her is a common one among alcoholics. Researchers think that for some people, alcohol does fix something, if only temporarily—a deficiency of some chemical in the brain, maybe dopamine or serotonin.

These messenger chemicals, or neuro-transmitters, play a big role in how we experience pleasure. When we get a hug or eat a favorite food, cells in certain areas of the brain send messages to one another by releasing one of these neurotransmitters. This results in feelings of euphoria or well-being.

But if your brain doesn’t release enough of one of these chemicals, you need something else to experience the stronger feelings of pleasure that come easy to many people. For some, alcohol does the trick—there’s evidence that drinking alcohol causes brain cells to release more serotonin or dopamine. But the feelings that result can be so pleasurable that some people go back for more again and again. With each alcohol rush, the good feelings reinforce the behavior, so eventually addiction is learned. Even the people, places, and rituals associated with drinking can trigger cravings for alcohol.

How to drink a lot is a lesson we’ve learned too well. Nearly 14 million Americans—one in every 13 adults—abuse alcohol or are alcoholic, according to the National Institute on Alcohol Abuse and Alcoholism. Researchers at Carolina’s alcohol-studies center work to help remedy the problem, by searching for its causes and by developing new treatments and diagnostic methods. Two new findings in particular show ways to help prevent or treat alcohol abuse by using our knowledge of the brain’s reward system.

Kampov, for example, has found that alcoholism may be indicated by a simple characteristic—preference for sweets. Kampov noticed this tendency when working as a clinician in his native Russia—the alcoholics he treated always cleaned out his candy dish. He points out that the handbook of Alcoholics Anonymous advises members to carry sweets to help curb alcohol cravings. The link between craving for sweets and for alcohol has been common lore among alcoholics for years, he says, but it has been almost ignored in scientific literature.

To test the idea, Kampov first worked with Amir Rezvani, research associate professor at the alcohol-studies center. Rezvani studies rats who have been selectively bred to drink alcohol. A normal rat, when offered both alcohol and water, will taste the alcohol, but drinks mostly water. The specially bred rats, though, will voluntarily drink large amounts of alcohol. Kampov and Rezvani found that when offered a sweet solution of saccharin and water, the “alcoholic” rats drank two to three times more of it than normal ones. They also preferred sweeter solutions than did normal rats. Because the researchers used saccharin, rather than sugar, they knew that the rats drank the solution because they craved its sweet taste, not the calories of sugar.

Kampov next tested his theory in people, this time working with James C. Garbutt, associate professor, and David S. Janowsky, professor, both of psychiatry. Their subjects were 20 alcoholic men and 37 men with no diagnosed alcohol problem. The alcoholics had not had alcohol for at least 28 days. During the study, subjects taste five different sugar solutions. Kampov hands them miniature plastic cups of each solution, one at a time, in random order, so the subject has no idea which solution he’s tasting. Then they rate the sweetness of each and how much they like it. Each solution is tasted five times. The repetition produces boredom with the experiment, Kampov says, so subjects don’t think about the taste of the solutions but give a more accurate, immediate reaction to them.

Sixty-five percent of the alcoholics preferred the most concentrated sugar solution, which is more than twice as sweet as a coke. The nonalcoholic men most often preferred a solution that was only half this sweet. Only 16 percent of them preferred the sweetest solution. These results are the first published to relate preference for sweet tastes to alcohol intake in humans.

If alcoholism is partly caused by a malfunction in the brain’s reward system, then it makes sense that alcoholics would like stronger sweet tastes, which are, in a sense, stronger doses of pleasure. Sugar can mimic serotonin or activate the pleasure center of the brain. And Kampov points out that the liking for sweet tastes is a basic instinct that can be detected in newborn humans and animals minutes after birth. Research shows that when a sweet solution is dotted onto a newborn’s lips, he starts smiling.

That’s not to say that everyone with a weakness for dessert is an alcoholic. The sweetest sugar solution used in the study, the one most preferred by the alcoholics, tastes so sickeningly sweet, it makes your mouth pucker.

The Carolina Sweet Test, as it’s called, seems to be more useful in identifying predisposition to alcoholism when used in combination with a personality measure. In a newer study, Kampov had subjects take both the sweet test and a psychological test called the Tri-Dimensional Personality Questionnaire (TPQ). The TPQ rates personality on three traits: “novelty-seeking,” which is associated with exploration and impulsive behavior; “harm avoidance,” which reflects the person’s fear of punishment or negative consequences; and “reward dependence,” which reflects attachment to pleasurable stimulus and the need for warmth.

The sweet-liking alcoholics in the study consistently scored high on both novelty-seeking and harm-avoidance. People high in novelty-seeking tend to be curious, excitable, and easily bored, while those high in harm avoidance are timid and inhibited. Combining these personality traits, Kam-pov says, results in a person who may have grand dreams and want new, exciting experiences, but is scared to pursue them. “Using alcohol can be like a substitute for the real world. You can get pleasurable feelings from dating a beautiful girl, having a job you love. But you can achieve similar feelings from using drugs or alcohol.

