What Makes Alcohol Addictive?

According to a 2007 ranking of 20 substances, alcohol is not the most addictive of substances. Researchers ranked alcohol as the fifth most addictive, after heroin, cocaine, nicotine, and barbiturates.

Last Edited: 04/09/2021

Author: Stephen Bitsoli Stephen Bitsoli

Clinically Reviewed:

04/15/2021

Medical Reviewer:

Dr. Neil Shah

Dr. Neil Shah

Alcohol is potentially addictive, but not everyone is at the same level of risk.

Most people try alcohol at some point in their lives, but only some progress to alcohol use disorder or addiction, also known as alcoholism. Of people who drink, about 22% will become dependent on alcohol at some point during their lives.

That raises the question- what makes alcohol addictive to some people? As with most things, there are multiple risk factors. An individual with alcohol use disorder may have more than one.

Among the risk factors for addiction are genetics, heredity, environment, behavior, and psychology.

Dangers of Alcohol Addiction

According to a 2007 ranking of 20 substances, alcohol is not the most addictive of substances. Researchers ranked alcohol as the fifth most addictive, after heroin, cocaine, nicotine, and barbiturates.

Addictiveness is not the only measurement of how dangerous a substance is, however. People do not start using alcohol or drugs to become addicted, so they don’t evaluate hypothetical addictiveness when deciding to use a substance.

Likewise, a rare or obscure substance doesn’t cause much harm if no one can access it. Alcohol is readily and legally available throughout society with only a few limitations.

The World Health Organization (WHO) estimated that alcohol use worldwide contributed to the deaths of more than 3 million people in 2012. Other estimates stated that more than 33,000 Americans died due to alcohol use in 2015. This made alcohol the second deadliest substance after nicotine, which killed more than 437,000 that year.

When harm to others overall was added to the harm to users, alcohol rose to the most harmful substance in the United Kingdom-based on a much contested 2010 study. This included harm to the users’ families, the environment, and related criminal activities.

A separate Centers for Disease Control and Prevention (CDC) study in 2010 placed the economic cost of excessive alcohol use at $249 billion, based on lost workplace productivity, health care, law enforcement, motor vehicle collisions, and other damages.

Behavioral Risk Factors

Alcohol use disorders such as alcoholism used to be considered completely behavioral: alcoholics either chose to drink or were too weak-willed to resist.

While very few medical professionals still believe this, alcohol use disorders do have a behavioral component. One’s drinking history is a factor in alcohol addiction. The more some people drink, the greater the odds that they will become an alcoholic.

If people don’t drink or only drink moderately, they may not experience the negative effects associated with alcoholic beverages.

Alcohol—like many pleasurable substances—is often safe in small amounts for many people, but there are exceptions. Moderation is the best policy in terms of maintaining good health and overall safety.

One or two drinks a day on average is probably a safe rate of alcohol consumption, but that may depend on the how and why of the drinking. It could still be a sign of or lead to alcohol use disorder.

It’s safer than binge drinking (four or five drinks in a couple of hours) two or three times a week, but even that doesn’t necessarily indicate an alcohol use disorder.

The cause of and risk for alcohol addiction, like most addictions, seems to lie largely in genetics—approximately half, according to one report—but more specifically in alcohol metabolism related genes.

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Chemical Risk Factors

The human body is made of chemicals. That includes the brain. They are passed on from previous generations through their DNA (deoxyribonucleic acids), also chemicals. Alcohol and other drugs are also chemicals, and they interact with the neurotransmitters—more chemicals—in the brain.

Neurotransmitters naturally occur in the brain and in combination are responsible for transmitting signals, generating emotions etc. Some make people feel happy and block pain. Alcohol increases the production and release of these chemicals, making continued alcohol consumption seem more desirable.

Habitual use of alcohol or other addictive substances increases the risk of inhibiting the body’s natural production of neurotransmitters. Using more alcohol more frequently can create tolerance, so greater amounts of alcohol are required to produce the same effects and addiction becomes more likely.

These addictive factors in alcohol are so strong that almost one-fourth of all people who use alcohol in their lifetime will develop dependence at some point.

The four “happy” neurotransmitters are:

  • Dopamine
  • Endorphins
  • Serotonin
  • Oxytocin

A 2012 study confirmed that alcohol consumption releases endorphins in the pleasure-reward centers of the brain. These areas link to addictive behavior and decision-making. The more alcohol consumed, the more endorphins released, and the more intoxicated heavy drinkers become.

Alcohol significantly increases the concentration of neurotransmitters, especially dopamine (40% to 360%) and endorphins in the brain, providing positive reinforcement for continued and increased use of alcohol.

The brain may also stop producing as many neurotransmitters and less serotonin if alcohol use stops (negative reinforcement), at least in the short term.

There are many healthier ways to raise dopamine and endorphin levels than drugs or alcohol, —such as exercise (the “runner’s high”), laughter, sex—but they don’t provoke as strong a reaction and don’t cause intoxication.

Genetic Risk Factors

Many studies have concluded that genes explain a large proportion of cases of alcohol use disorder. There is no single alcohol addiction gene, however. A 2020 Yale University study found 29 genetic risk factors for alcohol abuse.

