What is Alcohol Dependence?

Alcohol plays a fundamental role in British society, present in celebrations, commemorations, sporting events and a huge variety of other functions. However, its ubiquity and high social acceptance means that getting hold of an alcoholic drink tends to be extremely easy – and for anyone who has developed a problem with alcohol, overcoming the problem can consequently be extremely difficult.

Alcohol dependence is a medical and psychiatric term referring to a condition in which an affected individual has become physically and/or psychologically dependent upon alcohol.

Dependence is a state in which a person’s brain and body have become accustomed to the presence of a certain substance – in this case, alcohol – which that person has consumed repeatedly over a prolonged period, and require certain levels of that substance in order to function normally. If those levels are not maintained – for example, if the person in question suddenly stops drinking alcohol – the system can react by functioning abnormally until it is able to re-stabilise over time; this abnormal function manifests in a range of possibly unpleasant and even dangerous symptoms which together are known as withdrawal syndrome.

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Alcohol dependence as a term is increasingly viewed by some within the medical community as being somewhat obsolete, with other terminology (see below) becoming more prevalent over time. However, “alcohol dependence” is still relatively commonly encountered, and is also widely used – occasionally inappropriately – by the general public along with various other terms.

History of Alcohol Dependence

It has been known since ancient times that alcohol use over time can lead to individuals feeling reliant upon alcohol and to the manifestation of various identifiable symptoms upon cessation of use. Different cultures have many different names for this condition and various specific aspects of it; in modern times, the term “alcoholism” – a catch-all term describing alcohol addiction and a host of related disorders and concepts – has tended to be replaced in medical literature (though still being commonplace in public use) by words and phrases describing more specifically various different conditions and behaviours associated with the long-term abuse of alcohol.

“Alcohol dependence” specifically was adopted as a means of enabling affected individuals to view their conditions differently: to look at alcohol as an external factor to which they resort for different reasons, rather than thinking of “alcoholism” as a disease which may be cured in the same way as others.

Other Names for Alcohol Dependence

Alcohol dependence relates specifically to the process by which a person’s system becomes reliant upon the presence of alcohol to function normally. It is closely related to, though distinct from, alcohol addiction, which is a primarily psychological phenomenon resulting from a disorder of the brain‘s reward system driving repeated alcohol consumption.

Closely related terms include alcohol use disorder and alcoholism, which describe the pattern of repeated alcohol consumption resulting in mental or physical health problems, and alcohol abuse, which describes an array of unhealthy drinking behaviours, including binge drinking, but does not necessarily require the presence of alcohol dependence or addiction.

Psychological alcohol dependence

Psychological dependence is a somewhat more nebulous – though no less real – condition whereby an affected individual becomes psychologically reliant upon alcohol, developing an obsessive desire to consume it and becoming unable to behave and think normally without it. Psychological dependence also features withdrawal symptoms (see below), though (predictably) of a psychological (especially behavioural) rather than a physical nature.

Physical alcohol dependence

Physical dependence is a physiological phenomenon in which the body adjusts to the presence of alcohol and creates a new equilibrium requiring alcohol to function normally. In the absence of alcohol, physical withdrawal symptoms – i.e., those symptoms having a physical impact upon the body – can manifest, including some which can prove fatal.

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The Psychological and Neurological Mechanisms of Alcohol Dependence

The psychological basis of addiction is not fully understood, though it is known to be a disorder of the brain’s reward system: repeatedly engaging in certain behaviours conditions the reward system to drive those behaviours and to create negative feelings when those behaviours are not engaged in. People regularly drinking alcohol will begin to feel comforted and psychologically supported by drinking, and will thus continue to do so both in order to feel that support and to avoid the negative feelings resulting from not drinking.

Neurologically, alcohol suppresses the activity of the central nervous system (CNS) by enhancing the effect the neurotransmitter GABA (gamma-aminobutyric acid). Regular consumption of alcohol causes the readjustment of GABA activity upon the CNS, which subsequently functions abnormally if alcohol is suddenly withdrawn from the system; because the CNS is such a fundamentally important part of the human body, its abnormal function can have extremely deleterious consequences, including death.

Causes and Types of Dependence

Each case of addiction is unique, and the factors which cause it are not fully understood, though it is known that both environmental and genetic factors can be responsible.

One thing which is undeniable is that alcohol dependence results from the regular consumption of alcohol over time, and someone abstaining from alcohol will not develop alcohol dependence.

