Why Alcohol Dependence Isn’t Your Fault: A Guide

What is Alcohol Dependence?

In short, alcohol dependence is a condition where, after an extended period of drinking, the brain and body adapt to see alcohol as essential for survival. What does that mean exactly? Let’s break it down. The limbic system is the fight or flight system in our brain which includes several glands like the hippocampus and amygdala. The limbic system helps us regulate our emotions, react to danger, and eat when we’re hungry. With the first drink of alcohol, the amygdala triggers the release of dopamine, the feel-good neurotransmitter. Our brain remembers this temporary euphoria and urges us to repeat the behavior. After several months or years of drinking, the glands in the limbic system not only crave alcohol for pleasurable feelings, but become altered to believe that we need alcohol to survive. The drive for alcohol becomes instinctive in the same way that we have an instinct to find food. In other words, the brain feels as if it will starve to death without alcohol. 

Alcohol dependence is often described as a “chemical romance.” Here’s a helpful example. When someone watches a horror movie, their heart rate increases and they feel scared, even though they know they’re safe at home. This is because the limbic system can’t tell if we are watching the movie or are in the movie. In the same vein, the limbic system also can’t tell if the relationship we have with alcohol is with another person or a chemical. The thought of stopping drinking can feel like saying goodbye to a good friend. When someone with alcohol dependence is confronted about their alcohol use, their brain can interpret this as a threat to their survival, and their body can go into “flight or fight” mode. 

Another key characteristic of alcohol dependence is the danger of experiencing withdrawal symptoms when alcohol is removed from the system. Because the body has effectively become “dependent” on alcohol for normal functioning, removing it can cause various symptoms such as nausea, headaches, and shakes and tremors. Withdrawal can become dangerous and even life-threatening, so it’s vital to consult a medical professional before you stop drinking.

Becoming Dependent on Alcohol Isn’t Your Fault

Alcohol dependence occurs gradually and unintentionally. No one purposely sets out to become dependent on alcohol. Alcohol dependence isn’t the result of a moral issue, lack of willpower, or character deficit. It’s a biological alteration in the brain’s function from repeated alcohol use which causes physiological and psychological dependence. There is no warning label, pamphlet or disclosure when you purchase alcohol and no information that explains what your life will be like if you become dependent on alcohol. Drinking is marketed as a socially acceptable activity with the intent to gain repeat customers. Habitual alcohol use can lead to severe adverse side effects, which include:

  • Chronic disease
  • Brain damage
  • Death
  • High blood pressure
  • Heart disease
  • Stroke
  • Liver disease
  • Insomnia
  • Digestive problems
  • Social, personal and economic consequences

We would never consider taking a medication that disclosed such side effects. Millions of people have become dependent on alcohol due to biological, psychological, and social factors in their life. Unfortunately, many of these people experience significant consequences before considering treatment. You don’t need to wait for more serious consequences or check any boxes in order to start changing your relationship with alcohol. Alcohol dependence is a diagnosable medical condition. Just like other medical conditions, alcohol dependence isn’t your fault, and there are evidence-based treatments for relief.

"what we were taught about alcohol: too much is bad for you. What we weren't taught about alcohol: it increases anxiety, it disrupts your sleep, it causes brain shrinkage, it dysregulates hormones, it affects long term memory, it inflames your gut, it impacts your sex drive, it increases the risk of cancer"

What Factors Lead to Alcohol Dependence?

Alcohol dependence can be associated with genetic predisposition, environmental factors, or a combination of both. Here’s a closer look at a few of the many factors that can lead to alcohol dependence. 

Genetic factors:

An estimated 40-60% of the risk for alcohol use disorder (AUD) can be attributed to various genetic factors. The offspring of people with alcohol use disorder are approximately four times more likely to develop alcohol use disorder than people without a family history of AUD. This is because certain genes can get passed down that influence the way your body responds to alcohol. In addition, people who are genetically predisposed to other mental health conditions can indirectly be at a greater risk for alcohol dependence. For example, ADHD tends to run in families, and there’s a strong connection between ADHD and AUD. The same can be true with depression and anxiety.

