There was one thing about my drinking that I simply couldn’t understand. I was perfectly capable in every other aspect of my life but for some bizarre reason I could not control my drinking. I drank more than I should, I drank more often than I should, and I drank at times and places that I shouldn’t. This inability to control my drinking was beyond confusing. It seemed like I didn’t have an “off” switch when it came to alcohol, and it turns out that this is quite literally the truth.
When an urge to drink comes on us it doesn’t come because we’ve willed it to, it comes entirely automatically and there is no conscious involvement at all. Sometimes we will get a gentle longing for a drink, sometimes we get the idea that a drink would be really good now, and sometimes we get the flat-out, primal scream: “I need a drink now!” All of these are cravings. They are all caused by the same mental mechanism and the only thing that differs is their intensity. Cravings don’t come randomly; they are “triggered” by parts of the brain that are collectively known as the “reward system”. The reward system is a group of connected parts that work together to encourage us to do things that aid our survival and to discourage us from doing things that could be dangerous or harmful. It is a self-learning system that operates entirely automatically and beneath our awareness. The reward system isn’t unique to humans; indeed it evolved well before we did. Its component parts lie right next to the brain stem and evolved long before our distinctively human cognitive capacity. Our awareness of self and analytical ability not only evolved after the reward system, they evolved independently of it. Our higher cognitive functions are not directly connected to the much older reward system and this is why we are completely unaware of its operation. But older does not mean lesser. The reward system directs our behaviour, not with language or ideas, but with feelings, and this makes it incredibly compelling. Not only is it compelling, it happens first. The part of our brain that launches cravings is automatic and does not involve thoughtful judgement or even words. The stimulus is the circumstances and the response is the craving, and this action is not only automatic it is blindingly fast. In fact we get a craving to drink before the rest of our mind is aware that the possibility of drinking even exists.
The reward system is where our problems with alcohol begin and intensify, but its actions are invisible to us. The only part of its operation we are aware of is the craving sensation. Cravings may appear to pop up in a fickle manner but they aren’t random at all and neither is their intensity. Cravings are launched when we find ourselves in circumstances that we have drunk before, and the intensity of the craving is determined by how many times we have drunk in that circumstance.
The reward system works by invoking feelings of wanting, longing for, or desire for things that are beneficial to us, and then motivating us to approach them. For things that may be harmful we experience feelings of disgust or fear, and we are motivated to move away. But we aren’t born knowing all the things that help or harm us; we learn new ones as we go along and this is why the reward system was such a huge evolutionary advance over instinct. As our life experience grows we encounter more and more things that are good for us or bad for us, and the appropriate behaviour for each circumstance is remembered: approach or move away. In this way we progressively improve our chances of survival. When we meet something beneficial or harmful that we’ve come across before; a circumstance, place, thing, etc. then our brain automatically motivates us to follow the action that was successful before; e.g. approach and eat, or hide or escape. When we take the action our brain has suggested as the thing to do in this circumstance then the nagging urge that encourages us to act is abruptly stopped and we feel an immediate sense of relief. If we are being encouraged to do something beneficial for survival then first we feel the motivation to act in a certain way and then we are rewarded with a sense of relief when we do it. If we are being encouraged to avoid something harmful then we feel fear, dislike or disgust to make us move away, and again, we feel relief when we do so. The motivating urge to act in a pre-determined way comes from the release of a chemical in our brain called dopamine.
In alcoholics the reward system latches onto alcohol as something very beneficial and it urges us to drink whenever alcohol is available or nearby. It remembers circumstances that yield alcohol and forms a new process for each of them. We call these “drinking triggers”, and each time we drink in a new circumstance then a new trigger is formed. We end up with thousands of them. But another feature of the reward system is that it reinforces successful triggers. If we were encouraged to seek alcohol by a trigger, and then did so, then this trigger was a successful one. Triggers that deliver the outcome sought are more valuable than ones that fail to deliver and our brain deliberately strengthens the successful ones. If a drinking trigger is successful in securing alcohol then its power is increased by releasing more dopamine and this makes the motivating craving stronger. If we take the action that a craving directs us to perform then the dopamine release is stopped immediately, and if the motivation urge was powerful then the sense of relief when it stops is also powerful. The “aaahhh!” sense of ease and comfort that we get on taking our first drink does not come from alcohol (it can’t be because it happens before the alcohol has even entered our bloodstream) it is the reward system in operation. That surge of relief comes from the abrupt absence of dopamine and this is the “reward” component of the “reward system”.
