Alcoholism is a brain disease. Brain research in the past several years has taught us much more than we have ever known before about the mechanics of how alcoholism affects us. At the same time, it has reaffirmed older wisdom about alcoholism that has too often been neglected. Seneca, the Roman poet, observed that some people drink, some people drink and get drunk, and some people seem controlled by alcohol. Two thousand years later the first principle of AA, the world’s most successful treatment for addictions, is an acknowledgment by the alcoholic that he or she is powerless over alcohol. Aristotle advised that women who are pregnant should not consume alcohol. A few years back the Surgeon General of the United States issued the same advice to all American women.
If you look one right and one down from the big John Hancock on the Declaration of Independence you will find the signature of Dr. Benjamin Rush. In addition to being a delegate to the Continental Congress, Dr. Rush served as physician for the Continental Congress. Dr. Rush’s insightful observations about alcoholism were that not only do some people drink too much, but that the problems these people face in life get progressively worse as they drink. Documentation of the progressive nature of addictive illness has been repeatedly demonstrated during the last thirty years and is basic to most medical definitions of the disease.
But just as there is much neglected knowledge about alcoholism, there are also many myths. Modern research is helping us to sort the wheat from the chaff. We start with basic biology which drives most of our behavioral urges. Before there were ministers, doctors, and all the health professionals that we have, people knew a lot of the right things to do to assure their own survival by virtue of their own biological drives. When body cells get a little dehydrated because our fluid intake falls behind, a chemical reaction in a certain part of the brain tells us we need water. There’s no need to calculate our fluid intake even if our intellect knew the formula because our emotions feel the thirst stronger than the intellectual thought. This thirst mechanism promotes behavior change necessary to life itself by making us thirsty. When we injure or fracture a leg, our body tells us to keep it steady and still and it will heal. In a sense, our biology actually talks to us and tells us to do the right things by giving us feelings of discomfort or reward. Chemicals released into the brain at the appropriate time and in the appropriate doses mediate this reward system. When we do something that is healthy, like taking a brisk walk, hugging our child, or holding the hand of one we love, the brain gives us a fix of drugs that reward us, that make us feel good “yes”, a natural high.
This system of brain chemical highs is complex and sometimes doesn’t work exactly right. When this reward system is broken, doing something that feels good may turn out to be unhealthy but, nonetheless, gets reinforced by the same chemistry that is supposed to serve as our survival mechanism. In other words, a person may do self-destructive things not because of some thought or conscious decision, but because the brain chemistry erroneously says “yes, that was good for you, do it again.” Eating disorders, gambling addictions, as well as abusive and violent behaviors are examples of this maladaptation played out in real life. In addition, alcohol and other chemicals that people use actually displace and alter the body’s natural feel-good chemicals.
The brain creates its own versions of Morphine, its own Demerol, and even its own Valium; and that’s a healthy thing when we are hurting. Most people have heard of the “runner’s high” from intensive exercise. The brain’s narcotics called endorphins contribute to this phenomenon. In our natural state, neurochemicals allow us to function better and get on with our life and do things that need doing. Then somebody discovered that plants make these same chemicals. People began to ingest these artificially, inducing a sense of well being and the drug culture was off to the races. For many people, whether one is having surgery or whatever the need might be, these external chemicals (medicines) seem to work without displacing the ordinary process by which these chemicals are naturally produced and used by the body. But some predisposed individuals develop a craving for the drug substitute. If the body gets Morphine or other Morphine-like chemicals from the outside, the brain shuts down its own factories that normally generate helpful internal natural “narcotics.” So after a while, a person takes drugs just to feel normal again. You’re hooked!
Alcohol tickles our reward system in a similar, but not identical way. The best way to talk about this is to describe what happens with alcoholics. Studies of persons who have died from alcoholism revealed Morphine-like substances in the brains of these deceased alcoholics. At first this seemed puzzling, since these people didn’t use narcotics. Research subsequently demonstrated that some individuals with a certain genetic tendency synthesize narcotic-like chemicals in their brains when their bodies are exposed to alcohol.
In addition to creating its own feel-good chemicals, the brain’s everyday functions operate through an electrochemical process. Substances called neurotransmitters mediate brain activity allowing communication between brain cells. This communication translates into thought and feelings. An overabundance of certain neurotransmitters results in emotional highs and lows, cravings, and feeling-driven behaviors. It seems that when the alcoholic drinks alcohol, a normal metabolic byproduct of the breakdown of alcohol to carbon dioxide and water produces a group of chemicals which combine with dopamine, one of the natural feel good neurotransmitters. The “condensation” of these two chemicals creates an entirely new one. It’s the chemical equivalent of mixing yellow paint and blue paint to form a new color, green. The new class of chemicals looks like and, more importantly, acts like Morphine. This Morphine-like chemical acts like a neurotransmitter and stimulates the urge to drink more alcohol.
