What Are the Causes of Alcoholism?

Understanding Alcoholism

Alcoholism, also known as alcohol dependence or alcohol use disorder, is a complex and serious condition that can have profound impacts on an individual's life. Understanding what alcoholism is, its symptoms, and how it is diagnosed can provide insight into what causes this disorder and how it can be treated.

Definition and Symptoms of Alcoholism

Alcoholism is a disorder that involves an individual being unable to control or stop their alcohol use despite its negative effects on their health, relationships, and responsibilities. It is a chronic disease characterized by a physical and psychological dependence on alcohol.

Symptoms of alcoholism can vary in severity and may include:

• Inability to limit the amount of alcohol consumed
• Spending a lot of time drinking or recovering from drinking
• Having a strong craving or urge to drink alcohol
• Continued alcohol use despite negative consequences
• Giving up important social, occupational, or recreational activities in favor of drinking
• Needing more alcohol to achieve the desired effect (tolerance)
• Experiencing withdrawal symptoms when alcohol wears off

Diagnosis of Alcohol Use Disorder

The diagnosis of Alcohol Use Disorder (AUD) is based on the presence of certain symptoms. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there are 11 symptoms of AUD. The severity of AUD is classified based on the number of symptoms presented. The presence of two to three symptoms indicates mild AUD, four to five symptoms indicate moderate AUD, and six or more symptoms indicate severe AUD.

These symptoms may occur within a 12-month period and can help healthcare providers identify individuals who may be struggling with alcoholism. It's crucial to remember that a diagnosis of AUD is a starting point for treatment and recovery. Understanding alcoholism is the first step towards addressing its causes and identifying appropriate treatment strategies.

The Role of Genetics in Alcoholism

While the causes of alcoholism are multifaceted, involving both genetic and environmental factors, there's no denying the significant influence genetics plays in determining an individual's susceptibility to alcohol use disorders (AUD). Understanding these genetic influences can provide valuable insights into the underlying biological mechanisms of alcoholism and contribute to the development of effective intervention strategies.

Key Genes Influencing Alcoholism

Alcoholism is a complex genetic disease, with variations in a large number of genes affecting risk. Some genes that have been identified to affect the risk for alcoholism include ADH1B and ALDH2, which have the strongest known effects on risk for alcoholism. Other genes impacting risk for alcoholism or related traits include GABRA2, CHRM2, KCNJ6, and AUTS2.

The ADH1B and ALDH2 genes affect the metabolism of alcohol, influencing the risk for alcohol dependence. For example, the ADH1B48His allele and ALDH2504K allele, common in East Asia, offer protective effects against alcohol dependence. However, societal circumstances can override these protective effects.

Additionally, genes such as GABRA2 and CHRM2 have been associated with an increased risk for alcohol dependence. The CHRM2 gene, in particular, shows association especially in individuals with early onset or comorbid drug dependence.

Through genome-wide association studies (GWAS), specific genes such as PECR, KCNJ6, AUTS2, and IPO11-HTR1A have been associated with alcohol consumption, alcohol-related endophenotypes, and susceptibility to addictions. While these studies have been limited by sample sizes and the clinical and genetic heterogeneity of alcohol dependence, larger meta-analyses are being developed to overcome these limitations [2].

Epigenetics and Alcohol Use Disorder

Epigenetics, the study of how various factors can alter the expression of genes, is increasingly being explored in relation to the risk of developing AUD. This field examines how changes in gene expression, rather than changes in the genetic code itself, may enhance a person's susceptibility to AUD [3].

Epigenetic changes can be influenced by a variety of factors including age, environment, lifestyle, and disease state. Understanding how these changes in gene expression contribute to the development of alcoholism can provide valuable insights into the complex interplay between genetics and environment in the etiology of AUD.

In conclusion, while the genetic landscape of alcoholism is complex and not yet fully understood, current research indicates a strong genetic component in the development of AUD. This knowledge could pave the way for new strategies in prevention, diagnosis, and treatment of alcoholism.

Environmental Factors Leading to Alcoholism

In the quest to answer the question, 'what are the causes of alcoholism?', it is crucial to recognize that environmental factors play a significant role. This section will discuss the impact of childhood experiences and peer pressure on alcohol use and abuse.

Impact of Childhood Experiences

Childhood experiences significantly contribute to the development of alcohol use disorder. Adverse childhood experiences, such as trauma within the first 18 years of life, have been found to contribute to the onset of alcoholism.

Parental alcohol use disorders can also negatively affect the family situation during childhood, leading to child maltreatment and problem drinking later in life [4]. On the other hand, positive parenting is associated with a lower incidence of alcohol use disorder.

Peer Pressure and Underage Drinking

Peer pressure, particularly during the teenage years, is another environmental factor that can lead to alcoholism. Influenced by social identity and the desire to fit in, peer pressure can have a significant impact on teenage alcohol consumption, leading to engagement in risky behaviors such as underage drinking. Social modeling, direct offers or encouragement to drink, and the perception that "everyone is doing it" are common forms of peer pressure that contribute to alcohol consumption among teenagers [5].

Evidence suggests that teenagers who drink alcohol before the age of 15 are around six times more likely to develop an addiction to alcohol later in life compared to those who wait until they are of legal drinking age. Alcohol impairs judgment and interferes with brain function, potentially disrupting healthy brain development when introduced at a young age.

