Disclaimer the use of the words;
To date there is no scientific evidence that addiction is a disease.
The evidence seems to indicate that poor choices lead to addiction and informed healthy choices can free us of an addiction.
If you would like to debate this issue with other SOS members join us at SOS International E-support Group.
This is an article written by an SOS member and shows the diversity of thought in SOS but is not in any way the official policy of SOS
Factors in the causation & development of Alcoholism
Traditionally, alcoholism has either been viewed as a moral disorder. It has been considered by society as the result of a weak character or personality defect. The Church and AA uphold this opinion and also emphasise that it also reflects a spiritual disorder in the individual, which can only be overcome through spiritual awakening and belief in God and a "Higher Power". Recent scientific research challenges these ideas by recognising that there is a strong physical component to alcoholism and addiction, which interacts with psychological problems to give rise to a physiological disorder. In other words, it matters not if one is a sinner or saint, good or bad, strong or weak, alcoholism is indiscriminate in who it attacks from the ordinary person in the street, to the many great contributors to society who have suffered from this illness. It attacks those who are pure at heart or evil through and through, as well as the majority of us who stand somewhere in between. It matters not, whether one has a strong or weak personality/character structure, no more than it does, if one has diabetes, cancer or any other life-threatening illness. Indeed, failure to understand this and to approach addiction from a moral/spiritual path can lead to unsatisfactory recovery programmes, with only limited success and in the worst cases, the death of the person who is unable to find sobriety through these misguided means. A correct diagnosis is the prerequisite to a better chance of recovery, which is what SOS offers.
By understanding the illness of alcoholism and addiction from concrete, scientific foundations, one is better able to deal with the illness and find feasible means to end its destructive control over people's lives. This also lays the basis in SOS for a rational, scientific and level-headed route to recovery for those who feel uncomfortable with the overtly cult/spiritualist approach and Christian orientation of the AA twelve step programmes. In SOS, the spiritual questions are left to the privacy of the individual and a secular space is provided for the spiritual and non-spiritual, religious and non-religious alike. Furthermore, respecting the uniqueness of each individual, each person is encouraged to simultaneously learn from the group, as well as, fashioning their own personal sobriety path to suit them.
In the lines below, I hope you will benefit from spotting some of the elements which were dominant in the development of your own alcoholism/addiction (and those which were not) and this may help you in understanding the illness and fashioning your own sobriety path. Let's briefly turn first to the medical evidence and the question of it being a physical or psychological illness.
Physical or Psychological ?
Recent medical research shows strong evidence that alcoholism can be genetically inherited, and this accounts for a third of alcoholics. Many alcoholics have also been shown to be abnormally deficient in dopamine genes and production, as well as their ability to metabolize alcohol in the way other people do. Alcohol is also clearly a highly addictive substance which the body can become chemically dependent on. It is also an active toxic agent which alters body/brain chemistry and, in addition to causing organ damage, it is also responsible for inducing clinical depression, anxiety and even psychosis.
On the other hand, while nobody chooses to be an be alcoholic, it is necessary to pursue behaviours that lead to chemical dependency. One may have a genetic predisposition, but unless you use and abuse alcohol, you are not going to become an alcoholic. Where a change in body chemistry arises, the person must first of all have consumed sufficient quantities of the substance long enough and frequently enough for dependency to occur. In other words, dysfunctional psychological thinking and behaviour must be present for the illness to develop.
Alcoholism is a progressive illness and as it develops the edges between the physical and the psychological become blurred and indistinguishable. There are no Chinese walls in alcoholism, there are no clear cut demarcations between physical and psychological features. A web of addiction is woven where physical and psychological factors interact and interweave, compounding and cementing the illness layer upon layer. Unraveling the web to find one or more key factors in causing alcoholism in any one individual is almost an impossible and futile task. We have, therefore, to view alcoholism from an holistic perspective and avoid a one-sided analysis.
Alcoholism is a dynamic and progressive illness,
which may take years and even decades to develop into an easily identifiable
condition. Generally, it has three main phases- 1) exposure/experimentation, 2)
learned, habitual-behavioural reliance and 3) chronic dependency. While there
are qualitative differences between each phase, there is also considerable
overlap between them and features of one phase can be found in another.
