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While the health information and fact sheets on this website relate to world-wide situations, the drug names will vary between countries – therefore the advice of your local GP should be sought.
Alcohol dependence
Published by Bupa's health information team, February 2008.
This factsheet is for people who are alcohol dependent, or who would like more information about it.
If you are dependent on alcohol you experience an overpowering urge to drink. Around one in 13 people in the UK are alcohol dependent. It's most common in people with anxiety, depression or job stress.
About alcohol dependence
Alcohol is an addictive drug on which you can become psychologically and physically dependent. Alcohol dependence syndrome (formerly known as alcoholism) is a pattern of routinely drinking excessive amounts of alcohol over a long period of time, resulting in addiction. It can be associated with psychological and physical health problems and can seriously affect your relationships with family and friends, and your job.
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 becoming addicted to alcohol.
Symptoms
The signs and symptoms that you are dependent on alcohol include:
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a strong or overpowering urge to drink alcohol
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the need to drink every day or on regular days
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feeling that you can't stop drinking once you have started
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a growing tolerance to alcohol - needing larger quantities to get the same effect
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neglecting other interests in favour of pursuits that involve alcohol
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spending more time drinking and recovering from the effects of alcohol than you used to
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drinking first thing in the morning
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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 are 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:
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shaking or tremors
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a rapid heartbeat
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anxiety
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insomnia
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feeling disorientated
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hallucinations (seeing and/or hearing things that are not there)
Complications
There are a number of physical and psychological complications which can result from alcohol dependence.
Physical complications
If you drink large amounts of alcohol, you are at greater risk of getting:
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liver disease such as fatty liver, alcoholic hepatitis or alcoholic cirrhosis
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high blood pressure and other heart problems such as coronary heart disease and stroke
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cancer of the liver, stomach, colon, rectum, lung, pancreas, larynx (voice box) and oesophagus (food pipe)
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a serious alcohol withdrawal symptom called delirium tremens, which includes shaking, sweating, diarrhoea and seizures; this requires urgent medical attention as it can be life threatening.
Psychological complications
These can include:
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high levels of anxiety and depression, which are often a cause of drinking in the first place, can become worse as a result of drinking
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delerium tremens, which can also cause you to feel agitated, confused, paranoid and experience hallucinations
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sleeplessness
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suicidal feelings
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problems with your sex life
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memory loss
Social complications
Heavy drinking can sometimes cause:
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the breakdown of relationships with family and friends
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poor performance in your job
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financial problems
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breaking the law, such as driving when over the alcohol limit
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aggressive, violent or argumentative behaviour
Causes
People drink alcohol for many different reasons. Many people who become alcohol dependent 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. It does this by reducing chemicals called neurotransmitters in your brain which naturally help you fight depression and anxiety.
Social factors, such as the affordability and availability of alcohol, are also thought to have a role in causing alcohol dependency.
Diagnosis
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, you should see your GP who will be able to help. Your GP will ask about your drinking, how you feel about it and its effect on your life and wellbeing. For example, he or she may ask you four specific questions, known as the CAGE questionnaire.
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Have you ever felt you should cut down on your drinking?
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Have people annoyed you by criticising your drinking?
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Have you ever felt bad or guilty about your drinking?
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Have you ever had a drink in the morning to get rid of a hangover (known as an "eye opener")?
Your GP may also be able to diagnose alcohol dependence if you have a psychological or physical illness that indicates you are drinking too much (see Complications).
Your GP may treat you or refer you to a doctor who specialises in treating addiction.
Treatment
Your treatment will be tailored to suit you as an individual and depends on how much you are drinking, and any associated physical or mental health problems that you may have.
Your GP may carry out a questionnaire, such as the Severity of Alcohol Dependence Questionnaire (SADQ) or the Leeds Dependence Questionnaire (LDQ) to assess your level of alcohol dependence. If you have severe alcohol dependence, especially if there is evidence of physical damage to internal organs such as your liver, then your doctor is likely to advise you to stop drinking completely (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 support groups that can give you the help and support you need to stop drinking.
Self-help
Acknowledging that you are 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 which can help you to stop drinking.
Other treatments
Detoxification
If you are a heavy drinker, physical withdrawal symptoms associated with stopping drinking can carry risks and you may need medical supervision while you give up. Detoxification or "detox" is the 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 stay in a specialist treatment centre during detoxification.
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 a trained counsellor who can help you understand the reasons for your drinking, and give you skills to control or stop the urge to drink. Counselling may also include your partner or family who may also benefit from involvement in the treatment.
Mutual-help support groups
There are many people in the UK who are alcohol dependent and who support each other by sharing personal experiences and advice. Mutual support groups can help you both while you are giving up and help prevent you becoming dependent again. Support groups such as Alcoholics Anonymous, SMART Recovery and Al-Anon (a support group for family and friends of those who are alcohol dependent) can be found nationwide (see Further information).
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 for you.
Special considerations
If you are pregnant
Drinking alcohol during pregnancy can affect the development of your unborn baby and may cause your baby to have a condition called foetal alcohol syndrome. Drinking during pregnancy can also increase the chance of having a miscarriage (see Related topics).
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 are more likely to successfully give up drinking if you receive help and support from family and friends, mutual support groups, your GP or from a counsellor.
There are medicines which your doctor may prescribe you 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.
Alcohol dependence Q&As
See our answers to common questions about alcohol dependence, including:
Related topics
Further information
Sources
- Clinical topic: Alcohol - problem drinking. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 10 October 2007
- Ringold, S, Glass, T, and Glass, R. Alcohol abuse and alcoholism. JAMA, 2005. 293(13): 1694
- The management of harmful drinking and alcohol dependence in primary care. SIGN, 2003. www.sign.ac.uk, accessed 10 October 2007
- Addaction. www.addaction.org.uk, accessed 10 October 2007
- Chick, J. Understanding alcohol and drinking problems. Family doctor series, ed. T.B.M. Association. Poole: Family Doctor Publications, 2002
- Alcohol: Our favourite drug. The Royal College of Psychiatrists. www.rcpsych.ac.uk, accessed 10 October 2007
- Cheers? Understanding the relationship between alcohol and mental health. Mental Health Foundation, 2007. www.mentalhealth.org.uk
- Simon, C, Everitt, H, and Kendrick, T. Oxford handbook of general practice. Oxford: Oxford University Press, 2005
- Kumar, P and Clark, M. Clinical medicine. 6th edition ed. London: Elsevier Saunders, 2005
- Review of the effectiveness of treatment for alcohol problems. Raistrick D, Heather N, Godfrey C. National Treatment Agency for Substance Misuse. 2006. www.dh.gov.uk
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr Adrian Winbow, Consultant Psychiatrist, Cygnet Hospital, Godden Green, Kent, and by Bupa doctors. It has been patient reviewed by Alcohol Concern. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: February 2008