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What Causes Alcohol Addiction?

By Will Solomon, Marta Manning
Learn what factors can make you more likely to develop a severe drinking problem.

What is the root cause of alcohol addiction? There is no easy answer. But certain factors can raise your risk.

Like other addictions, alcoholism—also called alcohol use disorder (AUD)—appeals to the pleasure centers of the brain. When you drink alcohol regularly, your brain begins to associate the drinks with sensations like euphoria, relaxation, and loss of inhibitions. This, along with  other predisposing factors, can result in cravings and dependency. Read on for the answers to six key questions about the causes of AUD. 

1. What Causes Alcoholism?

Alcohol triggers your brain to release the reward-system chemical dopamine. This leads your brain to link positive feelings with drinking and motivates you to crave more. It also affects serotonin, which plays a role in things like mood and sleep, says a 2020 study in the Journal of Neuroscience.

As you drink more and addiction takes hold, you will experience less pleasure (develop tolerance), and you may have withdrawal symptoms when you try to stop drinking. Heavy drinkers will begin to drink even more in an attempt to keep withdrawal at bay. 

“Early signs of problem drinking or alcohol misuse can be subtle,” Wellbridge Addiction Treatment and Research medical director Harshal Kirane, MD, tells WebMD Connect to Care. “For example, starting to prioritize activities that involve alcohol steadily leads to a shift in daily routines and relationships.”

“As drinking becomes more routine, changes in sleep patterns, mood, energy, and interests can signal the onset of early alcohol use disorder,” says Kirane. “For some, this is a critical tipping point, because alcohol intake increases in an attempt to alleviate the very challenges it is creating.”

2. What are the Psychological Causes of Alcoholism?

There are many psychological roots to alcoholism, and these can vary considerably from person to person. According to the American Psychological Association, a number of factors can intersect to create conditions that increase the risk for alcohol use disorder. These include:

  • Personal tendencies toward impulsive decisions
  • Persistent issues with low self-esteem
  • Mental health disorders, such as depression and anxiety
  • Prior trauma, sometimes including physical and/or sexual abuse

“Alcohol use disorder most often develops when alcohol becomes a tool for a person to cope with their emotions,” Kara Nassour, LPC, NCC at Shaded Bough Counseling tells WebMD Connect to Care. “People may rely on alcohol to avoid feeling stress, anxiety, sadness, anger, grief, to forget about responsibilities, or to feel more confident socializing. To understand the addiction, you have to ask what function the alcohol serves for someone, even if it comes at a great cost.”

3. How Does Alcohol Addiction Work in the Brain?

Alcohol addiction can have profound—and increasingly dangerous—effects on the brain as it progresses. As noted above, alcohol’s interaction with neurotransmitters like dopamine and serotonin can increase “pleasure” sensations in the brain, necessitating increased alcohol use to achieve the same effects.

It is important to note that alcohol’s effects on the brain are self-reinforcing, and tend to worsen over time. “Alcohol addiction results in changes to brain chemistry and neural pathways such that as the addiction develops, the person feels normal without alcohol in their brain, but feels better with alcohol in their brain,” Dean Drosnes, MD and psychiatrist with Mindpath Health, tells WebMD Connect to Care. 

“Over time, however, with repeated drinking, the person feels poorly (anxious, depressed, sick) when alcohol is not in the brain, and feels ‘normal’ when alcohol is present. The new normal is the result of brain changes. This is why people often don’t understand that they have a problem; they claim to feel normal,” Drosnes says. 

Over the long term, a persistent pattern of alcohol abuse can lead to serious consequences. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), alcohol use disorder interferes with the brain’s ability to communicate, and may produce impairments in capacities including memory, balance, speech, and others. This is particularly acute in adolescents and young adults who drink, as developing brains can be dangerously affected by consuming alcohol.

