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Alcohol dependence

Alcohol dependency is a condition that is marked by an overpowering urge to drink alcohol. It's more common in people who have anxiety, depression or a lot of stress in their lives.

Alcohol is an addictive drug and although many people drink safely, you can become psychologically and physically dependent on it. In the UK, around nine in 100 men and four in 100 women show signs of being dependent on alcohol.

Alcohol dependence – or 'alcohol dependence syndrome' (formerly known as alcoholism) – is a pattern of routinely drinking excessive amounts of alcohol over a long period of time, and giving priority to drinking over other activities and obligations in your life. It can cause or worsen psychological and physical health problems and can seriously affect your relationships with family and friends. It can also affect your job, or result in drinking-related offences.

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Long-term effects of alcohol
If you regularly drink too much alcohol, you can be putting your long-term health at risk

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  • Symptoms Symptoms of alcohol dependence

    The main symptom of alcohol dependence is having an overpowering urge to drink alcohol and not being able to limit or stop drinking once you have started. Some people who are dependent on alcohol report being preoccupied with it and that the need to drink alcohol takes over their lives.

    If you drink regularly, your body gets used to lots of alcohol and you may find that you need to drink increasingly more to feel its effects. This is known as alcohol tolerance and has a role in you becoming addicted to alcohol.

    Other symptoms of alcohol dependence can include:

    • neglecting other interests in favour of pursuits that involve alcohol
    • spending more time drinking and recovering from the effects of alcohol than you used to
    • drinking before midday
    • anxiety or irritability
    • feeling that you can't cut down on your drinking despite signs that it's damaging your health, your personal relationships or your work

    You don’t necessarily need to have all of these symptoms to be affected by alcohol dependence, and any of the above can indicate that there is a problem.

    Another sign that you're dependent on alcohol is if you have physical withdrawal symptoms when you stop drinking. You may feel the need to drink to avoid or relieve such symptoms. Withdrawal symptoms include:

    • shaking or tremors
    • feeling or being sick first thing in the morning
    • sweating a lot
    • finding it difficult to sleep
    • feeling your heart race
    • anxiety or irritability
  • Diagnosis Diagnosis of alcohol dependence

    Acknowledging that alcohol has a negative impact on your life is an important first step to get the help and support that is available. If you feel that you may be dependent on alcohol, see your GP. He or she will ask about your symptoms and may examine you. Your GP may also ask you about your medical history.

    Your GP will ask about your drinking, how you feel about it and its effect on your life and wellbeing. He or she may ask you some specific questions that are listed in questionnaires, which aim to establish if you’re alcohol dependent. Examples of these questionnaires include the alcohol use disorders identification test (AUDIT) and severity of alcohol dependence questionnaire (SADQ).

    If your lifestyle, psychological or physical illness or the score on one of the questionnaires indicate you may be drinking too much, your GP may refer you to specialist alcohol services. In most areas in the UK, you can self-refer to some alcohol services too. If your problem is less severe, your GP may give you advice or offer written information aimed at preventing you from developing problems in the future.

  • Treatment Treatment of alcohol dependence

    Your treatment will be tailored to suit you and will depend on how much you drink, and if you have any physical or mental health problems.

    Your GP will assess your level of alcohol dependence. If you have severe alcohol dependence, especially if there is evidence of physical damage to your internal organs such as your liver, then your GP is likely to advise you to cut down on alcohol with the aim of stopping drinking completely. This is called abstinence.

    However, there are people with a lower level of alcohol use or who may not be willing to give up alcohol completely for whom controlled drinking might be a possibility. It's important to work with your GP to agree on a treatment plan that is realistic for you, and which you can stick to. It may be that you aim to cut down your drinking to a controlled, lower level.

    There are professional services and groups that can give you help and support to stop drinking.

    Self-help

    Acknowledging that you're dependent on alcohol and finding the determination to change and the willpower to do so is important for your treatment to be a success. There are a number of self-help tools such as information leaflets and websites that can help you to stop drinking. These tools should normally be used in addition to help from a healthcare professional or voluntary agency.

    Detoxification

    If you're a heavy drinker, you may need to be supervised by health professionals while you give up alcohol (assisted alcohol withdrawal). This is because the physical withdrawal symptoms associated with stopping drinking can carry health risks. Detoxification or ‘detox’ is a planned withdrawal from drinking alcohol and may involve taking a short course of a medicine to help prevent withdrawal symptoms. Benzodiazepine medicines, such as diazepam or chlordiazepoxide, are most commonly used during detoxification. Your GP may prescribe these for you to take at home or you may need to stay in a specialist treatment centre during detoxification. You will gradually take less and less of the medicine until you can stop altogether – medicines are only a short-term treatment to help you gain control and not a long-term solution.

