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Alcohol Use Disorder Causes: Why Do People Become Alcoholics?

You may wonder why some people become addicted to alcohol while others can drink excessively without developing problems if you have a loved one struggling with alcoholism. A glass of wine with dinner may be enjoyable for some people, but it can be difficult for others to stop at just one. What characteristics or experiences lead certain people to alcoholism?

Some people are predisposed to alcoholism for various reasons, while others aren’t. Alcoholism is a complex disease with multiple contributing factors, including genetics, upbringing, and mental health. There are, however, people who show no signs of risk but still battle alcoholism. In the end, alcoholics can be anyone, regardless of social status.

What Causes a Person to be an Alcoholic?

In 2021, 11.3% of people aged 18 years and above were found to have Alcohol Use Disorder (AUD), according to case study data from the National Survey on Drug Use and Health. This percentage translates to a staggering 28.6 million adults. Furthermore, during the same period, approximately 894,000 individuals between the ages of 12 and 17 (equivalent to 3.4% of this age group) were categorized as alcoholics or alcohol-dependent.

Various factors related to the frequency, quantity, and pace of alcohol consumption can influence an individual’s susceptibility to developing AUD. The following factors contribute to the likelihood of developing AUD.

What are the Causes of Alcohol Use Disorder (AUD)?

Alcohol addiction, like other forms of addiction, is a complex condition influenced by a combination of genetic, environmental, and individual factors. Here are some common factors that contribute to the development of alcohol addiction:

1. Genetic Factors

Genetics plays a significant role in the risk of developing alcohol addiction, though it is not the sole factor. According to heritability estimates from the National Institute on Alcohol Abuse and Alcoholism in 2020, genetics contribute to around 60% of the risk for AUD. Certain genes affect the amount of alcohol people consume and their likelihood of developing alcohol dependence. These genetic factors may influence how a person responds to alcohol, how much pleasure they derive from drinking, or how high their tolerance might be.

However, like other chronic health conditions, the interaction between genes and environmental variables substantially impacts an individual’s susceptibility to alcohol and drug use disorder (AUD). In addition, a child’s risk of developing alcohol use disorder might be affected by the drinking patterns of their parents.

Example: John comes from a family with a history of alcohol addiction. Despite his efforts to drink moderately, he finds it difficult to control his consumption, suggesting a genetic predisposition to alcohol use disorder.

2. Environmental Factors

Environmental factors significantly influence the risk of developing alcohol addiction, with impacts stemming from various socio-cultural and familial contexts:

  • Family and Upbringing: According to the NIAAA, individuals who grow up in environments where alcohol use is normalized, or where family members have alcohol use disorders, are more likely to develop alcohol problems. Children of alcohol-dependent parents are approximately four times more likely to develop alcohol issues themselves compared to their peers from non-alcohol-dependent families.
  • Socioeconomic Factors: Economic stress and poverty are linked to higher rates of alcohol consumption and addiction. Research by the National Institute on Drug Abuse indicates that individuals facing socioeconomic pressures may turn to alcohol as a coping mechanism, with lower socioeconomic status being associated with an increased risk of developing alcohol use disorders.
  • Peer Influence: Peer groups significantly impact alcohol use, especially among adolescents and young adults. Social pressure and behaviors of peers who engage in heavy drinking can influence an individual’s drinking habits. The prevalence of alcohol use among peers is a strong predictor of personal alcohol consumption and potential misuse.
  • Cultural and Societal Norms: Cultural practices and societal attitudes towards alcohol consumption also play a critical role. According to the National Institute on Drug Abuse, in societies where heavy drinking is more accepted or even encouraged, there tends to be a higher prevalence of alcohol use disorders.

Example: Sarah grew up in a household where drinking was a regular part of social gatherings. As an adult, she finds herself drinking heavily at social events, influenced by the normalized alcohol use she observed during her upbringing.

3. Neuropsychological Factors

Neuropsychological factors involve the complex interplay between the brain’s neurochemistry and psychological state. Individuals might use alcohol as a way to self-medicate, attempting to alleviate the distress associated with conditions such as depression, anxiety, post-traumatic stress disorder (PTSD), and attention-deficit/hyperactivity disorder (ADHD). Additionally, alcohol interacts with the brain’s reward system by increasing the release of dopamine, a neurotransmitter that enhances feelings of pleasure and satisfaction. This dopamine release initially acts as a reward for drinking behavior, reinforcing alcohol consumption.

Research by the NIAAA indicates that about 20% to 40% of individuals treated for anxiety disorders also struggle with AUD. Similarly, the co-occurrence of AUD with major depressive disorder ranges from 27% to 40%, and among those with bipolar disorder, the prevalence of AUD can be as high as 42%. This highlights the significant overlap between AUD and other mental health conditions, emphasizing the need for integrated treatment approaches that address both substance use and underlying psychological issues.

