Evoo

I've been trying to better understand the science behind addiction and what we really know about it, where the studies are and how addicts of all kinds differ. I've been reading about the "five subtypes," (young adult, young anti-social, functional, intermediate familial, and chronic severe). These are interesting breakdowns (I believe I fell into "functional subtype" above all others).

What's odd, however, is that my brothers -- all three of us have -- have had addiction issues / alcohol use disorder to varying degrees, but it manifests in completely different ways.

Anecdotally (and within my family and extended family alone) there seem there are different kinds of alcoholics:

• Situational addiction: painful/difficult circumstances or physical pain or injury that leads to substance abuse over time. Might start with an injury, an introduction to prescription opiates - alcohol is one piece of that puzzle (and often the most destructive). Person may be able to moderate after therapy/treatment where the primary psychological issue is addressed.
• Dopamine addiction (anti-social subtype): people who are addicted to virtual anything that provides a "high." A need to escape anxiety or mental illness... whether it's cannabis, tobacco, sugar, alcohol, or even inhalants, they find sobriety in general to be a very scary and painful plane of existence. Recovery is extremely difficult and requires intensive therapy as one learns to live with their thoughts and emotions.
• Exclusive addiction: Addiction to one specific substance, in this case - alcohol. Something about the high (and more specifically, the hangover/withdrawals) compel the person to keep drinking. But little to no immediate issue with other substances. Recovery requires permanent abstention.

Note, the above aren't at all scientific - just observational. My brother's addiction issues started with a severe physical injury resulting in chronic pain. My other brother's addiction issues have always been mental health related - and run the gambit (cannabis use disorder, inhalants, anything-but-sober, severe mental health issues and anti-social personality).

Then, there's me. I've always found my addiction issues to be inexplicable. Alcohol hits me differently than it seems to other people - I experience an immediate and intense high, followed by insurmountable anxiety, inflammation and withdrawal (even in small amounts). Two glasses of wine quickly turns into drinking alone into the early morning, and a hangover so painful that it leads to more drinking, then functional/white-knuckled withdrawals over the course of the bender. The need to continue drinking once I start is to quiet intense feelings of existential dread.

Bizarrely, I have never had issues with:

• Tobacco (despite multiple attempts to "be cool" and smoke in my youth) I've never been able to get addicted to the stuff.
• Pain meds (Still have Tramadol in the medicine locker from a slipped disc. Never used more than prescribed. Stopped immediately when the pain went away).
• Cannabis (I periodically consume small amounts of medical cannabis in microdose capsules for Crohns disease, to help avoid malnutrition issues and weight loss [high CBD ratio]. I only use in a severe flare to keep Ensures down, and cease use in remission / when symptoms lighten). Otherwise I find the cannabis "high" to be very uncomfortable.
• Sugar (I eat a regular/balanced diet).

In truth, I absolutely love being sober. Always have. But alcohol was always so woven into my existence, family structure, social network and self-identity that the idea of living without it permanently was nothing short of terrifying. My 20s and early 30s are a mess of intense periods of functional alcoholism/workaholism and carefully "drinking off" withdrawals between bursts of sobriety, relapse, and denial.

So what is it about alcohol?

The last time I consumed alcohol (A final asinine attempt to "test" moderation with two glasses of wine) I broke out in hives, had an inflammation response, and went into a flare for several weeks that resulted in a week in the hospital (due to Crohns). I asked my doctor about it, and he suggested I may actually have, and always have had, an allergy to alcohol. Would that help to explain the almost immediate withdrawal symptoms? The anxiety? The intense need and cycle of drinking and functional maintenance? It certainly explains why I'm committed to 100 percent sobriety now.

I ask, because when I explain my relationship with alcohol to my wife - it seems completely alien to her. She drinks a glass of wine, gets a little drowsy - but she absolutely cannot relate to the euphoric response and crash or intense/anxiety and desire to continue drinking to excess. She said alcohol has never made her feel that good (or that bad), it's just another beverage to her. She can relate very similarly, however, on an addiction level, having recovered from a childhood eating disorder... where AV/Rational Recovery methods are commonly used in treatment.

Anyway, thanks for reading if you're still here. Maybe it's folly to try and understand all of this. I'm 100-percent committed to not drinking, and that's enough. But the inquisitive part of me wants to understand what's happening in my system and why I've struggled with this ubiquitous substance for so many years. Thoughts?

ScottFromWI

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I don't think it's folly, we are inquisitive beings by nature. Having said that, my personal sobriety relies on the fact that I have accepted that I will never understand "why" I am an alcoholic. I did a ton of research myself, but in the end my inquisition had a hidden motive - to find what was wrong so I could fix it and drink normally again.

biminiblue

Yeah, I mean I blame genetics. Like I posted elsewhere yesterday: some of us have a little something extra on the compulsion gene.

