What is Alcohol Addiction?
Addiction is distinct from dependence (see below for the difference between the two) which is a physical phenomenon; however, the two are frequently closely connected, and alcohol addiction is almost invariably accompanied by alcohol dependence.
Alcohol addiction is a widespread and extremely damaging phenomenon, affecting many millions of people around the world and responsible for millions of deaths and a vast if unquantifiable social cost.
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Also Known As…
The term “alcohol addiction” is often used interchangeably (and frequently incorrectly) with certain other words and phrases, some of which describe distinct (though related) aspects of the condition.
The word most frequently used by the general public to describe alcohol addiction, alcoholism is more correctly a broad term used to describe the repeated consumption of alcohol over time resulting in physical and/or mental health problems. Alcoholism itself is not a term with a precise medical definition, and most authorities strive to avoid using the term despite its establishment in common parlance. The most common lay interpretation of alcoholism would be the compulsive consumption of alcohol, to the detriment of the drinker, who is unable to stop drinking despite that detriment (in other words, alcohol addiction).
Alcohol dependence syndrome:
The International Classification of Diseases (ICD) of the World Health Organisation (WHO) describes alcohol dependence syndrome as, variously, “a chronic disease in which a person craves drinks that contain alcohol and is unable to control his or her drinking”; “a disorder characterised by a pathological pattern of alcohol use that causes a serious impairment in social or occupational functioning”; and “a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations”.
Alcohol use disorder (AUD):
in 2013, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) of the American Psychiatric Association (along with the ICD, the principal authority psychiatric diagnoses globally) reclassified both alcohol dependence and alcohol abuse under the definition “alcohol use disorder”. Previously, the DSM-IV had defined alcohol abuse as “repeated use despite recurrent adverse consequences” and alcohol dependence as “alcohol abuse combined with tolerance, withdrawal, and an uncontrollable drive to drink” (while the first two editions of the DSM had offered the simple term “alcoholism”). DSM-V offers 11 symptoms, the presence of at least two of which indicates a diagnosis of alcohol use disorder, further sub-classified as “mild” (two or three symptoms), “moderate” (four or five”) or “severe” (six or more).
The Difference Between Alcohol Abuse and Alcohol Dependence
As discussed above, the term “alcohol abuse” has previously had a specific psychiatric definition; nowadays, and as commonly interpretative by the layperson, alcohol abuse refers to any of a broad spectrum of damaging and/or unhealthy drinking behaviours, including (but not limited to) binge drinking, drinking to a dangerous level of intoxication, alcohol addiction and alcohol dependence. Generally speaking, in a non-medical setting alcohol abuse can be used to refer to any unhealthy consumption of alcohol.
Alcohol dependence is a more precisely defined term relating to a physical and/or psychological dependence upon alcohol in an individual. Dependence occurs when a person consumes a particular drug – in this case, ethanol – for long enough and in sufficient quantities for their brain and body to become accustomed to the presence of certain levels of that drug, and thence to require such levels of the drug in order to function properly. A sudden withdrawal of that drug from the system (for example, suddenly stopping drinking after months or years of heavy alcohol consumption) can trigger abnormal functioning of the system and the manifestation of withdrawal symptoms (which in the case of withdrawal from alcohol can prove dangerous and even fatal).
Why Do People Drink Alcohol?
Since prehistoric times, people have consumed alcohol simply for its intoxicating qualities: in appropriate doses it can provide an elevated mood and a sensation of euphoria, disinhibition and increased sociability, and lower levels of anxiety. Because of these pleasurable effects – as well as alcohol’s role in countless rituals and ceremonies over the millennia – alcohol has established itself across most of human culture as an accompaniment to celebration and commemoration.
Indeed, alcohol’s relative ubiquity across the years has seen it come to be used for a huge variety of purposes: to stave off fear ahead of battle or other intimidating events; medicinally (including as an anaesthetic, or to rouse people from hypothermia); in ceremonial toasts; as a performance-enhancing drug; as a means of ameliorating the impact of traumatic news; and countless others.
