What is Alcoholism, Alcohol Abuse and Alcohol Dependence?
Content Overview – What is Alcoholism
Alcoholism is both a physical and mental illness, which causes people to drink alcohol despite it resulting in negative consequences. It affects hundreds of thousands of people in the UK, and millions more around the world. Although not a curable illness, it can be effectively treated and managed with a programme of detoxification and rehabilitation.
It can be difficult to tell the difference between alcoholism, alcohol abuse, and alcohol dependence, with many people unable to correctly distinguish between them. The main difference between the three is in the effect each has on daily life.
Alcohol is considered safe in moderation, but when occasional use becomes more common and begins to interfere with everyday life, it is typically classed as abuse. The UK Government’s guidelines on alcohol consumption states that no more than fourteen units of alcohol should be consumed by adult men and women each week; which means that consuming a large amount at one time (binge drinking), may still be considered abuse, without it being a regular occurrence.
It is also possible to become dependent on alcohol without actually having an addiction. When alcohol dependence develops, your body will begin to crave it when its effects wear off. You may start to notice withdrawal symptoms and will feel the need to drink more than before now that you have built up a tolerance.
By the time an alcohol addiction develops you will have formed a deep physical and psychological need for it. You will also continue to drink, even when knowing that doing so will cause harmful consequences for you and those around you.
Over 7.5 million people in the UK show signs of alcohol dependence, according to NHS figures. For them, drinking alcohol is an important, or maybe the most important, part of their day, with many feeling unable to function properly without it.
The effects of alcohol abuse are detrimental to physical health as well as mental health and can lead to many different illnesses.
You are likely to experience problems with sleep, and in the event you drink to solve the issue, your quality of sleep will be poor. This will result in you feeling constantly tired and sluggish.
Since alcohol contains what are commonly referred to as ’empty calories’, you may notice your weight starting to creep up. Moreover, if you are getting most of your calories from alcohol, you are unlikely to be getting the nutrients your body needs, which could also have a negative impact on your health and wellbeing.
As alcohol abuse progresses from dependency to addiction, your need for alcohol will become increasingly overwhelming. You may start to spend more and more of your time drinking or thinking about drinking, leaving little time for anyone or anything else. This can affect your ability to take care of responsibilities at home and work, and can have a negative impact on your relationships with family members, friends, and work colleagues.
As is the case with all addictions, you will find that your finances will begin to suffer. Spending an increasing amount of money funding your habit while also struggling to perform at work will affect with your ability to earn an income, landing you in financial difficulty.
Recognising the Start of a Drinking Problem
It can be difficult to recognise the start of a drinking problem, because you may not have realised that your drinking habits have changed, until a family member or friend mentions changes in your behaviour or personality.
Alcohol dependency is different for different people. Although many sufferers share things in common, their relationships with alcohol might at first seem to be nothing alike. This can make it difficult for people to identify themselves as alcohol dependent, even as drinking has an increasingly more damaging effect on their relationships, health, and enjoyment of life.
Though alcohol dependency may come in various guises, the chemistry at the heart of it is the same for everyone. When problematic drinking habits continue over a period of time, it leads to long-term electrical changes in the brain, which causes the compulsive attitude towards alcohol that characterises alcoholism. The brain is essentially being hijacked by chemicals, which steer the mind’s attention towards finding and consuming more alcohol.
Alcohol dependency is not a failure of will or lack of strength of character, as was believed for many years. However, progress in science over the last few decades has shown us that alcoholism is rooted in both biology and behaviour, making it a ‘bio-behavioural disorder’. Biology and behaviour are two sides of the same coin, and alcohol dependency cannot be treated by just focusing on one side alone.
Physical dependence can soon follow, as abstinence begins to cause withdrawal symptoms such as shaking, feeling sick and feeling tired without reason.
Even before withdrawal, heavy and prolonged drinking can cause several physical symptoms because of large amounts of alcohol on the body.
Do You Have a Drinking Problem?
Here are some drinking patterns that might suggest a drinking problem:
Drinking in the day time on a regular basis
Drinking large amounts in social situations
‘Blacking out’ – drinking so much that you have no memory of what you did the next day
Drinking regularly to relax or feel better
Drinking before stressful events
Possible signs of alcohol dependency:
Lack of or increased appetite, leading to weight loss or gain
Increased tolerance to alcohol, meaning that more and more alcohol needs to be consumed to feel ‘drunk’
Blood vessels appear on the skin, looking like tiny red spider-webs. These are called spider angiomas
Swelling or redness on palms of the hands
Redness of the face, especially the eyes and nose
Sore or upset stomach that doesn’t go away; this might be accompanied by heartburn
Moderate alcohol use means sticking within the recommended weekly guideline amount of fourteen units. A unit of alcohol is equivalent to one measure (25ml) of 40% spirits. Fourteen units of alcohol equates to around six pints of 4% strength beer or lager or six glasses of 13% wine.