THE LOOP OF ADDICTION
The key factors giving rise to alcoholism are ;
1) social conditioning
It is not necessary for all of these factors to be present for a person to develop alcoholism. However, the greater the numbers present significantly increases the likelihood of a person becoming alcoholic and also the speed at which the illness progresses. The above list can be summarised into a Cycle of Addiction which has 3 interconnected and interactive parts ; 1) Chemical Dependency, 2) Learned Behaviours and Habits , 3) Denial of Dependency.
Alcoholism can develop at any age from early teens
to old age. However, the majority of cases become
The social conditioning of alcohol use is something we are all subject to. In some cultures, like France and the southern Mediterranean countries, it begins early in childhood, but most of us begin to experience and experiment with alcohol independently in our teens and early adulthood. Our conditioning begins with the family and its circle, adolescent peer groups and society at large. We learn from our parents that alcohol can be a source of pleasure and relief, both privately and socially. It is associated with certain social situations or regular habits and behaviours. Simultaneously, we are bombarded by advertising which equates alcohol with pleasure and relief, with fun, fashion, social acceptability, friendship, happiness and being cool. We watch people enjoying alcohol at home and in bars and restaurants. Moreover, in Western cultures, alcohol use is seen as an adult initiation rite. The average adult drinks, full stop. Together with the actions of significant others, peer groups, social customs and habits, and the advertising industry, there are, therefore, strong modeling influences at work, which can play a role in influencing the later development of alcoholism.
For most of us , the period of experimentation coincides with the onset of adolescence and early adulthood with all its vibrancy and extremes, with its parties, dances, wild weekends, etc. In adolescence, the peer group can become associated with drinking as a form of rebellion, adult initiation, acceptability, etc. Here the peer group can have a powerful effect, even where the person comes from a non-alcohol abusing family. While some peer groups gravitate more towards drugs, alcohol is generally present and overlapping in most of the youth scenes. This makes it difficult, especially among young men, (though increasingly among young women too), to clearly differentiate between adolescent alcohol abuse and real tendencies toward alcoholism. Ironically, early experimentation has many of the features of the chronic stage - loss of control over bodily functions, anti-social behaviour, low tolerance levels, etc.
When we first experiment with alcohol, we are
usually quite ill, since the body responds by rejecting the toxic substance.
Indeed, it takes some practice and pain to overcome the unpleasant experiences,
the unusual tastes, the vomiting, spinning ceilings and so on. But we persist,
not because we are alcoholic, but because we have been conditioned so strongly
to associate alcohol with pleasure. We persist in order to find the hidden
treasure behind the uncomfortable or painful initial experiences. As a
consequence of repeated painful experiences, physically or socially, most people
react by treating alcohol with some respect and using it in moderation as a
social stimulant. For the majority of people who participate in these
experimental activities, it will be a passing phase, and at this stage of «
primitive abuse », it is difficult if not impossible to identify who will go on
to become an alcoholic and who will not. Unlike many other hard drugs, alcohol
addiction usually develops over a longer period, and only rarely does the
illness become full-blown at an early stage. Rapid and chronic alcoholism only
usually develops and becomes easily identifiable in the adolescent/young adult
when other factors are present. Paramount among these are ; genetic inheritance,
physical susceptibility, an alcoholic family environment and/or mental illness.
Even then, the sufferers often continue to function socially for another 5, 10,
15 years, before seeking help.
Anyone coming from an alcoholic or dysfunctional family is more at risk of becoming an alcoholic. Children of alcoholics develop co-dependent and para-alcoholic behaviours and thought patterns, which make it easier for them to fit into « real » behaviours in later life. Much of the groundwork has already been prepared by the family environment, where they fail to develop adequate coping mechanisms and life skills for adulthood. Even if they do not go on to become alcoholics, they often mimic alcoholic behaviours in their emotional and relational lives and continue to act out behaviours, habits and patterns of thought related to the alcoholism in the family. This can manifest itself in many dysfunctional ways, from depression, eating disorders compulsive-obsessive behaviours, entering destructive relationships, etc, and doesn't necessarily mean that all children of alcoholics go onto to become alcoholics themselves. But a high proportion of alcoholics come from families where one or more parents or significant others were alcoholic, addicted or otherwise dysfunctional. The characteristics to look for here in the adult individual are ;
impulsiveness leading to confusion, self-loathing
and loss of control
3) Genetic/Physical Susceptibility
The latest medical research has revealed that addiction is, at base, a biological illness, though one with a profound psychological dimension. Studies in Dublin among heroin addicts, for example, have shown that a very high proportion come from families with alcoholic parents. In other words, if you come from a family with one or more parents addicted to alcohol and/or other drugs and medication, your body may be « pre-wired » or more highly susceptible to become addicted to alcohol and other addictive substances.
