Alcohol dependency and the difficulties of withdrawal
Case study / by Conor D’Andrade
With the ability to trigger a powerful cascade of effects in our brain, alcohol is one of the most potent elements to introduce into our bodies. So how can some people develop a tolerance to it? Conor D’Andrade breaks down the process of developing alcohol tolerance and what makes it such a difficult issue to tackle.
For many people, a glass of wine with dinner or a quick pint down the pub is something to be cherished as the alcohol in these drinks acts on chemicals in our brain to induce a feeling of happiness and relaxation, providing a welcome break from the stresses of everyday life.
When we abuse this effect though, our body does what it has learned to do over millions of years: adapt. So, if we decide to drink alcohol regularly, its effects gradually lessen to the point that we need far more alcohol to induce the same euphoric response we experienced the first time we drank it.
For people with poor mental health who use alcohol as a way to deal with symptoms, building this kind of tolerance to alcohol is one of the many reasons why some people become addicted to it – and it’s also one of the hardest conditions to treat.
Why the ‘little over long’ concept doesn’t work
At this point, you might be thinking that an easy solution to this issue is to drink small amounts of alcohol to maintain a stable mood. But there are two major reasons why this is not possible with alcohol.
Firstly, alcohol is a depressant meaning that in the long run, once its euphoric effects have gone, it contributes to low mood. This results in a brutal cycle of low mood motivating alcohol consumption and alcohol consumption causing low mood – this is how alcohol dependency forms.
Secondly, as the liver (the organ responsible for processing alcohol in the body) is repeatedly exposed to alcohol, it becomes quicker and more efficient at breaking it down. This means that when repeatedly drinking alcohol, more will need to be consumed to achieve the same effect to make up for the liver’s improved ability to break it down – this is how alcohol tolerance forms.
The combination of alcohol dependency and alcohol tolerance means that when alcohol is used for self-medication – even in small amounts to start – it can quickly contribute to making the illness worse. And not just in biological terms. When people reach the point of needing to drink large volumes to feel functional, maintaining commitments such as jobs, friendships and relationships becomes very difficult. As these break down, the person is only left feeling worse and in need of more alcohol to feel better.
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Conor D’Andrade maps out alcohol’s journey through the body to the brain, and why some people struggle to keep their relationship with it under control.
The war with withdrawal
It is very common for people that have had a substance dependency for a long time to report that they no longer feel pleasure from it, and yet they remain extremely motivated to consume that substance when they try to stop. The same applies to long-term alcohol dependency too.
The first reason why this happens, and possibly the easiest to understand, is that withdrawal is an agonising process. Symptoms of alcohol withdrawal come on swiftly and are intense. As quickly as 6 hours after stopping drinking, people can experience anxiety, vomiting, shaking and more. At around 12-48 hours after drinking, more serious symptoms can present themselves, including hallucinations and seizures. At around 48-72 hours after drinking, these hallucinations can grow in intensity, and delusions and fever can also set in.
These effects are caused by an increased number of receptors that have formed in the brain to try and counter the effects of alcohol which, when suddenly there is no alcohol interacting with them, leave the brain in a highly excitatory state, to the point of hallucinating.
Because it is such a terrible ordeal, many people keep drinking to avoid the negative feelings of withdrawal rather than to experience the positive effects of alcohol. This is particularly important for people that are dependent on alcohol but are still working – if they aren’t in a position to get time off then they can’t allow withdrawal to interfere with their work.
The second reason why people develop an addiction to alcohol is a combination of increased tolerance towards a chemical in the brain called β-endorphin, and an increased sensitivity to another chemical called dopamine.
The amount of β-endorphin in the body is increased by alcohol consumption and is responsible for the euphoric effects alcohol brings. But, just like the liver builds a tolerance to alcohol after repeated exposure to it, the brain can build a tolerance to β-endorphin too. This occurs because specific glands increase in size and release higher levels of other chemicals that suppress β-endorphin.
At the same time as this tolerance towards what gives alcohol its pleasurable feeling builds, a sensitivity towards dopamine grows. Dopamine plays a key role in making us feel satisfied, and when we drink alcohol, dopamine levels increase. Unfortunately, once a person stops drinking alcohol and dopamine levels drop , they then feel dissatisfied. . Over time, becoming more sensitive to the actions of dopamine means that each time dopamine levels fall, the feeling of dissatisfaction becomes even stronger, increasing a person’s motivation to drink again in order to get rid of that negative feeling.
The importance of support
The difficulties of withdrawal are why professional rehabilitation is so important for helping people recover from alcohol dependency. Unfortunately for many low-income people – who are the most likely to experience alcohol dependency due to its relative ease of access and increased rates of mental illness among the low-income populations – accessing these services is not always possible.
A support network then becomes a crucial part of the solution for people recovering from alcohol dependency. Having a loved one to provide comfort, food and water makes it significantly more likely that an individual can fight through the effects of alcohol withdrawal.