Alcoholism: Genetic Disease or Lifestyle Choice? Debunking Myths

Alcoholism — now often called alcohol use disorder (AUD) — is more than just enjoying an occasional drink at a party or during a dinner. It’s a medical condition characterized by an inability to stop or control alcohol use despite negative social, occupational, or health consequences. 

But is alcoholism hereditary (a genetic disease) or is it merely a lifestyle choice? Can alcoholism be inherited? And if so, what percentage of someone’s genetic background may contribute to alcohol dependency? Let’s look at scientific evidence and explore how our view of AUD evolved over the years.

A Brief History of Booze and Its Dark Side

Alcohol consumption is nothing new. Long before the days of beer pong, dive bars, and champagne and caviar soirées, our ancestors discovered its unique effects and made use of them — for better or worse. Originating as early as 7000 BC in ancient China, fermented beverages found their way into various cultures and rituals around the world. From its use in ancient religious ceremonies to its role as a traded commodity on global routes, alcohol left a distinct footprint on history. 

At the same time, its impact has always been a double-edged sword, bringing both social bonding and significant health and societal challenges.

• Ancient civilizations. Ancient Egyptians and Greeks documented the excessive consumption of alcohol and its detrimental effects. However, rather than labeling it as a disorder, it was considered a lack of self-control or a divine punishment.
• Middle Ages. The medieval period swung between extremes. While some embraced alcohol as a staple (sometimes it was safer than water!), others — especially the religious community — viewed excessive drinking as a moral failing or the work of dark forces.
• 19th century and the Temperance Movement. As society rapidly changed, so did views on alcohol. The Temperance Movement, which began in the United States and spread globally, called for ending alcohol consumption. Proponents of the movement, which culminated in the 1920-1933 Prohibition era in the U.S., believed alcohol was the root of society's evils, seeing it as a moral weakness rather than a medical issue.
• Early 20th century and the rise of psychiatry. With Sigmund Freud revolutionizing the world of psychoanalysis, the medical community began recognizing AUD as a condition that could be treated rather than as a moral failing. However, their methods — limited to hypnosis and early forms of therapy — were crude, still in their infancy.
• Late 20th century: a modern understanding. With scientific advancements, we began unraveling the intricacies of genetics, brain chemistry, and environmental factors in AUD, viewing it less as a personal failing and more as a complex interplay of factors that could be managed and treated.

AUD Today: A Holistic View

Today, our understanding of AUD as a multifaceted issue allows us to combine medical treatments with psychological therapies, community support, and personal strategies to address it. We now recognize genetics, lifestyle choices, and the neuroscience of habits as potential contributing factors. These understandings allow us to debunk the myths of AUD as moral or intellectual failings.

Let’s take a closer look at the symptoms of AUD the way scientists and physicians define it today. Next, we’ll look at what does — and doesn’t — contribute to its development.

Symptoms of AUD

When it comes to identifying the signs of AUD, some of the most obvious ones are changes in behavior and habits — something feels “off” and, gradually, the person we have known for years (and maybe that person is ourself!) seems to be morphing into a stranger.

• Loss of control. Repeated, unsuccessful efforts to reduce or control alcohol consumption are frequent signs of AUD.
• Neglecting responsibilities. It’s common to start missing commitments at work, at school, or at home due to drinking or its aftereffects.
• Decreased socialization. A person suffering from AUD starts canceling plans often or steps away from activities they once enjoyed.
• Continuous usage. Consuming alcohol — even in hazardous situations such as before driving — is another red flag.
• Time consumed. Spending a significant amount of time obtaining, using, or recovering from the effects of alcohol is a common sign.

Beyond the behavioral symptoms, there are physical signs of a problematic relationship with alcohol. These might not be as overt as some behavioral patterns, but they’re crucial to spot.

• Red or bloodshot eyes. Consistent alcohol consumption can lead to redness and bloodshot appearance in the eyes.
• Flushed skin or broken capillaries. Alcohol can cause blood vessels to dilate, leading to a flushed appearance, especially on the face.
• Weight gain or loss. Drastic changes in weight can result from increased caloric intake from alcohol or neglecting proper nutrition.
• Swollen or bloated appearance. Alcohol can cause inflammation and water retention, leading to puffiness, especially in the face and abdomen.
• Poor hygiene. Neglecting personal grooming and cleanliness can sometimes accompany chronic alcohol use.
• Hand tremors. Noticeable shaking or trembling of the hands, especially in the morning or when alcohol consumption is reduced.
• Stomach issues. Persistent nausea, vomiting, or other digestive problems are common signs.
• Frequent illness. A weakened immune system due to chronic drinking can make us more susceptible to infections and lead to longer recovery times.
• Bruising. Alcohol can thin the blood and lead to easy bruising, even with minor bumps.

Sometimes the presence of a few of these symptoms is coincidental: they aren’t necessarily an indication of AUD. But when they occur together and are accompanied by heavy or regular alcohol use, it’s an indication that we may be experiencing AUD.

The Causes of AUD: Is Alcoholism Genetic?

Now, let’s turn our attention to the main causes of AUD, which come down to a combination of genetic, environmental, and psychological factors.

The Genetic Connection

Why can some people enjoy a casual drink without spiraling while others can't seem to control their drinking habits? Genetics might be playing a role here. Can alcoholism be inherited and, if so, to what extent? A plethora of studies has shown that AUD does have a genetic component. For example, children of alcoholics are about four times more likely to develop alcoholism than the general population. However, at this point it’s impossible to quantify just how hereditary it is — there are simply too many variables at play in this complex behavioral trait.

