Why we’ve ended up in this position is a question that haunts us. It is as though knowing the answer will absolve us of the awful things we’ve done. But knowing the answer ultimately changes nothing; we are alcoholics, and the only remedy for this is to stop drinking permanently. Knowing the answer to how we became alcoholics does not change that, nevertheless, we seem to need to know.
Alcoholics drink compulsively. I.e. we don’t drink because the occasion warrants it; we drink regardless of the circumstances because we are compelled to do so. We are compelled to do so because the triggers and cravings that encourage us to drink have become far more powerful than the triggers and revulsions to avoid drink. In time the brain adapts to heavy drinking by reducing the effectiveness of dopamine and serotonin, and speeding the brain up. The result of these changes is that we live in a state where we feel unhappy, irritable, alone, and have a very poor self-image. These feelings are relieved by drinking, and we are triggered to drink when we feel like this. This is the alcohol trap, and once these changes have taken place then we drink in response to being sober.
To reach this position requires that we drink both significantly and regularly, but most people that drink do not end up like us. So what is it that determines who drinks and then goes on to become alcoholic?
There is no single factor that pre-determines that we will become an alcoholic; nobody is pre-destined to become addicted. There are however some key variables that increase the likelihood of this happening, and research has identified five main groups of factors that predispose alcoholism; age, gender, genetic aspects, personality factors and social environment. Some of these on their own can be sufficient to encourage the onset of addiction and the presence of multiple factors is perfectly common.
In this book it has been said here that certain characteristics provide a natural pathway for the formation of addiction. I.e. alcoholics are likely to greatly overvalue the benefits of drinking, undervalue the negative effects of drinking, and greatly prefer a reward now over a greater reward in the future. This is only one of several distinct pathways into addiction but another is closely related to it: if we drink regularly in our teenage years we are far more likely to become alcoholic. This is because the teenage brain’s pleasure centres mature quicker than the part of the brain responsible for sound decision-making; they already over-value the benefits of drinking. This follows the natural pathway to addiction in that while we are in our early teens we are quite normally motivated in this way; we very greatly prefer good things now over good things later… benefits in the future carry little importance.
But there is another reason that excessive drinking is common among teenagers and this is to do with establishing ourselves in the social order. In our teens we are instinctively driven to try and assert ourselves as the alpha male or alpha female in our social circles, and when we drink our brains release more serotonin. This makes us more confident socially, and we therefore feel that we are socially more successful: it artificially elevates our belief of our ranking in the social order. Teenagers that do not feel that they “fit in” are particularly vulnerable to this as alcohol allows them to socialise comfortably; so they drink a lot, and they drink often. Drinking heavily in our youth builds powerful triggers early on. Most people will grow out of drinking excessively as they mature, but those that drank heavily from their early teens may never subsequently develop sufficient strength in the drink avoiding triggers; and they become addicted.
Many other reasons are given for young people drinking heavily; because they are distressed about something in their lives, for the thrill, because their friends do, because the adults do, because they see it in the media and so on. But regardless of the reasons they drink, teenagers that begin drinking before the age of 15 are four times more likely to develop alcohol-related problems later in life than those who began drinking later.
The brain of a heavy and persistent drinker adapts to the regular presence of alcohol by changing the levels of dopamine, serotonin, GABA and glutamate. The effect of diminished serotonin is that they feel miserable and anxious and need to drink to feel normal. But this state isn’t unique to alcoholics. People living with persistent distress are already in this state, and this is another pathway into addiction. Addiction becomes locked in place when we drink to get relief from distress, and people that have suffered some major trauma in their past (like childhood abuse), or if they suffer certain mental illnesses, can already be in this position. For them drinking gives them relief from their persistent problems. They drink to relieve distress, and from there the addiction follows same course. Tolerance to alcohol develops over an extended period, and from there the downward trajectory is locked in place. For people in this position then counselling for the underlying issue needs to accompany any attempt at recovery, otherwise relapse is virtually inevitable.
While there are several distinct pathways into alcoholism, one thing is clear. While there is no single gene that determines whether or not we will become addicted, genetics has a very significant bearing on the likelihood that we will or will not. Research suggests that 50%-60% of the likelihood that addiction will form is genetic. The principal research behind this statistic comes from studies of children born to alcoholic parents but raised in non-alcoholic families. Children born to alcoholic parents have a two to tenfold increase in risk of becoming alcoholic themselves. Another study also demonstrates that adoption itself is not the causal issue; children born to alcoholic parents but adopted away during infancy were at greater risk for alcoholism than were adopted-away children of non-alcoholic parents. While the evidence shows that susceptibility to alcoholism can to a great extent be inherited, the precise mechanism by which this happens is not at all clear.
Our genetic composition determines all our human traits. Our DNA dictates our physical characteristics (such as hair colour) and also our behavioural characteristics (such as aggression). The flawed automated brain processes surrounding triggers and cravings, the favouring of rewards now rather than greater benefits later are both genetic traits that can be passed on to us by our parents. But just as addiction is a composite of many contributing parts, so are the genetic factors that aid its development. There are genes that increase a person’s risk of developing addiction, as well as those that decrease that risk, and these gene variations are perfectly common.