If you are consuming your full allowance every week, you should make sure that it is spread across at least three days, but also make sure that some days are kept alcohol-free.
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Risk Factors for Drinking Problems and Alcoholism
Alcoholism can creep up on you, working its way into your life almost unnoticed, and by the time it is recognised the original catalysts might seem irrelevant. Though there are many different elements that can lead to alcohol dependency, there are common risk factors shared by almost all alcoholics, and it is worthwhile considering them as understanding paves the way for recovery.
A large body of scientific evidence has been gathered in recent years to show that addiction can run in families. In fact, children of alcohol-addicted parents are four times more likely to develop alcohol addiction in later life than those born to parents without alcohol addictions. How this works is complex, and there is no one ‘alcohol gene’ to blame for this; instead a number of genetic variations, which mean some individuals are more pre-disposed to alcoholism than others.
Stages of Alcoholism
Alcoholism is not something that happens overnight though. It is a process that involves a number of stages:
Genetics make up about 50% of the risk for alcohol dependence, but they by no means tell the whole story. Genetic history is often hard to distinguish, but if parents are regular heavy drinkers, or they drink to reduce stress and depression, it is likely that their children will grow up believing that these behaviours are normal and possibly harmless. But environmental influence doesn’t come only from the home; peer pressure from friends, colleagues and partners can also encourage new and difficult patterns of drinking which can lead to dependency or co-dependency.
Stress and Difficult Life Events
For others, dependency comes after a prolonged period of difficulty in their life. Drinking might appear to be a good method of coping in these situations, and sufferers will often start as a ‘stop-gap’, just to tide them over until conditions improve. Nevertheless, as drinking begins to impact relationships and responsibilities, and hangovers exacerbate the very stress the drinking sought to avoid, the difficulties can increase, encouraging yet more drinking and leading to a vicious cycle.
Individuals who are alcohol dependant have higher rates of psychiatric disorders than the rest of the population, including depression, anxiety, post-traumatic stress disorder, and psychosis. For these people, alcohol might be a DIY solution to their disorder, and at first might be effective at keeping the symptoms under control. Nonetheless, in time, these problems will only intensify as a result of alcohol abuse.
The first stage is occasional use or binge drinking. This usually involves experimentation. If you like the taste or the way alcohol makes you feel, you might choose to drink again. However, at this stage, you can still exert control over your drinking, even if you do drink more than the recommended weekly amount. You might think that occasional binge drinking is harmless, but the reality is that it can have a negative impact on your health and put you at risk of alcohol poisoning. Furthermore, if you continue to binge drink regularly, it can lead to a bigger problem.
After occasional use comes alcohol abuse. This stage involves more frequent use of alcohol and you may be drinking more than the recommended amount on a regular basis. You might start drinking for more than just social reasons. Maybe you are drinking alcohol to make you feel better or different. You might be using it to boost your confidence or to alleviate feelings of stress or anxiety. This can lead to a cycle of abuse and an emotional attachment to alcohol.
At this stage, you will have developed a problem with alcohol and will be drinking out of habit than choice. Your use may be starting to have an impact on other aspects of your life and you might be noticing problems with your moods and sleeping patterns. Nevertheless, you are probably still at the stage where you are enjoying alcohol and believe that it is making your life better.
Problem drinking soon progresses to physical dependency. At this stage, you have probably developed a tolerance to alcohol and require more of it to feel the same level of enjoyment as before. This increased consumption can cause your body to get used to alcohol. When you are not using it, or the effects begin to wear off, you will experience physical withdrawal symptoms such as a rapid heartbeat, sweating, tremors, and nausea.
After physical dependency comes addiction. At this stage, you are drinking because you have a physical and psychological need to do so, and not for pleasure or because you want to. You will crave alcohol and it will be interfering with your ability to enjoy life. It is likely to be having a negative impact on your relationships with others as well as on your health and finances. Even knowing the harm that it is causing will not be able to stop. You will be compelled to drink and will be powerless to resist.
Denial and how it protects alcoholism
Denial is common among those suffering with alcoholism. Your loved ones may have tried to discuss the problem with you, but you were unable to see things as clearly as them. Denial is one of the body’s defence mechanisms and is employed by the brain to protect you from a harsh reality. It can be useful for a short period but if it continues, can end up causing harm.