Over time, repeated alcohol exposure can lead to substantial changes in the brain’s neurochemical balance, enhancing the user’s dependence on alcohol to stimulate these reward pathways. Prolonged alcohol use also affects other neurotransmitters like glutamate and GABA, which are involved in the brain’s reward circuits and stress responses. This alteration in neurotransmitter activity can exacerbate cravings and dependency, making it difficult for individuals to stop drinking despite negative consequences.

Additionally, chronic alcohol exposure can lead to neuroadaptations in the brain’s reward and stress circuits, eventually reducing the brain’s ability to naturally produce these neurotransmitters without the presence of alcohol. This change contributes to the compulsive drinking patterns observed in alcohol use disorder (AUD).

Example: After experiencing a traumatic event, Michael begins using alcohol to cope with his PTSD symptoms. Over time, his reliance on alcohol to manage his psychological distress, combined with the neurochemical changes in his brain due to alcohol use, leads to the development of an alcohol use disorder.

Example: Emily finds that after a period of heavy drinking, she needs to consume more alcohol to achieve the same pleasurable effects. This increased tolerance and dependence are signs of the neurochemical changes in her brain due to alcohol use.

4. Behavioral Factors

Certain behavioral patterns significantly elevate the risk of developing alcohol use disorder. According to the NIAAA, behaviors such as early initiation of alcohol use, regular heavy drinking, binge drinking, and using alcohol as a coping mechanism for stress or emotional distress are all potent risk factors for alcohol use disorder (AUD).

  • Early Initiation: Starting to drink alcohol at a young age is a strong predictor of later alcohol abuse. Research indicates that individuals who begin drinking before age 15 are four times more likely to develop alcohol dependence at some point in their lives compared to those who begin drinking at age 21 or older.
  • Regular Heavy Drinking and Binge Drinking: Engaging in heavy drinking, defined as consuming more than four drinks on any day for men or more than three for women, or binge drinking, which involves drinking five or more drinks on a single occasion for men or four or more for women, can significantly disrupt the neurochemical systems in the brain. This disruption enhances the likelihood of developing an addiction.
  • Using Alcohol to Cope: Utilizing alcohol as a means to manage stress or emotional issues often leads to greater alcohol dependency. This pattern of using alcohol to self-medicate can accelerate the progression to alcohol addiction by reinforcing the behavior and increasing tolerance and dependence.
  • Binge Drinking: Consuming a significant quantity of alcohol in a short length of time, known as binge drinking, can lead to tolerance, dependence, and, eventually, an alcohol use disorder. Regularly engaging in binge drinking can disrupt brain chemistry and reinforce addictive behaviors.
  • Excessive Drinking: Excessive drinking, which surpasses recommended alcohol limits according to NIAA and the Dietary Guidelines for Americans 2020-2025,” U.S. Department of Health and Human Services and U.S. Department of Agriculture, can lead to alcohol dependence and addiction. Repeated exposure to high levels of alcohol puts individuals at a greater risk of developing alcohol use disorder because it disrupts brain function and impairs decision-making abilities.
  • Underage Drinking: Initiating alcohol consumption at a young age poses a significant risk factor for developing AUD. People who started drinking before the age of 15 are more than three times as likely to report having AUD within the past year, according to recent national research by NCTSN focusing on people aged 26 and older. Furthermore, women face a greater vulnerability within this age group than men.

These behavioral factors do not operate in isolation but interact with genetic, environmental, and psychological factors to influence the causes of alcohol use disorder. This complex interplay means that the risk of developing AUD is multifaceted and requires a comprehensive approach to understanding and treatment.

How Do People Become Alcoholics?

Alcohol use disorder is a condition that makes it difficult for you to regulate your drinking or quit drinking, despite the numerous negative consequences of your drinking. The severity of AUD varies from person to person, with alcohol constituting the most severe case.

Addiction requires intricate brain changes to initiate. Alcohol, like many other substances, can have a profound influence on the brain, altering our emotional experiences both positively and negatively. Despite the potential dangers to an individual’s health and well-being, these pleasures can be powerful motivators for individuals to continue participating. A report by Stephen Armeli published in the National Library of Medicine in 2015 shows that using alcohol to manage stress can alleviate emotional distress. This results in more negative emotions between doses, leading to feedback encouraging continued alcohol consumption.

Continuous alcohol consumption is associated with permanent alterations in the structure and function of the brain. These changes can make it more challenging to control excessive drinking and cause people to transition from socially acceptable but infrequent drinking to out-of-control binge drinking. Notably, these alterations may persist long after a person stops drinking, making them susceptible to relapse.

Alcohol affects the brain regions responsible for decision-making, planning, and self-control. The basal ganglia regulate excessive drinking and intoxication, the prefrontal cortex handles concentration and anticipation, and the extended amygdala is responsible for negative emotion and avoidance behavior. As a result of chronic alcohol consumption, these regions endure alterations that feed the addictive cycle and make a recovery from alcoholism more difficult.

As per a study by Koob GF published in 2020 in NCBI, Understanding the intricate relationship between alcohol and the brain is essential for comprehending how chronic consumers succumb to alcoholism. By learning the neurobiological processes at play and the long-term effects of alcohol abuse, we can prevent and treat this disease more effectively. We can better assist those with alcohol use disorder to overcome their addictions if we can convince them to cease drinking.