Evolution made the reward system impart urgency to doing things that benefit survival. However, something beneficial like a food that is available now might not be found again for some time, so the reward system encourages us to take advantage of the opportunity while it is present; but it also encourages us do so efficiently. If for example there is a bird in the middle of a field of fruiting berry bushes then there are berries all around it. There is good food in every direction but it would be inefficient in terms of energy use for the bird to pick berries randomly from all corners of the field. So the reward system evolved to use energy efficiently by encouraging the bird to take the closest fruit first. The motivating urge launched by a trigger is stronger when its subject is closer than when the subject is more distant, and in terms of alcohol this means that a craving to drink is far more powerful when we are close to the triggering circumstance. But it also means that if we begin drinking in a location where alcohol is freely available then we experience another craving for a drink as soon as we have finished our first one, and this craving will be powerful because we are close to the circumstances of many triggers. Once we have started drinking in a location where alcohol is available then our reward system continues to demand that we carry on drinking. This is why, when we walk into a bar or similar, we end up drinking more, and drinking for longer, than we intended to when we first walked in.
Our brain constantly scans incoming information looking for triggering circumstances that have been met before and every new circumstance in which we drink forms a new trigger. Directly seeing or smelling alcohol will make that trigger fire, but drinking triggers are not limited to this direct identification. A flying bird may not be able to see the actual berries on a bush but it can see that the bush is of a type that bears good fruit. And the bird may be so far away that it can’t even see the bush but it can see the terrain that bushes of this type grow. The bird forms triggers for the berries, bushes of the correct form, and for the terrain that supports this type of bush, and we do exactly the same with alcohol. Yes, we form a trigger to drink whenever we see or smell alcohol, but we also form triggers for places at which we’ve drunk previously and we also form triggers for the routes that lead to those places. Over an extended period we accumulate hundreds and hundreds of triggers that encourage us to drink. The cravings brought on by these triggers grow stronger each time we act on them and they grow stronger as we draw closer to the trigger’s location. But the reward system can be fooled regarding closeness.
The reward system evolved before our human ability to visualise and imagine, and it evolved before the existence of pictures, photographs, television etc. To the reward system all of these things are recognised as though they are real: it cannot distinguish between a glass containing alcohol and a picture of a glass containing alcohol. Both of these are real to the reward system so they both cause a craving to be launched. Photographs of alcohol and images of people drinking will bring on cravings and even imagining these things will cause the corresponding triggers to fire. We can bring powerful cravings on ourselves by simply daydreaming about drinking. But regardless of how they are triggered, or how intense they are, all cravings are have one thing in common: they are time-limited.
When a bird is in the vicinity of a bush that it has fed at successfully before then dopamine is released to make it want to go there again: it gets a craving. But what if that bush has been stripped bare of its fruit? If the reward system only motivated the bird to go there, and continued that motivation until the bird fed, then if there was no food at the bush then the bird would be urged to stay there for no purpose. Eventually that urge to go to the bush would cause the bird to starve. But this is not what birds do because the reward system evolved to accommodate this circumstance. If the bird finds food at the bush then it continues to be motivated to stay and feed, but if there is no food forthcoming then the motivating urge ceases after a while. The bird is no longer motivated towards that particular bush so it moves on to look for food elsewhere. But if there is food on the bush that day then the bird feeds and the urge to visit that particular bush is again further strengthened.
Whether or not drinking becomes compulsive rather than chosen depends on the vigour that our drinking triggers acquire. The intensity of a craving is determined by how close we are to the circumstances of the trigger and also by the number of times that this trigger has been successful in delivering alcohol. Every time we drink in response to the craving initiated by a trigger then the more powerful that trigger becomes. This means that the next craving we get from that trigger will be stronger. The reward system steadily encourages us to drink more and it encourages us to drink more often, and if this continues unchecked then our drinking triggers strengthen without limit. But everybody has this reward system, so how come that everyone that ever has a drink doesn’t become alcoholic?
