Alcoholism - Part 3

Chronic Alcohol Use / When a Problem Becomes an Addiction

I continue my series on alcoholism, in which we take a step-by-step look at how a person's relationship with alcohol can change and what happens when drinking stops being merely a social activity or an occasional escape.

In the previous part, we discussed the first warning signs of problematic drinking. A person may begin to experience the consequences of their behavior—conflicts arise, responsibilities are neglected, feelings of guilt appear, and there are repeated promises such as, "Starting tomorrow, I won't drink anymore." Despite this, they may still feel that they are able to regain control of the situation.

Today we move one step further—to the stage where alcohol gradually begins to occupy an increasingly important place in a person's life.

In everyday language, we may refer to this as chronic drinking or alcoholism. In professional terminology, however, the condition is more commonly referred to as Alcohol Use Disorder (AUD), which can vary in severity. There is no sharp line after which a person suddenly "becomes an alcoholic." Addiction usually develops gradually, and its severity is assessed based on several symptoms—for example, loss of control over the amount of alcohol consumed, intense cravings for alcohol, unsuccessful attempts to quit, continued drinking despite harmful consequences, tolerance, or withdrawal symptoms.

One of the most significant turning points occurs when a person no longer drinks simply to feel good, but increasingly drinks to avoid feeling bad.

At first, alcohol may bring relaxation, euphoria, or temporary relief from stress. However, if this way of coping with unpleasant emotions is repeated, the brain gradually adapts. From a psychological perspective, alcohol can begin to function as a dominant coping mechanism—a way of dealing with stress, anxiety, loneliness, tension, frustration, or inner distress.

The person is no longer learning how to deal with the problem. They are learning how to numb it.

And this is where one of the traps of addiction lies.

From a neurobiological perspective, it is not as simple as saying that "alcohol increases dopamine and the brain can no longer experience pleasure." The process is far more complex. Repeated heavy drinking causes changes in the brain's reward, motivation, stress, and self-regulation systems. Over time, sensitivity to natural rewards may decrease, while stress systems become more active in the absence of alcohol. The result can be anxiety, irritability, restlessness, or dysphoria, all of which alcohol temporarily relieves.

The brain may then become trapped in a mechanism known as negative reinforcement:

A person no longer drinks only to achieve a pleasant feeling—they drink to remove an unpleasant one.

And this further strengthens the addiction...
 
 What Can Advanced Alcohol Addiction Look Like?

Not everyone with a severe Alcohol Use Disorder drinks in the same way, and not everyone has to drink every day. Addiction is heterogeneous—it can look different from one person to another.

However, some of the most common signs include:

• A strong craving for alcohol.
• Thoughts about alcohol begin to occupy an increasingly larger part of the day. The person plans when they will be able to drink, whether they have enough alcohol at home, or how to hide their drinking.

Loss of control...

The original plan of "I'll just have two drinks" repeatedly turns into consuming much larger amounts. A person may genuinely want to cut back, yet repeatedly fails to do so.

Tolerance...

Increasingly larger amounts of alcohol may be needed to achieve the same effect that much smaller amounts once produced.

Continuing despite the consequences...

The person is already aware of problems in their relationships, health issues, conflicts at work, or financial difficulties, yet continues drinking despite them.

Withdrawal symptoms...

After reducing or stopping alcohol consumption, withdrawal symptoms may appear, including trembling, sweating, anxiety, irritability, insomnia, nausea, or a rapid heartbeat. In severe cases, epileptic seizures, hallucinations, or delirium tremens may occur.

This is an important point that is sometimes underestimated:

A person with long-term heavy alcohol use should not stop drinking abruptly without a medical assessment. Severe alcohol withdrawal syndrome can be life-threatening and may require medical supervision.

The mind begins to revolve around alcohol...

Addiction changes much more than whether or how much a person drinks. It changes their attention, decision-making, motivation, and the way they respond to the world around them.

Activities that once brought joy may gradually disappear. Hobbies fade away, relationships become limited, and interest in everyday life declines. Anhedonia may develop—a markedly reduced ability to experience pleasure.

Alcohol is also associated with depression, anxiety, sleep disorders, impulsive behavior, and an increased risk of self-harm or suicidal behavior. The relationship between alcohol and mental health problems often works in both directions—a person may drink to relieve anxiety or depression, while alcohol itself later makes these conditions even worse.

Another powerful psychological mechanism is cognitive dissonance.

On one hand, the person sees the consequences of their drinking. On the other hand, they are not yet ready to give up alcohol.

This creates an uncomfortable inner conflict that they may try to reduce through rationalization:

"I don't have a problem."

"I still go to work."

"If I wanted to, I could stop."

"I've had a really hard day today."

"Other people drink much more than I do."

This is not always a conscious lie. Over time, a person may develop an entire system of explanations that allows them to continue drinking without fully admitting how serious the situation has become.
 
Life gradually becomes narrower...

As addiction progresses, life can begin to function like a tunnel. More and more energy is directed toward alcohol—obtaining it, drinking it, recovering from drinking, and then drinking again. The things that once mattered most may slowly move into the background:

• Family
• Partner
• Children
• Work
• Hobbies
• Health

A person does not suddenly stop loving their family overnight. However, addiction can profoundly disrupt their priorities, self-regulation, and decision-making. That is why it is more accurate to speak not of a "collapse of personality," but of a gradual impairment of functioning across many areas of life.

