Apart from caffeine, alcohol is probably the most normalized substance in most societies around the world. It is heavily integrated into many cultures and is associated with all social classes, probably because it is so accessible. Most people end up drinking at least once in their lives.
While not inherently harmful in small doses, we need to take a look at the bigger picture. What does alcohol mean in the long term? What are some of the other side effects of drinking? What does drinking actually do to our brains?
There are many risks associated with drinking, including liver and heart diseases. In this article, we will discuss the specific behavioral mechanisms involved in drinking and relapse in those with chronic alcohol abuse.
Please note: I am by no means an expert, and this article was written purely out of my own interests for entertainment and informative purposes. If you are in need of help or rehabilitation, please reach out to a healthcare professional.
What is Relapse?
The effects of addictive substances such as alcohol are well-known; nobody wants [insert any disease name], so it’s common to see people attempt to “quit”. This is often followed by a period of withdrawal, where a person may act irrationally, feel extreme physical and emotional pain, and feel hypersensitive to everything around them.
Relapse is the return to an addictive substance after a period of abstinence. Severity of effect on health depends greatly on the substance, but regardless it is negative.
Relapse occurs for a variety of reasons, including:
- escape from negative feedback mechanism of withdrawal
- environmental factors
- peer pressure
- habit
In this article, we will focus on withdrawal in the brain and habit, but it’s critical to acknowledge these critical factors when looking at addiction.
Withdrawal in the Brain
Glutamate, one of the most common excitatory neurotransmitters in the brain, is responsible for a lot of action potentials that occur in the brain. Its receptors, alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) and N-methyl D-aspartate (NMDA), are particularly abundant in the hippocampus (center for memory), the amygdala (center for emotional processing), and the prefrontal cortex (the center for critical thinking).
Alcohol as a Depressant
Alcohol is a depressant, which means that it decreases the effects of the neurotransmitters. In particular relation to the brain, ethanol blocks AMPA and NMDA receptors from receiving glutamate, and so action potentials are not achieved as often as they usually are. This results in the feeling of intoxication.
Decreased excitatory activity in the hippocampus explains why some people wake up the morning after drinking heavily without any memory of the night before. Because ethanol dampens the hippocampus, it may be more difficult to create or retain memories.
Ethanol in the amygdala means that there’s less emotional processing that occurs when a person feels “drunk”. That’s why it’s common to hear people drinking to “numb” themselves from bad feelings – they literally have slower emotional reactions and thoughts.
In the prefrontal cortex, decreased activity is detrimental because it means decreased critical thinking. This is why people who drink often act irrationally or have untrustworthy senses of judgement.
The Brain’s Response:
The brain detects a lack of glutamate reception, and upregulates the glutamate genes. This means that more glutamate is being released, and post-synaptic neurons increase their rate of glutamatergic receptor synthesis.
- This explains why, as addiction progresses, individuals need to drink increasing amounts and concentrations of alcohol to achieve the same “numbing” feeling.
Withdrawal on a Molecular Level
When a person stops taking in alcohol, the brain suddenly has much more glutamatergic receptors and glutamate than it usually has. It receives a sudden amount of glutamate, leading to hyperactivity. Especially in the amygdala, this hyperactivity can lead to emotional irritability and increase negative emotions easily.
The Good News
This can be reversed! Over time, if ethanol does not enter the brain, it will recognize that it is receiving too much glutamate and will downregulate the genes that form glutamatergic receptors.
Alcohol as a Habit
As mentioned previously, environmental factors often play a major role in relapse. Triggers can cue a habit to form, and over a long amount of time can induce relapse.
LTP: Long-Term Potentiation
LTP, long-term potentiation, is the act of your neurons growing closer together as a result of their synapse being fired often. This occurs as a result of two factors: the initial impact of the memory that the synapse triggers, and the number of repetitions that action potentials were fired.
This essentially means that if a memory was particularly significant, then the neurons would grow closer together, and it would be harder to forget. Childhood trauma is an example of a deeply significant memory that could be difficult to forget. Neurons will also grow closer if their connections are used very often (i.e. you recall this memory very often). An example of that is the memory that you have to turn the lights on if a room is dark.
When you don’t recall a memory often (i.e. the signal between neurons is rarely fired), the neurons will move farther and farther away from each other, resulting in what we call “forgetting”.
Habit Formation
Psychologists have theorized the model for habit formation occurs in three steps: cue, action, and result. Habits follow the second factor of LTP: repetition. The more you repeat a habit, the stronger it becomes.
Within addiction, cues vary, which is why identifying triggers is so important.
The action is always the active intake of alcohol. And the result is a feeling of intoxication that is often followed by guilt.
In order to break habits once they have formed, the easiest step to undertake is to remove the cue. However, this is easier said than done because cues look, sound, and feel different to each individual.
This ultimately makes breaking a habit of addiction incredibly difficult, especially since there is no one-size-fits-all solution.
TL;DR
Chronic alcohol use has detrimental effects on the brain, and can become a vicious cycle of addiction. Habit formation and societal structure makes it very difficult to escape the cycle of addiction. But there is hope: if one is able to abstain from alcohol for long enough, its effects will eventually be reversed. There are also many who have rehabilitated successfully!
If you or someone you know is seeking help or rehabilitation, please reach out to a healthcare professional. The sooner you receive the help you need and deserve, the better.