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Why Do People With Alcohol Use Disorder Drink?

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Drinking is a significant part of American social culture. Throughout a lifetime, 85.6% of US adults use alcohol at some point. Approximately 5% (14 million individuals) are diagnosed with alcohol use disorder (AUD). AUD is more than heavy alcohol use or binge drinking; it is a behavioral health condition affecting the health, familial, occupational, and social aspects of a person’s life. Understanding why AUD develops is critical for successful treatment and continued sobriety.

If you or someone you love is dealing with chronic alcohol use, Guardian Recovery can help. Our dual-diagnosis treatment programs focus on your substance use and mental health concerns. From initial medical detox to aftercare planning, our knowledgeable, experienced staff members will navigate you through each step of your recovery. Contact us today to speak with a treatment advisor 24/7 who can give you more information about our comprehensive, individualized services.

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Environmental Factors

Like most behavioral health disorders, AUD is a combination of genetic and environmental factors. Research indicates the influence of a person’s genetic makeup and surroundings are equally responsible for the development of substance use and often influence one another. While biology impacts some aspects of personality, most people cannot control the world into which they are born. 

Society, community, and social networks are three primary mechanisms contributing to substance use. These mechanisms either nurture and create opportunity – therefore preventing substance use – or they can contribute to the development of addiction by providing adverse, constraining experiences.

Societal mechanisms responsible for AUD include poverty, racial disclusion, and a lack of job opportunities. Within the community, advertising, the presence of easily accessible alcohol retailers, and elevated crime rates contribute to higher rates of alcohol misuse. Individuals exposed to excessive alcohol use in the home also tend to engage in problematic drinking more often than those raised in a home where alcohol use was monitored and limited. Likewise, a history of childhood abuse or exposure to traumatic stressors in adolescence can trigger negative drinking behaviors in young adults.

Chemical Imbalance

Besides the role environment plays in alcohol dependence, biological elements are equally provoking. Brain chemicals (neurotransmitters) are responsible for mood, energy levels, sleep, stress, pain, and other bodily functions. Several neurotransmitters are implicated in alcohol use and mental health conditions linked to excessive drinking. Because alcohol is a nervous system depressant (or “downer”), It blocks some excitatory brain chemicals while triggering some inhibitory neurotransmitters. 

GABA

Gamma-aminobutyric acid (GABA) is an inhibitory neurotransmitter. Alcohol intensifies GABA’s effects, leading to short-term memory loss and poor muscle control. The anxiety-reducing and sedating properties associated with alcohol’s effects on GABA receptors contribute significantly to its addictive potential. Approximately 75% of individuals with AUD have a pre-existing anxiety disorder, indicating alcohol is frequently used to self-medicate.

Glutamate

Glutamate is an excitatory neurotransmitter or “upper.” It is strongly implicated in developing alcohol dependence due to the changes drinking triggers in the brain. Alcohol blocks glutamate’s stimulating effects, resulting in memory impairment and sedation. Long-term drinking may increase the number of glutamate receptors in the brain to offset the inhibitory effects of alcohol. When someone reduces their alcohol intake, the newly formed receptors remain, leaving the brain in a more anxious, excitatory state that reinforces the need for a substance.

Dopamine

More than other neurotransmitters, dopamine is heavily linked to the brain’s reward system. Drinking causes a dopamine surge that increases the experience of pleasure. The more alcohol a person consumes, the greater the feel-good sensations. As a result, the pleasant effects of alcohol use encourage acute intoxication and contribute to the unpleasant withdrawal symptoms preceding relapse.

Serotonin

Serotonin is the brain chemical associated with feelings of satisfaction and well-being. Drinking depletes serotonin, potentially increasing anxiety and depression. Individuals with AUD continue drinking to mitigate these adverse effects. Most importantly, under the influence of alcohol, serotonin triggers an increase in GABA and dopamine activity to reinforce drinking habits.

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Alcohol Changes the Brain

Alcohol’s influence on neurotransmitters ultimately alters how the brain functions. The brain recovers from these changes quickly for social drinkers with limited alcohol use. Chronic alcohol misuse, however, can lead to permanent damage and altered brain activity. 

Prefrontal–Striatal–Limbic Circuit

The prefrontal-striatal-limbic (PSL) circuit regulates motivation and emotion. This portion of the brain is responsible for decision-making and stress, as well as triggering the reward system. Chronic alcohol use disrupts the PSL circuit, increasing alcohol cravings due to elevated physical and emotional excitation.