Whether someone has alcoholic genes or not, it is also possible that alcoholics may be chemically different from others in a way that predisposes their bodies to latch onto to the addictive substances. One area where this seems significant is with regard to dopamine production - the neurotransmitter responsible for creating pleasure states in the brain. Research suggests that many alcoholics suffer neurotransmitter deficiency which undermines their ability to produce balanced levels of the body’s natural mood changing substances. During the period of experimentation such a person may then discover alcohol and become dependent upon it as a sort of synthetic dopamine substitute/medication.
Someone developing chronic alcoholism in their teens/early adulthood is likely to be genetically and bio-chemically predisposed to alcoholism and other addictions. However, even if you are not dopamine deficient you can go onto to develop this condition over a longer period. Repeated abuse of alcohol will habituate the brain to be dependent on this pleasure substitute. Moreover, the alcohol acts to clog up the brains neuro-receptors, which means one needs increasing amounts of the substance to have the same effect. In other words, if you use alcohol long enough and hard enough, you will eventually change your brain chemistry. It is important to restate the obvious that if you drink enough and you will get hooked. You don't have to come from an alcoholic or dysfunctional family or have a predisposed body chemistry - you can develop the illness through maladapted behaviours and habits.
Since there are no generally available medical tests
for genetic inheritance or dopamine deficiency, it is necessary to research the
family history of the client to establish whether there is a likelihood of
genetic inheritance, i.e., whether one or more of the parents, aunts, uncles or
grandparents suffered from alcoholism or, indeed, other chemical addictions. A
note of warning here however - not only can the client be in denial concerning
their own alcoholism, s/he can also be in denial concerning alcoholism in their
family, and it is sometimes necessary to explore this avenue skillfully.
If the person is also suffering from mental illness, likewise, alcohol can become integrated into his illness and dysfunctional behaviours. The person may use alcohol as a self-medication and/or abuse the substance as a consequence of his disorder and eventually become addicted. Unconsciously, he may seek to replace a psychological or biological deficiency with an external stimulant. If he is not producing sufficient serotonin, he may use alcohol as a relaxant, or, if he lacks dopamine, as a pleasure stimulant. One of the « beauties » of alcohol is that it is a very flexible drug, unlike the more effect-specific drugs like cocaine or heroin. It can lift you if you feel down or calm you if you feel anxious.
If the persons suffers from depression, anxiety or emotional problems, alcohol can be a means of coping with and avoiding his problems. Initially it appears to be effective for the users problems by causing beneficial mood changes, but eventually it becomes counter-productive, because it a depressant drug and eventually amplifies neurotic illnesses.
It is frequent in the recovery movement, to find people who are suffering from dual diagnosis - alcoholism and mental illness. When the person continues to drink it is impossible to make an accurate diagnosis because their mind is intoxicated and it is impossible to clearly define which symptoms are caused by the chemical agent and which are organic to the subject. Depression can also be a physically induced feature of withdrawal for some time. Therefore, only once the person has been dry for a period can proper diagnosis and treatment begin. On the other hand, some alcoholics suffer purely chemically induced neurosis and when they go sober, the symptoms disappear. However, the majority of alcoholics suffer some form neurotic illness, which needs to be addressed in recovery.
Most people outgrow the alcohol abuses of adolescence and early adulthood and abuse of alcohol becomes a rarer occurrence. Alcohol is taken in moderation and the healthy person integrates the unfavorable consequences of abuse. The healthy adult makes an association that alcohol abuse equals pain and that other life skills offer more effective sources of pleasure and relief. The developing alcoholic, however, not only fails to do this, but instead makes the converse association, i.e., alcohol equals the main source of pleasure and relief. That is not to say that non-alcoholics do not use alcohol for pleasure and relief, but it is a secondary and not primary source.
Where chemical and psychological dependency begin and end is impossible to specify, as are dealing with a dynamic interactive process. The two are inextricably interwoven. However, for the purposes of clarification we can begin with the habituation process, which can last years and which goes through progressive stages. These stages will vary in specifics and time span with the individual concerned, but general they follow a similar pattern.
