Alcoholism is a word which many people use to mean alcohol dependence (alcohol addiction). Some people are problem drinkers without being dependent on alcohol. If you are alcohol-dependent then detoxification ('detox') can help you to stop drinking.
Problems with drinking alcohol
There are roughly four levels of alcohol drinking - social, heavy, problem and dependent. As a rule, each level increases the risk to your health and safety.
Most people drink some alcohol. However, even a small amount of alcohol can be dangerous if you drive, you operate machinery, or you take some types of medication.
Heavy (hazardous) drinking
This is drinking above the recommended safe limits, which, in the UK, are that both men and women should drink no more than 14 units of alcohol per week, no more than three units in any one day and have at least two alcohol-free days a week. Read more about alcohol and sensible drinking.
Problem (harmful) drinking
In this type of drinking, you continue to drink heavily even though you have caused harm, or are causing harm or problems to yourself, family, or society.
About 1 in 3 men and about 1 in 7 women drink more than the safe levels. Many people who drink heavily are not addicted to alcohol and are not alcohol-dependent. To stop or reduce alcohol would not be a problem if there was the will to do so. However, for various reasons, many people have got into a habit of drinking regularly and heavily. But, drinking heavily is a serious health risk.
If you drink heavily you have an increased risk of developing:
- Alcohol-related liver problems.
- Some cancers (for example, mouth, throat, liver, colon and breast).
- Stomach disorders.
- Severe inflammation of the pancreas (pancreatitis).
- Mental health problems, including depression, anxiety and various other problems.
- Wernicke's encephalopathy - an alcohol-related brain disorder treated with vitamin B1 (thiamine); Korsakoff syndrome is a chronic memory disorder caused by severe deficiency of vitamin B1, most commonly caused by alcohol misuse.
- Sexual difficulties such as impotence.
- Muscle and heart muscle disease.
- High blood pressure.
- Damage to nervous tissue.
- Drinking alcohol is associated with a much increased risk of accidents.
- In particular, injury and death from fire and car crashes. About 1 in 7 road deaths are caused by drinking alcohol.
- Obesity (alcohol is calorie-rich). One glass of wine has as many calories as a bag of crisps and a pint of lager is the calorie equivalent of a sausage roll.
Damage to an unborn baby in pregnant women
Alcohol gets to a baby through the placenta if a pregnant woman drinks alcohol. A baby cannot process alcohol very well. So, any alcohol in your baby stays in their body much longer than in you. This is known to be a risk for causing serious problems such as:
- A low birth weight.
- Learning, behavioural and thinking (cognitive) problems.
- Defects of the heart and other organs.
- Abnormal facial features.
When these problems are severe, the condition is called fetal alcohol syndrome.
However, there has been debate over the years as to whether small amounts of alcohol are safe to drink during pregnancy; also, whether there is a time of pregnancy when alcohol is most likely to cause harm. Recent research supports the advice of not drinking any alcohol whilst pregnant.
Alcohol drinking and problems to others
Heavy alcohol drinking in one person often seriously damages others. Many families have become severely affected by one member becoming a problem drinker. Emotional and financial problems often occur in such families. It is estimated that 3 in 10 divorces, 4 in 10 cases of domestic violence and 2 in 10 cases of child abuse are alcohol-related. Often, the problem drinker denies or refuses to accept that the root cause is alcohol.
Many problem drinkers are not addicted to (dependent on) alcohol. They could stop drinking without withdrawal symptoms if they wanted to. But, for one reason or another, they continue to drink heavily.
This is a serious situation where drinking alcohol takes a high priority in your life. You drink every day and often need to drink to prevent unpleasant withdrawal symptoms (see below). In the UK, about 2 in 100 women and about 6 in 100 men are alcohol-dependent.
What are the symptoms of alcohol dependence?
If you are alcohol-dependent you have a strong desire for alcohol and have great difficulty in controlling your drinking. In addition, your body is used to lots of alcohol. Therefore, you may develop withdrawal symptoms 3-8 hours after your last drink as the effect of the alcohol wears off. So, even if you want to stop drinking, it is often difficult because of withdrawal symptoms. The symptoms include:
- Feeling sick (nausea).
- The 'shakes' (trembling).
- Craving for alcohol.
- Feeling unwell.
- Convulsions - these occur in a small number of cases.
As a result, you drink alcohol regularly and depend on it to prevent withdrawal symptoms. If you do not have any more alcohol, withdrawal symptoms usually last 5-7 days but a craving for alcohol may continue for longer.
The severity of dependence can vary. It can develop gradually and become more severe. You may be developing alcohol dependence if you:
- Often have a strong desire to drink alcohol and need a drink every day.
- Drink alone often.
- Need a drink to stop trembling (the shakes).
- Drink early, or first thing in the morning (to avoid withdrawal symptoms).
