Many individuals treat alcohol as a solution to their life’s problems. When consuming alcohol becomes problematic and hijacks the brain, it leads to alcohol use disorder (AUD). AUD is a chronic relapsing brain disease that is accompanied by persistent alcohol use, loss of control over alcohol intake and a negative emotional state on withdrawal from alcohol.
According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), about 16 million individuals are living with AUD in the United States. Drinking puts considerable stress on the society through myriad ways, such as the economic burden of treating alcohol-related problems, underage drinking, alcohol-related accidents and deaths. It not only affects the individual who drinks alcohol but also his or her family who has to deal with this alcoholism.
Three stages of AUD
To reduce the public health burden and drive medical advancements in the field of treating alcohol-related issues, a continual process of research is required. Understanding the mechanism by which alcohol affects people is crucial for developing new means and tools to arrest alcohol abuse over large demographic regions in an effective way. At this point, the onset of AUD is best described through a three-stage cycle as given below:
- Binge or intoxication stage: This stage shows how drinking affects the key regions of the brain, specifically the nucleus accumbens and striatum located in the basal ganglia. The nucleus accumbens is associated with experiencing the pleasurable effects of alcohol. When this brain region is activated over and over again, it builds habits that complement the development of compulsive alcohol use and the development of relapse triggers. It also develops a phenomenon known as incentive salience that depicts how people begin to intensely desire alcohol and levitate toward drinking when exposed to alcohol-related cues.
- Withdrawal or negative effect stage: When an individual develops increased dependency on alcohol, his or her body automatically begins to inhibit the production of the neurotransmitter dopamine. Dopamine is largely associated with the reward centers of the brain with special links to neurotransmitters that activate stress and counter stress. During the phase of withdrawal from alcohol, these functions contribute to the development of the overwhelming feeling of unease, anxiety and irritability. This further increases the cravings for alcohol and other substances. The deficit of dopamine, activation of the brain’s stress mechanisms and development of incentive salience drive the motivation to drink and the likelihood of witnessing a relapse when not consuming alcohol.
- Preoccupation or anticipation stage: In this final stage, the changes in the brain occurs in the prefrontal cortex. It is the brain region responsible for executive functions, such as the ability to systemize thoughts and actions, prioritize tasks, manage time and make decisions. The function of the prefrontal cortex can be divided into a “go” system that controls impulsive behavior and habitual responding and a “no-go” system that inhibits such responses and exercises control over the “go” system. Research has discovered that heightened activities in the “go” system or low activity in the “no-go” system can contribute to binge drinking by regulating the activation of the brain stress systems and inhibiting the response to alcohol-related cues. Furthermore, these mechanisms also control how a person experiences cravings and succumbs to a relapse.
The three-stage model of AUD not only explains how alcohol can take over the brain, but also explains the impact of quitting its habit. The changes in the neurotransmitters and other activities of the brain following alcohol cessation persist for long, even years before the brain naturally stabilizes. Recovery is not a simple task, especially when addiction is so multifaceted in nature in AUD patients. Fortunately, the disorder is treatable in the right medical set-up and individuals diagnosed with it can attain sobriety.