“There’s nothing bad about these personality traits by themselves,” Kampov says. “It’s just that when they get channeled into the world of substance abuse, they become a problem.”

This combination of sweet liking and personality doesn’t describe all alcoholics, only a certain type. Most of the sweet-liking alcoholics in the study fit the profile of a “Type B” alcoholic, described in 1992 by psychiatrist Thomas Babor. These alcoholics are usually sons of male alcoholics and suffer from alcoholism that starts during adolescence or early adulthood, is moderately severe, and is usually associated with criminal behavior.

Kampov hopes that the sweet test can be used with the TPQ to find people who are predisposed to this type of alcoholism. Then they can make choices to help them avoid problems with alcohol. David Sinclair, a scientist at Finland’s National Public Health Institute, says that the sweet test has “great potential.” He has been discussing the possibility of using it commercially at ContrAl, an international chain of alcohol abuse clinics that use his method for treating alcoholism.

Another finding from the Skip-per-Bowles center suggests a way to manipulate the brain’s reward system to reduce alcohol craving. Amir Rezvani has found that the popular herbal remedy St. John’s Wort inhibits alcohol drinking in his specially bred rats. Rezvani decided to try the herb because it has been clinically proven in Germany to be effective against moderate depression and is thought to work through the neurotransmitters serotonin and dopamine. St. John’s Wort has not yet been approved to treat depression in the U.S., though it is sold over the counter as a food supplement.

With little funding for the project, Rezvani started simple. He bought a bottle of St. John’s Wort at the nutrition store at the mall, paying for it with his own money. “I tried it in a few rats who were drinking alcohol, and their alcohol intake went down forty to fifty percent,” he says. When he tried it in another strain of rats, he got similar results.

To replicate his findings, Rezvani wanted to use a pure extract of the active ingredient in St. John’s Wort, hypericin. A German pharmaceutical company agreed to send him the extract. He tested it in his rats, and again they reduced their alcohol intake. In further experiments, with the help of David Overstreet, research associate professor at the Skipper-Bowles Center, he tested the rats to see if they would develop tolerance to the hypericin. Earlier, when the team had tried them on a drug currently used to reduce alcohol craving in humans—Naltrexone—their alcohol intake had decreased for five or six days, but as they developed tolerance to Naltrexone, their drinking had slowly increased. But with the St. John’s Wort extract, even after 15 days, the rats’ alcohol drinking stayed way below that of rats who weren’t treated. Two independent groups in Italy recently replicated these findings.

The next logical step, Rezvani says, is to test St. John’s Wort’s ability to reduce alcohol intake in humans. Even if it does prove effective in people, it won’t work by itself, Rezvani says, since alcoholism is such a complex disease. “It would be very naïve to think that with one drug like St. John’s or Naltrexone or Prozac, we can fix it. The disease should be attacked from different angles—maybe with St. John’s Wort, but also with psychotherapy, family support, and changing environment.”

Kevin McDonald, president of a Durham, N.C., residential treatment program for substance abusers, agrees. “The physical addiction is only part of the problem. For a lot of people, substance abuse is part of a whole lifestyle.” A former addict himself, McDonald runs TROSA, Triangle Residential Option for Substance Abusers. TROSA is for “hard core” abusers. About half go there as an alternative to prison sentences.

For the first 30 days of the two-year program, residents work morning and night as interns, cleaning up and maintaining the grounds of TROSA’s business center, housed in an abandoned dairy plant that residents renovated themselves.

After that first phase, residents take classes and start work in any of TROSA’s businesses, which include moving, tele-marketing, painting, and an auto repair shop. The work brings in income to support the center and help residents learn skills. The schedule seems rigorous, but it’s no more than most people juggling career and family manage, McDonald says.

One resident explains that, on the street, addicts constantly think about their next fix, their next easy pleasure. “But we have to learn to live the way normal people do,” he says.

TROSA is an example of a rather drastic treatment option. Others include groups such as Alcoholics Anonymous (AA), 30- and 60-day residential clinics, and drugs such as antibuse, which makes those who take it severely ill if they drink.

Helping patients choose among treatments may fall to doctors in general practice, since they’re often the first health care workers to see signs of alcoholism, Rezvani says. About 15 percent of outpatient visits and 25 to 40 percent of inpatient visits are related to substance abuse, he adds. That’s why Rezvani teaches a class about substance abuse and addiction for medical and social work students. He takes students on trips to treatment centers such as TROSA, asks recovering addicts to speak to the class, and provides information on the right questions to ask to find out if a patient may be abusing alcohol or other drugs.

The treatment that worked for Robin was AA, which advocates complete abstinence from alcohol, taking it one day at a time, and helping others by sharing your story. She started attending a few months after her parents took her to the hospital. Today, she’s been sober for 17 years. She’s still a member of AA, sponsors other members, and enjoys her work as a computer programmer.

“That spot that I was trying to reach through alcohol—I’ve found a way to reach that now,” she says. “And it’s real, not an illusion. I’m not saying I’m there every minute of every day. But I’ve learned some things that enable me to get that feeling without booze.”