It is a non-alterable fact of my personal biology/psychology. I don't need to dig any deeper than that. I've done all the experiments.

Evoo

Yeah, that's not on my radar. I don't think this post is my AV talking or trying to reason myself back into moderation (been down that road too many times). Alcohol and I are divorced, full stop.

I'd just really like to understand chemically/genetically how this predisposition works - and whether the possibility of allergy to the substance really does play a role.

ScottFromWI

To clarify, it wasn't on my radar either - and that was part of the problem ;-) I mainly realized this in hindsight.

What would you do with the knowledge if you did indeed have it? Would it change how you go about your life and sobriety?

biminiblue

Your doctor may have ascribed to the Alcoholics Anonymous 1939 theory about an allergy to alcohol as written in its literature. Have you read the Big Book?

You could also read the 2015 book, "Alcohol, Explained," or the 1981 book, "Under The Influence." They talk about the science behind compulsive drinking - but I don't think there is a one-size-fits-all complete explanation. Humans are too complex when it comes to addiction and the process requires some amount of psychology as well as physiology.

Nature and nurture.

Dee74

Bims suggestions are good books for a more scientific approach.

I don't think about why anymore - I just don't do the stuff I know will end badly for me and that's worked for 15 years now

Alcohol was not my only addiction - I was also addicted to pot and nicotine but I have no problem with prescribed pain relief.

it is what it is?

D

advbike

I have what used to be called "an addictive personality", the subtype you refer to as anti-social, or just wanting to escape. The need to avoid reality and emotional pain from feelings. This is the "emotional void" that many addicts have. Always seeking escape through alcohol, other substances, sex, fast cars, motorcycles, and even shopping. I used all of those at one time or another.

I believe more in environmental theories as to why this happens however, than some "alcoholic gene". Gabor Mate wrote a fantastic book about the addicts of Vancouver, BC - how most were abused at a young age, or from environments with no security/stability. This results in a longing, always seeking to fill that emotional "void" that was caused by the absence of the primary caregiver at a young age. I have it myself - for decades I drank, sought new relationships, cars, homes, expensive toys, adventures.. and could never explain why. Want, want, want...

After I read Mate's book it all made sense - in my case there was chaos from multiple countries and caregivers before the age of 5, trauma from the loss of my older sister in a plane crash when I was 4, the subsequent withdrawal of my mom due to grief, dad being alcoholic, and completely absent, and on and on. This is what causes addiction, not some gene. It is well supported by the fact that alcoholism and other dysfunctional behaviors tend to run in families. Well no surprise - the parents role model the behavior and the kids think it's normal. There are family secrets. Trying to always appear normal, etc.. even in those who are relatively successful. You can also learn about this in research about ACOA - Adult Children of Alcoholics.

Having said that, some people from great, "normal" families just like to drink, perhaps they have some social anxiety, and it eventually turns into a problem. If you read Alcohol Explained by William Porter, you can understand why - it is an almost inevitable progression over 10-15 years of continuous heavy drinking, So that individual might fit another of your subtypes, since they don't actually have that emotional void and need to escape, as I do. They just drank too much for very common reasons, of which there are many. I suggest some reading on the topic - it does help us understand some of the patterns and hopefully work on them.

Evoo

Yes! Thank you - the "Alcohol Explained" book looks like it's exactly what I'm looking for. Just picked up the Audiobook.

For me, knowledge is always a positive. The more I know about addiction and how alcohol works, the more equipped I am to take on my AV for the long haul. I'm on a good path right now, I don't want to ever get complacent and start to think, "Well, maybe I actually could moderate drinking again," or "maybe it won't bother my condition anymore if I get into remission."

I think the real reason I'm back at SR right now is that my AV has been a little bit louder lately. Lot going on. Another newborn, grad school, full-time work, wife working, tons of responsibilities both personal/financial etc. -- I mean it's all good, but I've heard my AV saying, "boy I miss cutting loose and just quieting my mind for a bit." I pushed it aside, of course - but even having that idea creep up kinda scared me.

novips

Thanks for the post. I enjoyed reading it. My recovery is rooted in A.A., and when I came back to the program in 2002 after roughly 15 years of relapsing (including stretches of sobriety lasting years) I was asked the following 3 questions, which may be relevant here.

1. Does my experience abundantly confirm that I can't predict what happens to me when I put alcohol in me? Easy answer: yes. Sometimes I say I'll only have two drinks and I'll manage to pull that off (though I always want more). Other times, I say I'll have two and then I'm off to the races -- you know, the race that leads to the gates of hell. IOW, I definitely have a physical allergy to alcohol that manifests as a physical craving after I take the first drink (sometimes overwhelming, other times not) and this makes me physically different from non-alcoholics.