Denial can be an obstacle to recovery because it can prevent you from seeing the truth of your situation. If you are practicing denial, you can continue with your addictive behaviour without consequence or responsibility for your actions. If it is strong enough, it can be projected to your family members and friends, who will then also be convinced that your problem is either not as bad as it seems or is something else entirely.
Heavy alcohol use can lead to damage in certain areas of the brain and is known as alcohol-related brain damage, or ARBD. Scientists know that brain function can be affected by prolonged alcohol abuse; its structure and physical shape can also be altered, leading to serious problems.
ARBD is responsible for mood, memory, and learning problems as well as changes in personality. Some of the symptoms of ARBD are similar to those of Alzheimer’s disease.
Alcohol abuse during pregnancy is also responsible for problems such as foetal alcohol syndrome, or foetal alcohol spectrum disorder (FASD), the name given for all types of problems occurring in babies born to mothers who have abused alcohol while pregnant. FASD can cause both mental and physical problems.
While it is known that alcohol crosses the placenta during pregnancy, it is not known if there is any safe level of alcohol consumption during pregnancy. Current UK guidelines recommend that pregnant women avoid it completely.
We do know that alcohol abuse during pregnancy leads to birth defects that include distinctive facial features such as a thin upper lip, small eyes, and a smaller-than-average head. It can also result in problems with internal organs, mainly the heart, kidneys, and liver.
Behavioural Problems associated with alcohol addiction
Alcohol addiction can alter the brain in such a way that it changes personality and causes behavioural problems. Prolonged regular use of alcohol can lead to impaired judgement and risk-taking behaviour. Furthermore, although not everyone who abuses alcohol will display verbal or physical aggression or violence, there is a strong link.
Alcohol and Other Illicit Drugs
Alcohol is often mixed with other illegal drugs, which can have serious implications for your health. In extreme cases, mixing two chemical substances can have fatal consequences. For example, when combining alcohol with a stimulant drug such as cocaine or amphetamine, the two substances will fight against each other as one has a sedative effect while the other is a stimulant. The result is a huge amount of pressure on the brain and central nervous system.
Alcohol addiction in Women
Historically, alcohol addiction was considered a male problem, but recent statistics show that it is just as prevalent in women. The Institute of Alcohol Studies (IAS) Health Survey for England 2014 showed that eighty per cent of women admitted to drinking alcohol in the previous twelve months compared to eighty-seven per cent of men.
The gap between men and women affected by alcohol abuse and addiction has closed too. In 2016, an analysis of sixty-eight studies from around the world with a combined sample size of over four million people was carried out. The results showed that in the early 1900s, men were 2.2 times more likely to drink alcohol than women. They were also three times more likely so experience problem alcohol use and 3.6 times more likely to experience harm from their alcohol use.
In the late 1990s those figures had dropped dramatically to 1.1, 1.2, and 1.3 respectively.
Alcohol addiction in Older Adults
It is well known that our body and appearance change the older we get, but most do not realise that the way in which alcohol is broken down and processed slows with age. According to the Royal College of Psychiatrists, the recommended alcohol guideline amounts of fourteen units per week should probably be lower for older adults to take account of these changes.
It is also estimated that around a third of all older adults with alcohol problems developed them in later life for the first time. It has been suggested that factors such as social isolation, poor health, bereavement, and boredom all contribute to alcohol abuse in older people. Some older adults may begin self-medicating with alcohol when experiencing chronic pain due to age-related health problems.
It is also thought that one of the reasons alcohol problems are often missed in older adults, is because doctors may be mistaking the symptoms of alcohol abuse with other mental or physical health problems.
Mental Health Issues and Alcohol Use Disorder
Alcohol abuse disrupts the balance of chemicals in the brain and it is this that is responsible for the changes in thoughts, emotions and behaviour that sometimes results from alcohol use.
It is for this reason that alcohol abuse is strongly linked to mental health disorders such as anxiety and depression. But while many individuals drink alcohol to relieve symptoms of these mental health problems, the relief will only ever be temporary.
The reality is that long term use of alcohol can actually exacerbate the symptoms. When the effects of alcohol wear off, the feelings of anxiety and depression tend to worsen. This then leads to more alcohol being consumed in a bid to self-medicate, and so a cycle of abuse begins.
Alcohol is also linked to self-harm, psychosis, and suicide and because it can impair judgement and lead to reckless, compulsive behaviour, many people who take their own lives do so while under the influence of alcohol. In fact, NHS Scotland has said that over half of all hospital admissions related to deliberate self-harm have a direct link to alcohol either immediately before or during the act.