Triggers exist to encourage some behaviour and discourage others, but a single subject can have multiple triggers for different circumstances. For example, we might have two triggers for lemons; we may feel the urge to squeeze some lemon juice over fried food, but we would recoil strongly from the suggestion that we should eat a whole one. Just like the example of the lemon most people have some triggers that encourage them to drink and other triggers that urge them not to. Normal drinkers have triggers motivating against drinking too much and they have triggers motivating against drinking at the wrong times. They have triggers linked to the discomforts of drinking too much; hangovers, vomiting, and loss of control, and they have triggers relating to the unwanted consequences of drinking; failing to meet important obligations, doing things that are regretted or shameful and so on. It is the balance of these competing triggers that most often prevents them from drinking unwisely. But alcohol-avoiding triggers do not form properly in us. We get the vague awareness that we seem to have no “off” switch when it comes to alcohol but we don’t realise that this is quite literally true. Normal drinkers are urged away from alcohol if it isn’t an appropriate time or place to drink and they are urged away from alcohol when having more is a bad idea, but we are not. It is not that we make bad choices when it comes to drinking; it is that we lack the normal means to make good ones. We have no “off” switch; ours is permanently fixed in the “on” position and this sets us on a catastrophic trajectory.
We didn’t get to be this way because we applied poor control and drank too much; we got to be this way because we were born without an off switch. We drank the same way as other people around us but something different happens in their brains. They sometimes drank too much and bad things happened as a consequence of that. This caused their triggers to avoid alcohol under some circumstances to gain strength. But those triggers never form for us. We do not learn from our mistakes when it comes to alcohol and the absence of these drink-avoiding triggers leaves us encouraged to drink even at times when it would be sensible not to. As the urge to find and move towards alcohol becomes stronger then so does the sense of relief we get when we secure a drink. It is a vicious cycle that leads to us drinking more because it is self-reinforcing: the act of drinking increases the demand to drink. Normal drinkers may get a motivation away from alcohol accompanied by a thought like “I shouldn’t have another because I have to drive soon” whereas we get the opposite. We get motivated to drink and the thought that comes with it is “there’s just time for one more”. Without the alcohol-avoiding triggers to hold it in check our reward system enters a runaway state which propels us in an ever more urgent pursuit of alcohol. This absence of alcohol-avoiding triggers means that alcoholism always becomes more severe, and it never gets better. The problem won’t fix itself and the longer we let it run its course then the worse it gets.
We can use this understanding of triggers and cravings to help ourselves stop drinking. But before we get to that there’s one more really important thing to know about cravings and that is that the triggers of the reward system, once established, remain in place forever. This is a feature of how the brain works: what has become known cannot become unknown. Once a trigger has been formed then it can never be removed and neither can its associated motivating urge. But while a trigger can never be removed the strength of the motivating urge that it invokes can be changed… and this is our way out.
The reward system aids survival but in the wild the availability of something beneficial like an important food can be unpredictable and the reward system accommodates this variability. For example, if a bird learned to visit a bush because it gave good fruit then the reward system would urge it to return to the bush and look for more food. But if the bush stopped producing fruit altogether, like at the end of its season, then the bird would still visit it forever and this would be an inefficient use of its energy. So the reward system evolved to be adaptable as well as compelling. Firstly, the cravings that are invoked have a limited time-span. If there isn’t any fruit available at the bush when the bird visits then the urge to continue to search there fades after several minutes and it loses interest and moves on. Secondly, if things stop happening the way that a trigger anticipates, then the importance of that trigger is lowered. In exactly the same way that a trigger strengthens through repeated success it is weakened by repeated failure. If the bird repeatedly visits the bush but finds no fruit then it loses interest in that particular bush. When a trigger consistently fails to return the object sought then the importance of acting on it (the intensity of the craving launched) is reduced. The brain can’t unlearn that something has been identified as something to be sought out, but the importance of securing it can be changed, and it is by not succumbing to cravings that we reduce their intensity.
By successively denying a craving the reward system recognises that the likelihood of a particular trigger being successful is less than anticipated and the urgency given to seeking out its subject is progressively reduced. This is an incredibly important piece of information for anyone attempting to stop drinking:
Every time we resist a craving then the intensity of the next craving induced by that trigger is diminished.
This is how we escape addiction. If this did not happen then the cravings would remain at their peak intensity forever and we would eventually drink because the enormous effort required to continually fight them off would overwhelm us. We do not manage to stop drinking because we get better at resisting the cravings, though we do get better at navigating them, we are able to stop drinking because over time the intensity of the cravings fall to an level that we can overcome them without undue effort. When people tell us; “Keep going! It gets easier” they are not just trying to encourage us; it is completely true.