- Spend a lot of your time in activities where alcohol is available. For example, if you spend a lot of time at the social club or pub.
- Neglect other interests or pleasures because of alcohol drinking.
If you are alcohol-dependent you are usually tolerant to the effect of alcohol. This means that you need more alcohol to notice any effects and to become drunk. This can make things worse, as it tends to make you drink even more.
If you are alcohol-dependent you may get drunk regularly. However, you may not get drunk. You may drink small amounts regularly to keep any withdrawal symptoms away. You may then be able to hide your problem from others. However, you are still at serious risk of developing conditions due to heavy drinking (liver damage (cirrhosis), cancers, etc).
The problem of denial
Some people who are heavy drinkers or who are alcohol-dependent deny that they have a problem. The sort of thoughts that people deceive themselves with include:
- "I can cope."
- "I'm only drinking what all my mates drink."
- "I can stop at any time."
Coming to terms with the fact that you may have a problem and seeking help when needed are often the biggest step to sorting out the problem.
If you feel that you need, or a relative or friend needs, help about alcohol, see your doctor or practice nurse.
Should I cut back, or should I stop alcohol completely?
If you are alcohol-dependent then it is best to cut back gradually and then stop alcohol completely. Do not stop alcohol suddenly if you are alcohol-dependent. Some withdrawal effects can be severe. This is why it is best to cut down gradually and then stop, or see your doctor about a 'detox'. Also, it is best to cut out alcohol completely if you have a condition due to alcohol, such as liver damage (cirrhosis). Otherwise, reducing to a safe level of drinking is an option.
If you are trying to cut down, some tips which may help include:
- Consider drinking low-alcohol beers, or at least do not drink strong beers or lagers.
- Try pacing the rate of drinking. Perhaps alternate soft drinks with alcoholic drinks.
- If you eat when you drink, you may drink less.
- It may be worth reviewing your entire social routine. For example, consider:
- Cutting back on types of social activity which involve drinking.
- Trying different social activities where drinking is not involved.
- Reducing the number of days in the week where you go out to drink.
- Going out to the pub or club later in the evening.
- Trying to resist any pressure from people who may encourage you to drink more than you really want to.
Some people are helped by books, websites, leaflets and their own determination. It is thought that about 1 in 3 people who have a problem with alcohol return to sensible drinking, or stop drinking, without any professional help.
Do you need help?
Help and treatment are available if you find that you cannot cut down your drinking to safe limits. Counselling and support from a doctor, nurse, or counsellor are often all that is needed.
Some people are helped by counselling and advice from a practice nurse or doctor. Sometimes a referral to a specially trained counsellor may be advised. They can help you to talk through the issues in more detail and help you to plan how to manage your drinking. In some cases, more intensive talking treatments such as cognitive behavioural therapy (CBT), motivational interviewing, or motivational enhanced therapy may be appropriate. For example, CBT helps you to change certain ways that you think, feel and behave; it may help some people with alcohol problems.
Talking treatments are particularly useful for children with alcohol-related problems who are aged between 10 and 17. Children may also be offered family therapy in which other members of their family may be involved in a course of treatment.
A 'detox' (detoxification) treatment may be advised if you are alcohol-dependent. Referral for specialist help may be best for some people.
Alcohol detoxification involves taking a short course of a medicine which helps to prevent withdrawal symptoms when you stop drinking alcohol. Benzodiazepine medicines such as chlordiazepoxide or diazepam are used for detox. Read more about alcohol withdrawal and detox.
After detoxification and staying off alcohol
Many people who successfully 'detox' go back to drinking heavily again at some point. There are various reasons why this may occur. It is thought that you are less likely to return to drinking heavily if you have counselling or other support to help you to stay off alcohol. Your doctor, practice nurse, or local drug and alcohol unit may provide ongoing support when you are trying to stay off alcohol. Self-help groups such as Alcoholics Anonymous have also helped many people to stay off alcohol.
If you do go back to heavy drinking, you can always try again to stop or cut down. Some people take several attempts before they stop drinking, or keep within the safe limits, for good.
Further reading and references
House of Commons Science and Technology Committee - Alcohol Guidelines (Eleventh Report); UK Parliament, December 2011
Schutze M, Boeing H, Pischon T, et al; Alcohol attributable burden of incidence of cancer in eight European countries based on results from prospective cohort study. BMJ. 2011 Apr 7342:d1584. doi: 10.1136/bmj.d1584.
I J Beckingham and S D Ryder; ABC of diseases of liver, pancreas, and biliary system: Investigation of liver and biliary disease. BMJ 2001322:33-36.
Antenatal care for uncomplicated pregnancies; NICE Clinical Guideline (March 2008, updated 2017)
UK Chief Medical Officers' Alcohol Guidelines Review, Summary of the proposed new guidelines; Dept of Health, January 2016
Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence; NICE Clinical Guideline (February 2011)
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