Is a drinking addiction psychological or physical?

Dear Healthy Drinker?,

Your confusion is understandable as alcohol use disorder can be BOTH a habitual (psychological) and a chemical (physical) addiction. Psychological dependence occurs when a person drinks in order to function "normally" and feel good. If a person stops drinking, they may experience changes in mood such as anxiety, depression, or irritability. Physical dependence, on the other hand, is when a person's body adapts to chronic use of alcohol and results in physical symptoms—such as vomiting and diarrhea—when the person stops drinking. That being said, the old assumption that there is a complete separation between the mind (the psychological) and the body (the physical) is both reductive and inaccurate based on our current understanding of how addictions work. It’s true that psychological dependence and physical dependence are different concepts, but there are also some ways in which the two are connected and may lead to alcohol use disorder. 

Psychological dependence refers to how a person’s cognitive abilities and emotions are affected by their relationship with a substance. Alcohol, like many substances, can produce pleasant feelings in the brain while simultaneously dulling negative feelings when consumed: a sensation which is referred to as the intoxication stage of an addiction. This response is why many people enjoy drinking; however, some people may begin to rely on alcohol and its effects to cope with difficult emotions. The more that someone drinks to alleviate stress or escape uncomfortable emotions, the more their risk of developing a psychological dependence increases. If a person stops drinking, they may begin to enter a withdrawal stage in which their anxiety and irritability grow more severe, leading to an anticipation stage where they fixate on how and when they can get access to alcohol to relieve the negative side effects. Some signs of a psychological dependence include:

• Experiencing cravings for alcohol
• Finding it difficult to socialize or feel happy without alcohol
• Feeling anxious or depressed when drinking stops
• Spending significant amounts of time trying to obtain alcohol
• Feeling like it’s impossible to stop drinking
• Having trouble concentrating or making decisions

In contrast, physical dependence usually describes a person who builds a tolerance to a substance over time. If a person continues to drink (perhaps as a way of managing negative feelings as described earlier), they may start to require more alcohol to feel the desired physical effects. This tolerance leads to a cycle in which a person has to keep increasing their alcohol use. When they suddenly stop drinking, they may begin to experience physical withdrawal symptoms as their body has become used to the presence of alcohol. As is also the case with a psychological dependence, these symptoms may be so uncomfortable that a person feels compelled to drink again, even if they're trying to stop. Physical withdrawal symptoms might include the following:

• Nausea
• Vomiting
• Diarrhea
• Seizures
• Hallucinations

Alcohol use disorder typically occurs when there are both physical and psychological dependences that cause abuse of the substance. Drinking becomes compulsive and difficult to control without experiencing negative physical and emotional reactions. Though the disorder has a spectrum of severity, any dependence (be it physical or psychological) has the potential to cause long-lasting harm. Unaddressed alcohol use disorder may lead to a variety of conditions such as depression, anxiety, a weakened immune system, memory problems, sleep disturbances, and poor liver health. Furthermore, alcohol use disorder may cause strain in a person’s relationships as they begin to prioritize drinking over interacting with loved ones. Some of the warning signs of someone who may have alcohol use disorder include:

• Being unable to reduce drinking, even if they want to
• Developing a high tolerance for alcohol 
• Drinking in spite of negative physical and mental health consequences
• Drinking even if it causes issues with family, friends, education, or work
• Experiencing withdrawal symptoms when drinking stops
• Avoiding social activities to make time for drinking

While drinking alcohol may be an enjoyable way to spend time with others, feeling like you or a loved one can’t stop or cut down on alcohol use can be an alarming experience. If you're concerned about your drinking habits, it may be beneficial to have a conversation with a health care professional and discuss ways to avoid (or manage) a physical or psychological dependence. Another option could be to seek counseling, where you or a loved one could explore the relationship with alcohol and learn about alternative coping mechanisms. While it is up to you to consider how you feel about your alcohol use habits, know that there are resources available if you would like assistance in changing it. 

Wishing you well,