4. What are Common Alcoholism Risk Factors?

These risk factors can make you more likely to become addicted to alcohol:

  • Genetics and family history. If you have a parent or a close relative with alcohol addiction, your risk goes up. Research shows that genes are responsible for about half of the risk for AUD, according to the National Institute on Alcohol Abuse and Alcoholism.
  • Underage drinking. If you start drinking before you’re 15 years old, you may be four times likelier to develop alcohol dependence later in life, the NIAAA says.
  • Frequent drinking. The Mayo Clinic says that drinking alcohol too often or engaging in binge drinking can lead to addiction.
  • Mental health conditions. According to a 2019 review in Lancet Psychiatry, illnesses like depression or bipolar disorder can predispose you to alcohol addiction, especially if you use alcohol to self-medicate.
  • Trauma history. Traumatic experiences in the past, including childhood abuse, are strongly linked to developing alcoholism later in life, the NIAAA says.
  • Male gender. Men are more likely than women to become addicted to alcohol. The 2018 National Survey on Drug Use and Health found 9.2 million men and 5.3 million women in the U.S. had an alcohol use disorder.
  • Social factors. Social and family customs, culture, poor parental support, and peer pressure can play roles in alcohol addiction, the Mayo Clinic says.

5. What is Considered an Alcoholic?

There is no “one size fits all” definition of an alcoholic. However, according to the Mayo Clinic, alcoholism—or alcohol use disorder—can generally be diagnosed in an individual who drinks heavily in a way that interferes with his or her life and daily functioning.

“Alcohol use disorder may be present if someone drinks alcohol more often, or in greater amounts than they intended; if they continue drinking despite trying to quit; if they spend a lot of time or effort obtaining alcohol; if they get cravings for alcohol; if they avoid social activities or other obligations in order to drink alcohol; or if they use alcohol even in disruptive situations or times that may be dangerous,” Nassour says.

Difficulty quitting or an inability to quit drinking alcohol can also be a sign of a problem. “Getting withdrawal symptoms after being sober for a period also indicates addiction," Nassour says.

6. What Constitutes Excessive Drinking?

The National Institute on Alcohol Abuse and Alcoholism defines moderate drinking as two drinks a day or less for men, and one drink a day or less for women, with a drink defined as .5 oz of alcohol. Regularly drinking more than this amount can suggest alcohol use disorder.
Specific types of excessive drinking include binge drinking, which generally refers to drinking a lot in a short time period and bringing blood alcohol content to .08% or higher, as well as “heavy drinking,” which means regularly consuming excessive quantities of alcohol throughout an extended period (for instance, according to the NIAAA, "heavy drinking" can refer to men drinking 4 or more drinks daily or over 14 drinks weekly, or women drinking 3 or more drinks daily or over 7 drinks weekly).
While the Diagnostic and Statistical Manual of Mental Disorders (DSM) has specific criteria for evaluating alcohol use disorder, many experts say that the presence of alcohol interfering with a person’s life or daily functioning is sufficient to indicate that there is an issue. “In short, if alcohol is damaging a person's mental health, relationships, work or finances, or if they or people around them think it might be a problem, it's likely a problem,” Nassour says.

Getting Help

There are a number of ways to successfully treat alcohol use disorder. Treatments for alcohol dependency can include a combination of:

Your primary care doctor is often your best starting point, and they can refer you to a specialist for treatment.

There is not necessarily one best route for recovering from alcohol use disorder. “The best treatment for alcoholism depends on the individual—there is no one right way to achieve and maintain recovery,” Aaron Weiner, PhD and clinical psychologist, tells WebMD Connect to Care. “Generally, success involves a mix of professional treatment (such as cognitive-behavioral therapy and mindfulness-based approaches) and peer-support groups (such as 12-step fellowships like Alcoholics Anonymous and SMART Recovery).”

Addressing the physical experience of addiction may often be the most immediate concern. “The best treatment for alcoholism includes medical detoxification first and foremost if warranted,” Lina Haji, PsyD and clinical psychologist, tells WebMD Connect to Care. “Inpatient rehabilitation, including 12-step programming, a support system, structured group and individual treatment, and relapse prevention psychoeducation is very effective.”

Don’t Wait. Get Help Now.

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Treatment & Resources for Alcohol Addiction