By HAYDEN FINCH, PhD
The concept of what alcoholism “is” has changed over time, including in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders, the controversial but widely used diagnostic manual for psychiatric conditions. The research has varied regarding how problematic alcohol use changes over time and whether it’s a disease or a personal weakness – and all of that has implications for how to study and treat the condition. Here are some of the basics about what we know about problematic alcohol use.
Problems from drinking alcohol can occur to anyone, at any age. We used to think that the pattern would worsen over time, that it was a disease that developed and progressed over time. But newer evidence suggests it can sometimes remit, worsen, or even improve over time. In other words, how the pattern changes over time is highly variable from person to person.
Certain factors about your environment can affect whether a person develops a pattern of problematic alcohol use. For example, the following environmental factors all increase risk for developing alcohol problems:
- A child’s perception of their parents’ and siblings’ drinking
- Instability of family dynamics because of parental drinking
- Poor or inadequate parenting
- Problems with family communication
- Insufficient problem-solving in the family
Of course genetics also play a role. Genes seem to explain about 40% to 60% of the variance in alcohol abuse and dependence, meaning general “life” factors explain the other 40% to 60% (like those things I listed above). For some reason, genes seem to be a bit more relevant in men than women. The following are some of the biological processes that significantly increase risk of alcohol problems and have strong genetic influences:
- Change in the production of the enzymes that help digest alcohol
- Change in the body’s response level to alcohol (like making you need more drinks to feel the effect)
- Change in certain brain activity, such as
- Low amplitude of the P300 wave (to be really simplistic, this is a brain response that happens when you make various decisions)
- Low alpha activity and voltage (to be really simplistic again, alpha waves describe what your brain is doing when you’re relaxing but not asleep)
“The bad news for women is that suicide attempts are almost twice as common among female than male alcohol abusers.”
In addition to your environment and your genes, certain patterns you’ve learned in your life also affect your risk for developing alcohol problems. For example,
Alcohol use gets paired with cues that trigger cravings. If you’re a person who doesn’t have a craving for Cinnabon until you walk in the mall and smell that intoxicating perfume wafting about, it’s because the smell of cinnamony-sugary deliciousness triggers a craving and then propels your Cinnabon addiction. Just me? Maybe. Same process with alcohol. Certain cues (bars, socializing, football games) trigger cravings.
Certain physical changes keep us wanting to drink, like a sense of relaxation that helps us get to sleep.
There are social consequences of drinking. If your friends are drinking, it can be hard to abstain. Or your boss might invite you for drinks and you’re not sure if it’s socially appropriate to drink water. Relatedly, we have expectations about how alcohol is going to affect us. We expect it’ll make us braver or chattier or more fun, so we drink it in situations when we perceive ourselves to benefit from these characteristics.
Some people drink to avoid or stop withdrawal symptoms. If alcohol use has already become problematic, then a person might experience withdrawal symptoms if they don’t drink when they normally do. To avoid or stop those symptoms, they might keep drinking.
If your parents, siblings, or other influential individuals in your life used alcohol excessively – to socialize, to cope, etc. – this may have taught you to use alcohol in a similar way.
Finally, perhaps the most common learning factor I hear from my clients in therapy is that alcohol helps them avoid their feelings. The learning experience that alcohol can temporarily numb emotional experience is a very powerful motivator that contributes to mental ill-health and alcohol problems.
Another factor affecting risk for developing alcohol problems is stress. The tension-reduction hypothesis is a theory that proposed that drinking alcohol will usually reduce stress, so people then will be motivated to drink when they’re stressed. We’ve actually discovered the relationship between alcohol, stress, and drinking behavior is much more complicated than this would suggest and is affected by
- Family history of alcohol problems
- Certain personality traits
- Self-consciousness
- Cognitive functioning
- Gender
- Certain situational factors (like the timing of drinking and stress)
“The learning experience that alcohol can temporarily numb emotional experience is a very powerful motivator that contributes to mental ill-health and alcohol problems.”
I’ve mentioned gender a couple of times. Here’s the deal. Women tend to drink less than men, and their drinking tends to lead to fewer social problems than it does for men. This is in part related to differences in how men and women process alcohol biologically and to differences in social roles, which influences drinking behavior (like it or not, traditional gender roles still exist and still affect behavior for many, many, many people). So women have got it better than men in some ways when it comes to alcohol. The bad news for women is that suicide attempts are almost twice as common among female than male alcohol abusers. But it’s bad either way: 21% of men and 41% of women who abuse alcohol report at least one suicide attempt. Yikes.
Check back for my next post (subscribe so you don’t miss it!), when we’ll chat more about mental health and alcoholism, with some fun facts about the biology, and I’ll share with you some of my thoughts about treatment and recovery. See you then!
Hayden C. Finch, PhD,
is a practicing psychologist
in Des Moines, Iowa.
