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What Makes Alcohol So Addictive?

Alcohol is an addictive substance, and misuse can lead to the development of alcohol use disorder (AUD).[1] No one sets out to have an addiction, but one can form relatively easily and quickly when certain factors are in place. 

Struggling with Alcohol Addiction? Get Help Now

When you drink, alcohol prompts dopamine and endorphin release, so you feel good.[2] This causes you to want to keep drinking, and alcohol’s continued effects on the body pile up. 

Some people are more prone to addictive behaviors, either due to genetic, environmental, or other factors.[3] Once dependence on alcohol forms, which can develop after repeated abuse, an alcohol addiction is present.

In the 2022 National Survey on Drug Use and Health (NSDUH), 48.7% of people 12 and older drank alcohol, and 21.7% were binge drinkers.[17] Binge drinking is defined as drinking four or more drinks on the same occasion for women and five or more for men.[17]

What Is Alcohol Use Disorder?

Alcohol use disorder (AUD) is a pattern of drinking that leads to significant distress and a lower level of functioning. Anyone might ask the question: Why is alcohol so addictive? People with AUD may live with the consequences regularly.

Doctors use the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) to diagnose AUD. To qualify, people must have two or more of the following symptoms within the same 12-month period:[16]

  • Drinking more, or over a longer period, than intended
  • Trying to quit or cut back on drinking but being unable to do so
  • Spending a lot of time getting, using, or recovering from alcohol
  • Craving alcohol
  • Continued drinking that results in a failure to meet obligations at work, school, or home
  • Continued use despite problems caused or worsened by drinking
  • Loss of social, recreational, or occupational activities due to drinking
  • Drinking in situations in which it’s dangerous
  • Continued use despite the knowledge that it’s causing physical or psychological problems
  • Needing to drink more to get the desired effect
  • Withdrawal symptoms during attempts to quit or cut back

In the 2022 NSDUH, 10.5% of people 12 and older had AUD per the criteria listed above.[17]

Why Is Alcohol So Addictive?

Alcohol is so addictive in part because of the significant impact it has on the brain’s reward system.[4]

Alcohol triggers brain cells to release the neurotransmitter dopamine. This chemical connects an activity (like drinking) with a sense of reward and well-being. Brain cells interpret drinking as harmless or even beneficial. In time, brain cells may produce powerful cravings when exposed to a trigger (like a pint glass) that is connected to drinking.[4]

Alcohol also causes brain cells to reduce the release of GABA. This neurotransmitter causes feelings of anxiety, fear, and stress. Without it, people feel happy and carefree.[4] 

When alcohol wears off, and GABA levels normalize, people may feel more anxious than they did previously. People may drink again to make those sensations stop.[4]

Alcohol also causes the brain stem to release serotonin. Initially, this chemical makes people feel happy and content. However, as levels rise, people may feel depressed. Some may drink in a mistaken attempt to lift their mood.[4]

A Spiraling Cycle of Abuse

The more someone drinks, the more they need to drink to get that feeling, which means that larger amounts of alcohol are needed over time. When combined with certain biological, environmental, social, and psychological factors, the scientific action of alcohol in the brain can quickly turn alcohol abuse into alcohol addiction.[6] 

Breaking the neurological mechanism of alcohol addiction requires professional assistance and support. Treatment strategies for alcohol addiction often involve consistent and long-term use of medication-assisted treatment, therapeutic intervention, support groups, and lifestyle modifications. 

How Does the Body Develop an Alcohol Dependency?

The physiological response to alcohol can be broken down by a handful of factors.

Dopamine Release

Alcohol consumption activates a large dopamine release in your brain’s reward pathway. Dopamine, an essential neurotransmitter linked with reward and reinforcement, produces a surge of pleasure that reinforces alcohol consumption behaviors.[7]

Tolerance Development

Alcohol abuse causes brain function adaptations that result in tolerance, making increasingly larger quantities of alcohol necessary to feel pleasurable effects.[8] This higher consumption of alcohol increases exposure to the toxin, which puts a strain on the liver, brain, and cardiovascular systems.

Neurochemical Imbalance

Long-term alcohol abuse disrupts the delicate balance between neurotransmitters in the brain, such as dopamine, serotonin, and other mood and reward-processing neurotransmitters.[9] This imbalance further fuels alcohol dependency.


When alcohol dependence is present, a drop or cessation of use can trigger withdrawal symptoms that can range from mild discomfort to serious physical and psychological side effects, which can be life-threatening.[10] These motivate people to continue drinking in order to ease the discomfort.


Continual exposure to alcohol and its effects can cause physical changes to brain structures, altering their function and response to stimuli.[11] This can result in personality changes, including increased compulsive behaviors and prioritization of alcohol use over relationships despite negative consequences.


Over time, addiction erodes the ability to control alcohol consumption.[12] These cravings often persist after the physical dependence has been addressed in detox. Cravings are arguably one of the most difficult aspects of addiction to overcome in treatment, but medications can help to manage them.[13]

Reward System Malfunction

Alcohol essentially hijacks the brain’s reward system.[14] Over time and with long-term alcohol use, it may be harder to manage mood naturally, which means that people who are already struggling with mental health issues, such as anxiety or depression, need treatment to help them learn how to cope with those issues without alcohol.

