Behavioral Mechanism of Action

Sedative-hypnotic drugs in general and alcohol in particular produce a common behavioral action – disinhibition – that can explain many of their behavioral effects, from “social lubrication” to paradoxical rage reactions. At low to moderate doses (blood alcohol levels of 0.05–0.10 g%), alcohol disinhibits behavior (that is, individuals show a release of inhibitions in situations where they normally might be socially constrained). Alcohol is widely used at social events to promote conversation and social interaction; the “social lubricant” effect. This disinhibition is often mistaken for a psychostimulant effect. As a result, alcohol at lower doses is often mislabeled as a stimulant. To understand alcohol’s well-documented aggression-promoting actions, one can look to benzodiazepines.

Benzodiazepines (tranquilizers) are sedative-hypnotic drugs that are commonly used to treat anxiety. They have long been known to produce a paradoxical rage reaction, reflected by aggression and impulsive behavior, presumably because of the disinhibited release of long-suppressed anger that only surfaces when the repression is lifted by the drug treatment. The disinhibition produced by alcohol is part of the classic continuum of behavioral effects of sedative-hypnotic drugs that relates behavioral effects to dose. Such disinhibition may also contribute to the use of alcohol as a form of self-medication.

The suffering of individuals with alcoholism has been hypothesized to be deeply rooted in disordered emotions characterized by unbearable and painful affect, a painful sense of emptiness, and an inability to express personal feelings that result in self-humiliation and frustration in interpersonal relationships (Box 6.9). Individuals who are cut off from their emotions will welcome repeated moderate doses of alcohol or depressants as medications to allow them to express feelings that they are usually unable to communicate (referred to as alexithymia). Such individuals are thus intrinsically vulnerable and exhibit deficits in how they care for themselves. They cannot control their behaviors and cannot contain what is repeatedly endangering their well-being, family, social relationships, and survival. Fundamentally, these individuals cannot adequately evaluate the consequences of dangers of the situation either rationally or emotionally, and they often exhibit fear, worry, and apprehension. In some cases, the individual seeks to relieve painful feelings or control his feelings. The paradox is that using alcohol to self-medicate emotional pain or a life out of control can perpetuate a life that revolves exclusively around alcohol, which, in turn, causes emotional pain caused by physiological consequences (withdrawal) and social consequences (neglect of responsibilities to family and work).

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