The number of alcohol related hospital admissions in England has increased by three per cent for the period 2015/2016 on the previous year. The figure (339,000) was a 22 per cent increase on the figure for 2005/2006.
In the past ten years, there has been little change in the percentage of hospital admissions attributed to alcohol consumption (2.1%), when compared with all admissions.
Sixty-one per cent of all patients admitted to hospital for alcohol-related problems were male.
In 2016, 57 per cent or 25.3 million adults in England admitted to drinking in the previous week. This was a drop from the figure of 64% in 2006.
It is estimated that there are more than 595,000 dependent drinkers in England. In 2016/2017, only 108,696 were in treatment.
Of those who seek treatment for alcohol addiction, around 61% will successfully complete their programme.
The Hidden Costs of Alcoholism
Even if you are aware of the harm that prolonged heavy drinking causes to the body, you will tend to believe that you would never let it get to that stage because you would be sure to stop long before then. But the truth is that drinking causes great harm to the body long before you can see the effects, and the most serious consequences might not be that far off. An idea of the extent of the negative health impacts of drinking can be seen in the NHS finances, which show that alcohol consumption is responsible for over 10% of the cost of healthcare in Britain.
The hidden cost of alcoholism does not stop with health. Alcoholism is also linked to violent crime, resulting in a cost to the economy in terms of policing and prosecution. However, it is difficult to put a price on the impact that alcoholism has to society. A report by the IAS showed that a figure of £21 billion is regularly quoted by the Government in terms of the cost of alcohol to society (in England and Wales). This does not include the personal cost of alcoholism and only considers the cost that is imposed on others.
The IAS believes that this figure should be revised as there is evidence to suggest that the true figure could be double that amount.
In addition, dependent drinkers often talk of how their drinking is a personal choice, believing that it only affects only them. However, the repercussions of alcoholism go far further than the dependent drinker, and can have deep impacts on families, relationships, strangers, and even the state.
The Neuroscience and Brain Chemistry behind Alcohol Withdrawal
Anxiety, depression, and suicidal thoughts are all common results of alcohol dependency. This is because prolonged heavy drinking effects the neurotransmitters in the brain which regulate mood. Two of the most important neurotransmitters for mood are dopamine and serotonin, which are responsible for creating the positive feelings vital for a healthy mind. Research shows that the levels of both serotonin and dopamine are often heavily altered in the brains of alcoholics, leading to deteriorating mental health and, often, a negative spiral of alcohol use.
When you abuse alcohol, your brain is exposed to the chemicals it contains, resulting in it becoming insensitive to the effects. This is known as an increased tolerance and explains why alcoholics often require more alcohol to feel the desired effects.
Changes in the brain chemistry also increases the risk of experiencing withdrawal symptoms when you stop drinking. As mentioned, alcohol impairs the way in which the brain functions and it can interfere with the way in which it communicates messages and chemical signals around the body. It slows down signal transmissions, which explains why you might experience sedation and sleepiness when intoxicated.
Over time, the brain will adjust to the presence of alcohol. It will increase the production of excitatory neurotransmitters to compensate for the depressant effects of the alcohol. Nevertheless, when alcohol supply is suddenly cut off, the brain is forced to respond and readjust again, leading to many of the unpleasant symptoms listed below:
Hand tremors and a general feeling of shakiness
Cutting back vs. quitting alcohol altogether
If you have been abusing alcohol without becoming addicted, you may be able to cut back instead of quitting. Nonetheless, if you are addicted, nothing less than complete abstinence is necessary. Alcoholism is not a curable illness and while controlled drinking might sound appealing to you, it does not work for those with an addiction.
Some people do manage to control their drinking for a while, but this can then lead to complacency as some end up believing they never had a problem in the first place. Pretty soon, they are right back where they started. If you have an addiction to alcohol, you will need to quit completely.
When Is It Time for Alcohol Addiction Treatment?
The idea that alcohol treatment is only necessary when you reach rock-bottom is one that many addicts adhere to, but it is also one that makes the least sense, considering that ‘rock-bottom’ is not the same for everyone.
It is time to access treatment for your alcohol addiction as soon as you realise you have a problem. It may take you longer to get to this point than another person, but once you recognise that your alcohol consumption is no longer something you have control over, it is time to seek help.
Alcoholism treatment typically consists of a detox, followed by rehab. Rehab programmes take place in either an inpatient or outpatient clinic, depending on your needs and circumstances. How severe your illness is, the length of time you have been addicted, and your personal situation will all play a role in what type of programme you choose.
