Alcohol Dependence (Alcoholism)

What is alcoholism?

Alcohol dependence is also known as alcoholism; however, health professionals tend not to use this term because of its potential to increase stigma and discrimination of the condition. Alcohol dependency is the most common substance use disorder in America. Individuals who are alcohol dependent tend to prioritise drinking alcohol over other activities (including seeing friends and going to work). However, alcohol dependency is not an all or nothing condition. It occurs on a continuum ranging from mild to severe. Individuals with a mild dependence on alcohol may crave an alcoholic drink when it is not available and find it difficult to stop drinking after a couple of drinks. Individuals with severe alcohol dependence suffer physical and/or psychological withdrawal symptoms (e.g. vomiting, anxiety) when they do not consume alcohol.

The guidelines recommend an average of not more than four standard drinks per day for men and two for women. Not more than six and four standard drinks respectively should be drunk by men and women at one time.

One standard drink is equal to 10 grams of ethanol, which is the substance in alcohol that causes intoxication or drunkenness. Alcohol consumed in excess of these quantities poses a number of health risks, including the risk of becoming dependent on alcohol.

In relation to its health effects, we would classify alcohol consumption as:

1. Low risk: Alcohol consumption patterns which fall within the guideline recommendations and which have little or no associated increased risk and potential health benefits.
2. Risky: Alcohol consumption patterns which slightly exceed the guidelines for either average or daily consumption, where potential harm outweighs potential benefits.
3. High risk: Alcohol consumption patterns far above the guidelines where there is a considerably increased risk of associated health problems.

Risk Factors for Alcoholism (Alcohol Dependence)

Some individuals have a higher risk of developing alcohol dependency than others. Individuals who drink frequently or in large quantities are more likely to become dependent on alcohol than those who don’t drink as much. People also have a higher risk of developing alcohol dependence if they:

• Have a relative that suffers from alcohol dependency;
• Suffer from a mental health disorder (e.g. depression, stress and anxiety); or
• Where brought up in a house where consuming large amounts of alcohol was normal.

Progression of Alcoholism (Alcohol Dependence)

Alcohol dependency occurs on a continuum. Many Americans are only moderately or mildly dependent on alcohol (e.g. they may find it difficult to stop drinking once they start). They do not exhibit physical withdrawals like those with severe alcohol dependence, and do not consider their drinking patterns problematic. This may be because the major health and social consequences of alcohol dependence (with the exclusion of violence) do not begin when an individual first becomes alcohol dependent. For example, it may take years for an individual who is alcohol dependent to have financial or relationship problems as a result of drinking. In many cases chronic excessive drinking may have no immediate health and social consequences.

Even if a mild to moderate drinker is not feeling the effects right now, they may be dependent on alcohol if they:

• Consume alcohol in quantities greater than those recommended for average or daily consumption;
• Need to drink every day or drink first thing in the morning to settle their nerves and recover from the effects of drinking the previous night;
• Experience physical and/or psychological withdrawal symptoms, including shaking in the morning, nausea and vomiting.
• Need to take days off work to recover from the effects of drinking too much;
• Miss going to social events or seeing friends so that they can drink alcohol; and/or
• Need to drink more alcohol to get drunk.

There is a tendency for some people with mild alcohol dependence to become more severely dependent.

Symptoms of Alcoholism (Alcohol Dependence)

In the early and mild stages of alcohol dependence individuals may find it difficult to stop drinking or feel anxious when they are unable to drink. At this stage, the health and social consequences of alcohol dependence are largely absent. Mild alcohol dependency often gradually leads to more frequent consumption of larger quantities of alcohol, which increases alcohol dependence.

As dependence increases, individuals are more likely to experience health and social consequences. The consumption of alcohol in moderation has health benefits for some (e.g. it reduces the risk of cardiovascular disease in older people). On the other hand, excessive alcohol consumption, especially when it is caused by alcohol dependence, is associated with an increased risk of numerous health problems. These include:

• Sexually transmitted infections
• Female or male sexual dysfunction
• Liver cirrhosis
• Brain damage
• Gastrointestinal diseases
• Cardiovascular diseases
• Dementia
• Infertility
• Anaemia
• Anxiety
• Stress
• Depression
• Cancer
• Stroke
• Suicide
• Metabolic syndrome

Alcohol dependence also has serious social consequences, both for the people dependent on alcohol and the people around them. These include:

• Increased incidence of domestic violence, sexual assault and rape, and associated health consequences (including post-traumatic stress disorder). These crimes are often committed by people who are intoxicated by alcohol. People who depend on alcohol regularly drink until they are drunk and are thus frequently in states which increase the likelihood of these experiences.
• Both men and women are more likely to verbally or physically abuse another person when they are intoxicated.
• Financial problems are commonly associated with chronic alcohol dependence. They relate both to the expense of buying alcohol and to reduced income (e.g. because of sick days or losing a job).
• Relationship problems: In addition to increased relationship violence, alcohol dependence increases social isolation and divorce.
• Problems at work including increased sick leave and job loss.

