Why Do People Become Alcoholics?

Alcoholism, or alcohol use disorder (AUD), is a complex condition that develops due to various factors, including genetic, environmental, and psychological influences. While there is no single cause, certain factors increase the risk of alcoholism, such as drinking at a young age, peer pressure, stress, trauma, and co-occurring mental health disorders. Binge drinking, in particular, alters brain chemistry by increasing the release of pleasure chemicals like serotonin and dopamine, making it highly addictive. Additionally, individuals may turn to alcohol to self-medicate and cope with stress, trauma, or underlying mental health conditions. Understanding these factors is crucial for developing effective prevention strategies and treatments, which often involve addressing the underlying causes and teaching healthy coping mechanisms.

Genetic, environmental, and psychological factors

Alcohol use disorder (AUD) is a medical condition characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. It is considered a brain disorder and can be mild, moderate, or severe.

Genetic factors: Studies show that genetics play a role in the development of AUD, with hereditability accounting for approximately 60%. People with a family history of alcohol misuse or AUD have an increased risk of developing it themselves. However, like other chronic health conditions, AUD risk is influenced by the interplay between a person's genes and their environment.

Environmental factors: A person's environment can also influence their risk of developing AUD. Social and cultural norms, family influences, age, education, and job status can all play a role. For example, individuals who are more prone to taking risks or who are less inhibited may be more likely to engage in heavy drinking. Additionally, drinking at an early age is a risk factor for AUD, with those who start drinking before the age of 15 being more likely to develop AUD later in life.

Psychological factors: Mental health conditions can also increase the risk of AUD. Individuals with conditions such as depression, post-traumatic stress disorder (PTSD), or attention-deficit/hyperactivity disorder (ADHD) may be more prone to developing AUD. Many individuals with psychological illnesses turn to alcohol as a coping mechanism, especially if they are undiagnosed or if medication creates unpleasant side effects. Alcohol may temporarily relieve symptoms or elevate mood, but it can also impair an individual's ability to perceive the reality of their drinking or acknowledge the risks and warning signs of AUD.

Binge drinking at a young age

Binge drinking is defined as drinking over the recommended level of standard drinks, which usually means no more than four standard drinks in one sitting for an adult male and three for an adult female. However, for underage drinkers, the threshold is lower, with girls requiring only three drinks and boys between three and five, depending on their age and size. Binge drinking is a common problem among young people, with 2.8% of 14-17 year olds drinking weekly and 27.9% drinking alcohol in the past month. Among college students, the rate of binge drinking is even higher, with 46.3% drinking alcohol and 27.9% binge drinking in the past month.

Starting to drink at a young age is a significant risk factor for developing Alcohol Use Disorder (AUD) later in life. Research shows that among people ages 26 and older, those who began drinking before age 15 were 3.6 times more likely to report having AUD in the past year compared to those who waited until age 21 or older. This risk is influenced by both genetic and environmental factors, with the interplay between the two unique to each individual. Binge drinking at a young age can also lead to cognitive or learning problems and interfere with brain development, which continues well into the twenties.

The dangers of underage binge drinking are numerous and include an increased risk of death, injury, and physical and sexual assault. Alcohol is a significant factor in the deaths of people under 21 in the United States each year, including from motor vehicle crashes, alcohol overdoses, falls, and suicides. Binge drinking can also lead to poor decision-making, resulting in unsafe sexual behaviour, drink driving, and aggressive or violent behaviour. It impairs judgment and increases the likelihood of engaging in risky behaviours, such as swimming or using machinery.

In addition to the immediate risks, binge drinking at a young age can have long-term health consequences. Even a single episode of binge drinking can compromise the immune system and lead to acute pancreatitis in those with underlying pancreatic damage. Repeated episodes of binge drinking contribute to liver disease and increase the risk of several types of cancer, including head and neck, esophageal, liver, breast, and colorectal cancers. It can also lead to alcohol-induced mental health issues such as depression, post-traumatic stress disorder (PTSD), or attention-deficit/hyperactivity disorder (ADHD), which may further increase the risk of developing AUD.

Parents and caregivers play a crucial role in encouraging safer drinking habits and educating young people about the risks associated with alcohol use. Discussing coping strategies, teaching youth about the negative consequences of binge drinking, and promoting behaviours that do not involve alcohol can all help to reduce the risks associated with underage drinking.

Self-medication for mental health issues

Alcohol use disorder (AUD) is a common medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. While researchers don't know all the reasons why someone develops AUD, certain factors have been identified, including genetics, drinking at an early age, and mental health conditions.

One significant factor contributing to AUD is self-medication for mental health issues. The self-medication hypothesis (SMH), first described by Dr. Edward J. Khantzian in 1985, posits that individuals with mood and anxiety disorders (MD and AD) use substances as a coping mechanism to deal with challenging symptoms associated with their mental health disorders. Alcohol is often used as a means of self-medication, which can lead to the development of AUD.

Data from epidemiological studies in Europe and the United States support the SMH. These studies found that phobic disorders, such as agoraphobia, social phobia, and post-traumatic stress disorder (PTSD), more commonly occurred after the onset of alcohol abuse or dependence. On the other hand, panic disorder and generalized anxiety disorder (GAD) were more likely to precede alcohol misuse.