Environmental factors:

The environment you grow up in can impact how early you start to drink. According to the NIAAA, people who start drinking before the age of 15 are 50% more likely to become alcohol dependent as adults. The same is true to a lesser extent for those who started drinking between ages 15 and 17. Early childhood abuse and trauma is also associated with an increased risk of developing alcohol dependence. Peer pressure, cultural norms, and the influence of advertising and media are all also environmental factors that can increase the risk of alcohol dependence.

Free Support Group: How to navigate relationship challenges while managing your drinking

Relationships are complex. And the challenges that come with changing your drinking can add additional complexity and stress. Join an honest discussion about cultivating healthy relationships through sobriety or moderation.
Check out the Schedule

How is Alcohol Dependence Diagnosed?

Alcohol dependence itself was once considered a diagnosable condition per the DSM-IV. With the update of the DSM-V, alcohol dependence was incorporated into the larger definition of the medical condition ‘alcohol use disorder.’ This is why you might sometimes hear these two terms used interchangeably. Here are some of the key criteria that were previously used to diagnose alcohol dependence, and are now used when diagnosing alcohol use disorder:

  • Increased tolerance for alcohol, i.e. needing more and more alcohol to feel the same effects 
  • Experiencing withdrawal symptoms, or drinking in order to avoid or relieve withdrawal symptoms
  • Drinking more or for longer than you intended to 
  • Consistent desire to cut back or one or more unsuccessful attempts to control your drinking
  • Giving up or reducing social, professional, or recreational activities that were once important to you 
  • A significant amount of time spent obtaining, using, or recovering from the effects of drinking
  • Continuing to drink despite knowing you have a persistent mental or physical health problem that is likely to be caused or exacerbated by drinking

To get more personalized care and a formal diagnosis, you can talk to a physician who specializes in diagnosing and treating alcohol use disorder. You can also take Monument’s free alcohol use questionnaire to see if you fall on the alcohol use disorder spectrum.

"Reminder: long-term alcohol use can change our brain chemistry, and make it especially hard to cut back on drinking without outside help"

Health Effects of Alcohol Dependence

There are a wide variety of adverse health effects associated with alcohol. To better understand them, here is a brief description of the biochemistry that takes place when you drink. Alcohol is both fat and water soluble, which means it can travel to just about every part of our body. The water spaces in our body include our blood stream as well as the blood brain barrier. Each time we have a drink, the enzymes in our liver break down the alcohol into a chemical called acetaldehyde which is a toxic carcinogen. Our liver then breaks down acetaldehyde into a less toxic substance called acetate, and then finally breaks it down into water and carbon dioxide. Acetaldehyde is also broken down in other parts of the body such as the pancreas, brain and gastrointestinal tract. As it’s processed through these organs, it can cause significant damage. As a person develops a habit of drinking, the body becomes more efficient at breaking down alcohol by creating more and more acetaldehyde, which in turn causes more damage across our essential organs. 

Here is a list of some of the long-term of alcohol on the body:

Again, no one would intentionally make a decision to suffer from these health effects. Alcohol dependency is not a moral failing, and with support, we all hold the power to overcome alcohol dependency and improve health outcomes.

How To Get Support for Alcohol Use and Dependence

Help is available and with today’s technology, there is a vast variety of treatment options. Monument offers a highly effective three-prong approach to treating alcohol use disorder:

  • Alcohol support groups. Meeting with a group of peers is a powerful therapeutic tool and helps you know you’re not alone. Group members share their experiences, trade tips for overcoming obstacles, and provide encouragement and accountability. 
  • Medication to stop drinking. You can see a highly trained medical doctor who specializes in treating alcohol dependency. The doctor can go over your medical history and discuss treatment options with you, including medication that curbs alcohol cravings. 
  • Alcohol therapy. Meeting with a specialized therapist who helps people stop drinking can provide expert guidance on your journey. Your therapist can help you discover and process the underlying issues that led to alcohol use disorder and provide essential tools to overcome it. 