    Residential treatment

    Your alcohol support worker or specialist may arrange for you to stay in a rehabilitation centre after you've completed a detox. This can help you stay free from alcohol. You may need to stay in the centre for a long time (weeks or months) while you have your treatment.

    Your alcohol support worker or specialist may recommend this if:

    • you have severe alcohol dependence 
    • you tried to give up alcohol before but other treatments haven’t helped 
    • you’re having difficulties in your personal life, for example, if you don’t have anywhere to live 
    • you may benefit from a more intense treatment programme

    Most centres offer treatments such as group therapy. The NHS may be able to fund your treatment, but this isn't always possible. Some insurance companies may also fund these types of treatment programmes. If you have any questions, talk to your GP for more information about what options are available to you.

    Counselling

    You might find that talking to someone about your drinking problem is a useful and important part of your treatment. You may wish to speak to your GP or trained counsellors who can help you understand the reasons for your drinking, and give you skills to control or stop the urge to drink.

    Your partner or family may also be invited to attend counselling with you and be involved in your treatment.

    Mutual help support groups

    There are a number of support groups in the UK where you can share personal experiences and advice with other people who are dependent on alcohol. Mutual help support groups can help you while you're giving up and can also help prevent you becoming dependent again. Support groups such as Alcoholics Anonymous and Al-Anon (a support group for family and friends of those who are alcohol dependent) are found nationwide.

    Dietary supplements

    You may be deficient in vitamins and minerals due to your alcohol intake; vitamin B1 (thiamine) deficiency is common, for example. Your GP may prescribe thiamine tablets and ask you to take multivitamins.

    Preventing a relapse

    If you successfully give up drinking, starting again (or relapsing) is common. There are a number of ways that you can plan ahead and minimise the risks of this happening to you. It's important to remember that treatment for alcohol dependence is an ongoing process. You're more likely to successfully give up drinking if you receive help and support from family and friends, mutual help support groups, your GP or from a counsellor.

    There are medicines that your GP may prescribe that can help prevent your cravings for alcohol (such as acamprosate) or other medicines (such as disulfiram), which help deter you from drinking by giving you unpleasant symptoms such as vomiting and a headache if you drink alcohol.

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  • Causes Causes of alcohol dependence

    There isn’t one main cause of alcohol dependence. People drink alcohol for many different reasons. You may, for example, use alcohol as a way of dealing with anxiety and depression. However, although it may help you dismiss your problems in the short term, alcohol actually makes anxiety and depression worse because it interacts with chemicals called neurotransmitters in your brain that alter your mood.

    Social factors, such as the affordability and availability of alcohol, peer pressure and the buying of rounds in groups may have a role in causing alcohol dependency.

    Alcohol dependence can run in families – if one of your parents is dependent on alcohol, you’re four times more likely to develop it too.

  • Complications Complications of alcohol dependence

    If you drink large amounts of alcohol, you’re at greater risk of having:

    • liver disease (such as fatty liver, alcoholic hepatitis or alcoholic cirrhosis)
    • high blood pressure and other heart problems (such as heart muscle damage, heart disease and stroke)
    • cancer (such as cancer of your liver, throat, mouth, bowel, oesophagus and breast)
    • memory loss
    • depression
    • suicidal feelings
    • problems with your sex life or fertility
    • dementia
    • pancreatitis
    • damage to your nerves (neuropathy)

    Another potential complication is delirium tremens, which can happen if you stop drinking immediately rather than cutting down gradually. This causes symptoms such as shaking, sweating, diarrhoea and seizures. It may also cause anxiety, confusion, paranoia and hallucinations (where you see and/or hear things that aren't there). Delirium tremens requires urgent medical attention as it can be life threatening.

    If you’re pregnant and drink alcohol, it can affect the development of your unborn baby and may cause him or her to have a condition called foetal alcohol syndrome. Drinking during pregnancy can also increase your chance of having a miscarriage.

  • FAQs FAQs

    Does alcohol dependence run in families?

    Answer

    Yes, alcohol dependency does run in some families, but there are a range of factors involved in becoming dependent on alcohol.

