Understanding Alcoholism as a Disease

Image Credit: Unsplash: Artem Labunsky

Andrea Beyer explores alcohol use disorder from a scientific and historic point of view.

Alcohol Use Disorder (AUD) is much more complex than just simply drinking to excess. It’s often accompanied by derogatory terms and is not acknowledged as a real disease. In an interview with UCD Professor Dr Keith Murphy from the School of Biomolecular and Biomedical science, he highlighted that in the medical world “it has been completely accepted that it is a brain disorder. It is a disease.” AUD is a medical illness associated with important changes in the brain. Addiction rewires your brain’s capacity to deal with stress, which creates a dependency for those suffering from AUD, which is showcased by their need to consume alcohol in order to cope with stressful situations. 

Professor  Murphy explained that all addictive drugs  “share in common an effect that they have on the brain, and that effect is that they activate a pathway in the brain called the reward pathway which uses a chemical transmitter or signal in the brain called dopamine”. Another change that happens in the brain is caused by this constant high reward system, the brain tries to fight back and inevitably the strength of the reward system is damaged. When a person suffering from alcohol addiction is not drinking alcohol they can experience severe episodes of sadness, known as dysphoria. 

The history of alcoholism as a disease: 

In an interview with UCD lecturer Dr Alice Mauger, historian of medicine, psychiatry and alcoholism, Dr Mauger noted that in the 1890s, doctors and psychiatrists began to look at the possibility of alcohol addiction being a disease rather than a bad habit. The medical journals and asylum admissions from 1900, show us that 1 in 10 asylum admissions in Ireland was due to “intemperance and drink”, which in simpler words means excessive drinking. There was a major problem worldwide concerning alcohol abuse as it was an underdeveloped field in the early 20th century. Dr Mauger highlighted in our interview that there was a huge issue with the readmission of people suffering from alcohol addiction because by law people who were admitted for excessive drinking would have to be dismissed once they were sober as they were not seen to be mentally ill or to be lunatics. 

The suggestion of alcoholism as a disease returned to medical conversations after the prohibition of alcohol ended in 1933 in the US. Dr Mauger described the event as “a ripple effect in shifting understandings of alcohol, which results in the development of a new disease view of alcohol.” One of the only justifications for alcohol to be legalised was the argument that not everyone was prone to become addicted and thus the concept of alcoholism as a legitimate disease emerged. 

Is there a genetic predisposition to becoming addicted to alcohol? 

Although there are no genetic variants that mean a person is bound to become an addict, Dr Murphy noted that “there is  an underpinning group of the population who are more prone to becoming addicted.” The ultimate question is why can some people binge drink recreationally and never become addicted while others may only drink a few times in their lifetime and struggle with long-term drinking problems?  Researchers have shown that a tendency to develop alcoholism can be passed down through generations, for example, studies done on alcoholism in adoptees demonstrate that alcohol use disorder is more strongly associated with their biological parents than with their adoptive parents. There is no gene for alcoholism, however, there is substantial evidence that genetic variants contribute to the predisposition of AUD. During the interview, Dr Murphy discussed non-genetic factors that lead to alcohol dependency such as age. He explained that if an individual is exposed to alcohol from an early age, especially in their  early teenage years, they are more likely to struggle with alcohol abuse as an adult. “Age is important because your brain is plastic when you are young, the brain is more flexible and can be adapted. If the brain is already plastic, it is easier for drugs to create the changes.” 

Treatments for AUD:

Contrary to popular belief, a person suffering from AUD cannot simply stop drinking, both Dr Mauger and Dr Murphy reinforced how dangerous it is to go “cold turkey” as it can be life-threatening. Dr Mauger highlighted that there are records from asylums detailing how doctors would give small amounts of alcohol to very heavy drinkers as a form of short-term treatment. However, the records do not specify why. We can speculate that doctors in the 19th and early 20th centuries understood to an extent the dangers involved with detoxing and alcohol withdrawal symptoms. 

Treatments today are more advanced and doctors manage withdrawal periods very carefully. Withdrawal treatments involve a combination of drug cocktails and psycho-therapies. Dr Murphy spoke specifically about a pharmacological drug called disulfiram. This drug blocks the metabolic breakdown of alcohol in the body. Normally alcohol eventually gets broken down into aldehyde, which further breaks down into water and carbon dioxide. However, when aldehyde builds up in the body and does not get broken down it elicits the state that we understand as a severe hangover. Therefore, the aim of disulfiram is for patients suffering from AUD to develop high sensitivity towards alcohol and subsequently then be put off by it. 

Is alcohol addiction a social issue? 

Alcohol is one of the most used addictive drugs worldwide and chronic alcohol abuse is linked to several psychiatric, medical and social problems. Addiction to alcohol goes beyond an individual’s suffering, it also has a long-term societal impact on their communities. Innocent people suffer laterally, the British Medical Association discovered that alcohol is connected to 60-70% of murders and 50% of domestic assaults. Alcohol can impair reasoning and the ability to make decisions, therefore it comes as no surprise that alcohol is heavily linked with crime. The ease of accessibility of alcohol is a catalyst for alcohol-related crimes and for the numerous victims of the disease. Governments have taken actions to regulate the consumption of alcohol, such as time limits for purchasing the substance, age restrictions, and minimum unit pricing, among other regulations. Alcohol addiction concerns us all and a shift in the language used around the disease needs to change to increase  awareness. If you or someone you know is suffering from alcohol abuse the HSE Drugs and Alcohol Helpline provide a confidential service via freephone (1800 459 459) and an email support service (helpline@hse.ie).