ALCOHOL ADDICTION, ABUSE & DEPENDENCY
Alcohol is consumed by a great many people who see it as a pleasant way of unwinding after a long, hard day at work or as an enjoyable aspect of socialising with others. Alcohol helps us to relax: it gives us confidence in an unfamiliar situation, enables us to interact with others or is a means of celebrating an occasion.
A moderate amount of alcohol is good for your health and as long as you don’t overdo it is unlikely to cause any problems. We know about the French diet, which includes red wine and yet they have some of the lowest rates of heart disease in the world. Their rates are lower than those in the UK.
Plus there is some research which suggests that there is a substance present in red wine which helps to protect against heart disease, although this is still open to debate.
These are the positive aspects of alcohol use. But, it is when you overdo it on a regular basis or find it increasingly difficult to manage without a drink that the situation changes from social use to an addiction. In other words you have crossed the line into ‘alcoholism’. But before we discuss this further here is a brief overview of what alcohol is.
What is alcohol?
If you ask someone to describe alcohol then they are likely to say that it is something you drink such as beer, wine or spirits. They may also add that it can get you drunk if you consume enough of it! But alcohol is actually the name given to a group of chemicals which are found in a wide variety of products such as mouthwashes, deodorants, body cleansers and of course, beer, wine and spirits.
There are four groups of alcohol which are as follows:
- Grain alcohol: also known as ethanol. This is made from the fermentation of sugars and starches and is the type of alcohol you find in drinks such as beer, wine and spirits.
- Aromatic alcohol: a form of alcohol which is found in health products or cosmetics.
- Denatured alcohol: this is similar to grain alcohol but with one difference - it contains addictives which means that it is unfit for human consumption. Usually found in cosmetics, mouthwashes, moisturising creams and deodorants.
- Fatty alcohol: this is also found in cosmetics. It is used as a lubricant to bind oil and water together in the production of skin creams.
In this guide when we talk about alcohol we mean grain alcohol (ethanol) which is present in all types of drinks, such as beer and wine.
Alcohol is a Depressant drug
Alcohol is classed as a depressant drug. Now you may think that this seems strange as a great many people find that having a drink makes them feel happy. But the first part of this term - ‘depressant’ is used to describe processes in which alcohol shuts down those areas of the brain which are responsible for our physical, mental and emotional behaviour. The second part - ‘drug’ refers to the fact that it directly affects the physical and mental state of the drinker and excessive use can lead to an addiction.
It is true that alcohol causes some people to become talkative, outgoing and upbeat but equally there other people who find that it makes them feel aggressive or depressed. It can be the case that if you are feeling low then having a few drinks will worsen that feeling. What confuses most people is what is considered a ‘safe’ amount to drink? Why are some people able to consume more alcohol than others but without any ill-effects? Also why is it such a major problem?
Units of alcohol
The NHS has information on what are considered ‘safe’ levels of alcohol. These are measured in units and differ between men and women. It is difficult to be exact about a ‘safe’ level of drinking as everyone is different in this aspect. But there are guidelines on the recommended levels of alcohol consumption which are measured in units.
A unit is equivalent to:
- Half a pint of cider, beer or lager
- A small measure of spirits
- A small glass of wine (125 ml)
- A standard measure of sherry or port
If you are buying alcohol to drink at home then a good way of understanding about units is to look at the amount of pure alcohol contained in a drink. This is called ‘ABV’ or ‘alcohol by volume’. In the UK a single unit of alcohol contains 10ml (8g) of pure alcohol. If you want to check the number of units of pure alcohol in a drink then multiple its volume (ml) by the ABV (its strength), and then divide this figure by 1,000. As you might imagine a higher ABV means a stronger drink with a higher concentration or alcohol.
The NHS advises men to drink no more than four units a day and women no more than two units a day. Men should have no more than fourteen units of alcohol in a week and women no more than nine units per week. Avoid drinking all of these units in a single go as a ‘binge drinking’ session.
Sticking to the recommended units doesn’t mean a completely safe level of drinking but it does put you in a low risk group. Units of alcohol and risk levels are categorised as follows:
- Low risk: men who drink three to four units of alcohol a day and women who drink one to two units of alcohol a day.
- Medium risk: people who drink more than these units, also called ‘increased risk drinkers’.
- High risk: men who drink more than eight units a day or fifty units in a week and women who drink more than six units a day or thirty five units in a week.