Unfortunately, alcohol can also be used in ways which can be negative for the individual drinking it. Many people drink to escape unpleasant daily realities, to cope with chronic pain or mental health issues, as a means of alleviating boredom and many others. In some cases, people who have been drinking alcohol over time develop addiction and/or dependence, and in such cases the affected individuals drink primarily because they simply cannot physically or psychologically stop drinking.
Causes of Alcohol Use Disorder
Human psychology is extraordinarily complex, and no two cases of alcohol use disorder are the same: there are as many reasons why someone might drink to excess as there are people drinking. Moreover, addiction as a phenomenon is still not fully understood: while many factors are known potentially to contribute to the development of an addiction, medical science has not yet established beyond doubt why one person may go on to develop an addiction and another, in very similar circumstances, may not.
Fundamentally, the one certainty is that alcohol addiction can only result from the repeated consumption of alcohol over a period of time, and that people who do not engage in the consumption of alcohol are, obviously, not susceptible to the condition. With that truism having been acknowledged, however, certain factors have been recognised as being potentially instrumental in the establishment of an addiction, with both the environment and genetics playing a role.
There is a strong link between a person’s environment and their chance of going on to develop an alcohol addiction. Some relevant factors include:
growing up around alcohol abuse
traumatic life events
associating regularly with heavy drinkers
proximity to places selling alcohol
exposure to alcohol advertising
Genetics are also known to affect a person’s susceptibility to alcoholism. A family history of alcoholism is one of the leading indicators of a likelihood to develop alcoholism in any individual. Meanwhile a person’s genetic composition affects their ability to metabolise alcohol and thus how they experience drinking; while studies are ongoing, it is thought that individuals who are genetically predisposed to process alcohol more efficiently, and therefore less likely to suffer extremely unpleasant hangovers, are more likely to go on to drink more at an early age and therefore to be more at risk of developing alcohol use disorders.
Psychology of Alcohol Addiction
Addiction – as distinct from dependence – is a psychological phenomenon, and as noted above the incredible diversity and complexity of human psychology means that there is no one universal “roadmap” to alcohol addiction: each addict comes to develop the condition in their own way and for their own reasons (though of course there may be similarities between individual case histories). What drives one person to engage repeatedly in detrimental alcohol consumption may differ significantly from the motives of another. This is one reason why psychotherapy is key in addiction treatment: getting to the bottom of such motives, and addressing them, can be a complex activity requiring very different approaches from one patient to another.
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Stress as a Causal Factor in Alcoholism
Stress is a major factor in alcohol abuse and alcohol addiction. Regardless of the nature of stress (be it as a result of general life events, a response to childhood trauma, the impact of catastrophe, exposure to discrimination or various other possible origins) many people feel that drinking alcohol can alleviate it, either in the short term (drinking in response to a particularly unpleasant event in order to lift mood and/or encourage action) or longer-term (drinking regularly – for example, every evening – as an “anaesthetic” against a high level of background stress).
However immediately beneficial the relieving effects of alcohol may feel, it is frequently a complicating factor in cases of stress. Physiologically, alcohol consumption creates effects on the body (such as a hangover) which make an individual more susceptible to stress once the pleasurable qualities of intoxication have declined (as well as making them more likely to injure themselves, compounding any stress they may feel); meanwhile, being under the influence of alcohol also places the individual at risk of issues such as professional difficulties or involvement with the police which themselves are likely to increase levels of stress greatly.
Moreover, the more someone resorts to alcohol as a means of dealing with stress, the more likely they are to develop an alcohol abuse disorder, which is itself an extremely stressful condition.
The Role of Tolerance in Alcohol Addiction
Tolerance is the phenomenon whereby the system of someone consuming a substance of abuse such as alcohol becomes accustomed to certain levels of that substance, and adjusts brain and nervous system function accordingly, so that higher and higher levels of the substance are required to produce the same desired effects as previously. In other words, someone drinking for the first time is very likely to require much less alcohol to get drunk than someone who drinks every day.
