What makes alcohol so addictive?

Addiction is regrettably an unavoidable topic when it comes to alcohol. In the UK alone, there are an estimated 600,000 ‘dependent drinkers’ - that's people with an excessive, sometimes uncontrollable, desire to drink. So what drives the compulsion to drink? To talk about alcohol’s addictive nature, and what can be done to help it, is Matt Field from the University of Sheffield…

Matt - It's a social lubricant. It produces a pleasurable feeling of intoxication and relieves anxiety at least in the short term. So, it produces a lot of immediate beneficial consequences. In terms of what it does in the brain. It operates on the neurotransmitter GABA, which then has a number of downstream effects on other neurotransmitters and like all other addictive drugs. What it does is it influences the brain's reward circuit. And that circuit is involved in not only how we experience pleasure, but also how we learn about which behaviors are good behaviors and behaviors that we should repeat. So it influences our learning and our motivation. And what we ultimately learn is we learn that drinking alcohol is a behavior that we want to repeat, and that that desire to repeat the behavior can then be triggered by cues in the environment that we associate with alcohol.

Chris - We've all got those traits. We all have a brain that has those characteristics. You've not said anything about a person who's susceptible to this happening that's any different from anyone else in the human race. So what is it about people who succumb where this becomes excessive?

Matt - There's certainly some heritable risk factors for addiction, so for alcohol use disorder. So if you have a family history, then you're more vulnerable to it. Perhaps more importantly these adaptations in the brain are dose dependent. So they'll occur to everyone to an extent and that will be proportional to the amount that you drink. But the more that you drink, the more those adaptations in the way the brain works will kind of manifest themselves.

Chris - Do you find that addiction with alcohol works the same way as addiction to anything else, whether it's crack, cocaine or heroin? Is it the same process, the same endpoint a person has a physical dependency, just it's how they get there.

Matt - The medical manuals which characterize different mental disorders, including the addictions, actually the way that they describe addiction to alcohol is very similar, is almost identical to the features of other addictions such as cocaine and heroin and so on. And actually those physical changes that you talk about, things like tolerance and withdrawal, they're an important part of addiction to all kinds of drugs. But there are a host of other features which are shared across addiction as well, such as loss of control. So an inability to control, or a difficulty in controlling drug use. Strong cravings also like harmful effects that Linda was just talking about. Damage to your health, but also to relationships and so on. And also changes in behavior. So you spend more and more time using the drug and less time doing other things that you find pleasant.

Chris - Is part of the problem that it takes a long time before you've accumulated enough damage that perhaps you notice or other people notice. Because I remember there was a documentary made for the BBC by Adrian Chiles, a broadcaster in the UK and he called it 'Drinkers Like Me. And he just described what most people would regard as a pretty normal lifestyle. But when he then went and did some medical tests and found actually there was evidence of damage already in his system and we were just hearing from Linda that alcohol does not have a safe level. It's always a bit damaging, but it's a trade off. Is it that it's socially acceptable, it's very available and you have to go a long way, way down the track before the obvious damage is visible to you or others. That as a result people often are far down that slippery slope before they suddenly realize perhaps they should reign it in.

Matt - That's right, and actually I've just finished reading Adrian Chiles' book, which is very informative. Yeah, that's absolutely right. I think a lot of people who are drinking more than is good for them. People tend to hang around with people who drink similar amounts to them. And so it's, it's always easy to find someone to think of someone who drinks more than you do. And a lot of people have this kind of stereotype of what an alcoholic looks like, you know the whiskey on the cornflakes type thing, and people, and it's really easy to convince yourself 'well I'm not like that so I'm not that bad.' Or such and such is worse than me. And so it's very easy to convince yourself that you're not doing yourself any harm when in fact you might be.

Chris - What are the danger signs for someone to look out for?

Matt - If you try to cut down and find it really difficult then that's probably quite a big red flag. Also, the way in which you start using alcohol. So if you find that you are primarily sort of drinking alone or drinking to manage a negative mood, those things tend to be associated with the development of a problematic relationship with alcohol. But the big one to watch out for is if you try to cut down and you struggle. And that's why something like Dry January can be quite helpful because people might think they'll be able to do it quite easily, but they may find it more difficult than they thought. And if that's you, then it's a good idea to ask for some help.

Chris - And just in the last 30 or 40 seconds, if either you yourself notice a problem perhaps trying to engage with dry January or among friends you notice some friends or colleagues that appear to be struggling, what should you do?

Matt - Well speak to your GP in the first place who will most likely be in a good position to refer you on to other services. But there's also lots of kind of self-help things which are very helpful. If you look on the NHS website, there's some good advice for what you can do to cut down and when you might need to seek specialist help. So those would be the first things I'd recommend.

Chris - Thank you Matt, very much for that very helpful, comprehensive overview. That's Matt Field. He's at the University of Sheffield.