Alcohol addiction is a disease. It is wrong to think of it as a problem of self-control. It is not entirely something that you can choose. Granted that nobody forced you to start drinking, and granted that drinking alcohol is something to an extent, under your control, there are some aspects of alcohol addiction that are beyond your control.
The factors that you cannot change are the physical and physiological aspects of alcohol addiction. We will explain the elements of these factors concisely in this article. About the emotional factor, we will discuss what facets of it can be changed through re-learning and re-education.
Let us present some recent evidence-based facts that cause alcohol addiction. But before that, we need to be clear what the term “alcohol addiction” means.
Medically, the term “Alcohol Use Disorder” (AUD) is used to describe alcohol addiction. Only medical professionals can diagnose AUD. In common usage, people refer to the terms “alcoholic” or “alcohol addict” when they are describing someone who has a drinking problem. There are three degrees of severity for AUD, and these are mild, moderate and severe. Medical professions use a standard criterion to evaluate AUD.
New studies have found that there are complex interactions in the body’s organ systems in patients who have AUD. These interactions are between the nervous, endocrinal, and immune systems.
The parts of the brain that control reward, emotional regulation, self-control, sleep, decision-making, learning and memory are all affected by AUD.
AUD has a different impact on a person, depending on what life stage the person is. During adolescence (ages 10 – 19), the brain is still developing. People who start using alcohol during the period when their brains are still developing take the chance of damaging their long-term and short-term cognitive functions. They are also at the risk of having AUD in their adulthood.
Genes and endophenotypes
Endophenotypes are biological characteristics that tell what personality traits a person will likely have. Sometimes, endotypes are referred to as “behavioural phenotypes”. These characteristics are something we inherit from our genes. It is a known fact that 50-50% of alcoholics have alcoholic parents. The behavioural traits which we likely inherit from our predecessors that increase our likelihood of AUD are: impulsivity, willingness to try new things, tendency not to follow rules, and active seeking of intense sensations.
The endophenotype can be called the “emotional factor” factor of AUD. Medical experts are still refining their research on what behavioural interventions can be used to change behaviours tied with these traits. Some of the leads include changing the environment, providing social support, and self-directed behavioural change through Cognitive Behavioural Therapy techniques.
The Three-Stage Cycle of AUD
Using brain scans such as Positron Emission Tomography (PET) scans, scientists have identified specific areas that are active when a person has AUD. These areas and the behaviours they control are:
- The basal ganglia – reward system and habit formation
- Extended amygdala – responses to stress and strong emotions such as fear and anxiety
- Prefrontal cortex – controls decision-making, personality, drive, self-control, and thinking rationally
There are three evident stages of AUD. In this part of the article, we are going to explain how the brain works depending on the stages of AUD.
- Binge/Intoxication Stage – People who are in this stage feel a loss of control over their drinking. At the level of the brain, this is what happens:
- Certain cues are present (for example, good feelings, a certain bar, 5 PM, weekends with friends)
- Nucleus Acumbens goes into action (feels pleasure)
- If repeated again and again, the straitum goes into action (habit formation)
- Incentive Salience, a type of associative learning takes place
- People who have learned incentive salience will have an irrational desire to drink, a compulsion or an urge that cannot be denied. This behaviour is governed not by the rational parts of the brain. This is why the people who have AUD say, “I have lost control over alcohol, it now controls me.”
- Withdrawal/Negative Affect Stage – During this stage, people with AUD will have the urge to quit. Their rational minds know that what they are doing is excessive and harmful.
- But when they quit drinking, they experience what scientists call “reward deficit”. Because they have been overtaxing their reward system through heavy drinking in the Binge/Intoxication stage, the brain got used to producing a high level of neurotransmitters that elicited the feeling of pleasure. Now that they have stopped drinking, the neurotransmitter level that the person is used to has dropped.
- Dropped nuerotransmitter levels triggers another part of the brain, the amygdala, which is responsible in countering stressful feelings. The amygdala is prompted to be in a “stress surfeit” state. Under this state, feelings of anxiety, sadness, irritability and uneasiness surface.
- When people who have AUD try to quit but come back again to drinking, the amygdala turns on its “anti-reward stress system”. When this happens, a person becomes apathetic. They become numb to situations that normally make people feel happy. It is as if they are robbed of their ability to feel any kind of pleasure.
- Pre-occupation/Anticipation Stage
- In this stage, the prefrontal cortex takes center stage. This part of the brain is about “executive functions”. These functions include decision-making and rational thinking.
- This part of the brain is home to two systems that oppose each other: the go and no-go system. In a brain that functions normally, there is a balance of these systems. For example, you can say “no” to things that are not good to you, and “yes” to things that are good to you in a balanced way.
- For people who have AUD, there is either too much activity in the go (“yes”) system , or too little activity in the no-go (“no”) system.
The three-stage cycle of AUD is a loop. It adequately explains why people who are addicted to alcohol keep being dependent on alcohol. Even if they are already in the process of recovering from alcohol addiction, it will take time for the brain to return back to a normal state.
We hope that the information we provided gave you a well-defined outline of the physical, physiological, and to some degree, the emotional aspects of alcohol addiction. We would like to convey the message that people with AUD are not victims of their brain. Granted that the brain sustain damage from alcohol addiction, there are steps that can be taken to facilitate change.