Alcohol is the most common name for ethanol, the main psychoactive component found in alcoholic beverages. It’s a socially accepted psychoactive drug, unlike cocaine or LSD. However, excessive drinking is common in many nations and is increasingly raising questions about public health.
Responsible use of alcoholic beverages may induce a positive mood and relaxation. In some circumstances, particularly when it comes to drinking wine, it may also have therapeutic value. But alcohol is a potentially addictive substance, and alcohol dependence leads to a withdrawal syndrome when the drug is not consumed. Around 10% of the population in the United States suffers from alcoholism, and only 11% of people affected receive treatment for their problem.
In this article, we will review in detail what happens when someone becomes an alcoholic. We will also review the main signs and symptoms of alcohol withdrawal syndrome and a series of strategies used by healthcare professionals to treat this condition.
The Journey From Moderate Drinking to Alcoholism
There are usually not many arguments against drinking moderately every once in a while. But some people are at a higher risk of alcoholism, and even moderate drinking can become a problem. Addictive vulnerability is defined as a higher risk of drug abuse, in this case, related to alcohol consumption. The journey from moderate drinking to addictive behavior is more common in these cases:
- It is more common in males than females, especially when these individuals start drinking at a very young age, especially before adulthood.
- It is more common in people with impulsive behavior and higher reactivity. It usually goes hand in hand with aggressive behaviors.
- Alcoholism is more common in people who do not exercise regularly and easily become habituated to other cravings such as sugar.
- Turning a habit into alcoholism is much more common in mental health patients and in dysfunctional family environments.
Many of the risk factors mentioned above lead to repeated consumption of alcohol. After drinking a constant amount for an extended period, there is a process of tolerance in which you need a higher intake of alcohol to achieve the same psychoactive effect. Tolerance then encourages alcohol consumption and leads to dependence.
Alcohol dependence is the urge to drink alcohol to feel a reward. Patients with alcoholism become dependent on these substances and go through withdrawal symptoms when their intake is reduced.
The brain becomes responsive to alcohol throughout the process and starts changing its chemistry. The stages of such changes include:
- Positive Reinforcement: This is an acute phase in which people experience the initial reward of alcohol drinking. They feel relaxed and lose inhibitions, which is sometimes a good thing socially. There are rising blood alcohol concentrations in the organism that stimulate dopamine, opioid, GABA, and 5-hydroxytryptophan neuron receptors in the brain. These receptors are responsible for an acute response that feels like a reward and makes people want to repeat the experience.
- Negative Reinforcement: After an acute positive reinforcement, people also experience negative reinforcement. As their blood alcohol concentrations drop, GABA receptors are not equally stimulated, and the sedative and relaxing effects of alcohol are gone. Other receptors in the neurons also fire a negative reinforcement that makes people want to repeat the experience to obtain the same reward, especially when they are anxious or feel socially awkward.
- Tolerance and Craving: In this stage, the negative reinforcement becomes more pronounced because the receptors start to change their capacity to become stimulated. Now they need more potent stimuli, and drinking becomes one of the only ways to achieve the same degree of mental calm or level of social performance. This stage is close to the alcohol addiction stage, which features more pronounced changes in the receptors. It is now difficult to return them to normal, so GABA, dopamine, and y-hydroxytryptophan signaling are abnormal. In such cases, the behavior of these receptors becomes deeply disturbed, and the brain becomes unable to function normally without alcohol. Thus, not drinking may trigger anxiety, seizures, and other symptoms of alcohol withdrawal.