Recognizing Alcoholism as a Disease

One of the difficulties in recognizing alcoholism as a disease is it doesn't quite seem like one. It doesn't look, sound or act like most diseases we know. And, generally, alcoholism remains hidden and resists treatment.

However, alcoholism has been recognized for many years by professional medical organizations as a primary, chronic, progressive, and sometimes fatal disease. The National Council on Alcoholism and Drug Dependence offers a detailed and complete definition of alcoholism, but the most simple way to describe it is a mental obsession causing a physical compulsion to drink.

Mental Obsession

Have you ever woken up in the morning with a song playing over and over in your head? It might have been a commercial jingle you heard on television or a song from the radio, but it kept playing ... and playing and playing.

Remember what that was like? No matter what you did, the silly tune kept on playing. You could try to whistle another song, or turn on the radio to listen to another tune, but the one in your head just kept on playing. This thought was taking over your mind, even though you didn't want it there and tried hard to get it out out.

Such is the nature of alcoholism. When the drinking "song" starts playing in the mind of an alcoholic, they are powerless. The alcoholic didn't put or want the thought there, the only way to get it to stop is to have another drink.

The problem is the alcoholic's mental obsession with alcohol is much more subtle than a song playing in one's mind. In fact, a person may not even know it's there. All they know is there is a sudden urge for a drink, a physical compulsion.

The Neurobiology of Alcoholism

In 2016, the U.S. Surgeon General issued a report, "Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health," which details the changes in the regions of the brain of someone with an addiction in a section entitled, "The Neurobiology of Substance Use, Misuse, and Addiction."

According to the report, substance use disorders result from changes in the brain that occur with the repeated use of alcohol or drugs. These changes take place in brain circuits involved in pleasure, learning, stress, decision-making and self-control.

How the Reward System is Affected by Repeated Use

When someone drinks alcohol—or takes drugs like opioids or cocaine—it produces a pleasurable surge of dopamine in the brain's basal ganglia, an area of the brain responsible for controlling reward systems and the ability to learn based on rewards.

With continued use of alcohol or drugs, nerve cells in the basal ganglia "scale back" their sensitivity to dopamine, reducing alcohol's ability to produce the same "high" it once produced. This is how one builds a tolerance to alcohol, which causes people to consume larger amounts to feel the same euphoria they once did.

The same dopamine neurotransmitters affected by alcohol and other substances are also involved in the ability to feel pleasure from ordinary pursuits such as eating food, having sex, and engaging in social interaction.

Drinking Linked to Other Cues

Another change chronic drinking can cause is "training" the brain to associate the pleasure the person achieves by drinking with other "cues" in the drinker's life. The friends they drink with, the places they go to drink, the glass or container they drink from, and any other habits connected to drinking can all become associated with the pleasure they feel when drinking.

When so many things in life become reminders of drinking, it becomes more and more difficult for people to not think about drinking.

Drive to Avoid Pain

While the brain's dopamine transmitters drive us to seek pleasure, the stress neurotransmitters found in the extended amygdala region of the brain drive us to avoid pain and unpleasant experiences.

Substance abuse, including alcohol use disorders, can disrupt the normal balance between these two basic drives, research has found.

Avoiding the Pain of Withdrawal

As alcohol use disorder progresses from mild to moderate to severe, the drinker experiences increasing distress when they are not drinking. Symptoms from alcohol withdrawal can become very uncomfortable or painful.

At this stage, the person is no longer drinking to experience pleasure. In fact, drinking may not even bring any feeling of pleasure anymore. The drinker is drinking to avoid pain, not to get those feelings of euphoria.

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The Cycle of Addiction

Alcoholics build such a tolerance that they are no longer able to reach the high they once did, however, the lows they experience when not drinking become lower and lower. Other pursuits in life that once brought pleasure and balanced out the lows no longer do so.

When the drinkers were still relatively healthy, they could control their impulse to drink because the judgment and decision-making circuits of their prefrontal cortex would balance out those impulses. But, once addicted, substance use also disrupts prefrontal circuits.

When this happens, research shows, alcoholics and addicts have a reduced ability to control their powerful impulse to use the substance, even when they are aware it is not in their best interest. At this point, their reward system has become pathological, or, in other words, diseased.

Compromised Self-Control Explained

The Surgeon General's report on the neurobiology of substance abuse, explains alcoholics' loss of self-control in this way:

"It is not a complete loss of autonomy—addicted individuals are still accountable for their actions, but they are much less able to override the powerful drive to seek relief from withdrawal provided by alcohol or drugs."

"At every turn, people with addictions who try to quit find their resolve challenged. Even if they can resist drug or alcohol use for a while, at some point the constant craving triggered by the many cues in their life may erode their resolve, resulting in a return to substance use, or relapse," said the report.

Progressive Disease

Compounding the problem already experienced by those facing alcoholism is the progressive nature of the disease. In the early stages of alcoholism, one or two drinks may be all it takes to get the "song" to stop. But soon it takes six or seven, and later maybe ten or twelve. Somewhere down the road, the only time the song stops is when the person is passed out.

For this reason, denial is an almost universal symptom of the disease. For those who have realized they have a problem, help may be as close as the white pages of the telephone directory. And, for those who need help and do not want it, help is still out there.

Are you worried you or a loved one have a drinking problem? Take a look at the Alcohol Abuse Screening Quiz to see how symptoms compare.