Problem drinking has multiple causes, with genetic, physiological, psychological and social factors all playing a role. Not every individual is equally affected by each cause. For some alcohol abusers, psychological traits such as impulsiveness, low self-esteem, and a need for approval prompt inappropriate drinking. Some individuals drink to cope with or medicate emotional problems. Social and environmental factors such as peer pressure and the easy availability of alcohol can play key roles. Poverty and physical or sexual abuse increase the odds of developing alcohol dependence.

Genetic factors make some people especially vulnerable to alcohol dependence. Contrary to myth, being able to hold your liquor means you're probably more at risk, not less, for alcohol problems. Yet a family history of alcohol problems doesn’t mean that children of those with alcohol problems will automatically grow up to have these problems_nor does the absence of family drinking problems necessarily protect children from developing these problems.

Once people begin drinking excessively, the problem can perpetuate itself. Heavy drinking can cause physiological changes that make more drinking the only way to avoid discomfort.