Alcoholics begin drinking just like everyone else. It starts with experimentation and social drinking. Since the development is gradual and given the perfidy of alcohol consumption and abuse in modern society, it is often difficult to identify who is and who isn't developing the illness. Even some non-alcoholics can experience temporary periods of excessive drinking, only to return to moderate consumption after a time. But clearly at a certain stage the alcoholic branches off from normal use and habitual drinking eventually becomes a dependency There are exceptions to this, where it may begin in adolescence or more suddenly later in life as a consequence of accumulated problems or significant life events. Also, more especially among women, the social aspect may not be so pronounced and drinking at home can be more dominant. Nevertheless, the development of the illness generally follows a similar etiologic path among sufferers.
Contrary to popular imagination the alcoholic is not necessarily someone who gets drunker and drunker over time. Most people view the alcoholic as someone who cannot handle their drink (among other things). They imagine the slurring bum at the bar, the guy falling over in the street, etc., This picture is more often correct only in the experimentation and chronic stages of the illness. Since drinking to excess occasionally is common in society, we shouldn't confuse the alcoholic and the occasional alcohol abuser. The alcoholic will certainly drink to excess, but for many years it is difficult to tell them apart from the general public in this respect. Indeed, the alcoholic may be the one who « can hold his drink », rather than the one who doesn't. Indeed, despite excesses, during the central years of the illness, the alcoholic develops quite a « comfortable » alcoholism. Total drunkenness can be quite rare, although the amounts consumed may be huge. This is because the alcoholic develops a tolerance toward the drug as a result of repeated use. They are the guys or girls who seem to have hollow legs, who are never drunk. Indeed, some of the classic denials of alcoholism by alcoholics are « I'm not an alcoholic, I never get really drunk ; « I can hold my drink, therefore I can't be an alcoholic » Quite the opposite is true, however. If you can take such large amounts of a toxic substance without the body rejecting it or being quickly made ill by it, then this signifies that the body has become habitualised to the noxious substance. The alcoholic is then forced to consume more and more of the substance in order to illicit the same effect. It is becomes a curve of diminishing returns and the process of chemical dependency is set in train.
Over time, the frequency and quantities of alcohol consumed steadily increases. The internalization of alcohol as the main pleasure/relief source is steadily reinforced by repetitive behaviours. This may be the after-work drink, the before, with or after the meal drink, Friday night, meeting family and friends, watching sport, etc, etc,. Alcohol becomes ritualized. It becomes an integral part of everyday life and activities ; part of the structure of existence ; an automatic habit and behaviour for, and response to, a multitude of situations. Alcohol becomes the main coping mechanism and life skill tool for enjoying and dealing with life.
Alcohol also begins to penetrate deeply into the individual’s psychology as response mechanism for dealing with feelings and emotions. If the person wants to celebrate, reward himself, console himself, party, flirt, have sex, etc, alcohol is used. The person also begins to recognise alcohol as a means to deal with emotions such as anger, guilt, fear, jealously, joy, by responding to them, giving vent to them or by repressing them. They learn that alcohol can facilitate and change emotions. It gradually becomes a universal tool. It is used as a stimulant, a comforter, a reward, an inspirer, a facilitator, etc. Where the person has deeply unresolved psychological problems from youth and adolescence, alcohol can be the means to anaesthetize and neglect their resolution. In the inappropriately individuated adult alcohol becomes a flexible vacuum-filler. The substance substitutes for the healthy resolution of unresolved conflicts and maturation needs e.g,. to integrate the mother and father figures, to overcome childhood traumas, deal with difficulties in social or intimate relationships, etc., alcohol steps into the breach. It becomes a friend, confidant, coach, lover. Gradually, it becomes part of the Self, part of the individual’s self-identity, of how they see themselves internally and toward the outside world.
6) Inadequate Individuation
By definition, individuation is synonymous with the achievement of independence and, is, therefore, antonymous with dependency. In this formative period of adulthood, the foundations of adult life skills are laid. One validates and integrates methods for enjoying and coping with life. These are our pleasure/relief strategies which are integrated and internalised and although they may vary and be refined in form over time, the general tendencies and strategies are impacted in early adulthood and remain in place for important life periods.