For people drinking for the effects of alcohol (rather than simply because they enjoy the taste), over time as tolerance builds up more alcohol is needed to achieve those effects. Understandably, however, drinking more, and more regularly, is more likely to lead to dependence and addiction (while also potentially rendering the consequences of that addiction more severe, with more money and time needed to be devoted to drinking).
Co-Occurring Disorders: Mental Health Issues & Alcohol Addiction
Alcohol is recognised as a very significant contributing factor to a wide range of mental health issues: chronic alcohol abuse can cause neurological damage, resulting in an array of mental disorders, whilst addiction can contribute to the onset of a similarly large number of disorders including, prominently, depression and anxiety.
Meanwhile, various mental health issues can themselves contribute to the development of alcoholism, as people use alcohol to self-medicate their conditions, and/or to escape the difficulties which those conditions may cause (for example, as a means of coping with homelessness which is often a result of mental health problems).
Because alcohol is so commonly an element of dual diagnosis (when a substance abuse disorder occurs alongside another mental health disorder) various approaches to treatment have been developed which take into account the specific challenges of dealing with dual diagnosis; specialist care is often required in such cases.
Signs and Symptoms of an Alcohol Problem
There are many signs and symptoms which may betray the presence of an alcohol problem. However, it is always worth bearing in mind that many individuals suffering from an alcohol use disorder go to great lengths to conceal their alcohol habits, sometimes extremely successfully, and that “an absence of evidence is not evidence of absence”. On the other hand, it must also always be understood that many of the potential symptoms of alcohol abuse may also, in reality, have different causes.
Physical signs of alcohol addiction
Meanwhile, some prominent physical symptoms of alcohol addiction include:
- alcohol cravings
- tremors (involuntary shaking) the morning after drinking
- lapses in memory (blacking out) after a night of drinking
- illnesses, such as alcoholic ketoacidosis (includes dehydration-type symptoms) or cirrhosis
Behavioural signs of addiction
Some of the most common behavioural symptoms of alcohol addiction include:
- a lack of interest in previously normal activities
- appearing intoxicated more regularly
- needing to drink more in order to achieve the same effects
- appearing tired, unwell or irritable
- an inability to say no to alcohol
- anxiety, depression or other mental health problems
- becoming secretive or dishonest
Complications of Alcohol Addiction
Addiction of any type can lead to a great many complications, depending on factors including (but not limited to) the quality of life of the addict, their living environment and circumstances, and the substance/s to which they are addicted. In the case of alcohol addiction, some of the most common
possible publications include:
- mental illness
- Wernicke–Korsakoff syndrome
- irregular heartbeat
- cirrhosis of the liver
- fetal alcohol spectrum disorder
Dangers of alcohol and multi-drug interactions
Individuals abusing alcohol often do so in combination with other drugs, whether recreational, medicinal or both. This can be extremely perilous, as alcohol can interact dangerously with numerous other substances, enhancing levels of intoxication and sometimes reacting to produce new and significantly more dangerous substances in the body.
Especially problematic is alcohol’s intensification of the sedation resulting from the consumption of other central nervous system depressants including opioids, non-benzodiazepines, barbiturates, benzodiazepines, antipsychotics, sedative antihistamines and some antidepressants; taken in excess with any of these substances, alcohol consumption can lead to overdose and other deadly conditions. Alcohol also reacts with cocaine to produce the more toxic cocaethylene in the body; and with cannabis to increase tetrahydrocannabinol (THC) levels which may enhance cannabis intoxication and render it more problematic. Alcohol is also known to interact dangerously with some antibiotics, including metronidazole.
Teen Alcohol Addiction
Despite alcohol being unavailable legally to under-18s in the UK, alcohol use and abuse is comparatively widespread amongst teenagers – and is indeed seen as something of a rite of passage. Alcohol’s ubiquity in modern British society means that despite the legal measures in place it remains relatively easy for many young people to access alcohol and to become intoxicated: 73% of 15-year-olds in the UK have drunk alcohol at least once. (It is worth noting, however, that alcohol consumption in teenagers has been on a downward trend since the start of the millennium, with the proportion of UK 15-year-olds having drunk in the last week dropping from 48% in 2000 to 18% in 2014, according to the NHS.)