Clinical Examination of Alcoholism (Alcohol Dependence)

There are many clues which can lead a doctor to suspect a patient is alcohol dependent, and will not usually require a physical examination. For example, a doctor may suspect alcohol dependence if a patient often asks for a medical certificate for time off work, has a mental health problem (e.g. depression) or physical conditions associated with alcohol consumption (especially liver cirrhosis). In such cases, a good doctor will ask the patient questions about their alcohol consumption patterns, or ask them to complete a questionnaire about alcohol, to assess whether or not their alcohol consumption is presenting a health risk.

How is Alcoholism (Alcohol Dependence) Diagnosed?

A person will be diagnosed with alcohol dependence if they report experiencing three or more of the following behaviours/feelings over a 12 month or longer period:¹

• Tolerance for the intoxicating effects of alcohol;
• Withdrawal symptoms or drinking to relieve withdrawal symptoms;
• Consuming more alcohol than intended or drinking for a longer periods of time than intended;
• A desire to reduce drinking and unsuccessful attempts to do so;
• Spending a lot of time obtaining, consuming and recovering from the effects of alcohol;
• Missing or leaving early from important social events in order to consume alcohol; and
• Drinking despite awareness of increased social and physical problems as a result.

Prognosis of Alcoholism (Alcohol Dependence)

Around a third of individuals with alcohol dependence resolve their alcohol consumption problems without professional intervention. Others need the support of a health professional who can recommend a range of treatments. While there are many effective treatments, people who overcome alcohol dependence often relapse (i.e. develop alcohol dependency once again).

How is Alcoholism (Alcohol Dependence) Treated?

Alcohol dependence is a legitimate health problem. Health professionals can provide advice, support and in some cases medication to help reduce alcohol dependence. You may feel embarrassed talking to a doctor about drinking too much, but remember that doctors and other health workers are there to help fix health problems, not to judge or berate their patients. A good doctor will encourage their patients to drink in moderation or perhaps abstain for periods of time, not make their patients feel guilty or bad for drinking drink too much alcohol.

If you have a friend or relative who is alcohol dependent, try not to be judgmental about their drinking habits, but rather to be supportive and understanding.

Treatment for alcohol dependence depends on the severity of alcohol dependence as well as the lifestyle of the person. It will commonly involve a range of health professionals (e.g. counsellors, doctors).

Mild or moderate alcohol dependence

When alcohol dependence is mild or moderate, health practitioners commonly provide counselling or support to change behaviour. They may recommend particular strategies for avoiding situations which involve a high risk of excessive alcohol consumption (e.g. nightclubs) or coping with stressful situations without drinking alcohol. Health professionals can help identify sources of support, and suggest strategies that will help people dependent on alcohol regulate their own consumption (e.g. by having one or two alcohol-free days per week).

Severe alcohol dependence

Most people diagnosed with severe alcohol dependence will be referred to specialist care and many get admitted to hospital for treatment, which usually involves controlled detoxification.

Unless detoxification is controlled, acute withdrawal symptoms may occur – these cause death in 10% of cases. In addition to the symptoms of mild withdrawal (i.e. headache, nausea, sweating, tremor), acute withdrawal symptoms include convulsions and delirium.

Detoxification begins 4–6 hours after the last consumption of alcohol and lasts for 5–7 days. In this period, diazepam is administered every six hours to control the detoxification process and withdrawal symptoms. While detoxification often occurs in hospitals, some people undergo detoxification in their homes. However, patients should not consider undergoing detoxification at home if they have suicidal feelings, do not have friends and family to support them, or have experienced severe withdrawal symptoms before.

Following detoxification, social support to abstain from or moderate drinking is needed for an extended period of time. It is useful for individuals who are recovering from alcohol dependence to identify people who can support them through the process, as it can still be very difficult not to drink alcohol, or to drink in moderation following detoxification. People who have difficulty may wish to investigate whether there is medication which can help them stay away from alcohol. There are range of prescription medicines which might assist some people. Talk to a doctor before taking any medication.

Alcohol dependence has consequences for the families of dependent people (e.g. through alcohol related domestic violence or financial problems). It may therefore be necessary for the family and friends of someone suffering from alcohol dependence to seek treatment.

Drug addiction: getting help – NHS
Am I alcohol dependent? | Drinkaware

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