Gender and alcohol
The reason why the number of units is higher for men is because generally, men have a higher level of tolerance than women and metabolise (break down) alcohol more quickly than women. Women have higher levels of body fat and less water in their bodies than men which means that alcohol is not easily diluted and so remains in the body much longer than for men. This is why women often become drunker more quickly or are unable to consume as much alcohol as men although there are exceptions. Men are bigger and heavier which is why they are able to consume larger amounts where as women are smaller and lighter.
But like we say there are exceptions to this and many women are drinking as much if not more than men. Evidence of this can be seen in town and city centres across the UK. Alcohol tends to be removed from the body at the rate of one unit per hour. This is why it helps to space your drinks out or to drink water or non-alcoholic drinks in between. Note: Pregnant women or those women trying to start a family should avoid alcohol.
Underestimation of units
One thing many of us are good at is underestimating the amount we drink. It is very easy to assume that you have drank only a certain amount when in fact you have more than your recommended units in a week. The units do add up and it is easy to forget how much you have had, especially if you are at a party or out at the weekend. This is something that alcoholics do when trying to defend the amount they have had to drink. They will engage in self-denial or lie about the amount of alcohol they have consumed, citing a lower amount than is really the case.
So what it is about alcohol that we like?
Effects of alcohol
The effects of alcohol vary according to your gender, age, weight, height and other similar factors. A state of drunkenness includes slurring of one’s words, staggering or difficulty walking upright, double vision and poor muscle control. Extreme drunkenness involves vomiting, an inability to stand, a coma state and incapability to communicate. It is the case that some appear less affected than others although excessive use can affect anyone.
The manner in which alcohol affects you depends upon the following:
- Your sensitivity to alcohol
- Whether you have eaten or not
- If you have eaten then the type of food and the amount
- How much you drink
- How often you drink
- The amount of time you have been drinking (period of time)
- Your environment at that time
- If you have taken drugs, e.g. cannabis at the same time
You may find that a few drinks may release your inhibitions, making you feel confident and self-assured. On the other hand alcohol may make you feel depressed or angry or possibly suicidal.
Women are generally more sensitive to these effects than men but this affects both sexes equally as they get older. Signs of alcohol intoxication include a flushed, reddened face, slower reactions and reduced inhibitions. If a person experiences extreme drunkenness then there is a great risk that they may vomit in their sleep and choke on this vomit. Overindulging on a few occasions, for example at a friend’s birthday, is unlikely to cause any long term effects but damage to health will occur if it becomes a regular habit.
There is also an unpleasant reminder of your overindulgence known as a ‘hangover’. A hangover is your body’s reaction to intoxication and is partly caused by dehydration and the production of a toxic chemical as alcohol is broken down by your liver. Symptoms of a hangover include headaches, nausea and possibly vomiting; shakiness, tiredness and thirst. The effects will have disappeared by either the end of the day or the next. But it is when this crosses the line from an occasional event to a regular event that signals a drinking problem.
Alcoholism (alcohol addiction/abuse) is the consumption of or preoccupation with alcoholic beverages to the extent that this behaviour interferes with the alcoholic’s normal personal, family, social, or work life. The chronic alcohol consumption caused by alcoholism can result in psychological and physiological disorders.
The primary effect of alcoholism is to encourage the sufferer to drink at times and in amounts that are damaging. The secondary damage caused by an inability to control one’s drinking manifests in many ways. It is common for a person suffering from alcoholism to drink well after physical health effects start to manifest. The physical health effects associated with alcohol consumption include cirrhosis of the liver, pancreatitis, polyneuropathy, alcoholic dementia, heart disease, increased chance of cancer, nutritional deficiencies, sexual dysfunction, and death from many sources.
Why do some people become alcoholics?
There is no easy answer for this. Why do some people drive too fast? Why do some people smoke or take drugs? Why do some people enjoy adrenaline sports? We are all different and make choices in our lives - some good some not so good which are the result of various factors. These include our background, family upbringing, lifestyle, genetics, environment etc. There may be family history of alcoholism. If for example either of your parents or grandparents was an alcoholic then this is a risk factor.
If you suffer from a mental illness such as anxiety, depression or manic depression then you may use alcohol as a way of coping with your illness. It can also be a form of escapism. If you work in an environment which has a ‘drinking culture’ then this is another risk factor. Also, stressful life events such as divorce, bereavement or moving house can all trigger alcohol abuse. It is difficult to say when social drinking becomes a problem which eventually leads to an addiction (alcoholism). However the first step for these people is recognising that their drinking is out of control.
