The alcohol paradox: a psychological model.

The paradoxical continuation of excessive drinking by chronic alcoholics despite extremely aversive personal deterioration is addressed by a two-factor theory. The theory regards the increasing stereotypy of alcohol-related behaviors as a function of: (a) primary neuropsychological impairments that result from alcohol abuse and (b) secondary fears of catastrophic failure attendant upon brain dysfunction, which leads to acquired aversions to situations that require adaptive behaviors. A schematic quantitative model of this formulation is presented that may be useful to practicing psychologists in explaining perserverative behavior in a variety of brain syndromes.