Self-medication with alcohol is a prevalent behavior, and those who self-medicate MD/AD symptoms with alcohol are significantly more likely to develop a comorbid substance use disorder (SUD). This comorbidity of MD/AD and SUD is associated with greater symptom severity, impairment, suicidality, and help-seeking behavior. The negative consequences of self-medicating with alcohol can impact an individual's health, relationships, and financial situation, often exacerbating the very issues they were trying to numb or escape.

It is important to recognize the signs of self-medication and seek professional help. Mental health providers can help individuals address their mental health concerns and develop healthier coping strategies. By understanding the role of self-medication in AUD, clinicians can provide concurrent treatment for AUD and MD/AD to break the cycle of substance misuse and improve overall well-being.

Positive reinforcement and increased tolerance

Alcohol use disorder (AUD) is a medical condition characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. While the exact causes of alcoholism are unknown, positive reinforcement and increased tolerance are two factors that contribute to the development of alcoholism.

Positive reinforcement refers to the rewarding effects of alcohol that reinforce its continued use. Alcohol can provide temporary relief from negative emotions, stress, and anxiety, making it a desirable coping mechanism for some individuals. For example, individuals with mental health conditions such as depression, post-traumatic stress disorder (PTSD), or attention-deficit/hyperactivity disorder (ADHD) may be more susceptible to alcohol's positive reinforcement effects. Alcohol may temporarily alleviate their symptoms, providing a sense of relaxation, pleasure, or escape. This positive reinforcement can lead to repeated drinking episodes, reinforcing the association between alcohol and positive feelings.

Additionally, individuals with certain personality traits may find that alcohol positively influences their social interactions. For instance, someone who struggles with shyness might turn to alcohol to reduce their inhibitions and feel more comfortable in social situations. Similarly, individuals who enjoy being the "life of the party" may associate drinking with being more outgoing and charismatic, reinforcing their positive perception of alcohol's effects.

Increased tolerance also plays a significant role in the development of alcoholism. Tolerance refers to the body's reduced response to a substance over time, requiring higher doses to achieve the desired effect. As individuals continue to drink, their bodies gradually adapt to the presence of alcohol, leading to increased tolerance. This means that they need to consume larger amounts to achieve the same level of intoxication or the positive effects they initially experienced. The development of tolerance can create a cycle where individuals drink more to compensate, increasing their risk of alcohol dependence and ultimately, alcoholism.

The interplay between positive reinforcement and increased tolerance can be a powerful driver of alcoholism. As individuals repeatedly experience the positive effects of alcohol, their tolerance also increases. This can lead to a cycle of drinking to maintain the desired effects, even as the amount of alcohol consumed escalates. Over time, what started as positive reinforcement can turn into a physical and psychological dependence, making it extremely challenging for individuals to reduce their alcohol intake or stop drinking altogether.

It is important to recognise that while positive reinforcement and increased tolerance are contributing factors, the development of alcoholism is influenced by a multitude of genetic, environmental, social, and psychological factors that vary from person to person. Understanding these factors is crucial in preventing and treating alcoholism, as it highlights the complex nature of this disorder and the need for comprehensive and individualised approaches to address it effectively.

Social factors and peer pressure

While there is no single cause of alcoholism, social factors and peer pressure play a significant role in the development of alcohol use disorders (AUDs). Social factors, including peer influence, cultural norms, and social expectations, can strongly influence an individual's decision to consume alcohol and the extent of their consumption.

Peer pressure is a crucial aspect of social influence. Individuals may feel pressured to drink by their peers, especially in social situations where alcohol is present. This pressure can be explicit, such as direct encouragement or coercion to drink, or implicit, where an individual feels the need to conform to the group's drinking behaviour to fit in or be accepted. For example, a person who always wants to be "the life of the party" might become a heavy social drinker as they perceive that alcohol enhances their social appeal. Similarly, individuals who are less inhibited or more prone to risk-taking may drink more heavily when influenced by their peers.

Cultural norms and expectations surrounding alcohol also contribute to social pressure. Alcohol is often associated with social gatherings, celebrations, and relaxation in many cultures. Social events frequently involve drinking, and refusing alcohol in these settings can be challenging due to the expectation to participate. This is particularly true in settings where alcohol is ingrained in cultural traditions, such as social bonding over drinks or toasting with alcohol at special occasions.

Additionally, social factors can influence an individual's perception of alcohol's role in their life. For instance, a person may view drinking as a necessary component of socialising or relieving stress after work. They may believe that drinking enhances their social experiences or provides a sense of belonging within their social circle. In some cases, individuals may turn to alcohol as a coping mechanism to deal with social anxiety or to fit in with their peers, especially if they perceive their peers as drinkers.

It is important to recognise that social factors and peer pressure do not operate in isolation. They interact with other internal and external factors, such as genetics, personality, and environmental influences, to contribute to the complex development of alcoholism. The influence of social factors varies across individuals, and not everyone will respond to social pressure in the same way. Some individuals may be more susceptible to peer pressure, while others may have stronger personal beliefs or values that guide their drinking choices, regardless of social expectations.

Frequently asked questions