Alcoholism is a problem that has been around for centuries, which is a strong indication that predicting and preventing this problem is not something that can be done easily. The reasons for alcohol abuse and addiction fall into a few different categories. These are reason for use, environment and attitudes toward use, biological reactions to use, genetics, and psychological factors.
Alcohol abuse is defined as the use above certain thresholds. According to the Tip manual 24, healthy consumption of Alcohol is no more than 2 drinks per day and 1 drink per day for women and all adults over the age of 65.(Sullivan, Levin, and Fleming, 1998) Drinks above 2-3 per day are strongly associated with negative health effects. In addition to these thresholds, it is considered to be at risk drinking to consume more than 3-4 alcoholic beverages per occasion. What is important is that drinking less than 2 drinks per day, less than 3 days per week is considered to be a low risk drinking pattern.
When looking at the pattern of addiction it is also important to realize the severity at which a small percentage of the population consumes alcohol. Nearly half of the adult population does not drink alcohol at all or does so very rarely. We can also address the entire population in 2 groups. These are 10% and the 90%. Ten percent of the alcohol consumed by the general population, is consumed by 90% of the population. The remaining 10% of the population consumes 90% of the alcohol sold in the United States. This strongly indicates that one of the major risk factors in the formation of addiction is the consumption of alcohol in large quantities.
One of the important things to look into is the biological factors of alcoholism and alcohol abuse. Genetics, for one, play a significant role. For some is prevents them from becoming an alcoholic. Asians, for example, have a lower rate of alcoholism because of a high rate of a genetic condition known as Asian flushing, which creates highly unpleasant side effects to drinking. For these people, even small amounts of alcohol create blotchiness of the face and neck associated with an increase in acetocoline. The only known treatment for this condition is to not consume alcohol. For others, they have a genetically influenced level of tolerance. If people have a low tolerance, they are likely to drink less, which may reduce the impact of the alcohol, but if someone has a very high tolerance, they would likely drink far more alcohol, giving the alcohol a much greater opportunity to impact the body's biological functions to a greater extent. In essence, a high tolerance to alcohol may actually increase the likelihood of alcoholism.
People start off with different levels of genetic risk. This interacts with the standard biological functions. Once alcohol crosses the blood brain barrier it acts as a GABA, serotonin, dopamine, and the endorphin agonist, increasing the activity of these chemicals. When these chemicals are increased in the brain, the effect is an increase in pleasure, decrease in pain and inhibition.
In addition to these short term effects on the brain, there are long term adaptations that occur with the use of drugs.(Mendola, 2003) There are two adaptations that are believed to occur. The first is the down-regulation of the post-synaptic neuron. When the neuron is overstimulates, the number of receptors is increased to accommodate the increased flow. With this, the sensitivity of that neuron is decreased. With this, the brain required more of each neurochemical to be released to have the same reaction. With this, the person experiences less pleasure without the drug. In addition, with the overproduction of the neurotransmitters, the per-synaptic neuron becomes less capable of producing these chemicals. What occurs in this situation is the drug user learns that the only way to achieve pleasure is to consume more of the drug.
When the individual ceases the use of alcohol, there are factors of withdrawal symptoms. With short term use, such as one binge drinking session, there is dehydration and headaches associated with the hangover. With long term use, there are more significant withdrawal symptoms. Alcohol is the one drug that can cause deadly withdrawal symptoms such a seizures. Other symptoms but are not limited to restlessness, anxiety and tremors. There are drugs that help alleviate these symptoms but for most at risk or problem drinkers the most effective and accessible method to alleviate symptoms is more alcohol.
Because of the physical effects of consuming alcohol there are a couple of different forms of reinforcement that occur. The sought after effects alcohol act as a positive reinforcer for its use. When alcohol is consumed it reinforces its own use. The withdrawal symptoms for many should act as a punishment, but the problem comes when people realize that drinking more removes these withdrawal symptoms. Once those harmful side effects of the drugs has been removed by drinking more, this acts as a negative reinforcement toward drinking. The level of psychological reinforcement is quite significant with drinking.
Regardless of all of these factors, if someone does not ever consume alcohol, they can not become addicted to it. Generally speaking, we consider alcohol to be an acceptable drug. Support for this position can be seen in how people express alcohol in a sentence. Alcohol is a drug, but we always express it as something separate. People could express it as simply drugs, but rather drugs and alcohol are expressed separately. Furthermore, even while tobacco is vilified for its health effects, there are many beer, wine and liqueur ads on television, radio and in print. People get the idea that it is acceptable.
There are psychological reasons that are becoming better understood in recent years that may increase the likelihood of addiction. It is one of the same factors that is blamed on the increased incidence of post traumatic stress disorder in soldiers in the United States when compared to countries like Israel. Isolation, is believed to increase these problems. (McStravick, 2013) When someone feels isolated, they lose one of the most effective coping techniques. The use of any drug such as alcohol having the impact of temporarily causing euphoria, and pleasure, may be something used to cover up problems that may have have better been handled through inter-personal communication.
The reverse of this effect may act to explain some of the level of success that programs like Alcoholic Anonymous has demonstrated over the years.(Big Book, 2007) When people join the program they are encouraged to become less isolated in two ways. The first is attending meetings, and interacting in the program. A mentor, the meetings and the work with each other decreases isolation and removes some of the need to self medicate. Another tool relevant to this topic is the interaction with a higher power. According to some, this higher power may be an internal locus of control, but in this case it acts like an external locus of control, offering some level of interaction and removing some of the feeling of isolation.
When you look people who are imprisoned for alcohol and drug related crimes, you see more support for the concept. If separation from the drug allows recovery of the brain, why do people often come out with worse addiction problems than before. There is the possibility of contraband, but more often, prison acts to exacerbate the problems of isolation that people have. Rather than punishing the behavior, we effectively reinforce it.
The causes of alcohol abuse and addiction are complicated and can only be explained through an inclusive biopsychosocial approach. Whether it be genetics, social environment, family history or something biological in nature, risk factors can be complicated to isolate because they tend to come in combination, building up to a point where drug use becomes out of control. Alcoholics Anonymous, in their Big Book, alludes to the idea that addiction has a biological basis. They may have fallen short on the specifics when they decided to call addiction an allergy, but they were correct in that there is a biological process that leads many people to not be able to quit using while others are able to without much or any difficulty. As of yet, unless research uncovers more information, we can assume that the best approach in understanding addiction will be an all of the above approach.
Work Cited
Alcoholics Anonymous Big Book. NY, NY: Alcoholics Anonymous World Service, 2007. Print.
McStravick, A. "Adolescent Social Isolation Leads To Quicker Addiction - Redorbit." Redorbit. 2013. Web. 16 Apr. 2016.
Mendola, Annette M. (Annette Mary). A Critique of the Disease Model of Addiction. 2003. Print.
Sullivan, Eleanor J., Saul M. Levin, and Michael F. Fleming. A Guide to Substance Abuse Services for Primary Care Clinicians. Rockville, MD (Rockwall II, 5600 Fishers Lane, Rockville 20857): U.S. Dept of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, 1998. Print.
