Why is Alcohol so Addictive?

Understanding why alcohol is addictive to some vulnerable people.

There’s more than brain biochemistry in knowing what makes alcoholics tic. Learning about endorphins and neurotransmitters helps researchers. Counsellors need personal experience and communication skills.

Alcohol alters the mood. It lifts it and then depresses it. We drink it because we like the good effects. Then we drink some more in order to counter the bad effects.

Some people drink merely for the taste. Others may say they do, becoming very knowledgable on real ales, fine wines and single malt whiskies. But, in some of these connoisseurs, this may be merely a disguise. They will drink other people’s leftovers or rotgut if that’s all that is available.

In most countries, 10% of the population drink 50% of the alcohol consumed. Mostly, they are the ones who get medical, marital, financial, social and other damaging consequences. In countries where there is a high level of abstainers, for religious or social reasons, as few as 5% may drink 50% of all the alcohol.
These are the people who fill up the Accident and Emergency departments and drain the Social Service budgets. But how did they get that way?

Commonly it is assumed that they were badly brought up or were weak willed. At other times they are said to be the victims of social circumstances or to have got in with a heavy-drinking crowd. They themselves often say they are stressed.

All of that may be true. But not universally. Alcohol problems are no respecters of persons. They can affect princes or paupers, politicians, professionals or housewives, students or anybody.
But why?

Academic researchers look at the biochemistry of the brain. They study endorphins, neurotransmitters and heaven knows what else. But clinicians, with patients or members of their families sitting in front of us, cannot help our patients by feeding them with an alphabet soup. Knowledge on the workings of serotonin, dopamine, nor-adrenaline, GABA and the rest is not useful to me – or the patient or anyone else – in helping people to stop drinking and stay stopped comfortably.

Talking about the boundaries between sensible drinking and abuse, binge drinking and dependent drinking, heavy drinking and alcoholism, helps nobody.

Giving advice on keeping a diary of alcohol consumption sounds sensible but it isn’t. It might help people who never had a problem in the first place. But it will be of no value whatever to the lost soul who is described accurately in a Chinese proverb: first the man takes the drink; then the drink takes the drink; then the drink takes the man.

The only potential mistake in that story is that there are as many women as men with alcohol problems.
An alcoholic is someone who cannot predict what will happen in any day after he or she takes the first drink. Will it be just one or two? Or will it go off into a binge?

These bingers are the people to whom alcohol is addictive – because they themselves have an addictive nature. And they are the ones who need the most help – precisely because they are so exasperating to themselves, their friends and families, their neighbours and employers (if any), their doctors and other professional helpers.
The sad truth may be that they get that way because they were born with that potential.
But we need to be clear that genetic components in an illness do not excuse unpleasant or frankly dangerous personal behaviour towards other people. Alcoholics (heavy drinkers, call them whatever you like) are not responsible for their genetic predisposition but they are responsible for how they behave towards others. They need to be challenged on that while, at the same time, being helped with their underlying illness.
That’s what I do professionally. I don’t talk about brain chemicals, the addictiveness of particular substances, behaviours or environments. Or about abuse, alcoholism, addicting processes or research studies. None of that helps in changing behaviour. It’s not effective. It’s not useful. It won’t help addicted drinkers to become sensible drinkers. That can’t be done. Usually, by the time people come to see me, they’ve tried all that 100 times and more.

What I have to do is to inform, encourage, support and inspire people in helping them to see that the leopard can change his or her spots. Daily commitment to working alongside other alcoholics, and addicts of any kind, and reaching out to help them personally, has worked for me – an addict myself – for the last 32 years. And, despite going through some dreadful experiences, I’m happier and more creative now than I’ve ever been.
It takes one to catch one. That is what works. As a trained doctor, I know my brain biochemistry but that doesn’t help me to help others.

The drinking alcoholic needs to be shown that he or she can be released from inner torment and feel a whole range of lovely feelings, not merely blame and self-pity. I can do that because I’ve been there. I’ve helped over 5,000 inpatients with one addictive behaviour or another. I speak their language.