When Drinking Takes Over: Understanding Alcohol Use Disorder

As the old saying goes, “First you take a drink, then the drink takes a drink, then the drink takes you.” This progression from casual drinking to dependence has affected countless lives, including writer F. Scott Fitzgerald, who struggled with alcohol misuse throughout his adult life. Despite achieving a year of sobriety before his death at 44, years of drinking had already taken their toll.

The Slippery Slope

Nobody expects to develop a drinking problem. It often starts innocently: a first taste, then weekend drinks with friends. The weekend might start creeping into Thursday or Wednesday, especially after a rough week. Eventually, drinking becomes nightly. Some people find themselves needing alcohol in the morning to steady their hands or drinking at 3 a.m. to quiet their racing minds.

Whether we call ourselves “alcoholics” or not, when drinking causes problems that keep getting worse, it’s time to pay attention.

Defining the Problem

Is alcoholism a disease? The short answer is yes, but this understanding has evolved significantly over time.

Historically, alcohol addiction was viewed as a moral failing, a curse, or even demonic possession. In the 19th and early 20th centuries, scientists began recognizing its physical “disease-like” nature, but outdated beliefs about “degeneration” – the idea that moral failings were inherited – still prevailed.

The terminology has also evolved. In 1994, the American Psychiatric Association replaced “alcoholism” with “alcohol abuse” and “alcohol dependence.” In 2013, these terms were consolidated into “alcohol use disorder” (AUD), defined as a medical condition where someone can’t stop or control alcohol use despite negative consequences.

AUD as Mental Illness

The current Diagnostic and Statistical Manual of Mental Disorders classifies AUD as a psychiatric disorder. Since psychiatric disorders are considered mental illnesses, yes, AUD qualifies as a mental illness.

But when does social drinking cross that line? The transition from habit to physical dependence is often gradual and blurry. To understand how this happens, we need to look at alcohol’s effect on the brain.

How Alcohol Affects the Brain

• Alcohol boosts dopamine: That warm, relaxed feeling after a few drinks comes from dopamine flooding your brain. This “reward” neurotransmitter can’t distinguish between good and bad habits, so alcohol gets the same “gold star” as healthy activities.
• It acts as a depressant: Alcohol increases GABA (which calms the brain) while suppressing glutamate (which excites it). This leads to relaxation that can turn into drowsiness and disrupts restorative sleep.
• It inhibits the prefrontal cortex: This decision-making part of your brain takes a break when you drink, leading to poor choices and regrettable actions.

The Progression of Alcohol Problems

Alcohol affects everyone’s brain similarly, but problems develop through distinct stages:

• Casual use: Occasional social drinking that doesn’t interfere with daily life
• Heavy drinking: Regularly exceeding recommended limits, putting health at risk
• Misuse: Alcohol interferes with relationships, work, and responsibilities
• Dependence: Loss of control, with withdrawal symptoms when not drinking

The Vicious Cycle of Dependence

Once dependence sets in, a three-stage cycle takes hold:

• Binge/intoxication: Giving in to cravings for alcohol’s “reward”
• Negative emotions/withdrawal: Feeling bad about drinking, then experiencing withdrawal symptoms when trying to stop
• Preoccupation/anticipation: Cravings return, leading to impulsive drinking despite intentions to stop

Co-occurring Disorders

AUD often appears alongside other mental health conditions:

• Anxiety disorders (20-30% develop AUD)
• Bipolar disorder (25-45% develop AUD)
• Schizophrenia (nearly 25% meet AUD criteria)
• PTSD and complex trauma (33-50% develop AUD)
• Depression

These conditions often interact in complex ways, making it difficult to determine which came first.

Recovery Is Possible

The good news is that AUD treatment works. Here’s how to approach recovery:

• Start with detox: Safely stop drinking, with medical supervision if needed
• Choose your approach: Options include talk therapy, cognitive behavioral therapy, and other evidence-based treatments
• Build your support team: Include doctors, mental health professionals, trusted friends, and family
• Address co-occurring disorders: Make sure all mental health conditions receive treatment
• Plan for triggers: Identify situations that might trigger cravings and have strategies ready

Moving Forward

Instead of focusing on whether AUD is a mental illness, the more important question is how to overcome it. At Quitemate, we’re here to help you tackle alcohol problems directly with science-backed programs and a supportive community. Recovery is achievable, and support is available every step of the way.