Alcoholism: The Brain and The Beast

By Bill P.

The human body is a wondrous thing. When a foreign substance, such as alcohol, a toxic chemical, is ingested in large amounts over a considerable period of time, the body “adapts” to the substance, developing tolerance and becoming physically dependent upon it. This changes our brain chemistry. These take place in the neurons’ receptor sites, altering the balance of glutamate and gamma-aminobutyric acid (GABA), and in transmitters such as dopamine, serotonin, acetylcholine, and norepinephrine.

Neurotransmitters are substances that convey data from one neuron to another. Neuromodulators resemble neurotransmitters but differ from them in that they tend to remain in the synaptic gap between neurons at levels depending on receptor uptake. For example, serotonin levels are increased by medications which inhibit uptake. They are frequently used to combat depression. Dopamine levels are increased to lessen the effects of Parkinson’s Disease. An excessive increase in dopamine, however, may result in hallucinations.

Deep in the lower recesses of the brain, close to its junction with the brain stem and the spinal cord, lie the more primitive areas (nucleus accumbens) such as the amygdala in the limbic system, sometimes colloquially referred to as the “lizard” brain. This, a product of an earlier evolutionary phase of brain development, responds to physical needs like hunger and thirst, and stimuli that produce fear, anger, and sexual appetite. It is pleasure seeking, demands immediate gratification (“I want what I want when I want it and I want it right now!”), and, when denied what it wants responds with child-like rage.

The ingestion of alcohol over a protracted period leads to physical and chemical changes that foster dependency and addiction. When the alcohol supply diminishes, the primitive brain seeks to distort the more rational thought processes of other brain areas. For the addict, this conflict within the brain results in a divided self. One part craves the alcohol that will satisfy the addicted part of the brain and tries to override the rational areas of the brain that are now increasingly numbed or anesthetized by long-term alcohol use. The other part knows the damage that the addiction is doing and wants to break free of the alcohol.

Programs such as Rational Recovery offer techniques to enable a person to listen to the “inner voice” (referred to as “The Beast”), disabling it and preventing its influence over the normally rational self. This “inner voice,” called the AV (addictive voice) by Rational Recovery, responds to alcohol-induced changes in brain chemistry and neurology by sending crude messages to a numbed and underdeveloped cerebral cortex such as “it’s fine to have just one more,” and “that first drink did no harm, so I guess I can drink like everybody else at this party.”

Rational Recovery claims that once The Beast has been recognized, brought under control, and successfully caged the urge to drink will disappear.

Recent findings indicate that the amygdala, which forms part of the primitive portion of the brain, develops more rapidly in adolescents than the more rational areas of the cerebral cortex. The amygdala deals with sensitivity, our response to fear, and our reactions to risky situations. Adolescents are more prone to experience fear, for example in certain social situations, and have greater difficulty unlearning automatic fear responses. For a further discussion of this see “Why Teenagers Act Crazy,” by Richard A. Friedman, a Professor of Clinical Psychology at Weill Cornell Medical Center, in New York (New York Times, June 29, 2014).

Teenagers are also prone to be risk takers. If in addition, they are socially awkward, shy, withdrawn, and lonely they are even more vulnerable. When they experience uneasiness, again, such as in social gatherings, they may respond by self-medicating with alcohol or with pharmaceutical psychostimulants like Ritalin and Adderall, the sales of which increased more than five-fold in the decade from 2002 to 2012. To make matters worse, the drinking culture at many high schools and colleges poses a challenge to vulnerable students. They may graduate from college not only with debt but with the beginnings of serious addiction.

Scientific research also indicates that alcoholics may have inherited genetic characteristics that cause their bodies to react to or metabolize alcohol in atypical ways. These people may have inherited a marked sensitivity or allergy to alcohol. Studies in England have revealed that single base-pair point mutations in a particular gene (Gabrb1), an important part of the GABAA receptor in the brain, have a particularly strong effect on the brain’s pleasure center (the nucleus accumbens) of laboratory mice, causing them to prefer alcohol containing liquid (primarily wine) over water at least 85% of the time.

Other research suggests that persons prone to addiction may have abnormalities in an area of the brain known as the medial forebrain pleasure circuit, where the neuromodulator dopamine plays a crucial role. On this see a recent study by Neuroscience professor David J. Linden of the Johns Hopkins University School of Medicine entitled The Compass of Pleasure (New York: Viking Press, 2011). You can also see the book by the well-known scientist-writer Marc Lewis called Memoirs of An Addicted Brain- A Neuroscientist Examines His Former Life on Drugs (New York: Public Affairs, 2012).

I was responsible for my alcoholism since it happened “on my watch.” When I became alcoholic, it was also my responsibility to do something about it, to get myself into recovery, and that took me too long because I was a slow learner. In denial, I thought I could drink moderately. Eventually, I learned I was wrong. I wish I had had the help of others on the internet, but that didn’t exist in those days. I should have sought the support of other recovering alcoholics in AA or elsewhere. That would have been the “higher power” which could have speeded my recovery. But that’s all in the past. I must live in the “Now.” I am old now, and the future is uncertain. So “now” I hope to help others. That’s why I have written this.


