Dr Chris Knowles was 18 when researchers arrived at his school in England to conduct an experiment on novice drinkers. They placed two double vodkas before each student to measure their reactions. Knowles downed his drinks, then reached over and consumed the two belonging to a girl beside him who had no interest in alcohol.

Now a professor of surgery at Queen Mary University of London and author of a new book on excessive drinking, Knowles later sought treatment for alcohol dependency. His story illuminates a critical question: why do some people struggle to stop drinking whilst others can take it or leave it?

The Scale of the Problem

Despite research showing no amount of alcohol benefits the heart or brain, excessive alcohol use remains widespread. In the United States, 17% of adults report binge drinking, according to the US Centers for Disease Control and Prevention. Understanding alcohol dependency requires examining the complex interplay of biology, psychology and environment.

Describing his drinking journey as “10 years of fun, then 10 years of fun with negative consequences and another 10 years of only negative consequences,” Knowles has investigated alcohol’s appeal in his new book, “Why We Drink Too Much: The Impact of Alcohol on Our Bodies and Culture.”

Why Humans Drink: The Short Answer

“Because it’s fun and because we learn that good things happen when we do it, or at least we think good things have happened when we did it,” Knowles explained.

The longer answer reveals why some individuals develop problematic drinking patterns whilst others don’t, and crucially, why they continue even when harmful consequences become apparent.

The Biology Behind Problem Drinking

When Knowles reflects on his early drinking days, he remembers friends who drank less than him, but also those who drank considerably more without developing any issues. There isn’t always a direct correlation between consumption levels and alcohol dependency.

How much someone drinks and their relationship with alcohol stems from multiple factors: environment, biology and psychology.

Alcohol stimulates the same pleasure centres in the brain that provide reward feelings when seeking necessities like food and relationships. However, it also activates negative pathways.

“The more you drink, the more you drive those stress neurotransmitters, and so you’re miserable when you’re not drinking,” said Dr George Koob, director of the National Institute on Alcohol Abuse and Alcoholism. “You’re really digging that hole, and you’re drinking to fill the hole. But unfortunately, every time you try to fill the hole by drinking, you’re making the hole deeper.”

Brain Wiring and Reward Processing

It’s tempting to assume some people are simply physiologically programmed to crave more alcohol from the first sip. Whilst there’s truth to this, the picture is more nuanced, said Dr Danielle Dick, director of the Rutgers Addiction Research Center.

A major biological factor in who develops problem drinking relates to how an individual’s brain processes rewards and risk. When a brain is wired to seek substantial rewards whilst worrying less about risks, that person is more likely to fall into patterns of increasing use.

This brain wiring contributes significantly to alcohol dependency, but it isn’t the complete explanation.

Psychological Factors and Drinking to Escape

Humans often drink past the point of feeling good due to psychological factors. People with conditions such as ADHD, bipolarity, schizophrenia and PTSD face particularly high risk for substance abuse. Psychological traits including neuroticism, low self-esteem, anxiety and depression also increase vulnerability.

Those who drink solely for enjoyment are less likely to develop dependency. This doesn’t mean binge drinking at parties won’t cause future health problems, but the motivations behind drinking make an enormous difference.

Many people consume alcohol to boost confidence, enhance performance or relieve stress, sadness or difficult memories. These additional motivations can work against you, Knowles warned.

“There’s an old adage, ‘If drinking is a problem, you’re in with a chance. If it’s your solution, you’ve already lost,'” he noted.

When someone experiences difficulties and alcohol feels like it switches on a light, allowing escape from hardship, drinking becomes extraordinarily difficult to resist, even when it clearly isn’t helping as hoped.

The Tolerance Trap

Compounding the problem is tolerance development. Your tolerance isn’t merely how many drinks you can consume whilst holding a conversation or walking straight. It’s also how many drinks you need before experiencing the same positive feelings or relief from negative ones, Koob explained.

The more you drink, the more you need to achieve the same effect. This perpetuates the cycle of alcohol dependency.

The Continuum of Problem Drinking

There aren’t just two types of drinkers, those with problems and those without, Dick emphasised. It’s a continuum.

On one end are those who don’t drink at all, those who occasionally drink but don’t particularly enjoy it, and those who drink in healthy, manageable ways. On the other end are people with clinical alcohol use disorder, which can be mild, moderate or severe.

Diagnostic criteria include continuing to drink despite effects on work or family, getting into dangerous situations and experiencing withdrawal symptoms, according to the National Institute on Alcohol Abuse and Alcoholism.

In the middle are “grey area drinkers.” This isn’t a medical definition but rather an acknowledgement of unhealthy patterns. They haven’t experienced work issues, lost relationships or suffered health consequences yet, but may not be performing optimally, feeling present with their children or dealing with stress effectively.

Breaking Free from Alcohol Dependency

Cutting back, regardless of your drinking level, can provide health benefits, Dick said.

Changing your relationship with alcohol should begin with abstinence, Knowles advised. Challenges like Dry January offer excellent opportunities to step back and examine alcohol’s role in your life.

From there, educate yourself on drinking’s pros and cons, engage in support and community not centred around alcohol, and learn to address psychological issues that alcohol may have masked.

For grey area drinkers, this might mean reading books on drinking and sobriety, addressing underlying stresses and discovering new socialisation methods.

Although alcohol seems omnipresent, people are generally drinking less than earlier generations, particularly younger people, Dick noted. This decline has coincided with rising mocktail and non-alcoholic drink culture. Finding these alternatives can help you engage in social routines without alcoholic drinks.

For those with clinical alcohol use disorder, support groups like Alcoholics Anonymous, treatment centres and medical detox resources may prove crucial. The National Institute of Alcohol Abuse and Alcoholism provides resources to help people find local treatment options, Koob said.

The Path Forward

The key isn’t merely cutting back on drinking but readjusting how your brain obtains rewards and addressing the stress that might motivate alcohol use, Knowles explained.

Regarding maintaining sobriety, “most people who are proudly showing you their 35-year pin are going to tell you it’s a lifelong effort,” Koob observed.

Understanding the science behind alcohol dependency helps explain why some people struggle whilst others don’t. Whether it’s brain wiring, psychological factors or environmental influences, recognising these elements is the first step towards healthier choices and, for some, breaking free from problematic drinking patterns altogether.

Source: CNN