Misconceptions About the Neuroscience of Alcohol Addiction
Written by Jade McNulty BMS'23 Neuro‘23
Published on November 10, 2020
Uninformed people believe that those who suffer from alcohol addiction have a choice. Since drinking is often associated with the euphoric feelings of celebration, people presume that individuals who consume the drug are obsessed with the warmth it elicits. They surmise that alcoholics depend on the infatuation of getting high and will do anything to fulfill their thirst-driven desires. Unbeknownst to them, there is a critical difference between liking and craving, as wanting is not always positive. Instead of having a choice, sufferers of addiction become controlled by the drug and form unconscious habits linked to overconsumption. It is an automated reaction, and in time those celebratory emotions cease to exist. Yet the drug misuse continues.
To understand the science of addiction, one must first understand the neurochemistry behind it. Emotions, learning, and memory are all rooted within the formation of the brain known as the hippocampus. Connected to the emotion-experiencing amygdala and involved in both the making and storing of memories, this petite portion of gray matter plays an important part in determining behavior. Behavior is a culmination of decisions that form as the hippocampus has a direct neural pathway to the nucleus accumbens. The nucleus accumbens is a crucial part of the reward circuit and works closely with mechanisms of pleasure within the ventral tegmental area. It connects the reasoning and planning processes with the seat of emotions through the control of dopamine.
Dopamine manages the brain’s reward center, including the prefrontal cortex and the ventral tegmental area. The neurotransmitter pathways function within this system by eliciting pleasure and compulsion through neurotransmission. Alcohol promotes the release of dopamine within the body, causing a state of exultation while stimulating the hippocampus to trigger memories associated with previous drug use. Without dopamine, anhedonia - dysfunction within the pleasure center – occurs, leading to depression and cravings.
To function normally, the process of neuroadaptation allows the body to compensate for the presence of a chemical. The diversion from dopaminergic to excitatory glutamatergic pathways causes the drug use to evolve from impulsive to compulsive action. Addiction forms its bearings within this unconscious control, leading to reinforcement due to the switch within the neurotransmitters of dopamine and endorphins. Association between alcohol and pleasure causes a settled tendency, a learned habit, and ultimately a dependent behavior. Similarly to the unconscious desires of appetitive cues, alcohol signals a physiological response that is independent of feelings of pleasure. The psychology of cravings is not a sentient desire, but the unknowing yearning causes many to over drink to try to regain control.
As intake increases, tolerance develops and it causes a new homeostatic balance. This balance is disturbed when alcohol intake is suddenly stopped, resulting in clinically manifested withdrawal symptoms. These feelings of withdrawal are inevitable and are typically the pathway to setback. Yet even free from physical withdrawal systems, 85% of alcohol use disorder patients relapse. For it is not the emotions, whether they be pain or pleasure, that cause addiction: the foundation is an inert, deep-seated, natural tendency to act.
Everything within the body is connected, and through unconscious desires, many fall victim to a dependency on alcohol. When drinking, the brain’s executive function within the frontal cortex is hijacked and judgment is impaired. This is what causes the change from an addiction to a behavioral problem. Treatments for alcohol addiction need to be more multifocal and target neural, behavioral, and external issues in order to effectively prevent relapse. This three-prong approach focuses on all the main factors that influence addiction. Alcohol awareness meetings and drugs like naltrexone are limited to tackling one concern and thus can only do so much. The problem must be truly addressed in order to find the best solution.