By HAYDEN FINCH, PhD
Recently, we started chatting about alcohol use and what puts people at increased risk of a problematic pattern of alcohol use. Today, let’s chat some about biology and mental health as it pertains to alcohol use, and then I’ll share with you some of my thoughts about recovery.
Here are some fun facts about alcohol and how it affects the body. Remember a while back when I posted a video about depression and cortisol? Don’t worry, no one else does either. Anyways, in that video I mentioned the HPA axis. The HPA axis (hypothalamic-pituitary-adrenal) is a connection between some really important areas of the brain that ultimately controls how your body responds to stress. It’s way complicated, but that explanation is good enough for this purpose. Anyways, drinking alcohol stimulates the HPA axis, and people whose HPA axis is more active tend to find drinking alcohol more reinforcing (fun, pleasurable) than people whose HPA axis is less active. Drinking alcohol also stimulates the endogenous opioid system. This is the same opioid of the “opioid epidemic” and “opioid overdose crisis” that’s all over the news, but “endogenous” means it’s your body’s natural painkillers (whereas the opioid epidemic and opioid overdose crisis are about “exogenous” opioids…the kind you find in pills). Because alcohol stimulates the body’s opioid system, this is part of what makes alcohol so reinforcing to drink. In fact, people who are at higher risk for developing alcohol problems tend to have an opioid system that reacts more to alcohol than people at lower risk for developing alcohol problems.
“The probability of relapse in people who have been in remission for several years is low, which is encouraging and motivating news for people on the recovery path.”
Where does mental health come in? Certain mental health conditions tend to show up where there are alcohol problems, and this can worsen the prognosis. Conditions like
- Depression
- Bipolar Disorder
- Anxiety
- Schizophrenia
- Personality Disorders, especially Antisocial Personality Disorder and Borderline Personality Disorder
Using other drugs along with alcohol also affects risk of developing a problematic pattern of alcohol use and probability of recovery. Drugs that work in the brain in a similar way as alcohol can have a synergistic effect, meaning that the drug combines with alcohol to produce an effect that’s greater than you’d expect from the sum of their individual effects [so, in this case, contrary to what you were taught in first grade, 1 + 1 > 2; alcohol + some other drug = big, big effect]. Similarly, if you’ve used drugs that are similar to alcohol in terms of the way they work in the body at a high level in the past, you might find yourself abnormally tolerant to alcohol, meaning you have to drink more to get the same effect as others who haven’t used those drugs in the past.
All that being said, recovery from problematic alcohol use is totally possible. Treatment is available, which varies depending on how severe a person’s alcohol use is. For really severe alcohol use, hospitalization might be required because withdrawal from alcohol can actually be fatal. But for milder alcohol use, sometimes your regular ol’ individual therapist can be sufficient. There are lots of treatment options in between as well. Certain individual characteristiscs can affect whether a person can or will enter and complete treatment. These are things like availability of childcare, transportation, ability to take time off work, or even an unwillingness to adopt an abstinence or reduction goal.
Setbacks will almost certainly occur during recovery, but it’s best to anticipate this and include it in your treatment plan. Then, those setbacks can be considered learning experiences that tell you how to prevent future setbacks and relapses. When setbacks sneak up on you, it’s easy to see them as evidence that you just can’t win against alcohol, which in most cases just isn’t true. The probability of relapse in people who have been in remission for several years is low, which is encouraging and motivating news for people on the recovery path. If you can predict the setbacks, have a plan for managing them, and can learn from them to prevent future setbacks, those lapses are less likely to turn into relapses. What’s the difference? I think of a relapse as falling completely off the horse, getting a head injury and permanent facial scar, and ruining your favorite and cutest horse riding outfit. And a setback is more like sliding down the side of the horse, yelling obscenities while gripping with all you’ve got, scrambling like a cartoon character to get back on the saddle, and then checking your pants for soiling. Lapses don’t have to be relapses. Keep getting on the horse. As I always tell people, life is a lot like the fable of the tortoise and the hare. Be a tortoise. (Hope you don’t mind mixed metaphors).
Hayden C. Finch, PhD,
is a practicing psychologist
in Des Moines, Iowa.
