What is alcoholism, addiction or a disease? 


When we look at answering the question “what is alcoholism?” we look at the malfunctioning of the brain rather than alcoholism symptoms.

Ordinarily, the frontal cortex, (which in evolutionary terms is the more recently evolved area of the human brain dealing with morality, judgement, choice, attachment and spirituality, socialisation, the ability to understand the world and understand consequences and attach emotional meaning) has control over the midbrain but in alcoholism and any other addiction, the midbrain takes over.

The drug (any addictive drug but for the purposes of this article, alcohol) hijacks this survival part of the brain and with continued use makes the drug and survival indistinguishable.  The midbrain fools the brain into thinking alcohol is better than all other things for survival.  This means that the midbrain associates alcohol with survival itself and so the need for alcohol takes precedence over every other survival function – food, sex, self protection, shelter, rest, everything.

Alcohol becomes life itself; the only way to get through the next 15 minutes alive.  The midbrain’s trick was to release dopamine, which handles the “drug wanting” and which it does when it is told something is especially good.  Remember that the midbrain is not conscious, it doesn’t judge or decide what is good for it and alcohol has hijacked the brain to tell it that this is the number one best survival tool around, causing the neurons of the midbrain to release dopamine (the drug of wanting more drug) in higher and higher doses.  This is alcohol addiction.

All this dopamine fixes memory through the frontal cortex by causing the frontal cortex to release glutamate.  Glutamate fixes into memory all the sights, sounds, smells and experiences that go with the dopamine release period.  In the case of the alcoholic, all the things that surround the seeking and obtaining of alcohol – the row with the wife, the slamming door, the sneaky drink in the pub between grocery shopping, the atmosphere of the pub, the friends drinking, the action of lifting the glass, the smell of the pub dog, somebody laughing, sunshine, holidays, a cigarette, the supermarket drinks isle –whatever it is – glutamate fixes a pleasurable memory into the brain.

Every time there is a trigger event, the frontal cortex sends glutamate neurons down into the midbrain to say “go get it” to the midbrain – the midbrain doesn’t think – it does as it’s told – the survival mechanism.  Over time these neural pathways become superhighways due to over use and the normal pathways become weak – the frontal cortex doesn’t get involved now because the whole program is sub conscious (like riding a bike).  Psychiatrists call this the pathological overlearning of a drug.  It is a fact about alcohol that more should know.

Next, under stress, the brain releases another drug to counter the dopamine surge (for example after a big binge) in order to restore balance to the brain’s delicate chemistry.  The brain can only reset control by resetting its set point at a higher level (a bit like raising the bar in high jump).  Now that the brain is reset to control dopamine, the levels of dopamine aren’t enough to give any feelings of pleasure.

The addict feels no pleasure in any normal activities and needs a fix to get over the bar and feel pleasure – the only thing that works at this point is the drug or another type of drug.  This is why a recovering alcoholic is very susceptible to relapse in times of stress and they won’t know why because the process is all subconscious.  This is the suffering of alcoholism.

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