The fight against alcoholism is not the one it seems. We are not fighting the bottle we are fighting our own minds and our minds lie to us. We don’t wilfully make poor decisions regarding alcohol; we lack the normal means to make good ones.
Alcoholism is widely held to be a failing of the individual. The general view of society is that alcoholism is a personal weakness and that alcoholics should exercise better control over themselves. But those of us that struggle with alcohol are also completely confused about this apparent lack of control. We make perfectly rational decisions in other aspects of our lives yet despite our most earnest intentions we drink more than we set out to, we drink more often than we mean to, and we drink at the wrong times. It doesn’t matter how hard we try we simply can’t control how much we drink… and right there is the misconception: “control”. Normal drinkers assume that everyone has the same ability as them to choose whether or not to drink and they judge alcoholics by that standard. But control is not poorly applied by alcoholics; the control available to us is severely compromised. The mental processes responsible for our decision-making regarding alcohol are not functioning correctly.
The brain has some automatic mental processes which exist to improve our chances of survival. We have no awareness of their operating but they direct how we behave under set circumstances and this behaviour asserts priority over our free will. These processes encourage us to do things that are beneficial to our survival and discourage us from doing things that are harmful. Collectively they are known as the “reward system” and this system normally directs us to act in ways that are helpful; but it operates abnormally in alcoholics. In us the reward system becomes incorrectly and excessively bound to alcohol and this has terrible consequences.
The reward system works by using feelings to motivate us to behave in certain ways. It encourages us to approach and partake of things that have been good for us previously and it encourages us to move away from things that have been previously found to be dangerous or harmful. The feelings that encourage us to approach are a longing for or wanting, and the feelings that encourage us to move away are dislike, disgust or fear. When we act in accordance with the attractive or repulsive feeling then we get rewarded with a sensation of wellbeing, hence the name, the “reward” system.
All animals have this reward system and the behaviour of birds at a bird feeder gives us a good illustration of how it works. When a bird first takes food at a feeder it does so cautiously, but it finds good and plentiful food there and the reward system records this. It remembers the details of the circumstance and sets up a motivation and a reward for the next time this circumstance is found. The next time the bird sees a similar feeder it is motivated (by a longing for) to approach and feed, and on doing so it is rewarded with a feeling of well-being. But the reward system doesn’t just encourage repeating behaviour that was previously found to be beneficial, it alters the urgency of taking this action depending on how often it has been successful in the past. If the bird feeder is always well stocked then the bird’s visit will always yield food and the reward system recognises that this source is more reliable than others. At each successful visit the reward system increases the importance of visiting this particular feeder. It does this by increasing the intensity of the urge to approach and by increasing the intensity of the sense of well-being the bird gets on feeding there. But if another bird feeder only occasionally yields food then the intensity of the urge to visit that feeder remains small. Any time the bird is in the vicinity of the well-stocked feeder it is encouraged to go and feed there by a strong yearning. And every time this feeder is visited and food is taken then the reward system increases the urgency of feeding there again. If that feeder remains reliably stocked then the urgency of going to that particular food source becomes more potent than the urge to go to any other, and the bird ends up feeding there almost exclusively.
None of this behaviour involves any thoughtful process. The bird’s actions are driven by processes in its brain that are learned, modified and executed entirely automatically. The bird ends up feeding at this feeder almost exclusively but it doesn’t make an active decision to do so; it is directed to feed there by mental processes that operate beneath its awareness. The bird doesn’t decide to feed there, and the bird isn’t aware of why it goes there, but it feeds there nonetheless. But the reward system that such does a wonderful job of directing beneficial behaviour in the natural world is tricked into behaving incorrectly by alcohol and other drugs.