Ventral Striatum

Behavioral conditioning is controlled in the ventral striatum as part of the reward system controlled by dopamine. Pleasure-seeking behaviors originate in this portion of the brain and contribute to habit formation, as seen in sustained alcohol misuse. Because drinking initiates a dopamine surge, chronic alcohol use reinforces the ongoing need to chase pleasurable effects associated with intoxication.

Prefrontal Cortex & Orbitofrontal Cortex

These cortices of the brain are responsible for executive functioning (i.e., decision-making, time management, and organization). They are involved in the final stage of the alcohol addiction cycle, known as the preoccupation/anticipation stage. In this phase, an individual with AUD begins to seek out alcohol after a period of abstinence and is unable to maintain sobriety due to impairment in the prefrontal and orbitofrontal cortices due to damage from prior alcohol use.

Relapsing

Recovery from alcohol misuse is most difficult after leaving treatment and re-entering society. Approximately 40% to 60% of people in recovery will have a relapse within their first year. Although part of rehab aftercare focuses on avoiding the people, places, and situations that may trigger alcohol use, this is not always possible. Furthermore, the brain undergoes significant chemical and physical changes during periods of alcohol misuse, and such modifications can last well into the recovery phase.

As previously mentioned, alcohol disrupts the normal functioning of glutamate and dopamine. AUD triggers the production of excess excitatory glutamate neurons that can contribute to the agitation and anxiety associated with withdrawal. Similarly, alcohol stimulates dopamine and the brain’s reward system, creating an ongoing cycle of drinking or drink-seeking. 

Overcoming alcohol cravings and preventing relapse can involve both psychotherapy and medication management. Therapy focuses on trigger identification and avoidance, establishing self-efficacy, and destigmatizing relapse. On the other hand, medication management can correct pre-existing, underlying chemical imbalances or those caused by sustained alcohol use.

Medications Used to Prevent Relapse Include:

  • Naltrexone (Vivitrol)
  • Acamprosate (Campral)
  • Disulfiram (Antabuse)
  • Topiramate (Topamax)
  • Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) to treat co-morbid mood and anxiety disorders

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While alcohol use disorder can develop from factors out of your control, such as genetics or the environment, overcoming alcohol misuse is within reach with the help of an experienced, compassionate care team. Guardian Recovery knows that alcohol use affects everyone differently, so your treatment must be tailored to your specific health needs. Our individualized approach allows us to focus on your entire health history and create a plan to help you meet your wellness goals. 

Our admission process is simple and straightforward. Once you reach out, we will provide a free, no-obligation health insurance benefit check and complimentary addiction assessment. The entire process takes just 15 minutes at one of our local facilities. Contact us today for more information about how we can help you heal.

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Disclaimer: Does not guarantee specific treatment outcomes, as individual results may vary. Our services are not a substitute for professional medical advice or diagnosis; please consult a qualified healthcare provider for such matters.

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  13. https://jamanetwork.com/journals/jama/article-abstract/1883017#:~:text=JAMA%20Psychiatry.,will%20relapse%20within%201%20year.
  14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844157/
  15. https://www.uptodate.com/contents/approach-to-treating-alcohol-use-disorder?search=alcohol%20use%20diosrder%20medication&sectionRank=1&usage_type=default&anchor=H2695180151&source=machineLearning&selectedTitle=1~150&display_rank=1#H2695180151
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Reviewed professionally for accuracy by:

Ryan Soave

L.M.H.C.

Ryan Soave brings deep experience as a Licensed Mental Health Counselor, certified trauma therapist, program developer, and research consultant for Huberman Lab at Stanford University Department of Neurobiology. Post-graduation from Wake Forest University, Ryan quickly discovered his acumen for the business world. After almost a decade of successful entrepreneurship and world traveling, he encountered a wave of personal and spiritual challenges; he felt a calling for something more. Ryan returned to school and completed his Master’s Degree in Mental Health Counseling. When he started working with those suffering from addiction and PTSD, he found his passion. He has never looked back.

Written by:

Cayla Clark

Cayla Clark

Cayla Clark grew up in Santa Barbara, CA and graduated from UCLA with a degree in playwriting. Since then she has been writing on addiction recovery and psychology full-time, and has found a home as part of the Guardian Recovery team.

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