There isn’t a single cause of alcoholism. Various genetic, environmental, psychological, and social factors play a role in its development.
The presence of certain risk factors increases the likelihood that someone may develop alcoholism.
What is the Pathophysiology of Alcoholism?
Many people drink socially or enjoy a drink after a long day. Some people drink more over time, while others can maintain a moderate level of drinking. The pathophysiology of alcoholism helps to explain why certain people develop alcohol use disorder, and other people do not.
The average alcoholic drink in the U.S. has roughly 14 grams of ethanol, or pure alcohol. One drink is enough to cause effects, especially for those who do not consume alcohol regularly.
When someone drinks alcohol, it stimulates the release of dopamine, a type of neurotransmitter, from the cells in the ventral tegmental area of the brain. This part of the brain plays a role in behavioral reward and motivation. There is a dopaminergic pathway in this part of the brain. When a person continues to consume alcohol, especially in excessive amounts, this essentially sensitizes this pathway, resulting in someone developing a dependence on alcohol.
With long-term alcohol abuse, several neurotransmitter systems can experience adaptive changes. If the person tries to abruptly stop using alcohol, the excitatory state that their alcohol abuse caused goes unopposed. This results in alcohol withdrawal.
Cravings for alcohol have been linked to serotonergic, dopaminergic, and opioid systems that are associated with positive reinforcement. Alcohol use has also been associated with stress-producing hormones and neurotransmitters. Because of this, people keep drinking so that they can cope with life’s stresses.
Alcohol has a toxic effect on the majority of organ systems if a healthy person consumes more than one to two standard drinks per day. With long-term exposure, there is a risk of damage to the cardiovascular, nervous, gastrointestinal, immune, and other body systems. However, due to how alcohol affects a person’s neurobehavioral elements, these consequences are generally not enough to make them want to stop drinking.
In the U.S. in 2015, about 15.1 million adults had alcohol use disorder. Recovering from this disorder can be challenging, but people do it every day.
Is There a Clear Cause of Alcoholism?
There is not one single cause of alcoholism, and no definitive cause has been identified yet. Experts believe that many factors play a role in its formation.
Some theories suggest that for some people, consuming alcohol has a stronger and different impact that puts them at a higher risk of developing alcoholism. Research shows that normal brain function can change over time as someone continues to consume alcohol, especially in excessive amounts.
Certain risk factors have been identified that may increase a person’s risk of developing alcohol use disorder. These include:
- Drinking at a young age
- Other mental health issues
- History of bariatric surgery
- Steady drinking over time
- A family history of alcoholism or other forms of substance abuse
- History of trauma
- Cultural and social factors
A paper published in 2018 looked at a signaling mechanism in the part of the brain that processes emotion. In studies on rats, when this mechanism was faulty, the rat became addicted to alcohol.
The mechanism issue causes a failure to remove gamma-Aminobutyric (GABA), a substance in the body that stops the signaling around brain cells (neurons) in the central amygdala area of the brain. The amygdala is associated with learning, motivation, emotion, and memory.
The rats who had this faulty mechanism continued to seek out alcohol even when they were met with negative consequences. To obtain alcohol, they have to push on a lever that gave them a minor electric shock to their paws. This did not stop them from pushing the lever to access the substance.
It is known that the balance of glutamate and GABA is disrupted due to regular alcohol consumption. Glutamate works to stimulate the nervous system, and GABA controls impulsiveness. A disruption in these brain chemicals due to long-term, excessive drinking results in people craving alcohol so they can continue to feel good.
Is Alcoholism Hereditary?
It is believed that people who have close relatives with a history of alcohol use disorder are at a higher risk of developing alcoholism. For example, people who have a parent with a history of alcohol use disorder are four times more likely to develop this disorder themselves. So far, no single gene has been shown to be associated with alcoholism.
One study showed that multiple genes that scientists isolated had been shown to potentially play a role in increasing a person’s genetic vulnerability to alcoholism. These include the following genes:
- ADH1B and ALDH2
- GABRA2 and GABA
Endorphins might also play a role in a person’s genetic risk for alcoholism. When you do certain things, such as eat specific foods or exercise, you feel good afterward. This is due to a release of endorphins.
Endorphin levels also increase when you consume alcohol.
As the effects of the alcohol decrease, so do the endorphins. This can result in a depressed mood while the brain works to get back to a chemical balance.
Some people naturally produce fewer endorphins. Without alcohol, this natural lack of endorphins may cause someone to drink more so they can feel happy.
This puts them at risk for dependence on alcohol and addiction. Not producing sufficient endorphins naturally can be hereditary.
Research shows that about half of a person’s risk for alcohol use disorder is due to their genes. Having certain genes, however, does not guarantee that a person will develop the disorder.
The remainder of the risk is due to environment and gene interactions and other environmental factors.
Alcoholism and Nature Vs. Nurture
Nature versus nurture is a common argument when it comes to alcohol use disorder. Does a person suffer from alcoholism because they are born that way (nature), or does their environment and upbringing foster the addiction (nurture)?
One study looked at a gene variant that may side with the people on the nature side of the argument. This variant makes it possible for pleasure signals to move quickly from one area of the brain to the other when the person is consuming alcohol.
This can cause someone to experience a major behavioral shift, even when they only consume a small amount of alcohol. The effects they experience are usually pleasurable, making them want to keep drinking.
On the nature side of the argument, looking at the environment that a person lives in or grew up in can provide some insight. One study determined that a person has about a 50 percent higher risk of heavy drinking if they are in an environment where other people drink heavily.
Ultimately, most experts agree that a combination of nurture and nature plays a role in someone developing alcohol use disorder. In most cases, people with alcoholism have a family history of drinking problems and a genetic predisposition to alcoholism, as well as environmental and personality factors that contribute to the disorder.