Understanding the environmental factors contributing to alcoholism can help in developing effective prevention and intervention strategies. It underscores the importance of providing supportive environments during childhood and adolescence, and of implementing measures to counteract peer pressure and underage drinking.

The Connection Between Mental Health and Alcoholism

The intricate relationship between mental health and alcohol use disorder (AUD) forms a significant part of the conversation around what causes alcoholism. Understanding this connection can help improve preventative measures and treatment strategies.

Alcoholism and Mental Health Disorders

More than one in four adults living with serious mental health problems also has a substance use problem according to SAMHSA. Substance use problems occur more frequently with certain mental health problems, creating a complex interplay between the two.

These disorders often share common genetic vulnerabilities with AUD, highlighting the genetic component in the development of alcoholism. For instance, traits such as novelty seeking and cyclothymia (a form of bipolar disorder) can influence the age at onset of alcohol abuse and dependence.

Alcohol as a Coping Mechanism

The use of alcohol as a coping mechanism is another facet of the connection between mental health and alcoholism. People dealing with mental health disorders may turn to alcohol to self-medicate, leading to a cycle of dependency and worsening mental health symptoms.

Adverse childhood experiences, such as trauma, can also contribute to the development of AUD [4]. These experiences can have a lasting impact on mental health, and in turn, influence alcohol use. Similarly, parental alcohol use disorders can negatively affect the family situation during childhood, leading to child maltreatment and problem drinking later in life.

Understanding the relationship between mental health and alcoholism is essential in addressing the root causes of alcoholism. It emphasizes the importance of integrated treatment approaches that address both mental health and substance use disorders. By focusing on these co-occurring conditions, we can provide more effective support and treatment for those struggling with alcoholism.

The Impact of Traumatic Events on Alcoholism

Traumatic events significantly contribute to the development of alcoholism. The connection between alcoholism and trauma can be traced back to individuals' attempts to cope with traumatic experiences and the physical changes that occur in their bodies as a result.

Post-Traumatic Stress Disorder and Alcoholism

There is a strong association between Posttraumatic Stress Disorder (PTSD) and alcoholism. More than half of Vietnam combat veterans with PTSD also show signs of alcohol addiction. This finding is indicative of a broader trend: individuals with PTSD frequently turn to alcohol as a means of self-medication, seeking temporary relief from the distressing symptoms of their disorder.

Women, in particular, have a higher risk for co-morbid PTSD and alcohol dependence. This higher risk is due, in part, to their higher incidence of childhood physical and sexual abuse.

The Endorphin Compensation Hypothesis

The Endorphin Compensation Hypothesis provides a physiological explanation for the connection between traumatic experiences and increased alcohol use. Traumatic events can increase endorphin activity, and alcohol use can also increase endorphin activity. Therefore, drinking alcohol after a traumatic event may be used to compensate for the endorphin withdrawal that follows trauma.

Endorphins are naturally occurring opioids that help to relieve pain and induce feelings of pleasure or euphoria. Following a traumatic event, endorphin activity can increase as a natural response to stress and pain. However, once the event is over, individuals may experience a sudden drop in endorphin levels, leading to feelings of depression and anxiety.

Alcohol can temporarily increase endorphin activity, providing temporary relief from these uncomfortable symptoms. This leads to the Endorphin Compensation Hypothesis, which suggests that alcohol consumption following trauma makes up for the lack of endorphin activity and helps to relieve emotional distress [6].

In summary, both PTSD and the physiological changes triggered by traumatic events play crucial roles in the development of alcoholism. Understanding these factors is crucial for developing effective strategies to prevent and treat alcoholism, particularly among individuals who have experienced significant trauma.

Alcoholism and Comorbid Conditions

Exploring the causes of alcoholism, it's essential to understand the role of comorbid conditions. Comorbidity refers to the occurrence of two or more disorders or illnesses in the same person. In the context of alcoholism, comorbid conditions can either precede, contribute to, or result from alcohol dependence.

Common Comorbid Conditions with Alcoholism

Alcoholism is associated with several psychiatric disorders that may develop independently of the alcoholism. These independent disorders can make certain individuals more prone to developing alcohol-related problems. Some of the common comorbid conditions include antisocial personality disorder, bipolar disorder, certain anxiety disorders, schizophrenia, and major depression.

Understanding Comorbidity in Diagnosis and Treatment

The presence of a comorbid condition can complicate the diagnosis and treatment of alcoholism. Clinicians should consider an algorithm that distinguishes among alcohol-related psychiatric symptoms and signs, alcohol-induced psychiatric syndromes, and independent psychiatric disorders commonly associated with alcoholism. Factors such as the patient's gender, family history, and course of illness over time should be taken into account for an accurate diagnosis [7].

In terms of treatment, the course and prognosis of alcohol-induced psychiatric disorders are different from those of independent major psychiatric disorders. Alcohol-induced psychiatric disorders typically improve on their own within several weeks of abstinence without requiring therapies beyond supportive care. However, independent psychiatric disorders may require specific treatments, such as medication or therapy, in addition to treatment for alcoholism.

Understanding the interplay between alcoholism and comorbid conditions can help to inform more effective prevention and treatment strategies. By addressing both the alcoholism and any underlying psychiatric disorders, individuals can increase their chances of recovery and reduce the risk of relapse.

References

[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6561398/

‍[2]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056340/

‍[4]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8932636/

‍[5]: https://alcohol.org/teens/peer-pressure-drinking/

‍[6]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6760386/

‍[7]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683829/