Alongside the division between physical and psychological alcohol dependence discussed above, there are various different types of alcohol abuse ranging from occasional binge drinking to full-blown alcoholism featuring both kinds of dependence. Some people are able to lead comparatively productive and successful lives despite having serious alcohol use disorders (such people are typically known as functional alcoholics), while others are unable to behave functionally and their entire lives are consumed by alcoholism.

Stages of alcohol dependence

Because alcoholism has been observable for thousands of years, and because in recent times a huge number of medical professionals have put vast effort into understanding the condition, a number of different classification systems have emerged to grade the development of alcohol dependence. Partly because of the sheer variety of such systems, and partly because each case is unique, there is no one universally accepted classification; however, alcohol dependence can be divided roughly into three stages.

  • Early: in the early stages of alcoholism, recreational use turns problematic. You may move from enjoying a few drinks now and then to feeling a strong urge for alcohol, the need to drink ever greater quantities in order to feel the desired effects, the desire to keep drinking once you have started, and the beginning of withdrawal symptoms once you stop drinking.
  • Middle: mid-stage alcoholism sees alcohol take a growing control of your life. Drinking will start having pronounced social effects – problems with relationships, work and studies – while physically you may experience increasingly severe withdrawal symptoms. Your cravings may be near-constant, and you will suffer significant mood swings. Blackouts will become quite frequent occurrences.
  • Late: late/end-stage alcoholism sees alcohol as the dominant force in your life; you will consume alcohol throughout much of your waking life and it will have serious, possibly catastrophic effects upon your relationships and life prospects. Withdrawal symptoms will be extremely unpleasant – perhaps deadly – if you stop drinking, and a range of health disorders may manifest, some of which – including cirrhosis of the liver – could become fatal.

Four Features of Alcohol Dependence

Although each case of alcohol dependence is unique, there are many possible commonalities. Some of the most common features of alcohol dependence include:

Cravings:

a strong need to drink.

Loss of control: not being able to stop drinking once you’ve started.

Physical dependence: withdrawal symptoms, such as nausea, sweating, or shakiness when you don’t drink (see below).

Tolerance:

the physical need to drink greater amounts of alcohol to feel the inital effects.

Who is Most at Risk of Alcohol Dependence Syndrome?

Anyone drinking alcohol regularly is at risk of developing alcohol dependence. However, some people are more susceptible to the condition than others; some common risk factors include:

  • co-occurring mental disorders
  • shyness and a lack of confidence
  • working in an environment with drinking is common
  • experience of trauma and difficult life challenges
  • childhood exposure to drinking or other substance abuse
  • beginning to drink early in life
  • stress
  • higher disposable income
  • living in close proximity to facilities selling or providing alcohol
  • exposure to alcohol advertising

Common traits in alcohol-dependent people
As mentioned above, each case of alcohol dependence is unique, but many commonalities may be observed across cases. Some of the most common personality traits in individuals with alcohol dependence include:

  • low self-esteem
  • manipulative behaviour
  • deceitfulness
  • impulsive behaviour
  • risk-taking
  • impatience
  • isolation
  • extreme sensitivity
  • preoccupation with how they’re perceived
  • defensiveness

Statistics on Alcohol Dependence

  • In the UK in 2016, 58% of adults drank alcohol at least once a week.
  • There were 337,000 hospital admissions in the UK in 2016/17 in which alcohol was a primary factor.
  • In England alone in 2016, there were 5,507 alcohol-specific deaths.
  • In the UK, 67% of those who die as a result of alcohol are men.
  • Some 31% of men and 16% of women in the UK drink at a level which indicates an increased risk of harm (more than 14 units per week).
How alcohol dependence affects the family and society

Any addiction can be devastating to the family unit, as members are forced to observe the deterioration of their loved one and suffer the results of any manipulative and deceitful – and perhaps violent – behaviour they may exhibit. Alcohol is a factor in a high proportion of family break-ups across the UK. Socially, alcohol abuse has profound consequences, including a cost to the NHS of around £3.5 billion per year, and an unquantifiable though the vast cost to police and social welfare services. The total cost of alcohol to the UK GDP is estimated at between £21 and £52 billion per year.

High-functioning alcoholics in society

As mentioned above, some people are able to continue to lead relatively normal and productive lives whilst living with serious alcohol problems; this is typically described as “high-functioning alcoholism”. Some studies put the total of alcoholics who could be described as high-functioning at around 20%. Because such people often do not resemble the stereotype of an alcoholic, their alcohol problems may not be obviously identifiable; nevertheless, they pose substantial health risks and frequently develop into low-function alcoholism over time.

