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Why Can’t Alcoholics Only Have One Drink?

Why Can’t Alcoholics Only Have One Drink?

One strange aspect of alcohol addiction is that alcoholics can’t stop after one drink. Most people can have a drink or two and stop, especially if they know they have to drive later or get up early. Alcoholics, on the other hand, even alcoholics with years in recovery, can’t have one drink and stop. They just keep drinking.

The reasons are complex. People addicted to alcohol may have a genetic predisposition, like there is some kind of alcoholism gene that determines whether a professional is at risk for alcohol addiction. In reality, it may be dozens of different genes interacting in various ways. For example, in some people, alcohol stimulates the release of a lot of dopamine, while in others the dopamine response is meager. Some people’s livers metabolize alcohol efficiently and some don’t. If your liver doesn’t metabolize alcohol efficiently, you might get a buildup of acetaldehyde in your body that makes you feel sick rather than buzzed. If you have both efficient alcohol metabolism and a big dopamine response, you are likely to drink a lot more than someone who just gets clumsy and nauseous.

If you are someone who gets a big dopamine response from alcohol, drinking will be strongly reinforced. The pathways in your brain related to alcohol change so that alcohol is essentially reclassified the same as food, shelter, and sex–an actual survival need that you aren’t able to question. It becomes a priority.

Alcohol poses a particular problem because the first thing it does is turn down the functionality in the part of your brain that signals the time to stop drinking. Most people have a tipping point when they drink. The decision to stop relies on some combination of physiological feedback, recalling previous experiences, and anticipating future outcomes.

In alcoholics, all of these fail-safes are often broken. Drinking always makes them want to drink more, even if they hadn’t planned on it. They have a first drink and feel fine, in which case they think, “See? Fine. Might as well have another.” Whenever they get to not fine, the prefrontal cortex, the part that reminds them of all the reasons not to drink and essentially pull the plug on the whole evening, is no longer in control. If you pile on a dopamine “jackpot” with diminished executive control and physiological feedback, it starts to make sense why someone addicted to alcohol can’t stop after one drink.

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