About the Author, Bill P.

Bill P. has had a long and successful career as a law professor, retiring in 1997. Since then he has focused on helping others with alcoholism and drug addiction. He has a web-site, Alcoholism, and the Higher Power, that offers guidance on how to utilize AA despite its “god stuff.” He also routinely posts on soberrecovery.com. Bill does not believe himself to be an agnostic, much less an atheist, but he appreciates what agnostic AA meetings have to offer. He lives on the east coast with his wife and an exceptionally wise and loving English Cocker Spaniel.

Audio Story:

The audio story was narrated and recorded by Len R. from Jasper, Georgia. Len is interested in starting a secular AA meeting in his area. If you would like to join him, please send an email to lenr.secularsobriety@gmail.com

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Thomas Purtzer

I have been sober for 36 continuous years in AA. I was a neurosurgeon for 20 years and have studied the brain and neuroscience for over 40 years. This is a great article and will be helpful to a lot of people. That is what us recovering alcoholics and addicts really want to do and you have done that very well here in my opinion. I am a born-again, water-baptized Christian who wants to help anyone suffering from addictions and possibly pull them back from death and disability. Reading on the Internet tells me that 88,000 people die each year… Read more »

Galen T.
Galen T.

Bill- Thank you for your informative and well-researched article.  I notice that despite all the evidence you cite about the effect of alcohol on the brain you don’t label alcoholism a brain disease.  In fact, in the final paragraph you count yourself as responsible for your addiction. As you know, the debate is fervid and ongoing.  Is alcoholism an inherited disease entity, a learned behavior, a product of personality twists and psychiatric ailments, a consequence of socio-economic factors, or a predictable outcome  of childhood trauma?  Probably all four, with one or two others thrown into the mix.  For any one… Read more »

Tommy H
Tommy H

Well said, Bill.

Victoria
Victoria

Hi Bill,

Great to see you doing your thing amongst the broader church 🙂

For any here wondering: I know Bill from his wonderfully eccentric and very wise posts over at soberrecovery (itself, a very broad ‘church’, encompassing large sub-sets of people travelling many different journeys to recovery from addictions). Many of which are neither fish nor fowl, or both.

Thanks for contributing here too at AA BB, Bill.

Warm regards, and a big paw-pat from Bessie (blue heeler – border collie) to your doggie.

Vic

 

Grimpeur
Grimpeur

Perhaps the greatest asset AA has is revealed when a member says “in my experience…”. Anything beyond that is mere conjuncture or opinion, and is usually worth what it costs.

If I wished to consider pronouncements about addiction and legal matters, I would pay attention to a lawyer. If I wished to hear about addiction and the burgeoning discipline of neuroscience, I would rather hear from one active in that ever changing and ever more relevant  field.

It’s sometimes amusing, sometimes alarming, this tendency for AA members to rush in where angels and mental health professionals fear to tread.

life-j
life-j

Grimpeur We have a complicated problem on our hands. AA does not want to hear about any science from after 1939. But AA is all too happy to lecture the professional community of doctors, lawyers and neuroscientists about how god can fix anything. To the point where AA is indirectly in control of the workings of the whole recovery “industry”. Yes make no mistake about it it, it’s a $500m  industry. So how do we help alcoholics when god doesn’t work, and shelling out $5000+ for a month at a recovery center in most cases does not work? And when… Read more »

life-j
life-j

OOps, I forgot to add “In my experience”.

Kit G
Kit G

Hilarious!  thank you

Bill P.

Grampeur: I stand corrected by you! Although I am not a full fledged “member” of AA,  I should only opine on matters which have fallen within my “experience”. Thus all the work I did on this article has been presumptuous if only physicians and medical health professionals are qualified to enter the realm where “angels fear to tread”. We laymen (lay persons?) must meekly accept AA’s doctrine that alcoholism is “caused” by “character defects” which can only be “removed” by surrendering to a “Higher Power…which is God”. Since I question whether this has really been my “experience” it follows that… Read more »

life-j
life-j

Hmm, Bill, you said it with more nuance than me 🙂

thanks

Bill P.

P.S. Many of the citations to the source material relied upon by me in discussing neurological research were deleted in the editorial stage of preparing this article. The deleted citations were to the New York Times. Despite the misgivings of some politicians and others, it largely succeeds in printing “all the news that’s fit to print”. I respect the Times and believe I did not act improperly in passing this information on. I found it interesting- neither “amusing” nor “alarming”.  When posting on Soberrecovery I carefully follow their rule that members should not give medical advice. I follow this rule… Read more »

Rachel
Rachel

The way you write reminds me of the way the big book is written.

Rachel
Rachel

Not meaning yourself Bill P. I enjoyed reading.