According to a 2018 study, one example is the gene GAT-3—a gamma-Aminobutyric acid (GABA) neurotransmitter that inhibits or stimulates the release of dopamine.

A deficiency of GAT-3 can cause a molecular dysfunction that may:

  • Make the brain crave alcohol over other evolutionarily desirable substances such as sugar.
  • Increase dopamine levels.
  • Make alcohol addiction more likely.

Other Physical Risk Factors

Other physical risk factors that increase the risk of alcohol use disorder include:

  • Gender. Men are almost twice as likely to abuse alcohol as women, including binge drinking and developing an alcohol use disorder. Part of the reason is that men are more prone to risky behavior in general- including other types of substance abuse and activities (sexual and driving).
  • Physical tolerance. Not everybody shows the same effects from drinking because some have a higher tolerance, but they suffer the same damage or impairment. The more one can drink without showing the side effects, the greater the likelihood of addiction also.
  • Physical withdrawal. Once physical tolerance develops, individuals no longer have the choice of quitting without enduring physical withdrawal symptoms such as clammy or unhealthily pale skin, nausea and vomiting, enlarged pupils, rapid heartbeat, hand tremors, and—in extreme cases—seizures or death. The desire not to feel these withdrawal symptoms is one factor that keeps people with alcohol use disorders drinking even if they don’t want to.

Psychological Risk Factors

The mind and the body are connected, and that applies to addiction.

Psychological dependence is when individuals know that a substance is harmful but still want it. It becomes the focus of their lives and thoughts.

Such psychological dependence may also have its roots in genetics. A 2018 Yale University study found that psychological disorders such as depression shared some of the same genetic risk factors as alcohol and other addictive drugs.

That doesn’t mean all addiction is genetic; that’s just one factor. There are psychological risk factors for alcoholism, such as mental health disorders.

Such mental health issues include:

  • Depression is a mood disorder characterized by extreme sadness and a lack of interest in doing almost anything. One study showed that almost 64% of people with an alcohol dependency concurrently have depression.
  • Bipolar disorder is alternating periods of depression followed by elation or mania. It used to be called manic depression. About 45% of people with bipolar disorder also have an AUD according to a review in 2013.
  • Social anxiety disorder is a fear of being watched or judged, such as public speaking. About 15% of people treated for alcohol dependence have social anxiety, and 20% of people with a social anxiety are also alcohol-dependent.
  • Post-traumatic stress disorder is stress related to violent trauma. According to the US Department of Veterans Affairs, roughly half of veterans reporting lifetime PTSD also had an AUD or other substance use disorder. That’s more than twice the rate for people without PTSD. For Vietnam veterans, it was almost 75%. This also afflicts non-vets.
  • Schizophrenia – Schizophrenia is a severe mental illness that affects the way people perceive and experience reality. Hallucinations and delusions can make it difficult to think clearly or govern their behavior leading to them living in their own version of reality. The prevalence of hazardous alcohol use among patients with schizophrenia was 6.4% in a study from 2017.

Co-Occurring Disorders

Alcohol use disorders—including the most severe AUD more commonly known as alcoholism— are associated with many psychological disorders. Sometimes they are linked. This co-occurrence is called a dual diagnosis.

In some instances, people with mental health issues try to self-medicate with alcohol or other substances. In others, substance use can cause the mental illness, especially when there genetic predispositions.

Alcoholism can both cause or be caused by such psychological factors. Alcohol can also intensify or trigger the symptoms of such disorders.

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Age Factors

Age can affect how the individual experiences alcohol. Raising the drinking age to 21 has a basis in science.

When someone begins drinking alcohol before age 15, the likelihood of developing an alcohol dependency becomes four times more likely than starting at age 21. The human brain doesn’t fully mature until age 25–30.

Alcohol abuse—including alcoholism and binge drinking—also reduces the density of white matter, resulting in the underdevelopment of the prefrontal cortex. This makes risky behavior more likely, including heavy drinking.

What compounds the problem is that alcohol doesn’t have as strong a sedating effect on young minds. They can drink longer before losing consciousness and hence do more damage.

Age also can affect how older adults experience alcohol. The effects of heavy drinking can become worse, and drinking levels that weren’t problems before can begin to have greater effects, causing intoxication or leading to health concerns such as cancers.

Personality Factors

Psychologists used to speak of people with a so-called addictive personality- people who always go overboard and are subject to multiple addictions in their lives.

The addictive personality supposedly consisted of entirely negative traits, described as:

  • Engaging in impulsive, risky, or thrill-seeking behavior
  • Dishonest or manipulative behavior
  • Being unwilling to take responsibility for actions
  • Selfish behavior
  • Feeling unmotivated
  • Having low self-esteem
  • Feeling socially isolated

That is now widely regarded as a myth because addiction is a mental health problem or brain disorder, not a personality disorder. One can have one or more of the above traits and not be an alcoholic, just as one can be an alcoholic without possessing many of these traits.

Addiction is a chronic psychological disease or illness. It is not contagious, like COVID-19, but is similar to diabetes or cancer. The addict may have engaged in behavior that led to the addiction, but others who engaged in the same or similar behavior may not become addicted.