    Explanation

    There is evidence to suggest that your family history may play a role, not only in whether you like the taste and effect of drinking alcohol, but also in whether you have a tendency to become addicted or dependent on it. However, social, personal and work factors can also play a role in alcohol dependence and because someone in your family has a drink problem, it doesn't mean that you will have one too.

    How am I likely to feel when I give up drinking?

    Answer

    People differ in how they feel when they stop drinking; some find it easy while others find it very difficult. You may get withdrawal symptoms.

    Explanation

    For up to seven days after you stop drinking, you may get withdrawal symptoms. The symptoms typically start around eight hours after your last drink and peak at around day two. These include:

    • shakes or tremors
    • feeling sick or vomiting
    • sweating
    • finding it difficult to sleep
    • feeling your heart beating rapidly
    • feeling anxious

    It's important to remember that the first few days are the worst and that your symptoms will wear off.

    Your GP may prescribe medicines that can help your body adjust to the absence of alcohol and reduce withdrawal symptoms. If you're a heavy drinker, withdrawal symptoms associated with stopping drinking can carry risks. These include delirium tremens, or seizures that require urgent medical attention. So, you may need medical supervision in a detox centre or hospital, for example, while you give up.

    How many units does someone need to drink to be classed as alcohol dependent?

    Answer

    Alcohol dependence isn't diagnosed by how many units of alcohol you drink, but by your dependence on, or addiction to, what you drink – however much that may be. However, the more you drink the more likely it is that you will become dependent.

    Explanation

    Alcohol dependence isn't related to the amount you drink in any given period; it's rather the pattern of dependence or addiction to what you drink. However, if you drink regularly, your body gets used to lots of alcohol and you may find that you need to drink increasingly more to feel the effects. This is known as alcohol tolerance and plays a key part in you becoming addicted to alcohol.

    Proposed new guidelines recommend that you should not regularly drink more than 14 units over the course of a week. If you do drink as much as 14 units, you should spread it over three days or more, rather than 'saving up' units.

    An easy way to cut back on your intake is to have several drink-free days each week.

    If you drink to deal with ongoing or underlying problems, such as stress, you're also at greater risk of becoming dependent.

    I drink to help me cope with my feelings but what else could I do to improve the way I think and feel?

    Answer

    There are many ways that you can improve the way you think and feel other than through drinking. If you think you're experiencing mental health problems, see your GP for help.

    Explanation

    There are a number of ways you can help yourself feel better. Why not try some of the following to improve your wellbeing.

    • Take regular exercise – there is evidence that exercise is linked to good mental health.
    • Eat a balanced diet rich in vitamins.
    • Ask for help when you need it.
    • Share your problems and feelings with others, either family or friends, or with a trained counsellor.
    • Take a break from your regular routine from time to time.

    I have given up drinking alcohol and am finding it difficult to get to sleep. Is there anything I can try?

    Answer

    Yes, there are a range of self-help methods you can try to help you get to sleep.

    Explanation

    Some of the following techniques may help you drift off to sleep.

    • Take more physical exercise.
    • Don't drink anything that contains caffeine (such as tea and coffee) after lunch.
    • Have a healthy snack or drink before you go to bed, such as hot milk.
    • Relax before you go to bed – for example listen to some gentle music as you lie in bed with your eyes closed and relax your body. This will help you rest even if you don't sleep.
    • Try to keep to a regular routine and go to bed at the same time each night.
    • If you find yourself lying there worrying, get up and do something relaxing, such as reading a book in a dimly lit room – don’t clock watch.

    If you find you’re still having difficulties sleeping after trying these measures, ask your GP for advice.

    I'm worried that my partner has a drink problem but he denies it. What should I do? How do I make him see he has a problem and get help?

    Answer

    If you're worried that your partner is drinking too much or is dependent on alcohol, contact a support group, your GP or a counsellor and speak to them for advice.

    Explanation

    You can't force your partner to seek help as it can lead to conflict and have a negative impact on his drinking. It’s important for your partner to personally understand for himself that he has a drinking problem and needs to do something about it. There are support groups for friends and relatives of people who are alcohol-dependent (such as Al-Anon), which can give you give you ideas for ways that you can help your partner come to the conclusion that he needs to seek help and become active in the process.

    Should I set a date and stop drinking completely on that day or should I cut down gradually over a period of time?

