Why is Alcohol Addictive?

By Geoffrey A. Booth, M.D., Medical Director Rehabs Malibu

When hearing the word “addiction,” most people will immediately conjure up images of heroin, cocaine, or prescription pill addicts. It might be surprising to learn that alcohol addiction affects the greatest number of people among those with substance use disorders.

Indeed, alcohol use disorders impact approximately 15 million people according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Additionally, about 95,000 Americans die each year due to alcohol-related causes. These include accidental injuries, cancer, organ failure, alcohol poisoning, and suicide.

So what is it about alcohol that makes it so addictive? Why do some people manage to partake in alcohol consumption with no long-term effects while others develop an addiction? Unfortunately, much about the causes of alcoholism is still shrouded in mystery. however it can have a devastating impact on those who do acquire the disorder.

What is Alcohol Use Disorder?

Alcohol is a mainstay in our culture. This legal, cheap, and accessible substance is woven into the very fabric of our lives, taking a central role in many pastimes, traditions, and celebrations. Alcohol can also be dangerous.

For some people, alcohol consumption can become disordered. This happens as tolerance increases and the level of consumption rises. Alcohol use disorder is diagnosed via the DSM-5 as mild, moderate, or severe based on how many of the telltale signs of alcoholism are present. The longer the history of excessive drinking, the more severe the disorder is.

According to the NIAAA, alcohol use disorder is a chronic brain disorder marked by compulsive drinking, loss of control over alcohol use, and negative emotions when not drinking.

How Does Alcohol Impact the Brain?

Because of its relaxing properties and dopamine burst, alcohol has the potential to become a substance of abuse. Over time, chronic heavy drinking can cause tolerance to build, leading the individual to have to consume even more alcohol to produce the desired effects.

As brain pathways are altered, the individual gradually becomes enslaved by the alcohol. The brain adapts to the effects of alcohol on the central nervous system and GABA levels, attempting to attempt homeostasis, or a chemical balance. As dependence eventually takes hold, the person will experience alcohol withdrawals when the effects wear off and the brain attempts to stabilize.

Alcohol addiction is the result of how alcohol has affected the brain’s reward system. The pleasurable effects of alcohol are registered in the brain, setting up a neural memory response prompting the person to drink again. Alcohol addiction, therefore, is characterized by the compulsive drinking behaviors that result from the impact of alcohol on the reward system.

Heed the Signs of Alcoholism

When alcohol addiction takes root there will be some common signs and symptoms, both physical and behavioral. These are the specific negative effects caused by the disease of alcoholism that begin to appear and be noticed by loved ones. The sooner the signs of alcohol addiction are recognized and treatment is offered, the better the outcome.

Signs of alcoholism include:

Unable to limit alcohol consumption
Prioritizing drinking above all else, obtaining alcohol, recovering from drinking
Having alcohol cravings
Hiding alcohol; lying about alcohol consumption
Experiencing blackouts
Not fulfilling normal obligations at work or at home
Continuing to drink despite mounting consequences
Engaging in high-risk behaviors, such as driving under the influence
Sustaining injuries due to drinking
Continue to drink regardless of the mounting consequences
Withdrawing socially, giving up hobbies, avoiding social events
Experiencing increased tolerance to alcohol
Attempt to reduce or stop drinking but cannot
Experience withdrawal symptoms when the effects of alcohol wear off

Breaking the Grip of Alcohol Addiction

Overcoming an alcohol use disorder is a lifelong process that requires commitment and patience. The process of recovery begins with detox and withdrawal, and then transitions to treatment. In treatment, the individual learns to change the disordered thought patterns and compulsive behaviors that held them captive in alcohol addiction.

Shifting the mind’s attention from thoughts of drinking toward taking new purposeful actions is central to sustaining sobriety. In recovery, the individual is basically rewiring neural pathways and replacing the alcohol experience in the brain’s reward system with new productive experiences. In essence, this helps re-train the brain to desire different experiences that will provide the satisfaction that alcohol once did.

What to Expect in Treatment

When someone enters rehab for alcoholism recovery they first meet for an interview with a clinician. The individual will be asked about their alcohol use, the history of their addiction, some general health information, and whether they have any co-occurring mental health issues. This helps the team gauge the detox and withdrawal timeline and potential symptom severity.

Detox is the first step of the recovery process, and will be closely monitored throughout. The typical timeline for alcohol detox and withdrawal is 5-7 days on average. Although there is no way to completely avoid the discomforts of withdrawal, the detox professionals will provide much relief using various medical interventions.

Treatment for a moderate to severe alcohol addiction should be provided through a residential treatment program. A residential program provides the appropriate level of care and support and a more intensive approach to treatment than an outpatient program.

Treatment elements include:

Individual and Group Therapy. Therapy is the cornerstone of rehabilitation. Participating in a variety of therapy modalities, such as cognitive behavioral therapy, dialectical behavior therapy, and motivation enhancement therapy, the individual is guided toward establishing new ways of managing triggers and stress.

12-Step Program. Alcoholics Anonymous’ 12-Step program is often integrated into treatment.

Education. Individuals in recovery need to be equipped with a better understanding of how alcohol addiction occurs and to acquire new coping skills to help sustain sobriety. Participation in classes provides this training.

Complementary Activities. Activities that further enhance the effects of therapy include mindfulness meditation, yoga, art therapy, acupuncture, therapeutic massage, and recreational therapy.

Reinforcing Sobriety

Once rehab has been completed the real work begins. It takes a concerted effort to sustain recovery after leaving the highly structured and supervised treatment setting. There are some continuing care actions that can help reduce the risk of relapse in early recovery. These include:

Sober living. Staying in sober living as an intermediary step between rehab and returning home can help ease the transition by providing a supportive and substance-free living space.

Outpatient therapy. Engaging in ongoing outpatient services like therapy and support groups provides an added level of protection against relapse.

Recovery community. Finding a local recovery community, such as A.A. or SMART Recovery, can provide the social support needed.

Recovery apps. Accessing smartphone recovery apps can be a highly useful tool for obtaining real time support.

Healthy lifestyle habits. Forming new healthy habits in recovery will be protective against relapse. These include a nutritious diet, getting regular exercise, and improving sleep quality.

Overcoming an alcohol use disorder is possible with the help of expert treatment resources and the support of loved ones.

About the Author

Geoffrey A. Booth, M.D. is the Medical Director of Rehabs Malibu, an exclusive rehabilitation program located in the heart of Malibu. Dr. Booth has treated thousands of addicts over the years and now has dedicated most of his clinical time to providing medical care and detoxification to clients who suffer from substance abuse. He is committed to helping them establish the foundations for long-term sobriety. While not working, Dr. Booth has a rich personal life filled with activities surrounded by friends and family.


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