There is some other factor at work, and it isn’t just personality.

Personality is the entire mental makeup:

  • Feelings
  • Thoughts
  • Motives
  • Intellect
  • Temperament
  • Skill
  • Morality
  • Attitudes.

Personality, like addiction, can be inherited (up to 50%). Personality is a combination of temperament and character traits, some of which may contribute to the likelihood of addiction.

The two temperament types most associated with worse alcohol addiction outcomes are hereditary and opposites:

  • Search for novelty: Impulsive, excitable, curious, and enthusiastic.
  • Avoidance of damage: Cautious, apprehensive, and fearful.

Opposites are more alike than many points between the two. Still, if such seemingly contradictory traits have a high rate of severe addition, anybody—with any personality type—may become addicted.

Religious Factors

Many religions view alcohol—or at least heavy alcohol drinking as a bad idea. Most preach moderation if not abstention. Still, some are more likely to allow drinking.

The following are some response according to a survey conducted by Pew Research Center:

Past month alcohol consumption rates:

  • Agnostics – 76%
  • No religion in particular – 61%
  • Catholics – 60%
  • Protestants – 51%

Past month binge drinking rates:

  • Agnostic – 33%
  • No religion in particular – 24%
  • Catholics – 17%
  • Protestants – 15%

Percentage of responders who viewed alcohol as “morally” wrong:

  • Protestants – 16%
  • Catholics – 15%
  • No religion in particular – 9%
  • Agnostic – 5%

The survey was not large enough or targeted to come up with any statistics about Muslims, Latter-day Saints (LDS), or Jews. LDS doctrine specifically proscribes wine and “strong drinks,” but 18% of its members admit they at least occasionally drink it.

There have been few studies of alcohol use disorders among or from those who identify as Jewish. Members of Judaism seem to have a low rate of alcohol consumption—and then too mostly wine—but this may be due to genetic factors more than religious or cultural ones.

It also may be due to denial. The existence of the dedicated 12-step group JACS—Jewish Alcoholics, Chemically Dependent Persons and Significant Others—suggests that there is some need for substance use treatment.

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Educational Factors

According to a 2019 study in Nature, there is a causal relationship with drinking patterns, not quantity.

Those with higher education:

  • Were less likely to binge drink and become dependent on alcohol
  • Drank less at a sitting
  • Drank more frequently with meals
  • More likely to drink wine and other alcoholic beverages with moderate alcohol content.

But a 2005 report from the Archives Of General Psychiatry found that:

  • While young people were in college, they drank more and had higher alcohol abuse rates than their non-college peers.
  • Those who did not plan to attend college drank more during high school than their peers who did.
  • Those who started college but did not graduate drank more than their peers who completed college and those who never attended college.
  • Those who graduated from college had lower lifetime rates of alcohol abuse than all other groups.

That suggests that a lack of or failed educational achievement might influence alcohol abuse.

Career Factors

Alcohol and drug abuse are nationwide problems that cut across all demographic categories, but there are some differences, according to the 2008-2012 National Survey on Drug Use and Health (NSDUH).

While the overall past month heavy alcohol use and illicit drug use (full-time, ages 18 to 64) was about the same (8.7% and 8.6%, respectively), combined alcohol and drug dependence in the past year was almost a percentage point higher (9.5%).

The differences grew when considered by profession.

For heavy alcohol use, the highest rates were:

  • 17.5% – Mining (5% for illicit drug use)
  • 16.5% – Construction (11.6% for illicit drug use)
  • 11.8% – Accommodations and food service (19.1% for illicit drug use; 16.9% for substance use)
  • 11.5% – Arts, entertainment, and recreation (13.7%, illicit drugs)

For illicit drugs, the highest rates were in the accommodations and food services industry (19.1 percent for the past month, 16.9% for the past year).

The categories didn’t include military personnel, but the 2015 Department of Defense Health Related Behaviors Survey (HRBS) found the rates were even higher, with 30% reporting binge drinking and 35.3% hazardous drinking.

Income Factors

Having a higher income also influences drinking. According to a 2015 Gallup poll of US drinkers by income:

$30k or less:
78% drink

47% had a drink in the past 24 hours.

30k to 74.9k:
67% drink

33% had a drink in the past 24 hours

75k or more:
45% drink

18% had a drink in the past 24 hours

Family and Environment

One can’t choose one’s family. Through adolescence, one can’t usually avoid them either.

If, as a child, one’s home is full of people drinking excessively or engaging in physical or psychological violence that leads to stress and trauma, the chance of alcohol use disorders developing is greater.

Likewise, if alcohol and drug use or violence are common in one’s neighborhood, city, school, or other surroundings, alcohol abuse is more likely because it is normalized.

Poorer neighborhoods are more likely to have billboards and advertisements promoting specific brands of beer and other alcoholic beverages.

If one doesn’t have a home, that can be a contributing factor too. As much as 80% of homeless individuals use alcohol.

There is no one cause or one gene associated with addiction, and alcohol is among the most addictive drugs. It can co-opt the brain, rewire it, and twist it. Don’t underestimate it.

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