Why some people can’t stay away from alcohol, even when they know it’s hurting them

By Madeline Holcombe, CNN

(CNN) — Researchers came to Dr. Chris Knowles’ school in England when he was 18 years old to run an experiment. They wanted to see which novice drinkers responded the most to alcohol and who would later go on to develop a drinking problem.

They placed two double vodkas in front of each student to measure their reaction, he recalled. Knowles downed his and then reached over and drank the two belonging to a girl next to him, who didn’t care much for liquor.

Knowles, now a professor of surgery at Queen Mary University of London and author of a new book on the science of excessive drinking, said he later went on to seek treatment for alcohol use disorder.

Research has shown no amount of alcohol is good for the heart or brain. Despite those findings, and often personal consequences for some drinkers, excessive alcohol use is fairly common, with 17% of adults in the United States reporting binge drinking, according to the US Centers for Disease Control and Prevention.

Describing his time drinking as 10 years of fun, then 10 years of fun with negative consequences and another 10 years of only negative consequences, Knowles has investigated alcohol’s appeal in his new book, “Why We Drink Too Much: The Impact of Alcohol on Our Bodies and Culture.”

The short answer to why humans drink? “Because it’s fun and because we learn that good things happen when we do it, or at least we think good things have happened when we did it,” Knowles said.

The long answer offers insight into why some people struggle more than others and why they keep drinking, even when it becomes clear good things aren’t happening.

Wired for alcohol

When he thinks back to friends from his early drinking days, plenty of them drank less than he did –– but he also knew some who drank a great deal more than he did and didn’t develop any problems, he said.

The same might be true of your friend group. There isn’t always a direct correlation between those who drink the most and those who will have a problem, Knowles said.

How much someone drinks and the relationship a person has with alcohol comes down to many factors, including environment, biology and psychology, he said.

Alcohol stimulates some of the same pleasure centers of the brain as those that give a feeling of reward when you seek out necessities such as food and relationships, Knowles said.

But alcohol also works on the negative side, too.

“The more you drink, the more you drive those stress neurotransmitters, and so you’re miserable when you’re not drinking,” said Dr. George Koob, director of the National Institute on Alcohol Abuse and Alcoholism.

“You’re really digging that hole, and you’re drinking to fill the hole. But unfortunately, every time you try to fill the hole by drinking, you’re making the hole deeper.”

When talking about biological factors behind excessive use of alcohol, it is easy to assume that some people are just physiologically wired to take a drink and have their brain say, “More, now” –– like young Knowles with vodka. And there is truth to such thinking because some people’s physiology will just agree more with alcohol, said Dr. Danielle Dick, director of the Rutgers Addiction Research Center and a professor of psychiatry at the Rutgers Robert Wood Johnson Medical School.

But that physiological factor isn’t the whole story, she added.

A major part of the biology behind who develops problematic use of alcohol has to do with how an individual’s brain is wired to process rewards and risk, Dick said.

Alcohol use is rewarding in the brain, and when a brain is wired to seek out a lot of reward and worry less about risks, such a person is more likely to fall into a pattern of wanting to use more and more, she said.

Drinking to escape

Humans also tend to drink –– especially past the point in which they feel good –– because of psychological factors.

People with conditions such as attention deficit hyperactivity disorder, bipolarity, schizophrenia and post-traumatic stress disorder are at particularly high risk for substance abuse, Knowles said. But psychological traits such as neuroticism, low self-esteem, anxiety and depression also increase risk.

People who only drink for fun are not likely to develop a dependency, Knowles said. It doesn’t mean that binge drinking at parties won’t lead to health problems down the road, just that the reasons people drink when they do can make a big difference.

Yes, some people just drink to enjoy, but many also consume alcohol to experience a boost in confidence or performance or to relieve stress, sadness or difficult memories, Knowles said. Those additional motivations can work against you, he said.

“There’s an old adage, ‘If drinking is a problem, you’re in with a chance. If it’s your solution, you’ve already lost,’” Knowles said.

If you are experiencing difficulty and alcohol feels like it turns on a light and allows you to escape that hardship, drinking is a hard thing to turn away from –– even if you are starting to see that it isn’t helping like you had hoped, he said.

Compounding the problem is the development of a tolerance.

Your tolerance isn’t just the number of drinks you can have and still hold a conversation or walk in a straight line. It is also how many drinks you need to have before you get the same good feeling or relief from bad ones, Koob said.

The more you drink, the more you need to keep drinking to get the same effect, he said.

The continuum of problem drinking

There aren’t just two types of drinkers –– those who have a problem and those who don’t have to worry about it, Dick said. It is a continuum.

On one side, there are those who don’t drink at all, those who may drink sometimes but don’t particularly like it, and those who drink but in a way that feels healthy and manageable. On the other side of the continuum are people who are considered to have a clinical alcohol use disorder, which can be mild, moderate or severe.

Diagnostic criteria for alcohol use disorder include factors such as continuing to drink even though it is affecting your job or family, getting into dangerous situations and having withdrawal symptoms, according to the National Institute on Alcohol Abuse and Alcoholism.

In the middle are those who call themselves gray area drinkers, Knowles said. It isn’t a medical definition but rather an acknowledgement of unhealthy drinking patterns.

They haven’t had issues at work because of their drinking, haven’t lost relationships or suffered health issues yet. But they may not be performing at their best, feeling present with their kids or dealing with stress or hardships effectively, Knowles said.

Drinking less, or not at all

Cutting back no matter what level of drinking you are at can have health benefits, Dick said.

A change in a relationship with alcohol should start with a period of abstinence, Knowles said. Challenges such as a Dry January are a good opportunity to take a step back and break down the role alcohol plays in your life.

From there, it is important to educate yourself on the pros and cons of drinking, find a way to engage in support and community that doesn’t center around alcohol, and learn to address the psychological problems that alcohol may have suppressed, Knowles said.

For those gray area drinkers, that can mean reading books on drinking and sobriety, addressing underlying stresses and finding new ways to socialize.

Although it feels like alcohol is a part of everything, in general, people are drinking less than they did in earlier generations, especially younger ones, Dick said. And with that decline has come a rise in mocktail and nonalcoholic drink culture. Finding those alternatives can be a good way to engage in social routines without grabbing an alcoholic drink, she said.

For people who have clinical alcohol use disorder, support groups such as Alcoholics Anonymous, treatment centers and medical detox resources may be crucial.

The National Institute of Alcohol Abuse and Alcoholism has a resource to help people find treatment options for them in their area, Koob said.

The key, however, is to readjust how your brain gets rewards and deal with the stress that might motivate alcohol use, not just to try to cut back on drinking, Knowles said.

When it comes to maintaining sobriety, “most people who are proudly showing you their 35-year pin are going to tell you it’s a lifelong effort,” Koob said.

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