When we first drink we enjoy the experience; alcohol makes us feel happy and we have a good time. But that happiness is caused by alcohol directly elevating our mood, it isn’t caused by our actual circumstances, and this is how the reward system gets tricked. Our reward system responds to a happy circumstance regardless of the fact that it is chemically induced. This makes it record; “that was good, do it again!” And just like the bird at the bird feeder our reward system sets up a motivating urge and a rewarding feeling of well-being ready for the next time that alcohol is nearby. The next time we are close to alcohol we are drawn to it by a motivating urge and if we drink we are rewarded with a glow of well-being. If we repeat and repeat this cycle then the motivating urge increases in intensity to become a craving and the reward, the sense of well-being, becomes the “aaahhh!” of relief we experience on taking the first drink of the day. If this was the whole extent of the reward system then the urge to drink would become more and more powerful every time we drank. Eventually that urge would become so intense that it would overwhelm all other desires or interests, and this is precisely what happens to alcoholics. But another facet of the reward system prevents this for the great majority of the population.
Just as the reward system encourages us to do things that are beneficial it also discourages us from doing things that are harmful, and drinking is not always an enjoyable or beneficial experience. If we drink too much we get hangovers and drinking too much or drinking at the wrong time can have unwanted consequences. For most people the reward system is sensitive to these bad outcomes as well as the good ones and in these people it creates motivating urges that deter drinking: their reward system doesn’t always encourage them to drink, sometimes it opposes it. For most people the reward system includes both encouragements and discouragements with regard to drinking and their brain automatically urges the appropriate behaviour for a given situation. But there are some people that only build these alcohol-deterring motivations very weakly. About 5% of the population has a reward system that recognises the benefits of alcohol far more strongly than any detrimental consequences. The reward system in these people never builds any significant motivation to avoid alcohol; it only ever grows and grows the intensity of the urge to drink. Most people have an “off” switch for alcohol, but we don’t; ours never forms. In us this wordless compulsion to seek out and consume alcohol grows in strength and it grows without limit, far exceeding the normal intensities found in the natural world. Each time we identify and then drink alcohol the reward system increases the importance of doing so even further. This leads to us drinking more and drinking more often, and the urge to drink strengthens without end. But in us the urge to not drink never gains strength at all. This causes our reward system to enter a runaway state with regard to alcohol. The act of drinking increases the urgency of wanting a drink and this keeps increasing without limit. But alcoholism is more than excessive drinking caused by a reward system that is locked into an ever-intensifying feedback loop. Other problems emerge as the seriousness of the condition progresses: we change physically, our memory becomes biased, and we change emotionally.
Once we drink regularly and heavily then our body and brain adapt to offset the regular impairment that alcohol causes. One of the noticeable bodily changes is that our heart speeds up and we feel on-edge, ready to respond, as though we are anticipating some sort of imminent danger. But it is the changes in our minds that have the greater impact on us. Our memory becomes heavily biased in favour of remembering drinking as a good experience; positive memories of drinking are reinforced but memories of bad outcomes are minimised. In our memory drinking is always good and the downsides of drinking, while they are remembered, are never remembered as important; they never gain enough significance to act as a deterrent. In our own minds “drinking is good” and we are quite literally unable to recognise the damage that alcohol is actually causing. But not only do our memories become distorted, so too do our emotions. As our brain tries to offset the effects of regular drinking our emotions change in three key ways; we feel a lowered base level of happiness, our social confidence drops, and we feel constantly distressed and irritable. These changes become more pronounced as our addiction strengthens. Now, when we are sober we are gripped by fear, confusion, frustration, despair and a crushing loneliness. But having a drink removes these feelings, so we now need to drink simply to lift our emotional state to normal. We are miserable and distressed when we are sober but a drink relieves these feelings, and the reward system recognises this. These emotions themselves become drinking triggers and we become urged to drink by the emotional consequences of being sober: fear, distress, confusion, frustration, despair and loneliness. At this point alcohol becomes the medicine that cures the symptoms that are themselves caused by drinking, but drinking more makes these symptoms even worse, so our problem forms into a vicious cycle of deepening hopelessness.
Our insatiable quest for alcohol establishes itself and progresses entirely automatically. We have no idea that our reward system has started to direct our behaviour regarding alcohol, and we don’t know that this directing motivation is becoming more intense; we aren’t even aware that it is operating! Powerful cravings come on us when we encounter circumstances that have yielded alcohol in the past, and powerful cravings come on us when we feel alone, miserable or distressed. We can’t stop the cravings from coming, we can’t negotiate with them, and we can’t ignore them. A normal drinker can choose whether or not to drink and they are prompted to make a choice when they’ve had enough. But we don’t have that freedom of choice because in us that choice is absent; we are never prompted to make it. In us decision to drink has already been made and it has been made in a part of the brain that we can’t see into. For us the decision that we should drink has already been formed by mental processes that are automatic, involuntary and compelling. Alcoholism is not poor behaviour, but abnormally functioning mental processes. It is not weakness, but an absence of the deterring motivations that would otherwise limit our drinking. In us the idea “I shouldn’t drink now” never happens; there is only ever “I should”.