If the person comes from a dysfunctional family background, it is more likely that they are already not properly prepared for the tasks of maturation. A vacuum is left in their upbringing which is waiting to be filled by the bottle. Instead of learning coping mechanism for daily stress, as well as healthy outlets for pleasure, the emerging adult can learn to link these activities to alcohol consumption. As they pass from the exposure/experimentation stage of adolescence, they begin to learn that alcohol can be used as a mood/mind-altering drug. Having emotional traumas from youth and lack of modeling in coping techniques and healthy activities helps to facilitate the turn towards the drug. If the person suffers from emotional volatility, depression or other neurotic tendencies for either psychological or biological reasons, the alcohol drug appears to offer a flexible and immediate form of self-medication. The person begins to associate most forms of pleasure and relief from pain with intoxication. Mostly, at this stage it is still used socially. It may lessen social inhibitions and facilitate social acceptance, integration, friendship, help overcome inadequacies in social techniques, feelings of loneliness, isolation and give the person a social context - usually the bar or club. The bottle becomes a psycho-social facilitator, though at this stage, it is rare for the individual to drink alone.
They are social drinkers, maybe abusing alcohol once or twice a week and usually at the weekends. Since this is also something general in early adulthood, again it is difficult to identify the alcoholic from the non-alcoholic. The alcoholic will probably even combine other more healthy coping mechanism and positive pleasure activities with unhealthy, negative, alcoholic ones and live a relatively functional and productive life. They will hold down a job or continue studies, even excel in their fields, participate in sports clubs, enjoy hobbies and normal social activities. There will, however, be tendencies to include alcohol consumption with or linked to all these facets of their lives - the after-work drink, the sports club bar, the theatre bar .
On the surface, there is little noticeable difference between the alcoholic and non-alcoholic With healthy, non-alcoholics, however, while drinking is often an important social part of early adulthood and beyond, it does not occupy a central role. Instead, they develop healthy pleasures and coping mechanism and alcohol is a peripheral aspect of their lives. For the alcoholic, on the other hand, in the process of individuation, alcohol begins to assume an increasingly important role as the central facilitator of pleasure and relief. It takes place mostly in an external social context at this stage, however on the internal side, the alcoholic is integrating alcoholic behaviours into their sense of developing self.
The developing alcoholic comes to integrate alcohol as an increasingly important pleasure/relief mechanism for dealing with life. Alcohol is tested and validated as an effective tool for everyday life, providing a pleasure stimulant and a source of relief from unpleasant experiences and feelings. At this point, while continuing to be a social facilitator, the emphasis moves towards dependency on the social and, more importantly, internal level. Alcohol is no longer an adjunctive part of social activity, but a prerequisite for pleasure and relief in these situations. The person becomes socially dependent upon alcohol and uses it in most or all social encounters. Social facilitation gives way to social dependency and alcohol is internalised as a life skill tool. This is then reinforced by repetitive, reinforcing behaviour.
Because, alcoholism develops gradually, the individual will to differing degrees acquire many normal basic life skills and superficially can appear to have achieved the tasks and socially recognised expressions of adulthood - job, family, etc,. they can be extremely talented achievers. But internally, their development is lopsided and propped up artificially by their dependency. As the illness progresses these contradictions inevitably begin to break to the surface in one way or another - through mental illness, break down of relationships, social problems. The accumulation of these psycho-social problems runs hand in hand with the biological progression of the illness.
The Limbic System
Unlike our higher brain - the neocortex - the limbic system is incapable of analyzing, comparing and deciding on various options. It does not discriminate or judge, but works automatically. When you leap into the air « without thinking », this is the limbic system in action. It is that part of the brain which causes the hand to whip back from naked flame, without time for thought or reasoning, since the limbic system has learned that fire = pain ! Through the amygadala it can even by-passes the neocortex and take charge of the brain and body. It also exercises great influence on very basic senses, feelings and emotions, like anger, fear, pleasure and relief. It thinks « Hunger - Eat !, Danger - Attack/Run ! Sex - Copulate! » etc., It is a vital survival tool at times, but it cannot exercise rational judgment, weigh-up options or postpone satisfaction. Thus, it makes mistakes. Since survival is more socially complex for humans than for other animals, we have developed the neocortex to evaluate how best to satisfy and cope with our conflicting demands for pleasure and relief, which often means forgoing certain pleasures, delaying gratification or taking preventative measures.
