Alcohol dependence

Published by Bupa's Health Information Team, May 2010.

This factsheet is for people who have a dependency on alcohol, or who would like information about it.

Alcohol dependency is an overpowering urge to drink. It's most common in people with anxiety, depression or who have a lot of stress in their job.

About alcohol dependence

Alcohol is an addictive drug and you can become psychologically and physically dependent on it. In the UK, around nine in 100 men and four in 100 women are 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, which results in addiction. It can be associated with psychological and physical health problems and can seriously affect your relationships with family and friends. It can also affect your job.

Symptoms of alcohol dependence

Alcohol dependence is usually characterised by an overpowering urge to drink alcohol and the inability 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 a person becoming addicted to alcohol.

Other symptoms of alcohol dependence 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 psychological or physical health, your personal relationships or your work

Another sign that you're dependent on alcohol is if you suffer from 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

Complications of alcohol dependence

If you drink large amounts of alcohol, you are 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 the liver, stomach, bowel, rectum, lung, pancreas and breast)
  
• memory loss
  
• depression
  
• suicidal feelings
  
• problems with your sex life
  
• alcoholic dementia
  
• pancreatitis

Another potential complication is delirium tremens which may occur with acute alcohol withdrawal. 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.

Causes of alcohol dependence

People drink alcohol for many different reasons. Many people who become dependent on alcohol use it as a way of dealing with anxiety and depression.

Although it may help you dismiss your problems in the short term, alcohol actually makes anxiety and depression worse. It does this by interacting with chemicals called neurotransmitters in your brain which naturally help you fight depression and anxiety.

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

Diagnosis of alcohol dependence

Acknowledging that alcohol is having a negative impact on your life is an important first step in your diagnosis and successful treatment.

If you feel that you may be alcohol dependent, see your GP. He or she will ask about your symptoms and may examine you.

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 the following four questions to establish if you are alcohol dependent. These are known as the CAGE questions.

• Have you ever felt you should Cut down on your drinking?
  
• Have people Annoyed you by criticising your drinking?
  
• Have you ever felt bad or Guilty about your drinking?
  
• Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)?

If your lifestyle, psychological or physical illness or the score on the CAGE indicates 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 alcohol services. Your GP may ask you to do this because it's an important step for you to be active and take control of your own addiction.

Treatment of alcohol dependence

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

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 doctor is likely to advise you to cut down on alcohol with the aim of stopping drinking completely. This is called abstinence.

However, it's recognised that some people have a lower level of alcohol dependence and may not be willing to give up alcohol completely. It's important to work with your doctor to agree on a treatment plan that is realistic for you, and which you can stick to, and in this case it may be that you aim to cut down your drinking to a controlled, lower level.

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

Self-help

Acknowledging that you're dependent on alcohol and finding the determination to change and the will-power to do so is important for successful treatment. There are a number of self-help tools such as information leaflets and websites that can help you to stop drinking.

Detoxification

If you're a heavy drinker, you may need to be supervised by health professionals while you give up. This is because the physical withdrawal symptoms associated with stopping drinking can carry risks. Detoxification or "detox" is a planned withdrawal from drinking alcohol and may involve taking a short course of medicine to help prevent withdrawal symptoms. Benzodiazepine medicines, such as diazepam or chlordiazepoxide hydrochloride, 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. Medicines are only available as a short-term treatment to help you gain control and not a long-term solution.

Counselling

Many people find that talking to someone about their problem is a useful and important part of 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 many people in the UK who are dependent on alcohol and who support each other by sharing personal experiences and advice. 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) can be found nationwide.

Dietary supplements

Some people who are alcohol dependent are deficient in vitamins and minerals; vitamin B1 (thiamine) deficiency is the most common. Your doctor may prescribe thiamine tablets and also ask you to take multivitamins.

Alcohol and pregnancy

Drinking alcohol during pregnancy can affect the development of your unborn baby and may cause your baby to have a condition called fetal alcohol syndrome. Drinking during pregnancy can also increase the chance of having a miscarriage.

Preventing a relapse

After you have successfully given 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 doctor may prescribe which can help prevent your cravings for alcohol (such as acamprosate calcium) 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.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.