With long-term heavy drinking, memory, attention, planning, and other cognitive functions may also deteriorate. Chronic excessive alcohol use is associated with an increased risk of serious neurocognitive disorders. One of the most severe complications is Wernicke-Korsakoff syndrome, which is primarily linked to a deficiency of vitamin B1 (thiamine) and can lead to severe memory impairment.

When it's not just one person drinking, but the whole family suffers...

Addiction rarely affects only the person who drinks. The World Health Organization (WHO) points out that alcohol-related harm extends to partners, children, friends, colleagues, and many others around them.

Gradually, family life may begin to revolve around alcohol.

• A partner checks whether the person has been drinking.
• Children judge their parent's mood by the sound of their footsteps as they come home.
• Family visits are canceled because no one knows what condition the person will be in.
• Someone makes excuses for missed days at work.
• Someone hides bottles.
• Someone pays off debts.
• Someone simply tries to make sure there is at least one peaceful evening at home.

Partners and other family members may gradually adapt their entire lives to another person's addiction.

In popular psychology, some of these patterns are described as codependency, although this is not a universally recognized psychiatric diagnosis.

Children are particularly vulnerable...

In a family with an unpredictable parent, children may learn to stay constantly alert, hide their emotions, take on responsibilities far beyond their age, or try to keep the peace at any cost.

The literature on families affected by addiction sometimes describes roles such as the family hero, scapegoat, lost child, or family clown. These are not rigid psychological categories but rather conceptual models that help explain certain behavioral patterns.

The most important point is this:

A child may learn to survive in an environment where they should never have had to learn survival in the first place.

And the strategies that helped them survive in childhood may later be carried into their adult relationships.

The social world begins to shrink...

Addiction gradually affects social and professional life as well.

Absences from work, arriving late, declining performance, conflicts, broken promises, and loss of trust become increasingly common.

Alcohol may contribute to problems within the family, at work, and financially, and in the most severe cases, it can lead to the loss of employment and social stability.

At the same time, the person may begin avoiding those who criticize their drinking.

"You don't understand me."

"You're always checking up on me."

"You're all against me."

Gradually, only the people and environments where their drinking is accepted—or at least not questioned—remain.

And then isolation may follow...

Isolation is particularly dangerous in addiction because alcohol can become both the problem and the only familiar way of escaping the distress that the problem itself creates.

The body eventually demands its price too...

Long-term excessive alcohol use can affect virtually every organ in the body.

It is associated with an increased risk of:

• Liver diseases, including alcoholic hepatitis and cirrhosis,
• Pancreatitis,
• Inflammatory and bleeding disorders of the digestive system,
• High blood pressure and heart rhythm disorders,
• Cardiomyopathy and stroke,
• Damage to peripheral nerves,
• Disorders of the immune system,
• Brain damage and memory impairment,
• Several types of cancer.

Alcohol is classified by the International Agency for Research on Cancer (IARC) as a Group 1 carcinogen and has been linked to at least seven types of cancer. Importantly, the risk does not begin only after addiction develops—for some cancers, it increases even with lower levels of alcohol consumption.

We can also state clearly that alcohol increases the risk of premature death through disease, injuries, traffic accidents, violence, and suicidal behavior. According to the World Health Organization (WHO), alcohol is associated with more than 200 diseases, injuries, and other health conditions.

Alcoholism is not only the problem of the person who drinks...

When we talk about addiction, we often focus on one question:

"Why doesn't the person just stop?"

But alcohol addiction is not simply a series of bad decisions.

It is the result of a complex interaction between biological, psychological, and social mechanisms. That does not mean a person is free from responsibility for their actions.

Understanding behavior is not the same as excusing it.

A person with an addiction may cause enormous pain to those around them. They may lie, manipulate, neglect responsibilities, or repeatedly break promises.

However, understanding the mechanisms of addiction allows us to ask a different question.

Not only:

"Why are they doing this?"

But also:

"What needs to change so that alcohol is no longer their primary way of coping with life?"

And that is where recovery truly begins...

Addiction is not a life sentence...

Chronic drinking can take away a person's health, trust, relationships, career, and years of life.

Yet one very important truth remains:

Addiction is treatable.

Many people with Alcohol Use Disorder recover and build stable, fulfilling lives.

Depending on the individual's needs, treatment may include psychotherapy, motivational interventions, cognitive behavioral therapy (CBT), family therapy, medication, peer-support groups, or a combination of several approaches.

When physical dependence is present, the first step may be the safe management of alcohol withdrawal.

However, detoxification alone does not cure addiction.

After detox, it is essential to address the psychological and social mechanisms that maintained the drinking and to develop healthier ways of coping with life.

Because it is not enough simply to take alcohol away.

A person must learn how to live when alcohol is no longer there.

And perhaps that is one of the most difficult parts of recovery.

Chronic drinking is not simply a condition in which someone "likes alcohol too much."

In advanced addiction, alcohol gradually stops being a source of pleasure and instead becomes a way to relieve anxiety, restlessness, withdrawal symptoms, or emotional pain.

The person no longer drinks to feel good.

They drink to avoid feeling bad.

And that is precisely where we see the difference between an ordinary glass of alcohol and addiction.

– JK –