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The Nature Of Alcohol Addiction: It’s Not A Choice

A common misconception that has permeated the discourse on alcohol addiction throughout history is that it is a choice. This concept is damaging on several fronts; while there may be the initial decision to drink alcohol for the first time or to smoke that first cigarette, the illusion of choice quickly diminishes as the neural pathways of the brain alter. Alcohol use disorders (AUD) are characterized by the inability to manage or stop alcohol use despite adverse personal, occupational, or health consequences. With nearly 15 million people facing an AUD in the US alone, it stands to say that if addiction were a choice and not a medical condition, fewer people would be suffering from it. 

It’s easier said than done to place personal feelings aside when watching a loved one struggle with an alcohol addiction. However, one does not have to set personal feelings aside to offer support. Still, the first hurdle one must face is accepting that an alcohol addiction is not a reflection of a personal choice or a personal vendetta against anyone else. Understanding the context behind addiction, why it occurs, and who is at risk of developing a substance use disorder (SUD) can help snub feelings of hopelessness or defensiveness in the loved one going through it and those trying to help. 

The Brain And Alcohol Abuse

Knowing that a loved one’s brain has been rewired to crave and seek alcohol to maintain some level of homeostasis in the body is one of the first steps of understanding why a loved one continues to drink. But what does that mean? How can the brain be rerouted to want alcohol even when adverse consequences are present? When alcohol enters the bloodstream and reaches the brain, it immediately interferes with the brain’s communication pathways. Pleasure endorphins are released, negative emotions are repressed, and the motivation to drink to chase those pleasurable feelings will increase with continued use. What begins as drinking to maintain positive emotions will transition to drinking to function on a day-to-day basis.

Unfortunately, drinking alcohol only poses as a reprieve from emotional discomfort, and those struggling with emotional regulation will continue to seek out alcohol. As time goes on, the structure and function of the brain will change, leading to a cycle of addiction that the National Institute on Alcohol Abuse and Alcoholism (NIAAA) describes as happening in 3 stages. 

The Cycle Of Addiction

One of the primary concepts defining addiction is the notion that it is a cyclical, chronic disorder. The repetition of damaging behaviors, like heavy or binge drinking, underlines the cycle. Moreover, the 3 regions of the brain that addiction impacts include the basal ganglia, the extended amygdala, and the prefrontal cortex. The 3 stages of addiction, as defined by NIAAA, are as follows:

  • Intoxication And Binge

In this stage, an individual begins to feel the short-term, “rewarding” effects of alcohol consumption. The reduction of anxieties and inhibitions and increased euphoria from drinking alcohol activate the brain’s reward system in the basal ganglia, reinforcing drinking behaviors. The basal ganglia play a role in motivation, formation of habits, and routine behaviors, so continued alcohol consumption will result in changes in the basal ganglia that lead to compulsive use. 

  • Withdrawal Avoidance

When individuals stop drinking alcohol after heavy usage, they will experience withdrawal symptoms like sleep disturbances, pain, dysphoria, etc. The brain’s stress systems in the extended amygdala activate during this period, resulting in anxiety and irritability. At this stage, an individual will no longer drink for the “pleasurable” side effects of alcohol consumption but to avoid withdrawal symptoms. 

  • Preoccupation Stage

In this stage, an individual seeks alcohol again after a period of abstinence. One’s thoughts become preoccupied with finding more alcohol and the next opportunity to drink. The prefrontal cortex, an area of the brain responsible for organizing ideas and activities, managing time, prioritizing tasks, and making decisions, is hindered in people experiencing alcohol addiction. 

What Makes Someone Vulnerable To Alcohol Addiction?

To reinforce the idea that alcohol addiction goes beyond personal choice, an individual’s genetic and family history can make up nearly 40-60% of the likelihood someone will develop an addiction. An individual’s gender, ethnicity, or presence of mental health conditions can also influence the risk of developing an addiction. 

Beyond genetics, the environment an individual exists in, their financial situation, if they were exposed early to drugs and alcohol, if they experienced sexual or physical abuse, etc., can also affect their risk. No one thing will determine who will develop an alcohol addiction, but understanding the context behind how environmental conditions and genetics factor into a loved one’s experience with alcohol addiction can aid in navigating a loved one’s recovery process.

What You Can Do To Help

The first step, and perhaps one of the more daunting steps, is approaching a loved one with concerns about their drinking patterns. Being able to approach a loved one empathetically and without judgment creates an environment where the discussion on treatment options can occur. Complex emotions are likely to arise, so establishing a plan before this discussion will help guide the conversation toward solutions versus anger, blame, or shame. To streamline this discussion with a loved one, it is essential to:

  • Plan what you are going to say
  • Choose the right time and place
  • Listen carefully and with compassion
  • Be honest about your concerns
  • Offer support
  • Intervene if necessary

This conversation will likely be difficult, but it does not have to be impossible. Offering support during a loved one’s recovery doesn’t have a set look, but it is integral in the recovery path for individuals with an alcohol addiction or those struggling with alcohol consumption. If this conversation with a loved one is not helpful or productive the first time around, one can consult with an intervention professional or a licensed counselor. 

Additional Resources

Educating oneself on viable treatment options for a loved one is another way to direct the conversation. At the end of the day, it is up to the individual if they want to pursue treatment or not, but knowing the options can help guide them to make the most informed decision without telling them what they should do. There are several approaches for treating an alcohol addiction including inpatient or outpatient rehab, counseling, and support groups. If you or a loved one is struggling with alcohol abuse, contact a treatment provider.

  • Author: Carmen McCrackin | Last Updated: May 10, 2022

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    Carmen McCrackin

    Carmen McCrackin earned a B.A. in Journalism from the University of Auburn and has over 3 years of professional writing experience. Her passion for writing and educating others led her to a career in journalism with a focus on mental health and social justice topics. Her main mission is to be a platform for all voices and stories, and to provide tangible resources to those seeking recovery for themselves or loved ones.

  • Medical Reviewer: David Hampton

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