Warning Signs that You are Dependent on Alcohol

It may be easy to brush off any concerns about your drinking, but typically there are numerous warning signs which manifest before serious alcohol problems develop. Some early signs to look out for include:

  • planning life around alcohol
  • feelings of anxiety about where the next drink is coming from
  • compulsive need to drink
  • drinking or wanting to drink when waking up
  • anxiety, alcohol-related depression: physical changes to the brain

Physical Withdrawal Symptoms

As mentioned previously, physical alcohol dependence leads to the manifestation of physical symptoms upon stopping drinking alcohol. Some of the most common withdrawal symptoms include:

  • hand tremors – “the shakes”
  • sweating
  • seeing things that aren’t real (visual hallucinations)
  • depression
  • anxiety
  • difficulty sleeping (insomnia)
  • seizures (potentially fatal)
  • delirium tremens
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Long-Term Health Effects of Alcohol Dependence

Long-term alcohol abuse can have devastating effects on the physical and mental health of the drinker, some of which can be fatal. Some of the most frequently observed effects include:

  • heart disease
  • stroke
  • liver disease (including cirrhosis)
  • liver cancer
  • bowel cancer
  • mouth cancer
  • breast cancer
  • pancreatitis

Diagnosis of Alcohol Dependence

Diagnosing alcohol dependence is sometimes difficult, particularly when the patient is unhelpful (perhaps seeking to conceal their condition). In the UK, various different screening questionnaires have been established which can identify and classify an alcohol use disorder. Two of the most common are the Alcohol Use Disorders Identification Test, and the Fast Alcohol Screening Test, both of which may be given by a GP.

Blood tests can also be carried out to identify longer-term alcohol abuse and any damage it may have done. Tests which may be carried out in the UK include GGT (gamma-glutamyl transferase), bilirubin, ALT (alanine aminotransferase) and MCV (mean cell volume).

Treatment of Alcohol Dependence

Fortunately, there is now a high degree of capability in the UK in the treatment of alcohol dependence, and treatment facilities can be found across the country. Treatment – often provided after a period of tapering down consumption, which may be made easier by the prescription of certain medicines – typically features two phases: detoxification and withdrawal (monitored by medical professionals for the patient’s safety, and possibly assisted by medication); and therapy, uncovering and addressing the root causes of an individual’s alcohol addiction.

Getting Help for Dependence on Alcohol

If you are struggling with alcohol addiction, do not despair: as mentioned above, there is help for you across the country. If you are prepared to acknowledge your condition and reach out for that help, you could soon be on the road back to recovery. Get in touch with your GP and an addiction specialist today to speak candidly about your situation and find out what treatment options you may be to access.

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FAQs

Is there a difference between physical dependence and addiction?
Yes: physical dependence is a physiological condition whereby the body has become reliant upon a given substance to function normally; addiction is a primarily psychological condition resulting from a disorder in the brain‘s reward system. However, addiction frequently features physical dependence.
What treatment is there for alcohol dependence?
Many treatment facilities now operate across the UK, providing help in the form of medicine, managed detoxification, therapy and much more. Contact your GP and an addiction specialist to get details of treatment options in your area.
What are the long-term effects of alcohol dependence?
Long-term alcohol use can have catastrophic effects on physical and mental health, including some which may be fatal. See above for fuller details.
Do I drink too much?
As a rule of thumb, if you worry that you drink too much, you probably do. If you have concerns about your alcohol intake, consult your GP.
What is considered a heavy drinker?
In the UK, having more than 14 drinks a week for men, or more than seven for women, is considered “at-risk” or “heavy” drinking.
If I need a drink am I alcohol-dependent?
It depends what you mean by “need”: if you physically need to drink in order for your body to function normally, then you are certainly alcohol-dependent. However, if you feel like you “need a drink”, it could be a sign that you want a drink – which could but does not necessarily, indicate a psychological dependence.
What should I do if I’m worried about my alcohol consumption?
Speak with your GP and/or an addiction specialist as soon as you can. Do not simply hope it will go away.
What is the Paddington alcohol test?
The Paddington alcohol test is a questionnaire designed to establish the extent and nature of alcohol use in patients attending accident and emergency (A&E) departments to optimise treatment.

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