Alcohol use is ubiquitous in American culture, as well as other cultures around the world. Stereotypes that come to mind include college students binge drinking beer and hard alcohol, soccer moms enjoying their 4pm glass of wine, and hipsters sipping on craft brews. Given how common it is for people to drink, it is important to understand the impact of alcohol and why we choose to drink or not drink. This article explores the bad and some good outcomes associated with alcohol, looks at brain areas related to alcohol use, and examines some personality traits that are related to drinking.
Problems Related to Alcohol Use
People use alcohol for a variety of reasons, including as a way to socialize with others (think happy hour drinks with coworkers or giving “liquid courage” for a first date or large party). While many people use alcohol responsibly, even responsible alcohol use is not without its consequences. Let us briefly look at some of the negative consequences of alcohol use.
When looking at the global cost of alcohol, approximately 4% of all global deaths and between 4 and 5% of the global burden of disease and injury are attributable to alcohol (Rehm et al., 2009). Alcohol-related costs number in the billions for the United States alone, with most of the costs coming from a loss of productivity (72%), although other costs include direct healthcare costs (13%), other direct costs (12%), and direct law enforcement costs (4%).
According to this study, the top five diseases/problems that have the highest number of alcohol-related deaths (ranked from higher to lower) are: unintentional injuries (e.g., drownings, car accidents, falls), cardiovascular diseases, cancer, cirrhosis of the liver, and intentional injuries (i.e., violence). In addition, the top five diseases/problems that are most severely impacted by alcohol are (ranked from higher to lower): neuropsychiatric disorders (e.g., alcohol use disorders [makes sense], depression), unintentional injuries, intentional injuries, cirrhosis of the liver, and cardiovascular diseases (with cancer not far behind).
As you can see, alcohol use is related to many different negative outcomes, including interpersonal problems, physical problems, and mental health problems. It is also important to note that the negative impact of alcohol does not affect all people equally; men and individuals aged 15 to 29 have higher rates of alcohol use and subsequently are more negatively impacted by alcohol.
Now this global study just looked at overall national alcohol consumption rates and did not separate the findings into what we might consider responsible use and not-so-responsible use (if there is such a thing). The question then becomes, what if you look at small to moderate drinkers, for example, thinking of the person who has a glass of wine with dinner.
It turns out that there are some good outcomes related to light to moderate alcohol use.
(Some) Good News for Alcohol Use
As previously mentioned, not all the research about alcohol use shows bad outcomes. For example, a review and meta-analysis of 84 studies from around the world that included hundreds of thousands of participants, examined the impact of alcohol on cardiovascular outcomes and found that light to moderate alcohol use was associated with reduced risk of several negative cardiovascular outcomes (Ronksley et al., 2011).
This meta-analysis also found that drinkers actually had a lower risk of cardiovascular-related mortality compared to non-drinkers. Indeed, the lowest risk for coronary heart disease occurred for individuals who had one to two drinks per day, although the lowest risk for stroke was for individuals who had one drink or less per day. Similar to other research, this meta-analysis found that heavy drinkers had an increased risk of cardiovascular problems.
But wait, you might say, I have read a bunch of news articles that talk about how alcohol drinkers live longer than people who abstain from alcohol use. It turns out that the research appears to be mixed; some meta-analyses have shown that light to moderate drinking is associated with a longer life whereas others do not show this relationship. The main problem seems to be how well these studies controlled for other factors that could influence this relationship.
For the moment, it appears that less is probably better for alcohol use, although it is obviously an individual decision about how much to drink. When in doubt, I would encourage you to consult with your physician and figure out what makes sense for you.
Brain Areas Associated with Alcohol Use
Alright, so now we know some of the outcomes related to alcohol use. A next logical question might be, well what impacts whether an individual chooses to drink or not? It turns out that our brain influences our alcohol use, so let’s examine a few key brain areas that have proven to be related to alcohol use.
One study that examined neuronal pathways related to alcohol craving and relapse found that dysfunctions in the brain’s “reward system” are associated with alcohol cravings, how people process alcohol-related stimuli (such as seeing a bottle of wine or hearing a bottle of beer being opened), and the expected positive benefits of alcohol (Heinz et al., 2009).
There are quite a few brain areas that are involved with the brain’s reward system, some of which you may have heard of before (prefrontal cortex, amygdala, hippocampus, hypothalamus) and others you may not have heard of (e.g., ventral tegmental area [VTA], nucleus accumbens). Essentially there are a lot of different brain areas that are involved with how we learn what we like and what motivates us to pursue those things we like.
One of the most important parts of this reward system is that it is the site of many dopamine neurons. Dopamine is a neurotransmitter that is key to pleasure and reward (amongst other functions); in the basic sense when we do or consume things we like, the reward system releases dopamine which feels good and makes us more likely to do or consume the same thing in the future. Research suggests that genetic differences in dopamine receptors can predict whether someone develops an alcohol use disorder (Munafò et al., 2007).
Other researchers have found that individuals with alcohol use disorders have abnormal white matter in their frontal lobes (Sorg et al., 2012). As the frontal lobe of our brain is involved in planning, impulse control, decision making, etc., it is easy to see how impairments in this area would contribute to continued problematic alcohol use.
Interestingly, it appears that impairments are not limited to the frontal lobe as research has found that those with alcohol use disorders have widespread cognitive impairments, including with working memory, verbal abilities, impulse control, processing speed, and overall intellectual functioning, that last for an average of one year past sobriety (Stavro et al., 2011). This area of research helps explain why those with alcohol use problems can find it so difficult to quit using.
