According to national statistics there are roughly 12 to 16 million alcoholics in this country. In spite of the prevalence of alcohol addiction, our collective understanding of it is often veiled in personal opinion or animated by commonplace social constructs. Pronouncements such as “People become alcoholics because they choose to drink that way” or “alcoholism is a problem of will, or lack thereof” are a reflection of typical opinions on the subject. The following discussion seeks to explore and clarify some important facts regarding the disorder of alcoholism.
This is a story of two college freshmen, Sandy and Jack, who are deciding to try alcohol for the first time. They are from similar socioeconomic backgrounds, have similar goals and aspirations, and similar potential to perform well while pursuing a higher education. Both Sandy and Jack decide to have a beer while at a party and both discover that drinking alcohol is an enjoyable experience. They feel slightly elated, less shy, and more comfortable in the party atmosphere. For the time being, the alcohol affects them in much the same way. However, as their futures unfold, Sandy and Jack may have very different stories to tell concerning their relationship to alcohol, and that difference may be a matter of life or death.
Sandy might continue to drink socially a few weekends per month or at the occasional party. The amount of drinking on each occasion may not exceed one or two beers or mixed drinks. Later in life you might find Sandy ordering one or two glasses of wine over dinner at a restaurant or having one or two beers while at a baseball game or out with friends. Sandy may rarely find herself inebriated or drinking past the point of having “had enough.” She is usually satisfied with the experience and avoids compromising her ability to remain in control. This is a feeling common to most people who drink alcohol. It is a feeling not unlike that of satiation after a delicious meal, or an ice cream cone or a cold soft drink on a hot summer day – “I had it, enjoyed it, and for now, I’m done.” Sandy might never reflect back on that first year in college when she decided to “go ahead and try a beer.” It was a moment of little consequence in the bigger picture of her life.When Social Drinking becomes MORE than JUST social Jack might also continue to drink socially, but for him that might mean drinking every weekend and occasionally on a weekday if the opportunity arises. Jack may find that inebriation is inherent to drinking, and that enjoying alcohol is largely about becoming intoxicated. Drinking to the point of excess is commonplace for Jack. Early on in his use of alcohol it becomes evident to the people around him that this is potentially problematic. He becomes inebriated even in situations when most others would deem it inappropriate. Drinking may cause problems for him in the social milieu. It may affect his academic performance. When he drinks it is likely that he lacks a feeling of satiation, that sense of having “had enough.” Jack’s relationship with alcohol may better be described as “I’m drinking, I’m enjoying it, and I want more.”
The implications for these two people may be obvious at this point. Sandy will most likely never experience any significant impact in her life from her use of alcohol. Jack, on the other hand, may someday find himself in a much different predicament. His maladaptive drinking behavior may lead to significant problems in most if not all areas of his functioning. His physical health and emotional wellbeing may be compromised. Relationships with significant others may become problematic. His career may be stymied and he may even suffer legal consequences as a result of being unable to control his drinking. Surely Jack could never foresee this the day he first decides to innocently have a beer at a party during his first year in college.
What Role does Genetics play in this?
How does one simple decision potentially lead to such divergent outcomes for these two individuals? At first glance one might be inclined to conclude that Jack is simply failing to control himself while Sandy is successfully exercising self-control. There are, however, more accurate and comprehensive explanations for alcohol’s impact upon Jack’s physical and emotional well being. One explanation in particular is that Jack may be genetically predisposed to become an alcoholic. Although heredity is certainly not the sole determining factor for a person becoming an alcoholic, the existence of a genetic link to alcoholism is supported by decades of research. Some studies have shown that 50% of what determines vulnerability to alcoholism is inherited. Studies have also found that even if raised by non-alcoholic parents, adopted children with one biological parent who is an alcoholic are four to six times at greater risk to becoming alcoholics. Many of these studies focus on traits inherited in brain functioning, as the brain plays a significant role in the disorder of alcoholism. Alcoholism (and addiction in general for that matter) is understood to be a disease of the brain. The brain’s functioning as a whole is facilitated by the transmission of electrical impulse messages between its cells. Transmission of these impulses between any two cells in the brain at the point of their nexus also involves a transfer of chemicals known as neurotransmitters. One of the most essential of these neurotransmitters is dopamine. Dopamine is involved in the brain’s regulation of cognition, voluntary movements, motivation, and expectation for the sensation of pleasure. Whenever a person is involved in a pleasure inducing activity there is an increase in brain activity in regions involving the release and transmission of the neurotransmitter dopamine.
What creates this Driving Force behind a compulsion for Alcohol?
When Sandy or Jack find themselves enjoying a drink, it is because alcohol increases the dopamine levels in their brain. It is believed that some people are genetically predisposed to have a deficiency in specific areas of their brain where this dopamine transmission takes place. The result of this deficiency is a compromised ability to experience pleasure. Such individuals may be prone to compulsive reward seeking, especially when it involves ingestion of substances that significantly increase dopamine activity. What this means then, is that compared to the general population, Jack has a diminished capacity to experience pleasure. This is likely the driving force behind his compulsion for alcohol. Further complicating this picture is that once Jack’s compulsion for alcohol ensues, he has difficulty limiting himself. He loses control and this is a big part of his problem. Once again, there is reason to believe that Jack’s brain functions differently from the norm. In this case it is the frontal lobe region of his brain. This area of the brain is involved in reasoning, judgment, and impulse control. Studies have shown that the frontal lobe functioning of those afflicted by alcoholism is compromised regarding a person’s capacity to limit compulsive pleasure seeking. Most people feel satisfied within reasonable limits after having a drink. For example, Sandy’s brain functions appropriately in this manner while Jack’s brain does not. Thus we can see that alcohol not only drives Jack to drink recklessly, he also lacks the inherent ability to appropriately restrain himself. Understanding Addiction and Early Intervention are Vital The effect of alcoholism on behavior and its overall impact on physical and emotional well-being can lead to pervasive and long-term dysfunction. A full grasp of the disorder’s basis in the functioning of the brain will surely provide for better understanding of persons afflicted by the disorder, and perhaps, improved treatment strategies.
James Ballester, M.S.
James Ballester is a mental health and addictions therapist with specialized training in treatment of dual disorders. He has taught courses on treatment for addictions to post-graduate counseling and seminary students and is currently a member of the Outreach team at Guest House, Inc., a private not for profit treatment center for clergy and men and women religious.