With regard to alcohol, the healthy adult learns through experience that excess alcohol = pain and he is more able to utilize his neocortex to exercise judgment and choice. However, the alcoholic gradually looses this ability and the limbic system gains more and more mastery over his addiction-driven actions. In the alcoholic, biological addiction confuses the body, and particularly the limbic system, into associating alcohol as the principal source of pleasure/relief in life, and even misguidedly with survival. Repeated use of alcohol teaches the limbic system that alcohol = pleasure/relief. Driven by increasing chemical dependency and trained by repeated behaviours and habits, the alcoholic’s limbic system learns to associate everything to do with pleasure and relief - fun, relaxation, socialising, sex, food, reward and reduction of anger, anxiety, fear, depression, etc., with alcohol. The limbic brain of the alcoholic is trained to make an automatic association of alcohol with pleasure, pain avoidance and relief. Faced with any pleasure/relief seeking stimulant, the limbic brain automatically provides the solution - alcohol ! It can be a chance to go out, a thought about the weekend, a party, a football match, a stressful day at work, an argument at home, a feeling of loneliness, depression, anxiety, emotional upset, etc., and up pops the answer - alcohol ! The higher brain functions are then dragooned to rationalise the primitive association with thoughts such as « Great, some drinks and a good time » or « Christ, do I deserve a drink ». Alcohol becomes an integral part of life, an unconscious mental association with any pleasure/relief stimulant and one which becomes anchored into the limbic system of the brain.
Scientists researching the biological basis of chemical dependency have pinpointed a neuronal circuit linked to the limbic system and the neurotransmitters which is linked to the reward system. Although serotonin, enkephalins and norepinephrine are involved, the key appears to be dopamine. This system is normally responsible for giving us feelings of well-being. If it is disrupted we are likely to feel consistently anxious, angry, unsettled and dominated by negative emotions. Studies show that people who are deficient in dopamine production are then more likely to seek out and become dependent upon alternative sources of pleasure stimuli like alcohol, drugs or smoking. They are predisposed to addiction by virtue of a chemical imbalance in the body’s pleasure/relief/reward system.
Alcohol causes an increased release of dopamine giving a pleasure rush. Dopamine production is also known to reduce stress. Thus, people with a dopamine deficiency tend to turn to alcohol for relief from negative emotions and to elicit positive ones and this translates into cravings for the substance and a need for increasing quantities as the body develops a tolerance toward the drug over time.
However, dopamine also seems to influence memory and
learning. The brain rewards the body for making what it mistakenly sees as a
positive or even survival-enhancing choice. Alcohol tricks the limbic brain into
believing it is an important life-enhancing substance, by virtue of its dramatic
effect on dopamine production. Furthermore, each time dopamine floods the
synapses, it appears that physical circuits concerned with thoughts and
motivations are established. Strong memories and associations, concerned with
the pleasure of using such as social surroundings, people, places are interwoven
into the memory circuits. The brain of the alcoholic, thus creates a positive
association, memory and motivation system for continuing to take the drug. The
brain becomes filled with automatic associations, situations, feelings and
emotions which lead to the brain response -
As mentioned before, research has shown that many alcoholics are born deficient in their ability to produce dopamine and therefore less naturally able to experience pleasure to the same degree as others. Research has now proven that there is a strong component to alcoholism. Studies on adopted children whose biological parents were alcoholic have shown that they are more likely to develop alcoholism than those born to non-alcoholic parents. A study in Denmark of 5,483 men adopted in early childhood found that they were three times more likely to become alcoholics than those of non-alcoholic fathers. Scientists have since confirmed that alcoholics are more likely to inherit the A1 allele, which results in up to 30% fewer dopamine gene receptors. It was found to be present in 77% of alcoholics and absent in 72% of non-alcoholics. Scientific studies have also pinpointed abnormalities in the electrical activity of the brains of alcoholics. Alcoholics produce fewer P300 waves and they were also found to be genetically the same in alcoholic fathers and their sons. Other factors pertaining to the bio-chemical differences between alcoholics and non-alcoholics have been discovered in various enzymes and alcohol metabolism.