If you believe you or someone you know has become dependent on alcohol, reading this article today is an incredible step towards change. Realizing alcohol dependency is not a moral failing can lift a weight of shame and empower you to view AUD just like any other medical condition. No matter where you are in your journey, Monument is here to provide tools and support so that you can live your happiest, healthiest life. 

Sources:

  1. Addiction Biology. “The genetics of alcoholism: Identifying specific genes through family studies, https://pubmed.ncbi.nlm.nih.gov/16961766/.” Accessed Dec 27th, 2022. 
  2. The Alcohol Pharmacology Education Partnership. “Where Does Alcohol Go in the Body?, https://sites.duke.edu/apep/module-1-gender-matters/content/content-where-does-alcohol-go-in-the-body/.” Accessed Dec 27th, 2022. 
  3. Alcohol Res Health. “The Role of Selected Factors in the Development and Consequences of Alcohol Dependence, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860467/.” Accessed Dec 27th, 2022. 
  4. Am J Addict. “Environmental influences on alcohol use: Informing research on the joint effects of genes and the environment in diverse U.S. populations, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695556/.” Accessed Dec 27th, 2022. 
  5. Children of Alcoholics: Critical Perspectives. “Prevalence of alcoholism among children of alcoholics, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875734/.”  Accessed Dec 27th, 2022.  
  6. Harvard Health Publishing. “Dopamine: The pathway to pleasure, https://www.health.harvard.edu/mind-and-mood/dopamine-the-pathway-to-pleasure.” Accessed Dec 27th, 2022. 
  7. J Stud Alcohol. “The familial incidence of alcoholism: A review. Journal of Studies on Alcohol, https://pubmed.ncbi.nlm.nih.gov/376949/.” Accessed Dec 27th, 2022. 
  8. Psychiatric Genetics. “Association analyses of the serotonin transporter gene with lifetime depression and alcohol dependence in the Collaborative Study on the Genetics of Alcoholism (COGA) sample, https://pubmed.ncbi.nlm.nih.gov/17167343/.” Accessed Dec 27th, 2022. 
  9. PsychoScene Hub. “The Impact of Alcohol on The Brain – Neurobiology of Dependence and Alcohol Related Brain Damage, https://psychscenehub.com/psychinsights/alcohol-brain-neurobiology/.” Accessed Dec 27th, 2022. 
  10. NIAAA. “Alcohol Metabolism: An Update, https://pubs.niaaa.nih.gov/publications/aa72/aa72.htm.” Accessed Dec 27th, 2022. 
  11. NHS. “Risks: Alcohol Misuse, https://www.nhs.uk/conditions/alcohol-misuse/risks/.” Accessed Dec 27th, 2022. 
  12. NIAAA. “Alcohol Use Disorder: A Comparison Between DSM–IV and DSM–5https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-use-disorder-comparison-between-dsm.” Accessed Dec 27th, 2022. 
  13. Verywell Mind. “Drinking Before Age 15 Increases the Risk of Alcoholism, https://www.verywellmind.com/early-drinking-age-and-the-risk-of-alcoholism.” Accessed Dec 27th, 2022. 
  14. Web MD. “ADHD and Substance Abuse, https://www.webmd.com/add-adhd/adhd-and-substance-abuse-is-there-a-link.” Accessed Dec 27th, 2022. 
Disclaimer: Our articles and resources do not constitute clinical or licensed therapy or other health care services. If you need counseling or therapy services please contact a licensed provider. If this is a medical emergency, call 911.

About the Author

Mark ZaussMark is a double board-certified licensed mental health counselor in Florida with over 12 years of experience. He is a board Clinical Mental Health Counselor by the NBCC – (National Board for Certified Counselors), a Nationally Certified Counselor by the NBCC as well as a Board Certified Telehealth counselor for online counseling.