How Your Personality is Related to Drinking
In addition to neurological processes, one factor related to alcohol use that you may or may not have thought about is your personality. In psychology, personality is defined as patterns of thoughts, behaviors, and feelings that individuals have. While personality appears to partially influenced by biology and genetics, an equal amount appears to be influenced by an individual’s environment.
Now there are a lot of pop psychology quizzes out there that proclaim to know what type of personality you are. As is often the case though with pop psychology, there is little research to support all of these different “personality types”.
However, one model of personality has been heavily supported by research and is typically seen as the most accurate model of personality out there. It’s called the five factor model (FFM) of personality.
The five factors that constitute this model can be remembered with the acronym OCEAN: openness, conscientiousness, extraversion, agreeableness, and neuroticism. Going into detail about this model would be a post of its own, but I will briefly highlight what each component taps into. It is important to note that each of these factors is typically seen on a continuum from low to high, with the unique combination of the levels of these five factors forming our personality.
Openness consists of how open an individual is to things such as emotions, art, novel ideas, and new experiences. People high in openness tend to be more intellectually curious (probably you if you are reading this blog!), creative, and willing to try new things. Conscientiousness refers to how much a person tends to be self-disciplined, structured, and prefer planned over spontaneous behavior.
You have probably heard about the next factor, extraversion, as everyone seems to talk about extroverts this, introverts that. There is a lot of misinformation about what these constructs actually mean, so here is what the FFM says about extraversion.
Extraversion is characterized by individuals who engage frequently with the outside world with parties and other activities, are often seen as having a lot of energy, tend to have more positive emotions, are impulsive, and like to talk and be social. The flipside of extraversion is introversion (i.e., being low in extraversion). Those who are introverted tend to have less energy, a reduced desire to engage in social activities, are quiet, and deliberate. Being introverted does not mean someone is unfriendly or depressed, just that she or he tends to prefer less activity than extraverts do.
Agreeableness is noted by how much an individual is concerned with getting along with others; individuals high in agreeableness tend to be considerate, kind, helpful, trustworthy, and willing to compromise.
Lastly, neuroticism, which has also been called emotional instability, is how much an individual tends to experience negative emotions, including anger, anxiety and depression. Individuals high in neuroticism tend to be easily provoked by stressors and are emotionally reactive.
Alright so that was a quick overview of the five factors, now the question is how do they relate to alcohol use? Several researchers conducted a meta-analysis of 20 studies that looked at the FFM and alcohol use and found that the profile of low conscientiousness, low agreeableness, and high neuroticism was most related to alcohol use (Malouff et al., 2007). The researchers note that this personality profile is characterized by low self-control, which makes sense given the impulse control problems related to substance use disorders more generally.
In addition, this personality profile is noted to be difficult to treat. You can imagine what it might be like trying to work with someone who has little self-control or structure, is not easy to get along with interpersonally, and has high emotional reactivity to events or triggers. It is not hard to see how someone with this particular personality configuration would get easily offended and prematurely terminate treatment due to a real/perceived slight by a therapist or provider.
Adding some credibility to their findings, the same personality profile is apparently also associated with cigarette smoking. Therefore, there is at least some indication that certain personality trait combinations are a general risk factor for substance use. This is by no means getting at the “addictive personality” that is often discussed in the news and media (a discussion for another time), but it does seem to suggest that certain individuals are at higher risk of substance use problems based on their personality traits.
It would be very interesting to know if any personality trait combinations are associated with a smaller likelihood of substance use or substance use problems (in psychology we would call them resiliency or protective factors). It is important to note that this meta-analysis did not show that these personality traits cause an individual to drink more, so more research is needed to better understand how personality and alcohol use are related to each other over time.
There are many different factors that are related to alcohol use including cultural norms regarding alcohol, laws that restrict alcohol use, the cost of alcohol, having family members who also drink, etc. This post looked at how brain areas and personality are related to alcohol use, to look at some of the ways physical and mental processes are related to each other, but this is not to say other factors are not equally important.
What are some takeaways from this article? Well, I think that for me the research emphasizes that while low to moderate alcohol use is not without its health consequences, it is not so glaringly dangerous that we must completely abstain from alcohol. As an avid wine drinker this is good news, but the research does show how important it is for one’s physical and mental health to reduce alcohol use as much as possible. As they say, moderation is key.
Another takeaway is that, at this point in our understanding of alcohol use problems, it is impossible to ignore that there are significant neurobiological factors that impact alcohol use. This body of research shows that the old stigmatizing belief that addiction was due to “weak willpower” is just not true. Hopefully, this knowledge helps increase our compassion for those struggling with alcohol use-related problems and helps our understanding of why it can be incredibly difficult, although very much possible, for those with alcohol use problems to no longer use.
While this article focused on how your brain and personality are related to alcohol use, factors that we typically think of as unchangeable (although this is not completely true), this is not to mean that individuals who have alcohol use problems cannot make meaningful changes. There are some great treatments, both medications and psychological therapies, that can help with alcohol use problems. In addition, other people change their alcohol use without any intervention at all, although it is often more difficult that way.
Hopefully this article shed some light on the impact, good and bad, of alcohol and offered some new insights into why people use problematic levels of alcohol. Thanks as always for reading!
The Clinically Relevant Insights Blog, part of ShawnWilsonPhD.com, shares news and research related to psychology and wellness.
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