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Alcohol can cause … a lot of problems.
Just drinking too much can poison and kill you, but so can the impaired judgment while
driving, or the diseases it puts you at greater risk for.
Lots of people drink fairly regularly without any of these problems, though.
And not everyone who has a little too much once in a while is an alcoholic.
So how do you know when drinking becomes a problem?
It mostly has to do with symptoms of addiction like tolerance and withdrawal, along with
how your drinking affects your relationships and responsibilities.
Even though the amount you drink is a big health risk on its own and a super important
part of the problem, diagnosing alcohol use disorder — the clinical term for alcoholism
— isn’t really about hard numbers.
For that, most psychiatrists turn to the Diagnostic and Statistical Manual of Mental Disorders,
or DSM, which lists two main types of symptoms.
First, there are the signs that have to do with the physical aspects of dependence, like
addiction, tolerance, and withdrawal.
For example, if you find yourself needing more alcohol to get the same effect, drinking
a lot more than you intended, or failing to cut back on drinking when you've tried.
Other symptoms are more about how your drinking affects your home life and responsibilities.
Like if your drinking has interfered with your relationships or responsibilities at
work or at home, or has put you or others at risk, but you still don't stop.
The DSM lists 11 symptoms in all, and if you have any two of them, that’s enough to be
diagnosed with alcohol use disorder.
The more symptoms someone has, the more severe it gets.
But no matter where they fall on the spectrum, people with alcohol use disorder are drinking
so much that it puts their relationships, responsibilities, and maybe even their life
at risk.
There are a thousand different ways to get to that point, but they all come down to one
thing: alcohol has a sedative effect, which makes you less anxious and more relaxed.
And the more you associate drinking alcohol with that relaxed feeling, the more your brain’s
reward system gets involved.
If thinking about a drink makes your brain release a lot of dopamine, the neurotransmitter
that’s involved in the motivation to seek rewards, you’re going to have a very strong
urge to satisfy that thought.
It’s the same basic process that drives most addictions.
But alcohol doesn’t affect everyone in exactly the same way.
From studies and statistics, we know that things like your genetics and experiences
can make you more or less likely to develop a disorder.
For example, certain genes seem to change how enzymes that metabolize alcohol work,
which changes how it affects your brain.
Everyone has enzymes in their liver called alcohol dehydrogenases, which convert alcohol
into acetaldehyde, a chemical that won't affect the brain the same way.
But some people have genes that make those enzymes faster at their job, compared to other
variants of those genes.
People with the genes that make the enzymes faster tend not to drink as much and are at
a lower risk of alcoholism, probably because less alcohol gets a chance to interfere with
their neurotransmitters.
But people with genes that make the enzyme slower have a higher chance of developing
a disorder.
Those genetic differences help explain what researchers have known for years: that a family
history of alcoholism puts people at higher risk.
But as usual, genes aren't the whole story.
Researchers have also found that just living with alcoholics can put people at a greater
risk, both through additional stresses and being exposed to that kind of drinking behavior.
For example, a study published in the Journal of Abnormal Psychology in 1991 looked at 454
adolescents, since that’s a stage of life when you’re at a high risk for starting
to develop an unhealthy relationship with alcohol.
In the study, having alcoholic parents made people more likely to report dependence themselves.
But it mattered whether their parents’ alcoholism was in remission or not — meaning, whether
they got sober.
Children of sober alcoholics drank less overall, and were less likely to report negative consequences
or dependence, than those whose parents still drank.
Even though the genetic risk factors were still there, their environment made a difference,
too.
But risk factors are just that — risk factors.
They don’t determine your fate.
For a lot of people with alcohol use disorder, recognizing and admitting that they have a
problem is incredibly difficult, and getting help can seem even harder.
That’s part of what the disorder does to your brain — it takes away your control.
But you can still choose to get help to regain that control.
The most common treatments are mutual-help groups, like Alcoholics Anonymous.
These programs can be helpful because you have peer support available when you need
it the most.
And research has found that people participating in AA for the first time have more days where
they don’t drink.
Rehab also tends to work well, partly because it’s designed to remove the triggers that
might encourage you to drink.
People who check into inpatient rehab programs report longer periods of abstinence, and the
longer the stay, the more helpful it seems to be.
Some medications can help too, especially when people just need to get alcohol out of
their system so they can start on long-term treatments.
A drug called Naltrexone, for example, can reduce cravings for alcohol, and studies have
found that people who take the drug end up drinking less, and on fewer days, compared
to a placebo.
There's also evidence that cognitive behavioral therapy can be effective.
That’s where you work with a therapist to identify things that trigger you to drink
and find healthier ways to cope.
Not everyone will respond to every kind of treatment, but doctors and psychologists have
so many tools in their arsenal that if you realize you want help, odds are you’ll find
one that makes sense for you.
Thanks for watching this episode of SciShow Psych, which was brought to you by our patrons
on Patreon.
If you want to learn more about what makes our weird human brains do the things they
do, you can go to youtube.com/scishowpsych and subscribe.
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