Causes of Alcoholism

As with any addiction, the risk of becoming addicted to alcohol depends on a combination of biological, genetic and environmental factors. While a significant portion of a person's risk for alcoholism appears to be genetically determined, everything from stress to family dynamics can determine whether someone develops a drinking problem.
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It’s estimated that one in every eight American adults struggles with an alcohol problem, and nearly one in four Americans under the age of 30 has alcohol addiction.

Despite the prevalence of alcohol consumption, there’s no one-size-fits-all explanation for why some people who drink develop an addiction and others don’t.

“It’s a slow, sort of insidious process,” Dr. Kenneth Leonard, director of the Research Institute on Addictions, told “Along the way there are a variety of psychological and social factors that come to play. These create a situation where the person’s entire social environment tends to be supportive of drinking.

“They lose friends who are non-drinkers or who are offended by their behavior when they’re drinking. They maintain friends who tolerate that behavior. Psychologically, they come to rely on alcohol for coping. And they have neurological changes that happen along the way as well.”

Most research in this area points to a variety of causes. While approximately 50 percent of a person’s risk for alcoholism appears to be tied to one’s genetic makeup, other factors such as emotions, physical health and upbringing can all play a role.

Genetics and Alcoholism

Genes alone don’t determine whether someone becomes addicted, but they can provide a prod in that direction. Numerous scientific studies looking at twins and children of alcoholics have revealed that about half of a person’s risk for alcoholism is inherited.

But while some diseases, such as cystic fibrosis or sickle cell anemia, can be traced to a single genetic mutation, there’s no single gene for alcoholism. Rather, a number of genetic variations combine with environmental factors to increase a person’s risk for becoming addicted.

Some genes can lower a person’s risk for alcoholism. Many people of Asian descent, for instance, carry a gene mutation that alters the way their bodies break down alcohol. As a result, people with the mutation experience alcohol flush reaction, a condition that causes uncomfortable symptoms such as flushing, headache, nausea and rapid heartbeat when they drink. Because many people who experience these reactions tend to avoid alcohol, such genes offer a sort of protection from alcoholism.

Even when a person has a genetic predisposition for alcoholism, positive environmental influences such as education, religion and marriage can decrease the chances of developing a drinking problem.

A Family History of Addiction

For reasons that are not entirely understood, a family history of alcoholism significantly increases a person’s chances of becoming an alcoholic. In fact, children of alcoholics are four times more likely than children of nonalcoholics to develop a drinking problem — but genes aren’t the only factor.

Family dynamics, including how parents treat their children and how they treat each other, also matter. Living with an alcoholic can create numerous problems for family members.

Research has shown that the risk of alcoholism is higher among people who have an alcoholic parent with depression or other psychological problems. The risk is also elevated when a person’s parents engage in severe alcohol abuse or when conflicts within the family often lead to aggression and violence.

Alcohol Changes Brain Chemistry

Most people drink because they like the way it makes them feel — happier, more relaxed and less inhibited. The scientific explanation for this effect is rather simple: When people drink, alcohol triggers a flood of “feel-good” chemicals similar to morphine called endorphins, which bind to opiate receptors in the brain and create a sense of euphoria.

At the same time, alcohol slows down brain activity because it acts as a central nervous system depressant. This causes the slurred speech, slowed reaction times, loss of coordination and other impairments we recognize as intoxication.

When people drink, alcohol triggers a flood of “feel-good” chemicals similar to morphine called endorphins.

For those who drink occasionally, these effects on the brain are temporary. With ongoing exposure to alcohol, however, the brain finds ways to compensate for the effects — and these changes in brain chemistry can lead to addiction.

Optimal brain function relies on a delicate balance of neurotransmitters, which are the brain’s chemical messengers. But repeated alcohol exposure disrupts this delicate balance.

To counteract the intoxicating effects of alcohol, for instance, the brain ramps up its “excitatory” neurotransmitters, which stimulate nerve activity. As a result, heavy, long-term drinkers often don’t appear drunk because their brain has found a way to overcome alcohol’s slowing effects.

But these changes also contribute to a person’s physical dependence. If a long-term, heavy drinker suddenly stops drinking, the brain’s over-amped excitatory neurotransmitters will continue firing as if alcohol is present. This may cause the person to experience agonizing alcohol withdrawal symptoms, such as profuse sweating, a racing heart, increased anxiety and tremors.

Chronic exposure to alcohol also impacts the brain’s so-called reward circuits by stimulating the release of dopamine, a chemical in the brain that triggers a sense of well-being and contributes to cravings.

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Psychological Factors

An underlying mental illness, such as depression, anxiety or post-traumatic stress disorder, can also increase a person’s chances of developing an alcohol problem. That’s because many people use alcohol as a way to self-medicate and relieve their emotional distress.

One large national study published in the Journal of Affective Disorders found that nearly a quarter of people with mood disorders — and 41 percent of people suffering from bipolar disorder — used alcohol or drugs in an attempt to relieve symptoms such as depression, anxiety and insomnia.

“When individuals struggle with coping with their emotions or with general life situations, they may turn to alcohol to feel better. Work stress, family stress, mental health issues, physical pain, emotional pain, social isolation or social lubrication can all be factors that lead to increased use and eventual dependence.”
Richard Molina, Head Therapist, The Recovery Village

Unfortunately, the strategy often worsens symptoms of alcoholism and co-occurring disorders. According to Mayo Clinic, drinking increases the likelihood of depression, mood swings, violence and suicide among people with bipolar disorder.

Worsening symptoms can lead a person to drink even more, creating a vicious cycle. That’s why individuals struggling with substance use disorders and co-occurring mental health conditions require treatment for both conditions. The most effective treatment approach addresses addiction and co-occurring disorders simultaneously.

Social Pressure

Even though the World Health Organization states that alcohol contributes to 3.3 million deaths worldwide every year, alcohol doesn’t carry the same stigma as other drugs. Drinking is deeply enmeshed in American culture.

From sporting events to social situations to work events, alcohol is often presented as the optimal way to bond with others, celebrate important occasions or just kick back and relax. Social drinking is often glorified in TV shows, movies and social media.

For young people, peer pressure can make it exceptionally difficult to abstain from drinking. By the time they’ve reached their senior year of high school, in fact, more than 60 percent of high school seniors will have tried alcohol, and more than 45 percent will have gotten drunk. These trends are troubling because underage drinking has been linked to a high risk of future alcohol problems.

While a number of risk factors can increase the chance that you’ll develop an alcohol addiction, no single factor alone causes alcoholism. Rather, alcoholism is a disease resulting from the interaction of many different factors related to your genes and upbringing. The important thing to remember is that no matter what factors caused a person’s drinking problem, alcohol recovery is possible and help is available.

Medical Disclaimer: aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

Amy Keller, RN, BSN
Content Writer,
As a former journalist and a registered nurse, Amy draws on her clinical experience, compassion and storytelling skills to provide insight into the disease of addiction and treatment options. Amy has completed the American Psychiatric Nurses Association’s course on Effective Treatments for Opioid Use Disorder and continuing education on Screening, Brief Intervention and Referral to Treatment (SBIRT). Amy is an advocate for patient- and family-centered care. She previously participated in Moffitt Cancer Center’s patient and family advisory program and was a speaker at the Institute of Patient-and Family-Centered Care’s 2015 national conference.
Medical Reviewer
Ashraf Ali
Psychiatrist, Los Angeles County Department of Mental Health

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