However, while the genetic argument seems to be more and more conclusive, it would not account for all alcoholics. Nevertheless, the dopamine connection still appears to be the prime agent. The reason for this is that even if one begins life with a normal level of dopamine, one can still get hooked on the rush effect and it appears that repeated use of alcohol actually creates dopamine deficiency by filling up the dopamine receptors, thus impairing their efficient functioning, and propelling the individual to crave more of the substance to gain the same effect.
An alcoholic web is, therefore, woven into the circuitry of the brain tying up the primitive, limbic system, the prefrontal cortex and our memory banks and associations through our neurological transmitters and receptors, in particular dopamine. In this way, physical causes take on psychological dimensions and vice versa. The massive damage and dysfunctioning of the natural neurotransmitters and synapses caused by alcohol, is one of the reasons that, when the drug is not available, the person suffers withdrawal with severe illness and even violent effects to the neurological system as it is robbed of the source it has become dependent on for its functioning. In the habitual dependency phase, this may take the form of daily drinking, the « hair of the dog », « the night-cap ». Their bodies need the drug to function « normally », to quieten their nerves, relax them, get them through the day, evening and to help them sleep. They will be able to exercise some control over their use and to delay gratification over many years. But as the chemical causes gradual changes in the body chemistry and achieves more addictive power over the nervous system, their need to consume more and more frequently will increase and their ability to delay gratification will lessen. Eventual they brain and nervous systems will need and demand alcohol in order to function with relative normalcy. Lack of the drug will become more and more painful and their limbic system will override cognitive reasoning or dragoon their powers of rationalisation to facilitate immediate gratification and increased consumption. Day-time drinking will increase and attempts to return to less abuse patterns of drinking will fail. The physical and psychological pain of being without the drug in the body system will become to unbearable to resist. Eventually, the person suffers cravings, anxiety and depression, paranoia, colossal dehydration, loss of control over body functions and may even go into delirium, spasms and may even die from epileptic like-convulsions if unable to consume the drug. They become totally chemically dependent.
Denial is probably the most baffling and bewildering of all the aspects of alcoholism. Despite all the evidence to the contrary, the alcoholic adamantly refuses to acknowledge and accept that he is an alcoholic, either to himself or to others. Denial is a phenomenon which, of course, is not unique to alcoholism or addiction. Many other neurotic and psychotic disorders contain this syndrome. What distinguishes alcoholic denial, is the ferocity of the resistance in a normally non-psychotic disorder. In order to understand it, it is insufficient to approach the problem from a purely psychological angle. We need to comprehend it from a physiological viewpoint, both mental and physical.
In the chronic stage of alcoholism, the person’s life begins to disintegrate on the social, physical and psychological levels. They loose ability to exercise control over their circumstances and manage their lives. The consumption of alcohol becomes the number one priority and everything else can « go to hell ». They may loose their job, spouse, crash the car, suffer terrible psychological and even physical pain, but they refuse to admit or accept their addiction. Life goes to pieces and with it the individual becomes more and more childlike, emotionally immature, and becomes almost animal-like in their behaviours. The Self fragments and becomes consumed by alcohol. By the chronic stage of the illness, life offers no pleasure or even pain, no reward or satisfaction outside of the consumption of the drug. The person’s relationship with the drug is stripped to its bare essence. No alcohol = pain, alcohol = pleasure/relief, therefore life = alcohol and alcohol = life.
The colossal resistance evident in denial is rooted in chemical dependence, combined with the long-term dysfunctional behavioural and the psychological effects of the drug itself. In the first place, the alcoholic is physically addicted to alcohol and craves the drug like a dying man in the desert craves water. Indeed, the limbic system is not only conditioned into accepting alcohol as the body/brain’s dominant source of pleasure/relief, but eventually comes to consider alcohol on the level of a primary survival tool. Such is physical and psychological pain of withdrawal that a the limbic system misguidedly considers lack of alcohol to be a life threatening condition. In reality, of course, the continued consumption is killing the person, but the neurological system, the brain’s memories and associations’ systems and the limbic system are tricked into acting in a self-destructive mode. It can then dragoon or even bypass the higher cognitive, reasoning brain into feeding this need. Rational thought is overpowered and social considerations can no longer carry sufficient counter balancing weight to moderate or halt the process. The alcoholic has one main tool left in his life skills tool box and that is alcohol. The social, psychological and physical consequences of continued drinking are dismissed or ignored. The alcoholic will be ready to loose all that he has acquired or achieved physically and mentally ; his job, possessions and reputation. His brain/body is driven and dominated by one motivation and value - alcohol. The alcoholic fights against acknowledgement and acceptance of the condition with all the mental weapons and energy that the brain’s survival mechanisms can muster. Indeed, such is the power of denial that many alcoholics die before accepting and acknowledging they have a problem. They will refute they are alcoholics with their last dying breaths.
