Decoding the bidirectional links between alcohol misuse and aggression: toward a unified translational framework.

RATIONALE: The relationship between alcohol misuse and aggression has long intrigued clinical and preclinical researchers. While acute alcohol use is well known to promote aggression, converging evidence indicates a more complex, bidirectional association. Both behaviors often arise from shared genetic, neurobiological, and environmental vulnerabilities and can mutually increase risk, creating a vicious spiral in which alcohol misuse and aggression reinforce one another over time.

OBJECTIVE: This review synthesizes epidemiological, clinical, and experimental findings to establish an integrated framework linking alcohol misuse and aggression, while introducing a translational perspective connecting human and animal research.

RESULTS & CONCLUSIONS: The relationship between alcohol misuse and aggression can be conceptualized through two complementary models. In the first, alcohol use facilitates aggression: acute intoxication disrupts executive control and heightens emotional reactivity, while chronic exposure induces neuroadaptations that sensitize individuals to aggression-promoting effects and may elevate aggression during abstinence. In the second, aggression increases vulnerability to alcohol misuse: longitudinal studies reveal that aggressive traits, emotional dysregulation, and externalizing psychopathology frequently precede problematic drinking. These pathways are influenced by shared dysfunctions within prefrontal-limbic circuits involved in emotion regulation and impulse control. Despite progress in modeling alcohol-induced aggression, little research addresses how aggressive phenotypes contribute to alcohol misuse, representing an important translational gap. Overall, this relationship is best understood as a dynamic, bidirectional system rooted in overlapping neurobehavioral mechanisms. By integrating clinical findings with preclinical models, this framework highlights targets for mechanistic investigation and the development of tailored therapeutic strategies.