Because of this peculiar sequence of chemical reactions, a person who has this abnormal genetic pattern can drink alcohol and have their brain create a drug that gives a tremendous sense of satisfaction and relief, a sense of pleasure, just like a person has who has taken an injection of Morphine. In the person with alcoholic genes, the ingestion of alcohol creates a euphoria that actually becomes its own reward. For most of us, hugging a relative, reading a good book, seeing a great movie or doing an enjoyable group activity stimulates the neurological reward that makes us feel good, that gives our lives day-to-day meaning, but for a significant percentage of the population who are biologically predisposed, drinking alcohol becomes a self-sustaining reward. Within their brain chemistry a cycle is established which drives them to drink more, creating more reward, driving them to drink more, creating more reward, driving them to drink more. You get it.
Alcoholism is often called a family disease. We normally need to have healthy relationships to maintain emotional health. In order to keep one’s own brain chemistry healthy, an individual needs to be able to connect with other people on an emotional level, to experience what is broadly termed “intimacy.” In the alcoholic, drinking becomes a comfortable substitute for that interaction with other people. The only way to keep the addicted brain chemistry in tune is to drink more alcohol. In fact, relationships can’t do for alcoholics what they do for a normal person. For the alcoholic, the relationship with alcohol replaces family, friends, and minister or priest and eventually, most other meaningful human interaction.
It’s a little easier to understand how the alcoholic’s neurochemistry affects him or her directly, than it is to understand how it affects others so significantly. The reality is that family members are connected together just like the organs of a body are connected. Organs are connected with nerves and blood vessels. A family physician sees family members as connected by relationships that actually stimulate brain chemistry. This brain chemistry connects one family member with the others. It is the way that a person gets his or her self worth and identity. Alcohol actually short circuits the relationship loop as the addict becomes totally and destructively self-sufficient through alcohol use. That’s why people with alcohol problems usually prefer to go ahead and just drink. It feels like a lot easier way to do life. The maintenance work of relationships can be difficult and the “lubrication” with alcohol makes it seem easier. Sort of like watching TV instead of playing football. You can watch a football game a lot easier than you can play it. Also there is a snowball effect. The more the person uses alcohol, the easier it is to meet one’s survival instinct through alcohol. The use becomes a conditioned or learned response. The alcoholic stops learning how to deal with relationships. The pain of nurturing a relationship is just too great to even make having relationships worthwhile. So while one person becomes self-sufficient with the use of alcohol through his or her alcoholism, family members are starved emotionally and socially by the loss of expressed love that goes part and parcel with addiction. As a consequence of these maladaptive relationships, very dysfunctional interactions become commonplace in alcoholic families.
A scary thing happens when a child is born into an alcoholic family. You have this relationship that we’ve just described of an alcoholic who needs alcohol to keep the brain chemistry balanced and a spouse who has not been able to meet his or her needs because of the lack of emotional support from the alcoholic. There’s just no healthy role model for a child to imprint on. There is no way for a child to learn how to deal with life in a healthy way. A medical doctor sees hordes of adults that grew up in alcoholic families that really don’t understand how to communicate and solve problems effectively. In the addicted mind the perceived solutions to bumps in the road of life is just to abandon a rocky relationship, hit somebody who doesn’t agree with you, or drink life away in search of happiness. There is no healthy sense of how to resolve problems because there has been no healthy model to learn from. As alcoholic families grow older these alcoholic traits become more deeply ingrained and passed from one generation to the next.
It is the creation of these negative relationship patterns that are a direct result of dysfunction in the brain neurochemistry that make the disease of alcoholism seem to be a blur between biology and psychology. Before the disease model of alcoholism became accepted, people would argue at length about whether alcoholism was a biological or a psychological problem. We now understand that both are correct, the two are connected in the brain’s chemistry. The origins are the physical disease of addiction but after generations and generations, even if the use of alcohol stops, the effects of addictive illness continue along family lines with often devastating social and psychological results.
– by Dr. Al Mooney and Don Carroll
Dr. Al J. Mooney is a member of the North Carolina State Bar’s PALS Steering Committee. He is the author of The Recovery Book. He practices family medicine and addictions medicine at Cardinal Family Medicine located at 2424 South West Cary Parkway in Cary, North Carolina. W. Donald Carroll, Jr., is the director of the North Carolina State Bar PALS program.
From, The North Carolina State Bar Quarterly, Vol. 45, No. 4, Fall 1995Tags: addiction, alcoholism, brain chemistry Posted by