2. Does my experience abundantly confirm that regardless of how sincerely I commit to sobriety, left to my own devices I will always return to the literally insane idea that the next right thing for me to do is obviously to pick up a drink. Easy answer: yes. Importantly, if the only thing that made me an alcoholic was my physical allergy, then I really wouldn't have much of a problem after I figured that out because I simply would never pick up that first drink again. Also important: there are alcoholics who only suffer from the physical allergy, and trying to follow their program of recovery (i.e., "just don't drink") will kill me. If alcoholics like me could just not drink there wouldn't be a need for any A.A. meetings. Bottom line: In addition to a physical allergy, I have a mental illness that manifests as an obsession to drink even after days, weeks, months, and sometimes years sober.

3. Does my experience abundantly confirm that because of (1) and (2) above, I am hopeless outside of A.A. The controversial / provocative point here is that there is a type of alcoholic whose only solution is A.A. I have come to believe there is such a type, and that I am one of those -- but the problem is that I don't want that to be true (Does anyone?), so I have to wear out every possible other solution -- and there are seemingly countless other solutions. As the Big Book says, "We have no monopoly ...." Unfortunately, I believe many alcoholics of my type die horrible alcoholic deaths before figuring all this out.

Hope that adds something useful to the thread.

DriGuy

I did read a scientific book on alcoholism early on. I can't remember the name of the book, but it described the physiological changes that happen with continued use of alcohol, and how it changes our response from sugar to alcohol. It's actually easier to process alcohol than it is sugar, and the body adapts easily, but then wants more alcohol. But even with a scientific understanding, it's still a mystery.

Think of it this way. We always hear about great advances in neurology, and how close we are to understanding how the brain works, but we are still confronted with a mass of bodily tissue that processes certain electro-chemical reactions in certain areas of the brain by passing reactions from one cell to a nearby cell. But no one has a clue to how these processes result in a memory with sounds, words, images, and attached emotions, and the sensations we actually experience in mental activity. I believe we never will. I could be surprised, but it seems to me we will never understand the very part of our body that offers us understanding in the first place.

That's OK. I'm OK with mysteries. I just accept them. I don't need to know all about alcoholism, although I continually read about it from what seems to be the most reliable sources available, but we don't need to fill in all the blanks. We can just quit doing what harms us. We may not have all the knowledge, but we have the power to make better choices, and I can work with that.

dustyfox

Fascinating thread - advbike - I agree with you completely about the emotional void and it's relationship with childhood trauma, particularly in regard to a child's primary caregiver - your own very traumatic childhood demonstrates how crucial a part it played in your later life and 'addictive' seeking behaviour. I have a particular interest in this area of childhood trauma. I have not read Gabor Mate's books though I know of his work. I feel I must read some.

Grymt

I really hated school. I always wanted to get away. From home, from everywhere. Never felt wanted or nurtured. Absent, probably alcoholic, father. Obsessed mother. I was scared and sad with nowhere to turn. So, with alcohol I found a reliable way to get away.

Notice that there was a deeply held wanting there long before alcohol.
In other words : The 'habit' to react was already acquired.
It makes sense that a different 'habit' could help.
The habit needs to address the more fundamental issue of the relationship to the primary cause, not just the acquired 'cure' (alcohol).

When one understands that wanting agreeable feelings to be present, wanting agreeable feelings to stay, wanting agreeable feelings to not go away, wanting agreeable feelings (that have gone) to come back, and, not wanting disagreeable feelings to be present, wanting disagreeable feelings to go away, wanting disagreeable feelings (that have gone away) to stay away, wanting a bigger tv, etc, are all 'wanting', or craving, in relation to feelings. (let alone the habit to be unaware of the subtle feelings, like that which makes one scratch an itch without being conscious of moving the hand to do the scratching).

So, it is really about the relationship to feelings, whether it is an itch, a mental construct, like an idea, an emotion and not, as it superficially seems, the 'mundane' causes.

An alcoholic drinks because he or she can't not drink. Imprisoned by 'habit'.

We are FAR less in control of what we do than we can even imagine. (this applies to non-alcoholics too). Like ignorant automatons, not knowing, but believing in freedom, we live in our complex prisons we build for our selves.

Grymt

... there is a realisation that I am not the feeling.

Instead there is the awareness of the feeling and with that an awareness of the ephemeral nature of the feelings. The feelings are in fact given solidity and seeming permanency by the tendency to crave.. Crave for them to stay, crave for them to go, until there is just constant craving.