 Alcoholism is a compounded phenomenon. For the many years of alcohol abuse and alcohol dependence, the brain itself changes. There are neurological changes, some of them irreversible and deep, for example to memory structures like the hippocampus, and there are biochemical changes, many of them reversible, once consumption stops. But at any rate, during the alcoholics phase of active consumption, the brain is different. But there's also a pronounced psychological dimension, and it is not clear who drives what. It would seem that first there was a psychological need, and the changes in the brain followed. My name is Sam Vakny and I'm the author of Malignant Self-Love, Narcissism Revisited. Alcoholism serves several psychological purposes effectively. This is why alcoholism is so intractable, difficult to get rid of, difficult to treat. The recidivism, the relapse rate of alcoholics who have gone through a rehab phase in a residential treatment program and then followed up with group sessions and individual psychotherapy. Even among this group, people who are committed to sobriety, the relapse rate is anywhere between 40 to 60%. That's even higher than among psychopathic criminals. And all this happens within the first year after rehab. So, the first psychological function of alcohol is palliative. It helps the alcoholic to cope with dissonance, frustration, narcissistic injury, anxiety, anger, stress, sadness, panic, helplessness, hopelessness, and other negative emotions or mood disorders. The alcoholic is overwhelmed by these emotions or overwhelmed by narcissistic injuries in case he is a narcissist or a psychopath. In order to palliate, in order to reduce and ameliorate this ego dissonance, this extremely painful inner turmoil, the alcoholic resorts to alcohol. The second function of alcohol is restorative. It helps the alcoholic to restore his or her sense of self-confidence and self-esteem. Also, sometimes, as a man or a woman, especially when it is coupled with a body image problem or issue. This is why, very often, alcohol leads to promiscuous sex. It is an attempt to self-medicate both with alcohol and with a member of the opposite sex, to buttress and uphold one's wavering sense of self-worth. And then there is the disinhibitory function. By lowering inhibitions, alcohol legitimizes narcissistic traits and behaviors like lack of empathy, extreme egotism and selfishness, a sense of entitlement or even aggressive impulses in the case of antisocial alcoholics. It allows the alcoholic to express his or her repressed promiscuity and aggression. Traits that he or she find ego dissonic. Traits that she, when sober, dislikes in herself. Alcohol renders the alcoholic much more sociable, much more grandiose and much more sociopathic. Many alcoholics become volumely defiant. They to authority feats. They ingain reckless behaviors like unprotected sex with a stranger or compulsive shopping or compulsive gambling. In this sense, alcohol is very intimately linked with antisocial traits and narcissistic traits. The fourth psychological action of alcohol is that it is instrumental. It allows the alcoholic to accomplish goals that he or she would never even try when sober. It is goal, it restores goal orientation. The drunk person becomes daring, risen and risk, instead of being risk averse, he becomes a risk taker or a risk seeker, a seeker. Some alcoholics just cancel. And so they enter a phase called alcohol-induced blackout. This is very typical of alcohol use disorder, rather than mere social drinking or functional alcoholics. When someone has already full fledged developed alcohol use disorder, blackouts become gradually more and more common. The drunk person during an alcohol-induced blackout is fully aware of what he or she is doing. She is fully aware of who she is doing it with and what he or she is doing is wrong. So there is this measure of right and wrong. And that's why people are answerable and accountable for their actions, even in the legal sense, when they are in an alcoholic blackout. They know if they are hurting loved ones with their promiscuity, immoral or antisocial or even criminal acts. During the entire episode, the drunk makes multiple choices and decisions based on rational analysis and his or her emotional states. She is 100% in control. The law recognizes this. Drunkards, even during a blackout, are fully accountable for enemies' contact and for criminal acts. For example, running over someone in a car. Throughout the blackout, orientation, reasoning, immoral sense, short-term memory and decision-making are not impaired. This is contrary to all this. There is some cognitive impairment, but it has to do more with other issues, which we will discuss shortly. But during a non-college used blackout, all these, I repeat, reasoning, orientation, moral sense, short-term memory, decision-making, they are all intact. The only defect is this long-term memory. The connection between the rest of the brain and the hippocampus were long-term memories are created. The next morning, the recovering alcoholic has zero recall of what has happened during the blackout. There is also something called brownout, fragmentary amnesia, where some of the images and some of events come back over the next few days. But in a classic full-scale blackout, they never come back because they were never created to stop it. This is why it is difficult to tell a drunk in a blackout state from a merely inebriate person or social drinker. They are going to be fully print. They are going to be fully cognizant throughout the blackout. And they actually are. They are absolutely there. The only thing they don't do is generate long-term memories. All the rest is perfectly functional. Motor functions are affected to some extent. And there is a tendency to repeat the same sentences over and over again, but essentially that's it. Like narcissists, people wasted to the point of a blackout just don't care about anything or anyone but themselves. Behavioral inhibitions are down. Alcohol disinhibits, of course. Empathy towards one's nearest and dearest is utterly turned off. Strangely, it is redirected with strangers. A sense of invulnerability, grandiose invincibility, omnipotence, and impunity sets in. The drunker experiences attraction or even infatuation with members of the opposite sex. This is because of inability to judge facial symmetry properly when drunk. So members of the opposite sex look much more attractive than they would when the person is sober. And the high and the buzz of the drink compensate for any frustration, depression, stress, or anxiety with a heightened sense of well-being and with aggression. Ironically, alcohol being a depressant, all these effects are viciously reversed on sobering up the morning after. A severe depression setting. People, and especially men, get that drunk in order to feel better about themselves and about their lives, legitimize their promiscuity and cheating. They say, the drink did it to me, and I cannot remember a thing. And also in order to trash themselves in a bout of punishments and destruction. These are of course common among men as well. But they've been identified much more prevalent among women who drink to excess. Women who drink in order to lose themselves. Women who drink up to the point of blackout. One of the main motives is self-destructive, trashing yourself with the wrong partner, with unprotected sex, other reckless behaviors, aggression with consequences that sometimes are life-ordering.