How do you know if you have an alcohol addiction or drinking problem?
The signs of a drinking problem or ‘alcohol abuse’ are:
- Unable to stick to one drink
- Guilt or feeling ashamed about your drinking
- Lying to family and/or friends about your drinking
- Having a need to drink in order to relax or feel confident
- Finding that you drink more than is good for you
- Experiencing ‘blackouts’ or forgetting what you did when drunk
- Your family and friends are worried about your drinking
- Need a drink to get through the day or to cope with your illness
The journey from problem drinking to full blown alcoholism happens over a period of time. However if detected at an early stage then it can be prevented. Having a problem with alcohol doesn’t mean that you will automatically become an alcoholic but it does increase the risk of that happening. What happens is that you develop a tolerance to alcohol over a period of time, which is a sign that your body is becoming used to alcohol and demands it in order for you to function normally. It can start off by a few drinks several times a week, then drinking every day or ‘binge drinking’ which can result in alcoholism.
Alcohol abuse is a self-destructive condition and one that many people consider to be alcoholism, but there is a minor difference between the two. Someone who abuses alcohol is causing damage to both their mental and physical health but they still retain the ability to curb their drinking. However this is likely to be dependent upon their mood at the time. Alcoholism doesn’t happen overnight: it is a gradual process in which the drinker passes through three stages to get to this point. The three stages of alcoholism are:
- Stage one: no obvious signs of damage yet. The drinker is still in control but is gradually developing a tolerance to alcohol.
- Stage two: problems have started to occur. The drinker is experiencing physical and mental effects of their habit and has developed alcohol abuse.
- Stage three: this is the final stage in the journey. The drinker has become a full blown alcoholic and is unable to stop drinking.
There are warning signs of alcoholism which include an increased tolerance; finding that you can drink more than your friends or colleagues; drinking to ease withdrawal symptoms such as shakiness or anxiety and denying or attempting to justify your drinking to family, friends and colleagues.
Physical signs of alcohol addiction
So what does excess alcohol do to our bodies? Alcoholism causes damage to many areas of the body which include the liver, stomach, pancreas, throat and the brain. The physical effects of alcoholism include:
- Cirrhosis of the liver
- Halitosis (bad breath)
- Slurred speech
- Menstrual problems
- Stomach ulcer
- Vitamin and mineral deficiencies
- Loss of appetite
- Increased risk of breast, stomach and liver cancer
- Numbness in fingers and toes
In some cases these can be fatal.
Psychological signs of alcohol addiction
Alcoholism affects the brain as much as the body. The psychological signs of alcoholism include:
- Poor personal hygiene
- Lack of interest in one’s appearance
- Lack of concentration or focus
- Slow reactions
- Impaired judgement
- Anxiety/panic attacks
- Depression/increased risk of suicide
- Difficulties with balance
- Consuming alcohol in dangerous or difficult situations
- Neglecting work, family, friends etc
- Committing an offence under the influence of alcohol, e.g. drink driving
- Possibly early onset of dementia
Social effects of alcohol addiction
The social problems arising from alcoholism can be significant. Being drunk or hung over during work hours can result in loss of employment, which can lead to financial problems including the loss of living quarters. Drinking at inappropriate times, and behaviour caused by reduced judgment, can lead to legal consequences, such as criminal charges for drunk driving or public disorder, or civil penalties for tortious behaviour. An alcoholic’s behaviour and mental impairment while drunk can profoundly impact surrounding family and friends, possibly leading to marital conflict and divorce, or contributing to domestic violence. This can contribute to lasting damage to the emotional development of the alcoholic’s children, even after they reach adulthood. The alcoholic could suffer from loss of respect from others who may see the problem as self-inflicted and easily avoided.
Alcohol withdrawal differs significantly from withdrawal from other drugs in that it can be directly fatal. While it is possible for heroin addicts, for instance, to die from other health problems made worse by the strain of withdrawal, an otherwise healthy alcoholic can die from the direct effects of withdrawal if it is not properly managed. Heavy consumption of alcohol reduces the production of GABA, which is a neuroinhibitor. An abrupt stop of alcohol consumption can induce a condition where neither alcohol nor GABA exists in the system in adequate quantities, causing uncontrolled firing of the synapses. This manifests as hallucinations, shakes, convulsions, seizures, and possible heart failure, all of which are collectively referred to as delirium tremens.