    Answer

    Both approaches are used by people who want to cut down or stop drinking alcohol but the best method depends on your individual circumstances. If you drink heavily, speak to your GP about what is most suitable for you before you decide to stop drinking so you can formulate a plan together.

    Explanation

    You may prefer to gradually cut down your alcohol consumption to reduce any withdrawal symptoms. However, if you find this hard to do, setting a date on which to give up may be a more successful approach.

    Discuss with your GP which way of giving up would best suit you. You may need to keep in contact with a medical professional when you stop drinking in case you get any serious withdrawal symptoms (such as delirium tremens, which requires urgent medical attention). Your GP may also prescribe medicines that will help your body to adjust and reduce withdrawal symptoms when you stop drinking.

    Why are people who are alcohol dependent sometimes undernourished? I thought that alcohol was high in calories?

    Answer

    Alcohol is high in calories but doesn't contain any vitamins. Also, some heavy drinkers neglect eating a healthy balanced diet.

    Explanation

    Alcoholic drinks are high in calories and are known as 'empty calories' because they have no nutritional value. This is why if you drink a lot you may put on weight but be undernourished. Also, if you drink heavily, you may neglect your diet and fail to eat a balanced diet that is rich in vitamins and minerals. Further to this, alcohol reduces your body's ability to absorb vitamins from the food that you eat.

    Most commonly, people who are alcohol dependent are deficient in vitamin B1 (thiamine). Your GP can prescribe thiamine tablets. Vitamin B1 deficiency is linked to brain and nerve damage and if you're in hospital, it may be given to you as an injection to ensure that it reaches your brain quickly.

  • Resources Resources

    Further information

    Sources

    • Alcohol use disorders: diagnosis and clinical management of alcohol-related physical complications. National Institute for Health and Clinical Excellence (NICE), 2010. www.nice.org.uk
    • Alcohol – problem drinking. Prodigy. www.prodigy.clarity.co.uk, published December 2011
    • Alcohol-use disorders: the NICE guideline on diagnosis, assessment and management of harmful drinking and alcohol dependence. National Institute for Health and Clinical Excellence (NICE), 2011. www.nice.org.uk
    • Statistics on alcohol: England, 2011. National Statistics, 2011. www.ic.nhs.uk
    • Amato L, Minozzi S, Vecchi S, et al. Benzodiazepines for alcohol withdrawal. Cochrane Database of Systematic Reviews 2010. doi:10.1002/14651858.CD005063.pub3
    • Alcohol and cancer. Cancer Research UK. http://cancerresearchuk.org, accessed 17 February 2012
    • Alcohol and heart disease. British Heart Foundation, accessed 17 February 2012
    • Antenatal care: routine care for the healthy pregnant woman. National Institute for Health and Clinical Excellence (NICE), 2008. www.nice.org.uk
    • Alcohol. Mental Health Foundation. www.mentalhealth.org.uk, accessed 17 February 2012
    • Alcohol-use disorders: preventing the development of hazardous and harmful drinking. National Institute for Health and Clinical Excellence (NICE), 2010. www.nice.org.uk
    • Alcohol and mental health. Mental Health Foundation, 2010. www.mentalhealth.org.uk
    • Alcohol services. Alcohol Concern. www.alcoholconcern.org.uk, accessed 17 February 2012
    • Amato L, Minozzi S, Davoli M. Efficacy and safety of pharmacological interventions for the treatment of the alcohol withdrawal syndrome. Cochrane Database of Systematic Reviews 2011. doi:10.1002/14651858.CD008537.pub2
    • Joint Formulary Committee. British National Formulary. 63rd ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2012
    • Alcohol advice. Department of Health. www.dh.gov.uk, accessed 14 February 2012
    • Schuckit MA. Alcohol-use disorders. Lancet 2009; 7(373):492–501. doi:10.1016/S0140-6736(09)60009-X
    • Calories in alcohol. Drinkaware. www.drinkaware.co.uk, published 15 November 2011
    • Start active, stay active: a report on physical activity for health from the four home countries’ chief medical officers Department of Health, 2011. www.dh.gov.uk
    • Insomnia. eMedicine. www.emedicine.medscape.com, published 17 January 2012
    • Alcohol guidelines. House of Commons Science and Technology Committee, www.publications.parliament.uk, published 7 December 2011
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    Produced by Rebecca Canvin, Bupa Health Information Team, June 2012.

    This information was updated in January 2016 following revisions to the Department of Health’s guidelines for alcohol consumption.

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