Alcohol dependence, also referred to as alcoholism, is the most serious type of drinking problem. While there is no definitive number of drinks per day that is characteristic of alcohol dependence, health experts have designated a limit above which the risks of alcohol consumption increase markedly.
Alcoholism is relatively common, and in the U.S., it is estimated that about 1 in 16 develop a severe problem with drinking, and millions more engage in alcohol consumption that is considered “risky” by medical experts. A recent analysis showed that nearly one-third (30%) of U.S. residents reported experiencing an alcohol use disorder (AUD) at one point in their lives.
Key characteristics of alcohol dependence including the following:
Tolerance is a condition defined as the need to drink more alcohol than before to achieve the same effect, or the ability to drink more than others without getting as intoxicated. The development of tolerance often compels the drinker to consume increasing amounts and thus, significantly raises the risk of many alcohol-related problems, such as disease, injury, legal and financial issues, relationship conflicts, and overdose (alcohol poisoning.)
Someone with alcohol dependence, by definition, has come to rely on alcohol use psychologically, physically, and emotionally. Withdrawals occur when a regular alcohol user tries to cut back or quit drinking altogether. Over time, the brain becomes accustomed to alcohol’s presence, and when the drinker reduces or halts intake, the body’s adapted environment is altered dramatically, thus resulting in withdrawal symptoms.
Such symptoms include anxiety, depression, sweating, tremors and shakiness, insomnia, nausea and vomiting, and in serious cases, seizures, confusion, and hallucinations. Rarely, the effects of alcohol withdrawal syndrome can be lethal.
Other characteristics of alcohol dependence include:
- The desire to stop drinking, but finding oneself unable to do so.
- A loss of control over the amount of alcohol consumed.
- A preoccupation with obtaining alcohol and drinking.
- The neglect of other life activities, hobbies, and responsibilities.
- Ignoring problems related to alcohol use, even those that are very obvious.
Alcohol Dependence: Adverse Effects in Every Aspect of Life
Alcoholism is associated with numerous psychological, interpersonal/social, economic, legal, and medical difficulties. Overuse increases the risk of depression and suicide and is related to violence such as homicide, assault, and domestic abuse. It also causes traffic accidents and personal injury (e.g., falls) and unsafe or criminal sexual behavior, resulting in pregnancy, STDs, or sexual assault.
Dependence on alcohol also increases the risk of liver disease, cirrhosis, heart disease, stroke, brain damage, pancreatitis, and several types of cancer.
Pregnant women who drink run of the risk of giving birth to a child with fetal alcohol syndrome, a long-lasting condition characterized by facial deformities and a host of physical, mental and emotional defects and impairments.
Problems related to alcohol use develop from a combination of biological and environmental influences.
Biology – People who drink and have a family history of using alcohol or drugs, such as opioids, are at a heightened risk for developing an addiction themselves. For example, a child who has a parent who is dependent on alcohol is has a four-times greater risk of developing their own dependency.
This is due in part to inherited genes that increase susceptibility, and frequently, alcohol is also used to self-medicate for underlying mental health conditions, such as depression, anxiety, or childhood trauma.
Environment – The experience of watching parents engage in alcohol use and the corresponding negative effects that it produces mentally and emotionally may contribute to the desire to use alcohol abusively oneself. Alcohol may also be a large (and often destructive) part of a person’s peer group and a person may use alcohol themselves to fit in or attempt to cope and get relief from stress.
Alcohol dependence can result in any of the following behavioral symptoms:
- Experiencing long periods of intoxication
- Drinking by oneself
- Experiencing work or financial problems related to drinking
- Carelessness about personal appearance/hygiene
- Experiencing blackouts/memory loss
- Drunk driving
- Hurting oneself or someone else during intoxication
- Hiding alcohol containers to conceal evidence of drinking
- Exhibiting mood and personality changes
Alcohol dependence can result in any of the following physical symptoms:
- Nausea or shaking upon waking
- Malnutrition due to a poor diet
- Abdominal pain, vomiting or diarrhea
- Flushed face and palms
- Numbness, weakness or tingling in the extremities
- Frequent accidental injuries – particularly falls
Alcohol Dependence: A Real Life Case Study
Melissa is a 45-year-old whose parents were both heavy alcohol users and she witnessed them drinking as she was growing up. At the age of 13, her mother allowed her to have two beers – she enjoyed the feeling and never forgot it.
As a young adult, she abused alcohol occasionally at parties, clubs, and bars. In her late 20’s, she became a heavy wine drinker and started having blackouts. Around 30, she was diagnosed with depression and was put on antidepressants, but continued drinking to excess.
At age 35, she was arrested for a DUI. She was put on probation but continued to drink whenever she could. For the next ten years, she remained a “high-functioning” alcoholic, held down a job, and got a graduate degree.
At age 45, her addiction progressed to the point in which she was no longer capable of functioning. She stopped working and started drinking non-stop for several weeks. Eventually, she was able to enter a rehab program where she got clean and began to maintain a sober lifestyle.
Although alcohol use disorder is quite common, only a small percentage of people identify the problem and seek help. For this reason, screening for alcoholism by health providers, friends, and family is to recognize and help those suffering.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends that primary care providers ask a very simple, but specific questions, including the following:
How many times in the past year have you consumed:
Five or more drinks in a day? (Men)
Four or more drinks in a day? (Women)
The objective in asking this question is to get a sense of whether or not the patient is at risk for incurring alcohol-related conditions. The recommended limits for men and women differ due to discrepancies in how alcohol is absorbed and processed by the body. Therefore, the risk increases for men who consume more than four drinks per day (or more than 14 per week) and women who consume more than three drinks per day (or 7 drinks per week.)
Of note, people who consume more alcohol than they should often feel defensive about their drinking and do so in secret, or minimize the problem. There is also a societal stigma attached to alcoholism, so it is very common for alcoholism to go unaddressed.
The CAGE test (an acronym for CUT DOWN, ANNOYED, GUILTY, AND EYE OPENER) may also be helpful, and questions may be easier for concerned loved ones to ask, since alcohol dependents may be hesitant to truthfully answer questions about quantity.
These questions include the following:
- Do you ever worry that you should CUT down on your drinking?
- Do you ever feel ANNOYED because other people have criticized your drinking habits?
- Do you ever feel GUILTY about drinking?
- Do you need a morning EYE OPENER drink to calm your nerves or to fight off a hangover?
Treatment for Alcohol Dependence
Alcohol dependence is a devastating and potentially life-threating condition that adversely affects the life of the person suffering as well those close to him or her. Treatment requires a full detox in a medical setting followed long-term intensive therapy in either an inpatient or outpatient addiction treatment program.
Our center offers a comprehensive approach that includes behavioral therapy, individual and group therapy, family counseling, and complementary practices such as yoga, meditation, and art and music therapy. After discharge, former patients can take advantage of our aftercare planning services, which identify local resources such as therapists, counselors, and 12-step meetings for ongoing treatment and support.
Recovery from alcohol addiction is a lifelong process but you don’t have to do it alone. We can provide you with the tools you need to maintain long-lasting sobriety and regain the life, health, and wellness that you deserve.