For most teenagers, drinking alcohol and drunkenness is purely recreational and the primary dangers of alcohol remain alcohol-related injury and overdose (with over 1,000 under-15s admitted to hospital each year with acute alcohol poisoning). However, a small but tragic proportion of teenagers go on to develop alcohol use disorders: 6% of under-15s drink weekly, and 40% of those who begin drinking regularly under the age of 13 go on to develop alcoholism at some point in their lives.
Alcohol Addiction and Pregnancy
Drinking anything above low quantities of alcohol (specific guidance on acceptable levels varies by location) when pregnant places the unborn child at risk of a group of conditions known as foetal alcohol spectrum disorders (FASDs): low birthweight, reduced height, low levels of intelligence, problems with hearing or seeing, behavioural difficulties, small head size, poor coordination, and a generally abnormal appearance are all established FASDs. Foetal alcohol syndrome (FAS) is the most serious FASD, comprising growth deficiency, damage to the central nervous system, the development of particular facial features, and potentially alcohol dependence at birth.
Drinking a large quantity of alcohol in one session whilst pregnant risks termination of the pregnancy; meanwhile women who are not pregnant but who are trying to become so are advised
to avoid alcohol altogether, as alcohol consumption is known to have a limiting effect on conception.
Top risk factors for teen alcohol addiction
- experience of abuse or other trauma in childhood
- mental health or behavioural issues (including ADHD)
- living in proximity to pubs and/or nightclubs
- peer group featuring regular alcohol consumption
- other substance abuse
- boredom and a lack of intellectual fulfilment
- lack of confidence
- low self-esteem
Alcohol Addiction in Older Adults
Despite the popular perception that young people (especially students) are the biggest drinkers, the age group which is actually most likely to drink in the UK is people aged 45-64. There are various reasons for this, including a general downward trend in alcohol consumption especially prominent in young people, a greater access to disposable spending amongst middle-aged Britons, the increased likelihood of alcohol use disorders over time and more.
Over the last 15 years, total abstinence from alcohol has actually fallen by 5% for Britons aged 65 and over, and alcoholism amongst older people is now recognised as an increasingly serious problem: some 28% of men and 14% of women aged over 65 now drink at least five times a week. Alcohol, and alcohol addiction, can have more serious health implications for the elderly who are less likely to be able to recover from alcohol-related illness and injury, are more likely to have co-occurring disorders, and are especially susceptible to motor control-related accidents.
Cost of Alcohol Addiction to Society and NHS
Alcoholism has been recognised as a social ill since time immemorial, with alcohol been prohibited altogether at various times in various parts of the world. Alcohol addiction and abuse causes problems from the level of the individual, up through family and local units to a national scale.
Alcohol is a major contributing factor to family breakup, domestic violence, child abuse, violent crime, accidents on the road and at work and many other factors which have detrimental impact – both financially and otherwise – upon society. In many ways this impact is unquantifiable – how can a cost be placed on broken hearts and families, for example? – but certain specific figures can be given: for instance, alcohol is estimated to cost the NHS alone approximately £3.5 billion per year (£120 per taxpayer). In 2014, alcohol dependence specifically was a factor in just under 200,000 prescriptions in the UK.
Living With & Managing Life with Alcohol Addiction
It is possible to live with an alcohol addiction for many years – indeed, some “functioning alcoholics” are able to hold down even high-level jobs for long periods whilst managing their addictions. However, in the end alcohol addiction invariably takes its toll on the addict’s mind and body – and even before any long-term irreversible damage is sustained, the addict may feel extreme distress and other negative emotions take over their life as a result of their addiction.
If you regularly drink to excess, and have tried and failed to stop drinking, you have an alcohol addiction that could be deadly in the long term. However manageable you may feel your condition is currently – and however much you may enjoy the alcohol you consume – for the benefit of the rest of your life, and those around you, you should seek help as soon as possible.
