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Alcoholism


Expert reviewer Dr Adrian Raby, General Practitioner
Next review due December 2022

Alcoholism or alcohol dependence is now often called ‘alcohol-use disorder’ by doctors. It means that you have difficulty controlling the amount you drink and how often. It can be mild, moderate or severe. People with an alcohol problem continue to drink, even though their drinking is causing increasing personal problems, difficulties at work and worsening physical or mental health.

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About alcoholism

As many as one in 10 people are thought to have a problem with alcohol at some point in their lives. There are around one million people in England between and ages of 16 and 65 who are alcohol dependent. Alcohol misuse is thought to be twice as common in men than women, although it may be that it is less likely to be picked up in women.

Problems with alcohol can be mild, moderate or severe. Alcohol dependence means that you crave alcohol and keep drinking despite the problems it’s causing you. There are specific criteria that make up the official medical diagnosis of alcohol-use disorder, such as how much you drink, whether there are times you can’t stop drinking, or needing a drink in the morning. The number of criteria you meet, and how often, determines the severity of the problem. You can see the full list of criteria in our section on diagnosing alcoholism below.

Symptoms of alcoholism

It can be difficult to spot signs of problem drinking, as it can creep up on you. Drinking alcohol is very common and is central to lots of social situations. The stigma around alcoholism can mean that people think of themselves more as ‘liking a drink’ than having a problem with it. They may underestimate how much they drink or be secretive about their drinking. They may even become angry when asked about it.

Someone who is developing alcohol-use disorder is likely to drink more and more over time. They may become tolerant to alcohol – that is, they need to drink more than they used to in order get the effect they want from it. They may become agitated and anxious when alcohol isn’t available. People with a severe alcohol addiction may even have seizures (fits) or become confused when they can’t drink.

If you have an alcohol-use disorder, alcohol can often become the most important thing in your life and you lose interest in activities and hobbies you used to enjoy. If alcohol is causing difficulties with relationships, work, physical or mental health, then there is a problem that needs to be addressed.

There are specific questions that doctors ask to diagnose alcohol-use disorder. These are listed below in the section on diagnosis.

Diagnosing alcoholism

What will happen at your appointment

If the doctor thinks you might have an alcohol problem, there are some questions they might ask you, such as.

  • How often do you have a drink that contains alcohol?
  • How many standard alcoholic drinks do you have on a typical day when you are drinking?
  • How often do you have six or more standard drinks on one occasion?
  • How often in the last year have you found you were not able to stop drinking once you had started?
  • How often in the last year have you failed to do what was expected of you because of drinking?
  • How often in the last year have you needed an alcoholic drink in the morning to get you going?
  • How often in the last year have you had a feeling of guilt or regret after drinking?
  • How often in the last year have you not been able to remember what happened when drinking the night before?
  • Have you or someone else been injured as a result of your drinking?

The doctor will use your answers to these questions to confirm whether or not you have an alcohol problem, and how severe it is.

If your drinking is just starting to become a problem, or is currently a mild problem, becoming aware of it may be all you need to help you to stop. Have a look at our top 10 tips for cutting down or stopping drinking.

Your doctor may also examine you physically because alcohol can cause particular medical problems, such as liver disease. They may arrange blood tests. They will also talk to you about how you’ve been feeling. Depression and anxiety are common among people with an alcohol problem.

If you’re worried about someone else’s drinking

If you are worried about your drinking, the first step to take is to see your GP. Or your doctor may ask you about it when you are seeing them for something else.

If you are concerned about a loved one’s drinking, it can be difficult to know how to help. Of course, you can encourage them to see their doctor. But they may be reluctant to admit that they have a problem or to seek help. Try to sound concerned rather than disapproving. You could say you are worried about their health and ask them to talk to their doctor about it. You do need to pick your moment – when you are both calm and have some privacy and definitely not when they have had a lot to drink.

Treatment for alcoholism

It’s not easy to overcome alcoholism. Many people view it as a lifelong condition, even if someone has managed to stay sober for a long time. Alcoholics Anonymous say that two-thirds of those who come to meetings have been sober for two years or more. But you’re more likely to be successful at overcoming alcohol problems with support. It may be your GP who plans and monitors your treatment, or a keyworker, who could be a nurse or doctor specialising in alcohol problems.

Your doctor will talk to you about your alcohol problem to get a full picture of how it is affecting you and how motivated you are to address it. Then they will discuss a treatment plan with you. Together, you agree short- and longer-term goals for your recovery. It’s really important that you’re fully involved in this part of your treatment.

Your doctor will help you to set your own goals and monitor your progress. They may ask if you’re willing to involve those closest to you. A partner or close relative or friend can help the doctor to understand the pattern of your drinking and how it is affecting you. They will also then be able to support you through your treatment.

First steps

For most people, it’s best to aim to stop drinking altogether (abstinence), particularly if alcohol is causing other health problems. If you only have a mild problem with alcohol, you may be able to moderate your drinking without stopping altogether. This can be risky for some people, as your drinking may start to creep up again. To manage it, you may benefit from the support of family and friends. Keeping a ‘drinking diary’ may be helpful.

