Why Do People Become Alcoholics?

For more than a century, the movies have given us Hollywood’s version of “alcoholics” — from the lighthearted antics of Dudley Moore’s Arthur to the heart-rending despair of Bradley Cooper’s Jack Maine in A Star Is Born. Whether the character is a silly millionaire without discipline or a tragic country rock has-been, it can be hard for us to relate. After all, does alcohol use disorder (AUD) stem from one love affair gone wrong, or a mom who misused alcohol, or an upbringing in poverty? As we’ll discover here, AUD is more often caused by a complex interplay of multiple factors. So let’s dig in and explore the entwined roots of AUD to help us on our journey to cut back or quit drinking.

What Makes You an Alcoholic?

Alcoholism, or alcohol use disorder (AUD), is a condition that is characterized by an impaired ability to quit or cut back on drinking despite adverse effects. Medical practitioners diagnose AUD and the severity of the condition using criteria from the DSM-5. The severity ranges from mild to severe with mild meeting 2 to 3 criteria, moderate meeting 4 to 5, and severe meeting 6 or more.

• Drinking more or longer than intended
• Having more than one failed attempt to stop or cut down on drinking
• Spending significant time getting over aftereffects
• Having intrusive thoughts about drinking
• Finding that drinking interferes with other priorities
• Continuing to drink even after relationship issues
• Giving up enjoyable activities to drink
• Getting into dangerous situations related to drinking
• Continuing to drink despite physical or mental health problems
• Developing increased tolerance to alcohol
• Experiencing withdrawal symptoms

Some of us may have an unhealthy relationship with alcohol but don’t quite have AUD, whereas others may have AUD. What factors contribute to developing the condition?

What Causes Alcoholism?

AUD is a physical and neurological dependence on alcohol that can be influenced by many factors. Let’s look into them.

Genetic Predisposition to Alcohol Use Disorder

Although there isn’t a gene for AUD, researchers believe that genetics accounts for roughly 50% of the risk factors of developing AUD. Those of us with a family history of AUD are more likely to develop the condition. This genetic predisposition explains why the condition is commonly “passed down,” or inherited. 

For example, research has shown that adopted children may be at higher risk of developing AUD if their biological parents had alcohol-related issues. On the other hand, the risk of developing AUD may be lower if it is the adopted parents who misused alcohol. 

The genetic predisposition of AUD may be affected by two main genes — the ALDH2 and ADH1B genes. These genes play a major role in how our body breaks down and processes alcohol. For example, those of us with alcohol intolerance have mutations in these genes. These mutations affect our body’s ability to break down alcohol — causing higher levels of acetaldehyde (the toxic compound in alcohol). This causes increased unpleasant side effects that may put us off from drinking alcohol — lowering the risk of AUD. 

Biological mechanisms can also be affected by our genes. Differences in alcohol sensitivity and neurotransmitter mechanisms, such as the production and action of dopamine and serotonin, can affect the risk of developing AUD. 

Psychological Factors 

Many psychological factors can impact alcohol consumption. Alcohol can temporarily boost our mood by promoting the production of our “feel-good” hormones, dopamine and serotonin. It also slows down messaging in our brain — providing a temporary reprieve from processing and feeling uncomfortable emotions. This is why alcohol is so commonly used to self-medicate, as it provides a short-term distraction from our emotions or problems. 

Have you ever wondered why some of us stress-eat whereas others may lose their appetite and undereat? Our personality traits — how we respond and deal with stress, for example — can impact our inclination to reach for the bottle or avoid it. Since our personality can affect our behavior, it can play a major role in our consumption habits. 

Other psychological factors include mental health disorders. Drinking is commonly associated with mental health conditions such as depression, anxiety, and mood disorders. However, these conditions also increase the risk of excessive alcohol consumption — creating a toxic cycle of poor mental health and self-medication. Similarly, traumatic experiences can lead to PTSD, which is also associated with negative drinking habits.

Environmental Influence

Genetics may set the stage for the way we think and act, but our environment strongly influences it. Environmental factors add to the risk of developing AUD. 

• Early life experiences. We often hear the saying “Children are like sponges.” That’s because they soak up all the information around them, which shapes their thoughts and actions. Early life experiences such as trauma or exposure to alcohol in the home increase the risk of drinking problems. Access to resources, education, and socioeconomic status also impact our risk of developing AUD.
• Peer pressure and social networks. We are influenced by those around us. If we’re surrounded by friends, family, and colleagues who drink regularly, we’re more likely to do so as well. This increases our risk of developing AUD, especially when combined with other risk factors. 
• Availability and accessibility of alcohol. The availability of alcohol can impact our drinking habits. If it’s harder to get, most likely we won’t consume as much. Let’s take a free car wash for example. If the business was just giving them away —nothing asked of us — many of us would be more than happy to accept. However, if we’re required to first complete an hour-long survey, chances are some of us are likely to pass on the deal. 

