And in fact?

Addiction does not have a single source. It has a set of interrelated biological, psychological and social origins.

Scientists and doctors are more and more often talking about addiction as a certain process of development rather than a pathology or medical condition. This development simply goes in an unfavorable direction.

For example, the ability of the brain to change in response to experience — neuroplasticity — is known to play an important role in the development of addiction.

Addiction uses ‘bugs’ in our body and mind and turns them from mechanisms useful for adaptation into agents destroying us.

Two levels of addiction

The levels of addiction can be compared to the tip of the iceberg and its subsurface part. The tip is visible to everybody, and that is why it is perceived as addiction. 

Even the person themselves may not know about the subsurface part. But it hides problems much more difficult than the use of alcohol.

The first level: the tip of the iceberg

Addictive automatic thoughts

Your thoughts about alcohol: ‘Tonight, it’s OK to have a drink,’ ‘I’m fed up, I need a drink’, ‘I’ll quit next time, and tonight I’m going to have a really good time,’ ‘I don’t have a drinking problem,’ and others. 

Other dysfunctional automatic thoughts

Self-concepts and concepts of the world and people around you. They are not directly linked to alcohol, but they can bring along addictive thoughts. 

External triggers

Places, people, emotions, situations, events, days of the week, time of day, and even the weather — everything that makes you want to drink.

Internal triggers

Memories, dreams, stress, fatigue, negative emotions, and positive emotions — any inner state may serve as an internal trigger.

Even the tip shows why those who quit relapse so often: simply abstaining is not enough.

You have to work with all these elements. You can learn to react to triggers in a different way, control your circle, and challenge your thoughts. And this is a tremendous work already.

But even if you do all this, there is no guarantee that you are done with addiction as there is the subsurface part of the iceberg, too. And if you do not target it, you are likely to face a relapse. And after the relapse, your behavior will quickly ‘roll back’ to the previous recurrent models.

The second level: underlying causes

Genes and epigenetics

It is not only one gene and not even a group of genes that is responsible for addictive behavior. Hundreds of genes are indirectly linked to it. The contribution of genetics to the risk of addiction is equal to about 50%. However, we should not forget that genetics accounts only for the probability of the development of addiction. Genetic predisposition does not imply that addiction is bound to develop. Moreover, it does not mean that you cannot get rid of it if you want to.

Neurobiology

Ethanol somewhat closes the work of important brain processes that determine behavior on itself.

For example, it fits into reward mechanisms. The limbic system has two groups of dopamine responsive neurons: some are responsible for wanting while others are responsible for liking. In other words, our motivation and sense of satisfaction are based on them. The more a person drinks, the more active are the neurons responsible for wanting, while the activity of the neurons responsible for liking weakens. In order to keep the pleasurable sensations at the same level, they have to increase the dose. As a result, they drink not to feel good but to stop feeling bad.  

At more advanced stages of addiction, changes begin in functioning of the cingulate gyrus and orbitofrontal cortex. These regions are associated with conscious control of behavior. The control weakens, and the desire to drink becomes compulsive, i.e. the person constantly feels considerable discomfort and obsessive drive to alcohol.

Family

The most important factor here is not even the attitude of the family to alcohol, and the amount of alcohol the relatives consume.

The type of attachment between parents and their child is much more important. Studies show that the risk of addiction is minimal if attachment is secure, even if genetics is ‘bad’. In the case of insecure attachments, the risk of addiction increases. The opinion that addiction is the surrogate attachment that an unsuccessful true attachment mutated into is increasingly popular.

Environment

The influence of other social connections and the environment. School, district, guys from the yard, reputable adults, movies, books, the Internet, mass media, and even whether you can buy alcohol without an ID or out of sale hours.  

Core dysfunctional beliefs

Our self-concept determines our behavior. ‘Nobody needs me,’ ‘I’m not like everyone else,’ ‘I’m not capable of anything,’ and similar thoughts lead to constant mental discomfort. And one uses alcohol to get rid of it.

It is harder to work with these beliefs than with the automatic thoughts from the top of the iceberg. But if you do not target them, a life without alcohol will not feel complete.

Addictive beliefs

Ideas about the benefits of alcohol and profits it brings. ‘To negotiate a good contract, you have to have a drink,’ ‘Your date will go smoothly if you have a little to drink before it.’
Consumption does not immediately affect your life, health, and personality. And it maintains the illusion of security for a while. And when addiction has already developed, these beliefs also work as a self-defence mechanism. 

Well, good news

Almost everyone will discover that they have some of these factors. But when these factors act simultaneously, and their role in a person's life is quite important, they make the person vulnerable. This vulnerability serves as a basis for the development of addiction.

You can work with almost each element of this model except for genetics, and change it as gradually as addiction was previously changing you.