"I just don't believe alcoholism is a disease, it's a choice. I don't know why alcoholics just don't stop drinking!"
The above is a common statement often made by friends and families of alcoholics before they learn more about the nature of addiction.
Yes, originally the alcoholic possibly did choose to start drinking in the first place. And, there was a period of time when he might have been able to stop drinking by merely making a decision to do so.
The alcoholics who wrote the book, "Alcoholics Anonymous: The Big Book" admitted that they may have been able to quit at some point early in their drinking days:
"Though there is no way of proving it, we believe that early in our drinking careers most of us could have stopped drinking. But the difficulty is that few alcoholics have enough desire to stop while there is yet time."
Drinking alcohol is a pleasant experience for most people. It's a way to relax, have fun, or celebrate. It's a way of rewarding themselves after a good day's work or a successful accomplishment.
Addiction Changes Brain's Reward System
Pursuing rewards is a normal, healthy activity for most of us. The pursuit of happiness in one form or another is the motivation for us to get up in the morning and go to work or school. Whether we gain happiness from the work itself or we work so that we can achieve other goals that we find satisfying, pursuing those rewards drives us.
It's the way we are wired. It's how our brains work, normally.
However, when the pursuit of rewards becomes obsessive, compulsive or impulsive so that it begins to dominate our lives and continues even after negative consequences it can become an addiction. After the addictive behavior is no longer pleasurable, the pursuit of rewards reaches the pathological state.
Not Being Able to Quit
When someone develops an addiction, whether to alcohol, drugs or an activity such as gambling or sex, chances are they have experienced some negative effects and, as a result, have tried to stop. If they were truly addicted, chances are they found that it was not so easy to quit.
Likewise, if you are a friend or family member of someone who has an addiction, you have probably become frustrated and bewildered when the person swore to you and to himself that they would never do it again, but a short time later repeated the addictive behavior.
Pathological Pursuit of Rewards
If this happened to you, you would probably find yourself absolutely dumbfounded that you returned to the addictive behavior after knowing it would cause even more trouble. You may be even more amazed to find that you kept repeating the behavior even after it no longer gave you the same pleasure that it once did.
This state of addiction, when the activity continues in spite of negative consequences and despite the fact it is no longer rewarding, is termed by addiction experts the "pathological pursuit of rewards." It is the result of chemical changes in the reward circuitry of the brain.
It Starts Out Innocently
People start out drinking or doing drugs - or eat, gamble, or have sex - because it makes them feel good. They do it to escape boredom, or discomfort, anxiety, or restlessness.
Their drug of choice gives them a "high" that feels like a reward or a relief from the dysphoria they were feeling.
The feeling they get is the result of an increase in dopamine and opioid peptide activity in the brain's reward circuits. It simply feels good.
However, after the rush of pleasant feelings, a neurochemical rebound takes place in the brain the drops the reward system below the original normal level. When they attempt to achieve that same high again by repeating the activity, the same feeling of euphoria or feeling of relief does not happen.
Try as they will, they never really get as high as they did the first time.
A Vicious Cycle
Making things worse, as the alcohol or addict tries to get back to that original high, he develops a tolerance for the drug, which means it now takes more alcohol to try to achieve that same feeling.
As tolerance continues to build and more alcohol is consumed, the brain damage continues to escalate.
At the same time, the emotional low they experience afterward gets lower. They no long return to "normal" but sink deeper into a state of dysphoria, which compels them to try again to reach that high.
Loss of Impulse Control
As the alcoholic keeps trying to achieve that high and then sinks down lower each time some very real chemical changes are taking place in his brain. The cycle of intoxication and withdrawal is playing havoc with the brain's reward system.
The alcoholic's pursuit of reward or relief is no longer pleasant, it has become pathological.
Also, at the same time, the increased level or frequency of intoxication is damaging the region of the brain that provides impulse control.
When Reward-Seeking Becomes Diseased
According to the American Society of Addiction Medicine (ASAM) the pursuit of rewards becomes pathological when the following take place:
- Reward seeking become compulsive or impulsive.
- The behavior ceases to be pleasurable.
- The behavior no longer provides relief.
No Longer a Choice, a Compulsion
At this point the alcoholic no longer decides to take another drink or go on another binge. He is compelled to do so by a reward system in the brain that is out of his control. He continues to drink although it no longer gives him pleasure, but does so to escape the overwhelming dysphoria he feels.
He may swear off again and again, promising himself and those closest to him, that he will never drink again. But, shortly that craving - sometimes described as a mental obsession coupled with a physical compulsion to drink - comes calling again.
And, when he answers he finds no relief. It's a vicious cycle and a miserable way to live for the alcoholic and usually everyone around him.
Addiction is a Brain Disease
This is why addiction is called a brain disease and alcoholism is called a severe alcohol use disorder. Very real changes have taken place in the brain that may take years of abstinence to reverse.
It may appear to the casual observer that the alcoholic is simply making poor choices, but at this point his brain is diseased. If "disease" doesn't work for you, try "mental disorder."
It just makes sense that if the alcoholic swears to High Heaven one day that he will never drink again, and two days later he is right back out there doing something that he doesn't even get pleasure from anymore, something is seriously wrong.
American Society of Addiction Medicine. "The Definition of Addiction (Long Version). 15 August 2011.
American Society of Addiction Medicine. "Definition Of Addiction: Frequently Asked Questions (PDF)," 15 August 2011.
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