There are very many genetic components that can encourage the development of addiction, and the research on these is really only just beginning, but much research suggests that genes affecting the activity of serotonin and GABA are likely candidates for involvement in alcoholism risk. Also identified as being significant is that people who have a family history of alcoholism have been shown to have a smaller than average amygdala. This is clearly significant as the amygdala is responsible for manging triggers and cravings, and is also central to emotion regulation; which are both central components of addiction.
What is not clear is the extent to which personal characteristics favour or dis-favour addiction; yet there are personal characteristics that are more commonly grouped among alcoholics than the general population. Some of these characteristics are clearly the result of addiction; compulsive behaviour, a very poor self-image and guilt cause obvious changes in personality that result from alcoholism. However, other characteristics commonly grouped among alcoholics are behaviours that favour the formation of addiction.
Impulsive behaviour and lack of patience indicate people who seek to be happy in the moment instead of holding out for better things and making long-term goals. People who cope with stress poorly, have low frustration tolerance or are excessively sensitive to criticism are at a higher risk of addiction because many people will use drugs, alcohol or food as a way of coping. Feelings of isolation, a high level of anxiety in interpersonal relations and emotional immaturity also all favour the formation of addiction as these factors are all ease by the boosted serotonin levels that initially accompany drinking.
Just as there are personal characteristics that encourage the onset of addiction there are others that dis-favour taking action to remedy the position. Also more significantly grouped among alcoholics than the general population are ambivalence towards authority and being highly self-reliant. These traits make people less likely to value the opinion of others (Doctors, therapists, counsellors etc.) and more likely to rely on their own opinions and resources. This makes them less willing to seek help. These characteristics in themselves don’t cause addiction, but they do however expose the underlying traits that favour it: valuing the benefits of something above the potential risks, and favouring a result now rather than later.
Personal characteristics aren’t directly passed genetically, only the likelihood that we will have them. And like there are genetic components that favour addiction, there are those too that ward it off. For example, it is common among Asian populations that the genetic coding for the liver enzyme ALDH is absent. This means that their liver is very poor at breaking down acetaldehyde, and Asians are likely to become violently ill if they drink too much. For them the triggers to avoid drink gain very significant power and they are strongly motivated away from significant drinking. This is one of the reasons that alcoholism is far less common among Asian populations.
However, while genetic factors account for more than half of the likelihood of addiction forming; much of the remainder comes from the circumstances surrounding of individual. Parental or familial example, associating regularly with heavy drinkers, peer pressure, youth, and persistent distress are among the leading environmental factors.
Having parents that are alcoholics does not mean that we are pre-destined to follow that course, we are not. Alcoholism itself is not directly inheritable, but factors that influence susceptibility (and factors that discourage susceptibility) can be. Equally, the coincidence of these same traits can occur perfectly randomly. But having alcoholic parents makes it quite likely that their children have the genes that favour addiction, and are raised in an environment where heavy drinking is seen as the normal behaviour; so both the genetic and the environmental parts are present. Nonetheless, having alcoholic parents still does not mean that we will become alcoholic… we have to drink too. It doesn’t matter how many addiction favouring genes a person has, if they never drink or take drugs then they will not become addicted; we aren’t inevitably driven to alcoholism, we also have to drink.
There is still a great deal to be learned about just what causes some to become addicted while others aren’t but among current research there is significant focus on a condition called alexithymia: a diminished ability to identify, define, and explain our own emotions. Alexithymia is present in 6% – 10% of the general population, but in as many as 78% of alcoholics and this is an enormous variance. It has been shown to be a vulnerability factor for addiction, and that it precedes addiction rather than being a consequence of it. Symptoms of alexithymia include; poor emotional regulation, interpersonal problems, reduced social support, anxiety and depressive disorders, and it has been associated with a family history of alcoholism. Heavy drinkers with alexithymia also report more alcohol craving, and obsessive thoughts about alcohol than those without.
There is still much to learn about why certain people become alcoholic while others don’t, but ultimately it makes little difference to the sufferer.
People who become alcoholic are often desperate to understand why this has happened to them. In part they want to know so that they have reasons for behaviours they can’t explain, and in part it is to re-direct blame away from themselves (“See! That’s why I behave like this”). It is also seated in the hope that if they understood the cause of their addiction then this may show them how to combat it.
But ultimately, knowing the cause of our addiction helps very little; it does not undo the physiological changes that have occurred in the brain, it does not remove the triggers that have formed, nor does it create those alcohol-avoiding triggers that did not form. Regardless of how our addiction formed the course of action required to become well again is the same; first we have to stop drinking, and then we have to undo the damage caused.
Alcoholism in a nutshell explains how alcoholism forms and how it alters our body, brain, mind, memories, and emotions. It gives the reader a full understanding of the challenges faced when attempting to overcome alcoholism and shows them the ways in which their own mind will oppose them.
Anyone trying to change their drinking or anyone trying to help someone struggling with an alcohol problem is most welcome to take a free copy of the eBook here. The download begins immediately on clicking.