What Increases the Risk?

We often equate alcohol use disorder with people who drink too much over a long period. While your drinking habits play an important role in the development of alcoholism, other factors matter too.

In 2008, researchers writing for the journal Alcohol Research and Health said the following five major risk factors were closely associated with the development of alcoholism:[18]

  1. Sex: While men tend to start drinking earlier in life, women tend to progress through the stages of alcoholism much faster and experience more significant consequences.
  2. Family history: Parents with a history of alcoholism tend to pass the issue to their children. Genetic factors and observed behaviors could both play a role.
  3. Underlying mental health: People with issues like depression and anxiety are more likely to struggle with alcoholism than those who do not have them.
  4. Other substance use disorders: People who struggle with other substances like nicotine or drugs are more likely to experience alcohol problems too.
  5. Age: People who begin drinking at an early age tend to have more problems with alcohol than those who start later.

Specific genes can increase the risk of alcohol use disorders too. Researchers say that genes involved in alcohol metabolism (such as ADH1B and ALDH2) can either increase or decrease the risk of alcohol use disorder by either making alcohol unpleasant or very rewarding.[19]

Stopping the Cycle of Alcohol Addiction

Alcohol addiction is a cycle of use that is defined by cravings and alcohol withdrawal symptoms. As behaviors become focused on getting more alcohol and staying under its influence, it becomes harder for the individual to maintain positive relationships that may have helped them recognize their issues and get help. It’s easy for an alcohol abuse issue to spiral out of control.

For this reason, alcohol use disorder is a psychological, physical, and social disorder.[15] All of these areas must be addressed in treatment for recovery to be effective. 

Comprehensive treatment for alcohol use disorder offers an evidence-based approach to recovery. It often involves the use of medications, therapy, and complementary treatment approaches to ensure recovery on all fronts of life. Any co-occurring mental health issues are also addressed in treatment. 

The sooner you seek treatment for alcohol addiction, the better the long-term outcomes. Reach out for help today.

Updated April 30, 2024
  1. Understanding alcohol use disorder. National Institute on Alcohol Abuse and Alcoholism. Published 2020. Accessed December 14, 2023.
  2. The dopamine system and alcohol dependence. Ma H, Zhu G. Shanghai Archives of Psychiatry. 2014;26(2):61-68.
  3. The impact of gene–environment interaction on alcohol use disorders. Dick DM, Kendler KS. Alcohol Research: Current Reviews. 2012;34(3):318-324.
  4. The role of alcohol and the mechanisms involved in the reward pathway affecting the brain: A comprehensive review. Vadakedath S, Kandi V. American Journal of Medical Sciences and Medicine. 2022;10(1):34-39.
  5. Alcohol and the brain. Nutt D, Hayes A, Fonville L, et al. Nutrients. 2021;13(11):3938.
  6. Intersection of familial risk and environmental social control on high-risk drinking and alcohol dependence in a US national sample of adults. Karriker-Jaffe KJ, Chartier KG, Bares CB, Kendler KS, Greenfield TK. Addictive Behaviors. 2021;113:106668.
  7. Long-term alcohol consumption alters dorsal striatal dopamine release and regulation by D2 dopamine receptors in rhesus macaques. Salinas AG, Mateo Y, Carlson VCC, et al. Neuropsychopharmacology. 2021;46(8):1432-1441.
  8. Tolerance to alcohol: A critical yet understudied factor in alcohol addiction. Elvig SK, McGinn MA, Smith C, Arends MA, Koob GF, Vendruscolo LF. Pharmacology Biochemistry and Behavior. 2021;204:173155.
  9. Serotonin in alcoholism. Accessed December 15, 2023.
  10. Alcohol withdrawal. Newman RK, Stobart MA, Gomez AE. National Institutes of Health. Published 2019. Accessed December 15, 2023.
  11. Alcohol’s effects on brain and behavior. Sullivan EV, Harris RA, Pfefferbaum A. Alcohol Research & Health: The Journal of the National Institute on Alcohol Abuse and Alcoholism. 2010;33(1-2):127-143.
  12. Identifying triggers of alcohol craving to develop effective virtual environments for cue exposure therapy. Ghiţă A, Teixidor L, Monras M, et al. Frontiers in Psychology. 2019;10.
  13. Pharmacological treatment of alcohol cravings. Marin D, Olívia M, Perrotte G, et al. Brain Sciences. 2023;13(8):1206-1206.
  14. The brain’s reward system in health and disease. Lewis RG, Florio E, Punzo D, Borrelli E. Advances in Experimental Medicine and Biology. 2021;1344:57-69.
  15. Alcohol use disorder. Nehring SM, Freeman AM. StatPearls. Published 2020. Accessed December 15, 2023.
  16. Alcoholism clinical presentation. Thompson W. Medscape. Published August 25, 2022. Accessed April 26, 2024.
  17. Key substance use and mental health indicators in the United States: Results from the 2022 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services
  18. The role of selected factors in the development and consequences of alcohol dependence. Gilbertson R, Prather R, Nixon S. Alcohol Research and Health. 2008;31(4):389–399.
  19. Genetics and alcoholism. Edenberg H, Foroud T. Nature Reviews Gastroenterology and Hepatology. 2013;10(8):487-494.
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