“Clean space, clear mind” holds true for many of us because our environment can have an impact on us — individually (for example, the friends we hang out with) and on a larger scale (the social and cultural norms around us).

Social and Cultural Factors

Social and cultural aspects of our environment can influence the way we think and act. For example, in a culture where milk may be thought to have healing properties, we might be more likely to consume dairy than we would in another culture. Similarly, social and cultural factors can impact our attitudes towards drinking and drinking habits. 

• Cultural attitudes towards alcohol. Different norms and values may impact our likelihood of drinking or not drinking alcohol. For example, In religions or cultures where alcohol is accepted, we may be more likely to consume alcohol regularly compared to cultures in which drinking is frowned upon. 
• Social acceptance and stigma. Acceptance and stigma can affect alcohol use and treatment. Commonly, drinking is socially accepted, but alcohol misuse is stigmatized. This can lead to high rates of alcohol misuse but low rates of treatment.
• Societal changes and trends. Societal change, such as our increasing focus on health, can lead to larger scale trends like the Sober-Curious movement, which is partly responsible for less drinking among younger generations.

Clearly, many different factors can promote the development of AUD. However, more often, it isn’t just one factor that brings on AUD but several of them, each influencing another and stacking up the risks. 

The Interplay of Multiple Factors

Genetics, psychological factors, social and cultural norms, and our environment all affect one another. Any one cause of AUD is, therefore, hard to pinpoint.

One common causal link is the interaction of our genetics and our environment, also known as the gene-environment correlation. The gene-environment theory states that our environmental experiences influence the way our genes are expressed. This means that although we may have certain genes that make us more at risk of developing AUD, external experiences, especially during early development, can turn a gene “on or off.” Environmental stimuli can spark signals between neurons, which produce gene regulatory proteins. These proteins can attract or repel enzymes that attach them to the genes — leading to expression or lack of expression of a gene. 

Another common interaction is between psychological and social factors. The self-medication hypothesis states that there’s an underlying cause for substance use. Social stressors such as financial strain, the absence of meaningful social relationships, and traumatic experiences can lead to substance use as a coping mechanism. This increases the risk of mental health disorders, which commonly co-occur with AUD.

Our unique experiences add to the complexity of AUD. The situational factors that lead to AUD create distinct characterizations of the condition, which are divided into different subtypes.

 Types of Alcoholics

According to the NIAAA, “alcoholics” are categorized into 5 subtypes. They help us identify certain risk factors and recognize signs of AUD.

1. Young adult. Young adults make up the largest subtype. This group is characterized by drinking less frequently but binge drinking when they do.

2. Functional. This subtype is made up mostly of middle-aged adults. They are often married and have successful jobs. The functional “alcoholic” is high-performing and often less likely to report problems from drinking. 

3. Intermediate familial. The intermediate familial subtype is more likely to drink and develop alcohol dependence at a younger age. They are also more likely to have immediate family members with AUD. This subtype is still “functional” but may not be as high performing. 

4. Young antisocial. This subtype is most likely to drink at the youngest age in comparison to other groups. They are also most likely to participate in other substance use and have co-occurring mental health disorders.

5. Chronic severe. The chronic severe subtype is most likely to have close family members with AUD. They are also most likely to have other substance dependence and have the highest rates of health and social consequences. This subtype is the smallest group, making up about 9% of those with AUD. 

Despite the differences in subtypes of “alcoholics,” AUD doesn’t define any one of us. No matter where we are in our relationship with alcohol, we can work on developing a healthier one through prevention and intervention. 

Strategies for Prevention and Intervention

Prevention and intervention may require individual and systemic action. We can work together to minimize the risk of AUD with various strategies.

• Education. Increased awareness about alcohol-related harms and mindful drinking practices can help us reduce negative drinking patterns. 
• Early intervention. Sometimes it can be difficult to realize we have a poor relationship with alcohol until it’s progressed into a bigger issue. Identifying early signs can help us minimize alcohol-related harms.
• Treatment approaches. Traditional treatment options include medication-assisted treatment and psychological therapies. However, not all approaches will work for everyone. We can try different options such as peer support groups, alcohol reduction apps such as Reframe, or a combination of treatments for a more comprehensive approach. 
• Community and policy interventions. In a recent report by the CDC, alcohol-related deaths increased significantly within recent years. It’s clear more effective policy measures are needed to address alcohol consumption and its related harms. We can also work together to support each other by developing strong support networks and community programs.

These strategies aren’t just for those who may be diagnosed with AUD. Quitting or cutting back on alcohol can be beneficial for any one of us.

A Sober Spur

As we’ve learned, “alcoholism,” or alcohol use disorder, is a condition that meets criteria outlined in the DSM-V. It  can be caused by an interplay of various factors in our lives. Although the causes of AUD can be complex, prevention or intervention need not be. From occasional drinkers to those diagnosed with AUD, we can develop healthier relationships with alcohol that will benefit our health and well-being!