What role does genetics play in alcoholism?

Research from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) suggests genetic factors for alcohol use disorder contribute to 50% of individuals developing AUD. Individuals with a family history of alcoholism are more likely to develop AUD themselves compared to those without such a history. However, genetics alone do not determine alcoholism; environmental factors and lifestyle choices also play a crucial role.

Can stress and trauma lead to alcoholism?

Yes, stress and trauma can be significant contributing factors to the development of alcoholism. Many people turn to alcohol as a coping mechanism to deal with stress, anxiety, or unresolved trauma. However, using alcohol as a means to escape or numb emotional pain can lead to dependence and addiction over time. Addressing underlying stressors and seeking healthier coping strategies are important steps in preventing alcoholism related to stress and trauma.

How does peer pressure influence alcoholism?

Peer pressure can play a significant role in the initiation and continuation of alcohol use, particularly during adolescence and young adulthood. People may feel compelled to drink alcohol in social settings to fit in or avoid feeling left out. Continued exposure to peer pressure to drink can increase the likelihood of developing alcoholism, especially if individuals have difficulty setting boundaries or resisting social influences.

Is alcoholism linked to mental health disorders?

Yes, there is a strong correlation between alcoholism and mental health disorders such as depression, anxiety, bipolar disorder, and post-traumatic stress disorder (PTSD). Many individuals with mental health issues may turn to alcohol as a form of self-medication to alleviate symptoms or numb emotional pain. However, alcohol can exacerbate underlying mental health conditions and lead to a vicious cycle of dependency and worsening symptoms.

How does childhood environment impact the risk of alcoholism?

The childhood environment can have a profound impact on the risk of developing alcoholism later in life. Factors such as parental alcoholism, exposure to substance abuse, family dysfunction, neglect, or physical and emotional abuse can increase the likelihood of alcoholism in adulthood. Adverse childhood experiences (ACEs) can also contribute to the development of maladaptive coping mechanisms, including alcohol abuse, as individuals seek to cope with unresolved trauma or emotional pain.

Are certain personality traits associated with alcoholism?

Certain personality traits, such as impulsivity, sensation-seeking behavior, low self-esteem, and difficulty managing stress, have been linked to an increased risk of alcoholism. Individuals with these traits may be more prone to using alcohol as a means of coping with negative emotions or seeking excitement and pleasure. However, it’s essential to recognize that personality traits alone do not determine alcoholism, as multiple factors contribute to its development.

Can socioeconomic factors influence alcoholism?

Socioeconomic factors can indeed influence the prevalence and patterns of alcoholism within populations. Factors such as income level, education, employment status, access to healthcare, and neighborhood environment can impact alcohol consumption and the risk of developing alcoholism. Economic stressors, lack of social support, and limited access to resources for treatment and recovery may contribute to higher rates of alcoholism in disadvantaged communities.

How does alcoholism affect physical health?

Alcoholism can have severe consequences on physical health, leading to various medical conditions such as liver disease, cardiovascular problems, digestive disorders, neurological damage, and an increased risk of certain cancers. Chronic alcohol abuse can weaken the immune system, disrupt hormonal balance, and damage vital organs, resulting in long-term health complications and reduced life expectancy. Seeking treatment and adopting healthier lifestyle choices are essential for mitigating these risks.

Can alcoholism lead to legal problems?

Yes, alcoholism can lead to legal problems due to impaired judgment and behavior while under the influence of alcohol. Individuals with alcohol use disorder (AUD) may engage in risky behaviors such as drunk driving, public intoxication, disorderly conduct, or domestic violence, which can result in legal consequences such as fines, probation, license suspension, or incarceration. Addressing alcoholism through treatment and rehabilitation can help individuals avoid further legal troubles and regain control of their lives.

How does alcoholism impact relationships and families?

Alcoholism impacts families, causing conflict, communication breakdowns, emotional distress, and financial strain. Loved ones may experience feelings of betrayal, anger, guilt, or shame as they witness the deterioration of the alcoholic’s health and behavior. Children of alcoholics are particularly vulnerable to experiencing trauma, neglect, and dysfunction within the family dynamic, which can have lasting psychological and emotional repercussions. Seeking support, therapy, and family interventions are crucial for healing and rebuilding relationships affected by alcoholism.

Ryan Wakim MD
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Dr. Wakim is a board-certified psychiatrist with a passion for and expertise in addiction, mood disorders, trauma-related disorders and the subspecialty of interventional psychiatry. He obtained his medical degree from West Virginia University where he also completed his residency training, finishing as chief resident. Dr. Wakim co-founded and served as the CEO of Transformations leading to a successful merger with Shore Capital in May 2021. He is purpose driven towards improving the standard of and removing stigma related to behavioral healthcare. Dr. Wakim enjoys golf, traveling and time spent with his two dogs, Lulu and Rayna.

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