Treatments for alcohol addiction
Before you seek treatment the first and most important part of the process is that of admitting that you have a problem. Once you have done so then the next step is help and support.
Beating an alcohol addiction is a long and painful process. It requires much more than sheer willpower: it requires you to make changes to every aspect of your life and some of that can be more difficult to do than others. But help and support is available so you don’t need to do this on your own.
Treatments for alcohol addiction are quite varied because there are multiple perspectives for the condition itself. Those who approach alcoholism as a medical condition or disease recommend differing treatments than, for instance, those who approach the condition as one of social choice.
Most treatments focus on helping people discontinue their alcohol intake, followed up with life training and/or social support in order to help them resist a return to alcohol use.
Since alcoholism involves multiple factors which encourage a person to continue drinking, they must all be addressed in order to successfully prevent a relapse. An example of this kind of treatment is detoxification followed by a combination of supportive therapy, attendance at self-help groups, and ongoing development of coping mechanisms. The treatment community for alcoholism typically supports an abstinence-based zero tolerance approach; however, there are some who promote a harm-reduction approach as well.
The effectiveness of alcohol addiction treatments varies widely. When considering the effectiveness of treatment options, one must consider the success rate based on those who enter a program, not just those who complete it. Since completion of a program is the qualification for success, success among those who complete a program is generally near 100%. It is also important to consider not just the rate of those reaching treatment goals but the rate of those relapsing. Results should also be compared to the roughly 5% rate at which people will quit on their own.
Detoxification or ’detox’ for alcoholics is an abrupt stop of alcohol drinking coupled with the substitution of drugs that have similar effects to offset the withdrawal symptoms. Benzodiazepines are the most common family of drugs used for this, followed by barbiturates.
Detoxes are performed in multiple ways. The first takes into consideration the varying degrees of tolerance. In it, a standard dose of the benzodiazepine is given every half hour until light sedation is reached. Once a baseline dose is determined, the medication is tapered over the ensuing 3-10 days. Another option is to give a standard dose of benzodiazepine based on history and adjust based on withdrawal phenomenon. A third option is to defer treatment until symptoms occur, which is safe only with relatively mild alcohol users.
Detoxification treats the physical effects of prolonged use of alcohol, but does not actually treat alcoholism. After detox is complete, relapse is likely without further treatment. These rehabilitations (or ’rehabs’) may take place in an inpatient or outpatient setting. Detoxification may or may not be necessary depending upon an individual’s age, medical status, and history of alcohol intake. For example, a young man who binge drinks and seeks treatment one week after his last use of alcohol may not require detoxification before beginning treatment for alcoholism.
Group therapy and psychotherapy for alcohol addiction
After detoxification, various forms of group therapy or psychotherapy can be used to deal with underlying psychological issues that are related to alcohol addiction, as well as provide relapse prevention skills. The mutual-help group-counselling approach is one of the most common ways of helping alcoholics maintain sobriety. Many organisations have been formed to provide this service, including Alcoholics Anonymous, LifeRing Secular Recovery, Rational Recovery, Smart Recovery, and Women For Sobriety.
Rationing and moderation for alcohol addiction
Rationing and moderation programs do not mandate complete abstinence. Since one of the effects of alcohol is to reduce a person’s judgment, each drink makes it more difficult to decide that the next drink is a bad idea. Additionally, for those who are predisposed towards alcoholism, drinking in moderation can result in the strengthening of the endorphin-based addiction.
While most alcoholics are unable to limit their drinking in this way, moderate drinking works for some people, and it may avoid the physical, financial, and social costs of other treatments - particularly in the early phase of recovery. Professional help can be sought for rationing from programs such as Moderation Management.
Medications for treating alcohol addiction
Although not necessary for treatment of alcoholism, a variety of medications may be prescribed as part of treatment. Some may ease the transition to sobriety, while others cause physical hardship to result from the use of alcohol. In most cases, the desired effect is to have an alcoholic abstain from drinking.
- Antabuse (disulfiram) prevents the elimination of (acetaldehyde), a chemical the body produces when breaking down ethanol. Acetaldehyde itself is the cause of many hang over symptoms from alcohol use. The overall effect is severe discomfort when alcohol is ingested: an extremely fast acting and long lasting uncomfortable hang over. This discourages an alcoholic from drinking in significant amounts while they take the medicine. Heavy drinking while on antabuse can cause severe illness and death.
