Alcohol is an addictive substance, but the risk each person has for developing an addiction to alcohol depends on a variety of individual factors. While alcohol use is widespread in the United States, not everyone who drinks will develop a dependency on the substance.
Alcohol use disorder (AUD) is the medical term for problem drinking that has become severe and compulsive. According to the National Institute on Alcohol Abuse and Alcoholism, AUD is a chronic brain disease signified by relapse.
Alcohol has different effects on different people, and these risk factors impact who is more susceptible to having problems with alcohol.
The risk factors for alcohol dependence include:
- A family history of alcoholism
- Age at first consumption
- The frequency of drinking
- How many drinks are consumed at a time
- Other health factors
How Does Alcohol Addiction Actually Happen?
NIAAA states that drinking small amounts of alcohol is safe, but as a person progressively consumes more alcohol and begins to misuse it, there can be changes in the structure and functioning of the brain that leads to AUD.
As these changes in the brain occur, occasional moderate use of alcohol can turn into a chronic, compulsive drinking habit where the person often feels unable to control their drinking.
NIAAA has identified three stages in the cycle of alcohol addiction.
- Binge intoxication: This part of the cycle is characterized by a loss of control over alcohol intake. It involves the nucleus accumbens and the striatum structures in the brain, which are located within the basal ganglia. The nucleus accumbens perceives the rewarding, pleasurable effects of alcohol, while the striatum is triggered to form a habit to reinforce this pleasurable experience. This is also the point at which triggers for alcohol consumption can develop. The brain begins to associate certain people, places, situations, or feelings as positive triggers for alcohol consumption.
- Negative affect withdrawal: When alcohol begins to leave the body, the reward system is left in a state of deficit, causing stress to the brain’s amygdala. This causes feelings of irritability, anxiety, and general discomfort that are associated with alcohol withdrawal symptoms.
With the repeated disruption of the brain’s neurotransmitter reward system, people become less sensitive to other forms of pleasure. Their brain begins to send messages to drink more, which are experienced as alcohol cravings.
- Preoccupation anticipation: As the brain’s patterns of reward and pleasure-seeking become dysregulated, the brain experiences heightened stress. This drives alcohol cravings to become stronger. During this time, a person becomes preoccupied with thinking about alcohol and can experience impulsive behaviors toward alcohol. This leads to the cycle starting over again as an alcohol binge.
The neural patterns that develop in the brain during active alcohol addiction can remain even after a person stops binge drinking. The brain can ingrain habits and patterns that are difficult to break, which is why alcohol abuse can be a chronic problem with a high potential for relapse.
The precise amount of time and level of alcohol consumption it takes to develop AUD is not specific. In general, the longer a person drinks at higher levels of consumption, the more likely they will be to develop an addiction.
Prevalence of Alcohol Use Disorder
According to NIAAA, 16 million people in the U.S. have AUD, including 6.2 percent of adults, ages 18 or over. Among adolescents ages 12 to 17, 623,000 were diagnosed with AUD in 2015.
Drinking is even more common than these numbers suggest. In 2015, 70 percent of adults in the U.S. reported drinking in the prior year, and 56 percent reported drinking in the prior month. Although not everyone who drinks will develop AUD, 26.9 percent of people, ages 18 and older, reported binge drinking in the past month in 2015.
Many people who drink may not be aware that the amount they drink is considered problematic. Binge drinking is typically considered to be four drinks or more for women and five drinks or more for men in a two-hour period. Heavy alcohol use is defined by SAMHSA as binge drinking on five or more days in one month.
How Does Alcohol Compare to Other Drugs in Terms of Addiction?
Alcohol is one of many addictive substances that trigger the pleasure and reward circuitry systems in the brain, creating behavioral reinforcement that drives compulsive drug-seeking behaviors. Alcohol, however, is a legal recreational substance with wide social availability and approval.
This sets alcohol apart from other addictive substances because its use is part of social culture in the United States. This complicates attempts to compare it with other addictive substances. The mechanisms that drive addiction in the brain are the same with alcohol as with other substances, whether the substances in question are prescribed medications or illegal drugs.
Alcohol is the most commonly used addictive substance. Marijuana is the most commonly used illicit substance, even though it is now legal in many states for either medicinal or recreational usage.
The National Institute on Drug Abuse (NIDA) reports that 22.2 million people use marijuana, with about 30 percent of those users having a marijuana use disorder. That amounts to about 6.6 million people with a marijuana use disorder compared with 16 million with an alcohol use disorder.
The American Society of Addiction Medicine reports that in 2016, an estimated 2 million people had substance use disorders (SUD) involving prescription painkillers, and 591,000 had an addiction that involved heroin.
These numbers indicate that alcohol use disorders are far more common than disorders of other drugs of abuse. Other substances can be more dangerous in terms of their overdose potential, however.
ASAM further states that opioid addiction is a lead cause of the overdose wave in this country. There were 20,101 deaths from prescription painkiller overdose and 12,990 heroin overdose deaths in 2015.
Opioids are responsible for 130 deaths a day, according to NIDA, while alcohol poisoning is responsible for approximately six deaths a day, according to the U.S. Centers for Disease Control and Prevention (CDC). This indicates that while alcohol misuse is more common, opioid misuse is more deadly.
How Is Alcohol Use Disorder Treated?
AUD is often treated with addiction counseling, sobriety support groups, and behavioral accountability modifications. There are also some options available for medication-assisted treatment (MAT) for alcoholism.
The Substance Abuse and Mental Health Administration outlines the following MAT options for alcohol use disorder:
- Naltrexone: This medication can block the pleasurable effects of intoxication, providing a strong deterrent to alcohol abuse. People with AUD can benefit from this medication, as it helps them avoid relapses and stay motivated to remain in treatment.
- Disulfiram: This drug is used to treat chronic alcoholism in people who have already gone through withdrawal and are abstinent. It can cause uncomfortable side effects within 10 minutes if even a small amount of alcohol is consumed, making it a strong deterrent against drinking.
- Acamprosate: This medication is for people who are already in recovery. It helps to prevent alcohol consumption.
A New Approach
Alcohol has historically been seen as a problem of willpower and a failure of moral character, but research and science have demonstrated that there are powerful systems that are triggered in the brain when alcohol or other addictive substances are consumed.
While excessive alcohol consumption causes real biological changes that promote and facilitate the cycle of addiction, there are also potential medical treatments that can help people struggling with alcohol use disorder.
While many people experience relapses during their recovery journey, there is help available for people who are ready for treatment and want to take control over their alcohol use finally. Finding the right treatment providers is the first step toward loosening the grip of alcohol addiction in your life.