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Helping Someone with Alcohol Addiction
Observing someone close to you struggling with an addiction can be heartbreaking, especially if they are unable to confront the reality of their condition, and/or behave deceitfully and manipulatively in order to conceal it. However, strong the impulse may be to tackle the issue straight on and confront the person in question about their situation, you may do more harm than good by doing so. Instead, speak with an addiction specialist about the situation; they will be able to offer advice on how to proceed. Most importantly, no matter how much you may love the affected individual, always act in a way which first and foremost protects you and others.
Diagnosis of Alcohol Addiction
Diagnosing alcohol abuse disorders can be surprisingly difficult – especially in cases where the patient is unhelpful or resistant to diagnosis. As noted earlier, different authorities have different definitions of alcoholism and alcohol abuse, and some of the criteria used by one authority to identify alcohol use disorders may be irrelevant in the eyes of another.
In many severe cases (especially when withdrawal is presented) it might be relatively straightforward to identify someone suffering the effects of alcohol addiction and/or long-term alcohol abuse. In other cases, however, various diagnostic methods may be applied to support – or refute – the opinion of a doctor.
Various screening questionnaires have been drawn up to establish the possible presence and extent of an alcohol use disorder. Two which are commonly used in the UK are the Alcohol Use Disorders Identification Test, and the Fast Alcohol Screening Test, both of which are available from the NHS online or maybe obtained from – and required by – your GP.
As well as tests to establish the presence of alcohol in blood, to work out how much alcohol someone has consumed recently (for example, in cases of potential drink-driving) some blood tests can be carried out which can give information regarding longer-term alcohol abuse and the damage it may have done. Some tests commonly carried out in the UK include GGT (gamma glutamyl transferase), bilirubin, ALT (alanine aminotransferase) and MCV (mean cell volume) which each investigate different aspects of alcohol consumption and its impact upon the body. For more information on these tests, consult an alcohol addiction specialist.
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How to Prevent Alcohol Addiction
Ultimately, the only way to guarantee that you never develop an alcohol addiction is, simply, never to drink alcohol at all. However, for most people alcohol can play an enjoyable and harmless role in their lives, and by drinking sensibly the risk of addiction and damage to health may be averted.
Some steps to take include:
- avoiding socialising with people who drink problematically
- avoiding binge drinking: limit your intake to a small number of drinks in any one sitting
- drink infrequently (no more than once a week if possible)
- try not to mix drinks
- do not drink to cope with emotional or other difficulties
- avoid keeping large quantities of alcohol in the house
- find a non-alcoholic drink you enjoy which is available in pubs and restaurants
if you reach a level of drinking which concerns you or others, seek help immediately
Coping strategies to prevent addiction relapse
If your drinking has reached problem levels, it is vital that you seek professional help. However, even if you have managed to stop drinking (with or without assistance) there is no guarantee that you will not relapse at some point: recovery is an ongoing process, requiring constant diligence and dedication. If you have been through rehab, you may have been given some relapse prevention measures that you can deploy for your recovery; if you have not yet gone through treatment, speak with an addiction specialist about such prevention measures.
Common relapse prevention measures include:
- identifying, recognising and avoiding your triggers
- having a strong support system in place
- creating distraction structures (such as regular exercise)
- giving yourself reminders of the consequences of falling back into addiction
- attending self-help groups such as Alcoholics Anonymous
- engaging in counselling
It is worth noting, however, that even if you do relapse that does not automatically mean that you will immediately fall back into addiction. People do make mistakes; the occasional relapse, while dangerous, need not be terminal as long as you seek the right help.
Common Misconceptions About Alcohol Addiction
Alcoholism is a much misunderstood phenomenon, despite its relative prevalence in today’s society. Some common misconceptions include:
- Alcoholics drink all day every day: some people manage to regulate their lives so that their drinking is structured rather than constant. That does not mean that they are not addicted to alcohol.
- Stopping drinking is merely a matter of willpower: alcoholism is a disease, and in many cases willpower alone is insufficient to overcome it.
- Alcoholism isn’t as bad as an addiction to other drugs: an addiction to alcohol can be just as catastrophic as an addiction to even the hardest illegal drug. Alcohol takes more lives than all other substance abuse put together, and alcohol withdrawal is amongst the most dangerous of all withdrawal syndromes.
