Alcoholism

Alcohol dependence

Possible symptoms

Being unable to limit the amount of alcohol you drink

Wanting to cut down or making unsuccessful attempts to do so

Spending a great deal of time drinking or obtaining alcohol

A strong desire or craving for alcohol

Failing to fulfil important responsibilities at work, school or home because of repeated alcohol use

Continuing to drink despite physical, social, work or relationship problems caused by alcohol

Reducing social or work activities or hobbies because of alcohol use

Drinking in unsafe situations, such as while driving or swimming

Developing tolerance to alcohol

Having withdrawal symptoms such as nausea, sweating or hand tremor, or drinking to avoid these symptoms

12 ounces (355 ml) of beer (about 5% alcohol)

8–9 ounces (237–266 ml) of malt liquor (about 7% alcohol)

5 ounces (148 ml) of wine (about 12% alcohol)

1.5 ounces (44 ml) of spirits or distilled liquor (about 40% alcohol)

Risk factors

Risk factors include:

Long-term regular drinking. Regular heavy drinking over a long period or repeated episodes of heavy drinking increase the risk of alcohol-related problems and alcohol use disorder.

Starting at an early age. People who begin drinking when young, particularly in large quantities on individual occasions, are at higher risk.

Family history. The risk of alcohol dependence is higher in people whose parent or close relative has this problem. Genetic factors may contribute.

Depression and other mental health problems. Conditions such as anxiety, depression, schizophrenia or bipolar disorder are often associated with alcohol or other substance use.

History of trauma. People with a history of emotional or physical trauma are at higher risk of developing alcohol dependence.

Bariatric surgery. Some research suggests that bariatric surgery may increase the risk of developing alcohol dependence or relapse.

Social and cultural factors. Friends or a partner who drink regularly may influence alcohol use. Romanticised portrayals of drinking in the media can suggest that excessive drinking is acceptable. Parents and peers can have a significant influence on young people.

Possible complications

Regular heavy alcohol use increases the risk of:

Mental health problems — depression, anxiety and reduced cognitive functioning.

Physical harm — liver cirrhosis, cardiovascular disease and a weakened immune system.

Social difficulties — worsening relationships, job loss and social isolation.

Effects on safety

Road traffic crashes and other accidents, such as drowning

Relationship problems

Poorer performance at work or school

A higher risk of committing a violent crime or becoming a victim

Legal problems and financial difficulties

A higher risk of using other substances

Unprotected sex and the risk of sexual assault or rape

An increased risk of attempted or completed suicide

Effects on health

Liver disease. Heavy drinking increases the risk of a buildup of fat in the liver (hepatic steatosis), liver inflammation (alcoholic hepatitis) and cirrhosis.

Digestive problems. Alcohol can damage the stomach lining and contribute to digestive problems and difficulties absorbing nutrients.

Heart problems. Excessive drinking increases the risk of high blood pressure, enlargement of the heart, heart failure and stroke.

Diabetes. Alcohol affects the release of glucose from the liver and increases the risk of hypoglycaemia (low blood sugar).

Sexual dysfunction. Excessive drinking can cause erectile dysfunction in men and menstrual irregularities in women.

Vision problems. Long-term alcohol use may cause nystagmus (rapid involuntary eye movements) and damage to the optic nerve.

Increased cancer risk. Harmful alcohol use is associated with an increased risk of cancers of the mouth, throat, liver, oesophagus, colon and breast.

Weakened immune system. Excessive drinking reduces the body’s ability to fight infections.

Possible warning signs (these signs alone do not establish a diagnosis):

Losing interest in hobbies or personal hygiene

Red eyes, slurred speech and problems with coordination or memory

Making new friends and breaking off existing relationships

Declining academic performance

Frequent mood changes and defensive behaviour

Treatment approaches

Detoxification and withdrawal management. When needed, a doctor plans medically supervised management of alcohol withdrawal. Duration and the choice of an outpatient or inpatient setting depend on individual risk and monitoring needs. Detoxification alone does not replace ongoing treatment for dependence.

Learning new skills and developing a treatment plan. Specialists are involved in this process. Treatment may include setting goals, making behavioural changes, self-help techniques, counselling and follow-up care.

Psychological counselling. Individual or group therapy may help you better understand the problem. Couples or family therapy may also be helpful, as family support plays an important role in recovery.

Medication. A doctor selects medication when appropriate, taking account of the person’s condition and possible contraindications; self-medication is not recommended.

Ongoing support. Follow-up programmes and support groups can help with managing relapse and changing one’s way of life.

Treatment of mental health conditions. Alcohol dependence often coexists with conditions such as depression or anxiety. These may require psychotherapy, medication or other treatment.

Medical treatment of health problems. Alcohol-related health problems often improve considerably after drinking stops. Some conditions nevertheless require ongoing medical follow-up.

If outpatient treatment has not helped sufficiently, a doctor reassesses the treatment plan and level of care. A day programme may be an option for some people; severe or complicated withdrawal may require hospital care.

When should you see a doctor?

Lifestyle and support (not a substitute for medical treatment)

Consider your social environment. After agreeing a safe plan with your doctor, let friends and family know about your plan to stop drinking. Build a supportive environment for recovery. You may need to avoid people or social situations that interfere with this process.

Developing healthy habits. Good sleep, regular physical activity, stress management and healthy eating may support recovery. These habits do not replace assessment of withdrawal risk and any necessary medical management.

Take part in activities that do not involve alcohol. You may find that many of your activities are linked to drinking. Try hobbies or activities that can be enjoyed without alcohol.

Preparing for a medical appointment

Write down the following in advance:

All your symptoms, including those that may not seem related to alcohol

Important personal information, including major stress or recent changes in your life

All medications, vitamins, herbal remedies or supplements you take, and their doses

See also

→ Psychiatric consultation for alcohol dependence

Related topics: Depression · Drug addiction · Psychiatrist consultation

Source: WHO — Alcohol.

ASAM — Alcohol Withdrawal Management Guideline

NICE CG115 — Assessment and management of alcohol dependence