An alcoholic in denial is almost impossible to communicate with. Even when not drinking, the brain remains toxic for long periods. The alcoholic’s mind is like « the killer on the road » from the Doors song, whose brain « is squirming like a toad », except that he is on a road of self-destruction. Close ones, doctors and psychologists may try to reason, cajole, threaten and implore the alcoholic to see reason and stop. But unless the realisation and desire to stop comes voluntarily from deep within the alcoholic himself, none of this will be of any lasting avail. So long as the alcoholic doesn’t come internally acknowledge and accept his alcoholism there is no hope of recovery. Periods of abstinence or drink reduction are usually only attempts to return to moderate drinking which fail because the brain/body system needs high levels of the drug to which it has become tolerant. Once alcohol enters his mouth the alcoholic is normally unable to stop until he becomes unconscious.
Ironically, it is at this point that the likelihood of recovery becomes possible, although it may take a long time and cost a great deal in self-damage and damage to others. Alcohol begins to create more and more pain, physically, psychologically and socially and the alcoholic is less and less able to derive pleasure or relief from it. On a physiological level, tolerance first means that ever increasing amounts are need to create the same level of pleasure and/or relief. The pain of withdrawal becomes excruciating. Inebriation less and less provides an escape from psychological torment as the alcohol neurosis becomes permissive - even drunk the alcoholic cannot escape from the realities of the consequences of the illness. Social life, friends, family often move away from them. Even relations which previously had enabled the alcoholic to continue with their addiction tend now to become untenable. The alcoholic becomes more and more psychologically and socially isolated. He is a person at war with himself, consumed by internal turmoil and pain.
Eventually, the body’s high tolerance to alcohol breaks down. The alcoholic then finds himself getting extremely drunk on small amounts of alcohol. Blackouts, which may occur earlier in the illness, now become more common and the consequent lack of control over behaviour results in more personal and social problems. The alcoholic may begin to loose control over bodily functions, stops eating properly and sinks into chronic states of depression, anxiety and paranoia. They loose all ability to functioning socially and carry out basic social roles and functions. Alcohol becomes just a means of briefly alleviating the pain of withdrawal and gives less and less pleasure or relief. The alcoholic is reduced to the level of a child and some might even say an animal or vegetable. The alcoholic reaches what is termed « rock bottom » in the recovery movement.
Around this point, the alcoholic begins to recognise his addiction on an intellectual level. But this recognition remains impotent so long as the alcoholic does wish to break emotionally with alcohol. For a period, the alcoholic fears the alternative of abstinence more than the pain of continuing to drink. Life without alcohol appears impossible and unthinkable. The immediate chemical need and all the alcoholic’s memories, neural associations, a life times habits and behaviours rally against this course of action. Life without alcohol seems boring and pleasureless. Over the sober horizon he can see only pain and suffering and his body searches out what it perceives as the lesser evil, or lesser painful of two alternatives, and continues to drink. Intellectually, he may now reluctantly concede to himself and others that he is an alcoholic or has « a drink problem », but intellectual understanding isn’t on its own enough to free the alcoholic from his addiction.
The alcoholic is now caught between the proverbial rock and a hard place. He needs alcohol to create pleasure and relief, yet all alcohol brings is more and more pain. An unstoppable force meets and immovable object and an internal crisis ensues. The impenetrable barrier of denial begins to break down. Like some alcoholic « Starr Report », the overwhelming weight of evidence means that denial becomes more and more untenable. In these circumstances, the reality that alcohol = pain and not pleasure/relief can lay the basis for a life saving internal revolution. Often a sudden alcohol related disaster breaks violently through the denial defenses of the alcoholic and confronts the alcoholic face on with the severity of the situation.
Author Stephen Morgan
Disclaimer the use of the words
To date there is no scientific evidence that addiction is a disease.
The evidence seems to indicate that poor choices lead to addiction and informed healthy choices can free us of an addiction.
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