Alcoholism is a widespread yet poorly understood disease. Find out how a new study locates its roots in the brain and may lead to better treatment.
Every time my friends and I crossed paths in the local sports grill, there would be Tom. (That’s not his real name). He’d be sitting on his regular barstool, off in the corner by himself, wearing work boots, faded jeans, a wrinkled t-shirt and a shabby, red ball cap.
While he aimlessly played video solitaire, the coin-operated terminal on the bar would bathe his face in blue light. In front of him would be a bottle of Canadian and a glass tumbler with a double shot of Canadian Club, along with some barely touched, flat ginger ale on the side.
He had a family at home, and he was a first-rate union electrician. He sometimes did quick wiring jobs for the owners.
BARSTOOL WAS WHERE HE SPENT MOST OF HIS TIME
Even so, that stool was where he spent most, if not all, of his time, seven days a week. He never ordered any food.
Tom went on like this for at least a decade as we watched his body get skinnier and the web of lines on his pallid face grow deeper. A few years ago, I heard a rumour that Tom eventually drank himself to death. Nobody knew for sure if it was true.
Tom was an extreme example of one of the most common mental disorders in the world. Most families have had to cope with alcoholism at some point in their history.
ALCOHOL INVOLVED IN 3 MILLION DEATHS WORLDWIDE
A 2019 World Health Organization report indicates that alcohol is involved in more than 3 million annual deaths every year worldwide. Alcohol abuse plays a part in about 5% of the global burden of disease.
Even though alcoholism is a widespread disease that cultures have recognized for thousands of years, it’s still a complex and poorly understood disorder. It’s a form of addiction, which the National Institute of Drug Abuse defines as ““A chronic disease characterized by substance seeking and use that is compulsive or difficult to control, despite harmful consequences.”
We’ve also known for some time that alcoholism is a physiological condition and not merely a lack of character. Alcohol dependence affects both the mind and the body.
ALCOHOL DEPENDENCE AFFECTS BOTH MIND AND BODY
People like Tom have virtually no control over how much they drink. The old adage that “one drink’s too many and a hundred’s not enough” turns out to be quite apt.
As with all addicts, alcohol had become the focus of Tom’s life. Increasingly, though, scientists are learning that conditions like Tom’s result from a chronic, relapsing brain disease.
This week, the journal Science Advances published a study that sheds new light on alcoholism as a brain disorder. A team of British and Chinese researchers has identified the brain’s pathway where alcohol addiction first develops.
BRAIN PATHWAY WHERE ALCOHOLISM FIRST DEVELOPS
Researchers from the University of Warwick, the University of Cambridge and Fudan University in Shangai co-led the study. Based on their findings, the team believes that alcoholism originates in the part of our brains that controls how we respond to danger.
When we encounter something nasty or scary, an area at the front of our brain called the medial orbitofrontal cortex (mOFC) senses the potential hazard. The mOFC sends this information to the dorsal periaqueductal gray (dPAG) in the amygdala, near the centre of our brains.
It’s the dPAG that processes whether there’s any need for a “flight or fight” response. This means that our response to danger is an information pathway within the brain and doesn’t sit in any specific place.
COMPULSIVE AND IMPULSIVE DRINKING
According to the research, there are two kinds of alcoholism; compulsive drinking and impulsive drinking. Compulsive drinkers don’t seem to know when to stop, while impulsive drinkers turn to alcohol to cope with adversity in their lives.
According to this new model, alcohol sometimes weakens the dPAG, impairs the drinker’s ability to recognize danger. They don’t seem to experience their body signalling they’ve already had one too many, and they become compulsive drinkers.
In other cases, alcohol stimulates the dPAG, causing alcoholics to overreact to life’s setbacks. They feel an urgent need to “drown their sorrows,” which leads to impulsive drinking to cope with misfortunes.
“COULD MALFUNCTION IN TWO DIFFERENT WAYS”
Dr. Tianye Jia of Fudan University is one of the team leaders. He explained the paradox this way, “We have found that the same neural top-down regulation could malfunction in two completely different ways, yet leading to similar alcohol abuse behaviour.”
The team reviewed research involving rodents. Then, they took it to the next level by analyzing MRI brain scans from a dataset of adolescents called IMAGEN.
IMAGEN provided a group of 1,890 youths from the UK, Germany, France and Ireland. The participants received two functional MRI (fMRI) scans; one was when at rest, and one was when given a task.
PARTICIPANTS RECEIVED TWO FUNCTIONAL MRI SCANS
Some of the participants showed an overexcited pathway between the mOFC and dPAG in their resting fMRI. These subjects were more likely to have abused alcohol in the past.
In the second fMRI, participants were given a task and denied a promised reward for it. This was to trigger negative emotions. Like in the rodent experiments, the connection between the mOFC and dPAG was impaired in participants who had abused alcohol.
Professor Trevor Robbins from Cambridge described the findings this way. “It is remarkable that these neural systems in the mouse concerned with responding to threat and punishment have been shown to be relevant to our understanding of the factors leading to alcohol abuse in adolescents.”
“WHEN I GET TO BE PERFECT, I’LL START JUDGIN’ OTHER FELLAS”
I remember sitting in the sports grill with some friends, talking about Tom’s issues. Our tone became more and more uncharitable until one of the older guys in the group piped up, saying, “Well, when I get to be perfect, I’ll start judgin’ other fellas.”
Those simple words of wisdom could have been the moral of the lesson from this study. Alcoholism isn’t a character flaw; it’s a chronic, physical disease.
ENTITLED TO RESPECT, TREATMENT AND SUPPORT
Even though our minds are subject to various disorders, they’re still unique among all the living things on our planet. Our individual human consciousness entitles us to respect, treatment and support from our neighbours, even if we live like Tom.
In announcing the study’s publication, staff from the University of Warwick concluded by saying, “Understanding how alcohol addiction forms in the human brain could lead to more effective interventions to tackle the global problem of alcohol abuse.”
We always have more to learn if we dare to know.
Neural roots/origins of alcoholism identified by British and Chinese researchers
Neural network involving medial orbitofrontal cortex and dorsal periaqueductal gray regulation in human alcohol abuse
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Patience: Where It Comes From and Why
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