When we decide to stop drinking then our mind immediately starts to work against us. Our brain fights our efforts at sobriety because the reward system still wants us to drink! In alcoholics the reward system has wound itself up to fever pitch. The motivating urge that directs a bird to a bird feeder is magnified a thousand-fold and compels us to drink. But our intellectual decision to stop drinking has no influence whatsoever on the operation of the reward system. It remains exactly as it was and it still commands us to drink.
Defying the constant and intense compulsion to drink is both difficult and exhausting, but it is not our only challenge; it is only the beginning. We try to mount this herculean effort at a time when our minds have made us depressed, hopeless, afraid and lonely. Our minds scream at us that a drink will make us feel better and the great problem this poses is that it is completely true; a drink really will make us feel better, but only briefly; in the longer term a drink makes our predicament worse. But our minds greatly prefer something now over something later so a drink now holds incredible appeal. Even if we manage to defy the compelling cravings then our minds still do not give up trying to make us drink; they engage a different tactic and start putting the feelings that we should drink into words. Our minds actively create plausible justifications for drinking, and these too must be overcome. Our thoughts run rampant trying to convince us to drink and it seems at times like we are going mad, but we are not. These self-sabotaging mental contortions are as inevitable as cravings and they cannot be avoided. They add an appearance of cunning and deviousness to our addiction and this means that our fight isn’t static; as we close one door it finds another. But recovery from addiction is possible despite how difficult and hopeless it may feel and recovery is possible regardless of how far the condition has progressed. But not only is it possible to stop drinking, it is also essential. Alcoholics that do not break free from the downward spiral into hopelessness will die prematurely, usually from organ failure, accident, or suicide.
Alcoholism has been and continues to be studied in depth. A great deal of how the addiction forms, develops and manifests itself is described in intricate detail in thousands of research papers. But these papers describe changes in the body and brain in scientific terms and this leaves out something fundamental; it misses how it feels, and feelings are central to our problem. When alcoholics talk to each other about their problem they don’t talk about how much they drank or how often, and they don’t talk about neurons or hormones or parts of the brain. They talk about how they thought and how they felt. This book explains in plain language how our brain deceives us about alcohol, and the mechanisms that cause that. This is explained through the lens of someone who’s been there and has experienced first-hand what it feels like. The information presented here is important because overcoming alcoholism is not the challenge that it seems. Alcohol does not wield some magical power over us. Alcohol does not compel us to drink it, our brain does that. Alcohol does not make us feel persistently depressed, stressed and alone, our brain does that too. And alcohol does not create the lies exhorting us to drink again, our brain does that as well. Addiction uses our own feelings, emotions and intellect against us and we have no direct counter for these. We cannot choose to not feel alone, stressed, anxious or fearful and we can’t choose to not feel that primal silent scream that demands that we drink. We also can’t choose to not have a torrent of self-sabotaging lies churning in our mind, lies that are every bit as cunning, devious and deceitful as we can be. But these things are not illusions or imaginary, they are completely real to us and we experience them very powerfully. They are real but they are the products of mis-performing mental processes. Alcoholism is not failure to exercise proper control over our mind, it is that some parts of our mind are purposefully steering us to our own destruction. To completely reverse the direction of these processes is one of the most difficult challenges we will ever meet, but most people struggling with alcohol don’t even know that these processes exist let alone how they can be altered. Addiction is a fight we are ill-equipped to win as it wields weapons which we have no direct counter for; we can only fight back with willpower and knowledge… but knowledge can greatly improve our chances. When we know how our mind will act against us then we can identify the falsehoods as they come and know what will help us combat them and what will not. Most significantly we can avoid being deceived. Our greatest weapon is to know that our fight is not with the bottle but with our own mind.