Moreover, it’s crucial to keep in mind that genes are not destiny! Just because there's a history of alcoholism in the family doesn't mean you’re bound to have the same fate. Think of it as a nudge in a certain direction but not a predetermined path.

The Brain’s Role

Our brains are intricate machines, and alcohol can change the way they operate. Chronic alcohol consumption can alter the structure and function of some brain regions, leading to an increased risk of developing alcohol dependence. Once the brain gets accustomed to the presence of alcohol, it might crave it more, leading to a vicious cycle. Signs of alcohol dependence include:

• Increased tolerance: needing more and more alcohol to feel its effects or finding that the same amount has less effect than before.
• Withdrawal symptoms: experiencing nausea, sweating, shaking, and anxiety when not drinking.

Recognizing these changes is crucial — they can serve as vital wake-up calls, emphasizing the need for intervention or support.

Environment and Lifestyle

While genetics and brain chemistry play a role, environmental factors can be equally influential. Childhood experiences, peer pressure, trauma, and stress can all increase the risk of developing AUD.

Adopting a lifestyle in which drinking is a frequent activity due to societal norms or personal choices can contribute to the onset of AUD. Genes might load the gun, but environment and lifestyle choices can pull the trigger.

In particular, binge drinking — consuming an excessive amount of alcohol in a short period, typically with the intention of getting drunk — can quickly become a slippery slope on the path to developing AUD. For men, this means consuming five or more drinks within about two hours, and for women, it's four or more drinks within the same time frame.

Here are some key features of binge drinking:

• It's episodic, often occurring during weekends or special occasions.
• It doesn't necessarily involve a physical dependence on alcohol at the beginning but can eventually lead to it.
• It can lead to immediate consequences such as accidents, injuries, risky behavior, and alcohol poisoning.

While binge drinking doesn’t equate to alcoholism, it can be a gateway. Regular binge-drinking episodes increase the risk of developing an alcohol use disorder. Moreover, binge drinking can cause many of the same health issues and social problems as AUD, even if dependency hasn't developed.

The Habit Factor

Why is binge drinking — drinking in response to emotional cues — likely to lead to AUD? The answer has to do with the way our brain forms habits.

The brain loves habits. If you've ever tried to skip that morning coffee or switch up your evening routine, you know how powerful habits can be! Our brains are naturally wired to form habits as they help us function more efficiently. But what happens when the habits we form revolve around alcohol? 

When we repeat an action — such as drinking excessively or drowning our feelings in booze — frequently enough, our brains start automating that process, saving energy and effort. This is the foundation of habit formation. Neurologically speaking, the basal ganglia, a deep-seated brain region, plays a significant role here: the more we repeat an action, the more entrenched this neural pathway becomes.

The brain’s reward system makes habits neurologically “sticky.” When we drink, our brain releases “feel-good” neurotransmitters such as dopamine. If we repeatedly turn to alcohol as a source of relief or celebration, the brain begins to link the action (drinking) with the reward (feeling good), reinforcing the habit loop.

Over time, if we're not cautious, this habit loop can intensify. What might have started as an occasional drink after work can turn into a deeply ingrained routine. As we build tolerance, we might consume more alcohol to achieve the same "reward," further solidifying the habit. This consistent and increased consumption can lay the foundation for AUD.

Breaking the Cycle

Our brains are naturally prone to forming habits — but we're not at their mercy! Recognizing the habit factor in AUD is a crucial step in the journey towards healthier patterns and a brighter future.

Understanding the role of habits in AUD is empowering — it means that with the right strategies, we can rewire those ingrained neural pathways. While it's not an overnight process, consistent efforts like seeking support, creating new routines, and actively working to replace the alcohol habit with healthier alternatives can make a significant difference.

The Myth of Willpower

While the mechanics of AUD involve habits, which we can change, that doesn’t mean it’s always within our control, especially as it progresses.

It's a common misconception that those struggling with AUD merely lack willpower. In reality, once someone develops an addiction, mere willpower often isn’t enough. Chemical changes in the brain make it challenging to quit without support. Let's bust this myth once and for all and recognize AUD for what it is: a complex interplay of genetics, brain chemistry, and environment, which sometimes requires medical intervention to jumpstart the recovery process.

Taking Action: 7 Steps to a Healthier You

Ready to make some changes? Here’s a handy list to guide you:

• Knowledge is power. Understand that AUD isn't about a lack of self-control. Recognize the biological and environmental factors at play. This awareness can help reduce self-blame and inspire action.
• Seek support. Talk to someone you trust about your concerns — a friend, family member, or healthcare professional. Remember, it’s okay to lean on others when the going gets tough.
• Limit exposure. Avoid environments or situations where you might feel a strong urge to drink. For example, if you know certain social situations prompt you to drink more, consider finding alternative ways to socialize or enjoy yourself.
• Manage stress. Alcohol might have been a way to cope with stress. Find healthier alternatives like exercising, meditating, or engaging in hobbies.
• Set clear goals. Clearly define what you want. Whether it's cutting back on drinking or quitting entirely, a clear objective can help.
• Stay accountable. Share your goals with someone you trust. They can help you stay on track and offer encouragement when you need it most.
• Educate and advocate. Share what you've learned with others. You never know who might benefit from the information or feel inspired by your journey!

Summing Up

As we can see, AUD is a complex problem. While genetics can influence our predisposition, it's not the sole culprit. Environmental factors and individual choices also play pivotal roles. By understanding the complexities, we can approach AUD with empathy and science-backed strategies.

Remember, every journey begins with a single step, and you have the power to chart your own course!