Alcohol dependence
A neuroadaptive state in which chronic GABA-potentiation and glutamate suppression by alcohol forces the brain to re-tune its own excitatory-inhibitory balance, so that stopping abruptly unmasks a dangerous rebound hyperexcitability.
First principles
Dependence is the brain compensating for a constant chemical presence
Alcohol acutely potentiates inhibitory GABA-A signalling and suppresses excitatory NMDA-glutamate signalling, producing sedation and disinhibition. With sustained heavy use the brain adapts to restore normal function in the presence of alcohol: GABA-A receptors down-regulate and NMDA-glutamate receptors up-regulate, shifting the resting excitatory-inhibitory balance towards excitation, masked only by the continued presence of alcohol. Dependence is this neuroadaptation itself, which is why tolerance (needing more alcohol for the same effect) and dependence typically develop together, both are the same underlying compensation.
Educational content pending clinical review. Not medical advice.