- Naltrexone is a competitive antagonist for opioid receptors, effectively blocking our ability to use endorphins and opiates. It also appears to act on glutamate neurotransmission. Naltrexone is used in two very different forms of treatment. The first treatment uses naltrexone to decrease cravings for alcohol and encourage abstinence. The other treatment, called pharmacological extinction, combines naltrexone with normal drinking habits in order to reverse the endorphin conditioning that causes alcohol addiction. Naltrexone comes in two forms. Oral naltrexone, originally but no longer available as the brand ReVia, is a pill form and must be taken daily to be effective. Vivitrol is a time-release formulation that is injected in the buttocks once a month.
- Acamprosate (also known as Campral) is thought to stabilize the chemical balance of the brain that would otherwise be disrupted by alcoholism. Campral is thought to act on the brain pathways related to alcohol abuse in maintaining abstinence for a short period of time. While effective alone, it is often paired with other medication treatments like naltrexone with great success. Acamprosate reduces glutamate release.
- Sodium oxybate is the sodium salt of gamma-hydroxybutyric acid (GHB). It is used for both acute alcohol withdrawal and medium to long-term detoxification. This drug enhances GABA neurotransmission and reduces glutamate levels. It is used in Italy in small amounts under the trade name Alcover.
- Baclofen has been shown in animal studies and in small human studies to enhance detoxification. This drug acts as a GABA B receptor agonist and this may be beneficial.
Pharmacological extinction is the use of opioid antagonists like naltrexone combined with normal drinking habits to eliminate the craving for alcohol. This technique is sometimes referred to as the Sinclair Method.
While standard naltrexone treatment uses the drug to curb craving and enforce abstinence, pharmacological extinction targets the endorphin-based neurological conditioning. Our behaviours become conditioned when our neurons are bathed in endorphins following that action. Conversely, we receive negative reinforcement when we perform that action and yet do not get our endorphins. By having the alcoholic go about their normal drinking habits (limited only by safety concerns), and while preventing the endorphins from being released by the alcohol, the pull to drink is eliminated over a period of about three months.
This allows an alcoholic to give up drinking as being sensibly unbeneficial. The effects persist after the drug is discontinued, but the addiction can return if the person drinks without first taking the drug. This treatment is also highly unusual in that it works better if the patient does not go through detoxification before starting it. Clinical studies have shown this treatment to allow 78-87% of inductees to reduce their drinking below levels dangerous to health, and allow 25% of inductees to achieve complete abstinence. Follow-up studies indicate an overall 50% relapse rate over five years, and 2% relapse rate for those who continue to take naltrexone before drinking.
There is a lot of professional resistance to this treatment for two reasons. Studies have demonstrated that controlled drinking for alcoholics was not a useful treatment technique. Other studies have also shown naltrexone to be of questionable value in supporting abstinence alone. The individual failure of these two separate treatments suggests that their use in combination is equally ineffective. This would be the case if the two treatments were merely additive, as for two people pushing a car. Experimental evidence indicates that the presence of naltrexone causes the drinking of alcohol to have a reverse effect on alcoholism, decreasing the alcoholic’s attachment to alcohol consumption when they drink instead of increasing it.
Nutritional therapy for alcohol addiction
Preventative treatment of alcohol complications includes long-term use of a multivitamin as well as such specific vitamins as B12 and folate.
While nutritional therapy is not a treatment of alcoholism itself, it treats the difficulties that can arise after years of heavy alcohol use. Many alcohol dependents have insulin resistance syndrome, a metabolic disorder where the body’s difficulty in processing sugars causes an unsteady supply to the blood stream. While the disorder can be diminished by a hypoglycemic diet, this can affect behaviour and emotions, side-effects often seen among alcohol dependents in treatment. The metabolic aspects of such dependence are often overlooked, causing poor treatment outcomes.
Guide to Drug Addiction
- Drug Addiction Guide
- About Drug Addiction
- What is addiction
- What causes an addiction
- Addictive personality
- Drug addiction myths
- Genetics and addiction
- Signs of an addiction
- Risk factors for drug addiction
- Stress and addiction
- Social use of drugs
- What is pseudo-addiction
- Am I Addicted to drugs
- Social effects of drug addiction
- Drug addiction and crime
- Types of addictions
- Alcohol addiction
- Caffeine addiction
- Anabolic steroids
- Hallucinogenic drugs
- Legal high drugs
- Prescription drugs
- Young people and addictions
- Treating addiction
- Assessing drug addiction
- Medical help
- Addiction support
- Cognitive behavioural therapy
- Relapse prevention
- Self help