Rehab in the UK is provided by various organisations including the NHS, charities, local support groups, and private clinics. While the NHS, charities, and local support groups tend to offer free outpatient programmes, private clinics typically offer paid-for residential programmes.
The Detoxification Process
The first stage in recovery is often the hardest; alcohol doesn’t loosen its grip easily and going ‘cold turkey’ can be extremely dangerous. Therefore, alcohol rehab tends to begin with a ‘detox’ – a medically managed detoxification programme designed to safely remove toxic substances from the body and remove physical withdrawal symptoms. During this period a medical professional may provide detox medication to help ease the withdrawal process.
Detox deals with the body, but alcohol rehab addresses the mind. As discussed above, alcohol abuse causes distinct changes in the brain. But the brain can change, and as it does so, the relationship with alcohol can shift completely. For each patient, the path will be different, and treatment should be tailored accordingly.
Your rehabilitation programme will include a variety of treatments in a programme that has been designed around your specific needs and circumstances. It might include elements of the following:
Twelve steps are a recovery framework that can be followed not only through the time spent in rehab, but also the months and years afterwards. Originating from Alcoholics Anonymous, it provides a set of guiding principles that have been at the core of the recovery of millions of people.
Group therapy is a cornerstone of both the twelve steps and almost all rehab programmes. Group therapy enables members to draw on the support and experiences of their peers to discover more about their own addiction. With the structure of the 12 steps programme, these groups can help individuals work through the process of recovery in an atmosphere of mutual respect and support.
Plan for triggers and cravings
As part of your recovery programme, you will work on identifying triggers and cravings when these appear. While some of these might be obvious, such as parties where alcohol will be present, some are more subtle. For example, a particular song may trigger memories of when you were drinking, which could signal a strong desire for alcohol.
It is important that you know how to act when triggers or cravings present themselves. If you have a plan in place, it can help to prevent a full-blown relapse. It may be that you will get in touch with your counsellor or sponsor, or perhaps distraction will help. You might find that going for a walk or doing something else to keep you busy can help the cravings subside.
Handling setbacks in your recovery
While a relapse or slip-up is by no means inevitable, you might face some setbacks during recovery. This does not have to mean returning to alcohol use. A lapse should not signify the end of your recovery, provided you act appropriately, in order to avoid a full relapse. You might even find that this small slip is enough to remind you of why you wanted to quit in the first place.
Use any setbacks in recovery as a learning experience and recognise that while you may have made a mistake, you do not have to make it worse by continuing to drink. Get yourself to your nearest fellowship meeting or call your sponsor as soon as possible. You will then need to take a good look at what led to your setback. It is important that you take the time to do this so that you can avoid another occurrence in the future.
Frequently Asked Questions
How much alcohol causes addiction?
There is no exact amount of alcohol that can cause addiction, and not everyone who abuses alcohol may go on to develop alcoholism. However, regularly drinking more than the recommended weekly allowance of fourteen units may increase your risk.
How many days to get over alcohol addiction?
This is a tricky question to answer as it depends on how severe your addiction is and how you respond to treatment. It varies from one person to the next.
How alcohol addiction starts?
Alcohol addiction begins with experimentation and progresses through the stages of abuse, problem drinking, and dependency before becoming an addiction.
Will rehab cure alcohol addiction?
There is currently no “cure” for alcohol addiction. It can be treated and effectively managed though.
How can alcohol addiction be treated?
Alcohol addiction is treated with a combination of detox and rehabilitation. Comprehensive recovery programmes might include the use of medication, talking therapies, and holistic treatments.
Can you beat alcohol addiction?
While alcohol addiction is not a curable illness, it is possible to overcome it and go on to live a long and healthy substance-free life.
Can you die from alcohol addiction?
If alcohol addiction is not treated, it could progress to the point of developing life-threatening illnesses. Alcohol poisoning can occur when you consume a large amount of alcohol over a short period, possibly resulting in coma or death.
What causes alcohol addiction?
There is no single cause of alcoholism. There are a few risk factors that can increase the risk including a family history of addiction, traumatic experiences, and early exposure to alcohol.
What medication is used for alcohol addiction?
Medication can include replacement drugs such as lorazepam or phenobarbital, which are administered in tapering doses to help with alcohol withdrawals. Drugs such as Naltrexone, Disulfiram or Acamprosate can help prevent a return to alcohol use.
How does alcohol addiction affect the family?
It can have a devastating impact on everyone close to you and lead to some family members developing co-dependency. This could lead to your loved one sacrificing happiness or changing behaviour in response to your illness.