If you’re physically dependent on alcohol, stopping suddenly can be risky as there’s a chance it can cause seizures. Your doctor can advise on how to do this safely. Some people can manage this at home, but in some cases your doctor may recommend inpatient treatment. If they think you’re at risk of withdrawal symptoms, your doctor will arrange a managed detoxification process using medication. This is usually diazepam (Valium) or a similar drug. They might also subscribe thiamine and/or vitamin B, as someone who’s been drinking heavily may have very low levels of these.

Ongoing treatment

Once you’ve got the alcohol out of your system, your treatment will probably involve some type of ‘talking therapy’ such as counselling or cognitive behavioural therapy (CBT). These can help you to work through your feelings and what leads you to drink. Recognising when you are thinking negatively or positively can help you to choose positive thoughts and behaviours to help you stay sober. You usually see your therapist weekly for at least 12 weeks. It may be helpful to involve your partner and see the therapist together.

If you have a moderate or severe alcohol misuse problem, your doctor may recommend medication, such as naltrexone, acamprosate or nalmefene. These medicines help by reducing your urge to drink. You usually take them for at least six months. They can have side-effects, including feeling sick, headaches and dizziness.

Another medication, called disulfiram (Antabuse) reacts with alcohol to make you feel sick, flushed and have palpitations if you do drink. One problem with this is that you may also have a reaction to alcohol in perfume, aerosols or foods. Your doctor will discuss this with you before prescribing it.

Many people find a support group helpful, such as Alcoholics Anonymous (AA) or SMART recovery. There is more information in the section on support and useful organisations.

Relapse

As with a lot of other addictions, it can take several attempts to give up alcohol for good. That isn’t to say that this will happen to you. But it’s best to be prepared. Your doctor will talk to you about this and make sure you both have a strategy in place to deal with it should it happen. It may be helpful to discuss it with your therapist too.

Causes

Like many conditions, alcoholism has multiple causes. It often runs in families and doctors now think that around half the risk is determined by your genes. But there are also often social and psychological factors.

People with alcohol misuse disorder often also have mental health problems such as stress, depression or anxiety. People often think that alcohol is a way of coping with these types of problems. But alcohol misuse can also cause mental health problems and if this is the case, they may start to get better when you stop drinking.

Complications

There are many health risks from drinking alcohol because it affects just about all systems of the body. Liver disease is one of the commonest complications. Alcohol-related liver diseases can be acute or chronic (long term) and include hepatitis, fatty liver and cirrhosis. Liver conditions can cause a painful swollen liver, jaundice, extreme fatigue and lack of energy. Liver disease is unlikely to improve if you continue to drink excessively. Removing the cause really is the only reliable treatment.

Alcohol can also cause:

  • diseases of the digestive tract, including ulcers, stomach inflammation (gastritis), pancreatitis and vomiting blood
  • cancers of the liver, oesophagus, stomach, mouth, tongue and throat
  • heart problems including heart failure, angina and abnormal heart rhythms
  • damage to nerves in the brain and elsewhere in the body, causing lack of feeling in the hands and feet, sight problems, loss of memory, difficulty thinking and learning, confusion, epilepsy and dementia

Heavy drinkers often don’t eat properly and this increases their risk of other health problems including infections.

Support for people with alcohol problems

If you have an alcohol misuse disorder, it can be difficult to give up drinking. Your doctor and therapist may encourage you to ask your partner, family and friends to support you through it. They may also suggest you join a support group. It can be very helpful to talk to people who are going through the same thing as you.

There are alcohol support groups all over the country that you can join. The best known is probably Alcoholics Anonymous (AA). But there are others, including SMART Recovery and Club Soda.

AA have regular meetings and encourage members to share their experiences. Their 12-step programme for recovery from alcoholism is based on a belief in gaining support from a higher power.

SMART Recovery is an organisation for all types of addiction. SMART stands for Self-Management and Recovery Training. Their self-help programme is based on teaching motivational skills and techniques from cognitive behavioural therapy. The aim is to help you cope with the urge to drink and carry on staying sober.

Club Soda call themselves a ‘Mindful Drinking Movement’. They run workshops, social events and a support network for people who want to stop drinking or drink more sensibly.

It can be hard going for family and friends when someone is dealing with alcoholism. Groups such as Al-Anon and SMART Recovery Family and Friends give them the opportunity to meet other people in a similar situation to them, discuss ways of coping and gain support.


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Related information

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    • The Twelve Steps of Alcoholics Anonymous. Alcoholics Anonymous. alcoholics-anonymous.org.uk, accessed November 2019
    • About SMART Recovery. SMART Recovery. smartrecovery.org.uk, accessed November 2019
    • Frequently Asked Questions. Club Soda. joinclubsoda.com, accessed November 2019
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  • Produced by Nick Ridgman, Head of Health Content, Bupa Health Content Team, December 2019
    Expert reviewer Dr Adrian Raby, General Practitioner
    Next review due December 2019



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