- If a person is an alcoholic, that’s their fault: there are numerous reasons why someone may become addicted to alcohol, including genetic factors which may prove overwhelming.
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Getting Help for Alcohol Addiction
If you or someone you love are struggling with an alcohol addiction, do not despair: there are treatment options throughout the country, both public and private, which can help you overcome your addiction. Speak with your GP and/or an addiction specialist today about your situation and what help you may be able to access.
Types of Alcohol Addiction Treatment
There are great many different approaches to treating alcohol addiction. However, most addiction treatment rests on a combination of detoxification/withdrawal (supervised by professionals, and potentially made easier with the help of certain medications) and therapy, the former to overcome immediate pressures of physical dependence, and the latter to identify and tackle the underlying psychological issues which have led to the development of addiction.
Alcohol addiction withdrawal and detox
Alcohol withdrawal can be extremely dangerous – potentially fatal – and is often very distressing, with numerous deeply unpleasant symptoms manifesting. However, if you have developed an alcohol dependence, detoxification is an indispensable part of treatment: your system needs to be cleansed of alcohol and any other substances of abuse before going on to deal with your psychological addiction through therapy. Alcohol withdrawal needs to be managed by trained professionals: do not attempt, ever, to withdraw from alcohol independently. Consult your GP and/or an addiction specialist if you are concerned about alcohol withdrawal.
Alcohol addiction treatment and rehab
Alcohol addiction is now treated at many residential rehabilitation (rehab) facilities across the country. Rehabs typically provide a combination of detoxification and therapy, along with other elements of a holistic treatment plan such as fitness and dietary management. Treatment can be provided either on an inpatient or outpatient basis: in the case of the former, stays are typically between one and three months. Outpatient treatment is sometimes preferable for addicts who feel unable to take sufficient time out from their daily lives for residential care, but can be challenging in that it does not take the addict out of their environment of alcohol abuse.
Medications used in alcohol addiction treatment
Numerous different medications have been developed to deal with various aspects of alcohol addiction: some are intended to reduce and eventually prevent drinking altogether, while others address specific aspects of withdrawal to alleviate those symptoms and make withdrawal a safer process. However, while many of these medications can be procured independently (for instance, via the dark web) it is extremely dangerous to take any addiction medication without medical advice. Do not self-medicate: speak with your GP and/or an addiction specialist about medications which may help you.
Outlook for alcoholics
Living with an alcohol addiction can be very distressing – and the importance of alcohol in today’s society, and its ubiquity, can make alcoholics feel that there is no escape from their condition. However, this is not the case: with the right help, you can overcome your addiction and go on to lead a long, happy, healthy, abstinent life.
Alcohol Addiction Statistics
- In the UK, over 80% of adults drink alcohol at least occasionally; 4% of men and 3% of women drink at least 50 and 35 units of alcohol respectively per week.
- Of Britons who drink alcohol, 27% are classed as binge drinkers.
- At least 21% of men and 13% of women aged 65 and over in the UK drink alcohol at least five days a week.
- In England in 2017 there were 5,843 alcohol specific deaths.
- In 2016 there were 230 deaths on British roads where at least one driver was over the drink drive limit: 13% of all road accident deaths.
- There are over 1.2 million alcohol-related hospital admissions each year in Britain.
Ready To Get Help?
As with every addiction, only those who are able to acknowledge their condition will benefit from treatment; however, if you are prepared to own up to an alcohol addiction there are now many facilities across the UK treating addicts and returning them to happy and healthy lives. You could soon be one of them.
Take control of your life – get started on the road to recovery
Alcohol addiction can make you feel like you’ve lost control of your life – but with help you can take back that control and resume a life of happiness and success. Speak with your GP and/or an addiction specialist, and take the first steps on the path back to a happy and healthy life.
Get help today
If you are able to acknowledge your alcohol addiction and reach out for help, don’t let another day go by in which you struggle under the burden of this condition. Contact your GP and/or an addiction specialist immediately to discuss treatment options which may be available to you.
Call our admissions line 24 hours a day to get help.
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