Alcohol Dependence (Alcoholism)

What is alcohol dependence?

Alcohol dependence (alcoholism) is a disease that includes:

• the need to drink greater amounts of alcohol to get high
• a strong urge to drink
• not being able to control your drinking even though you know that it is harmful
• withdrawal symptoms, such as nausea, sweating, and shakiness when you stop drinking.

Signs that you have lost control over your use of alcohol include:

• not being able to limit your drinking even when you try
• having problems at work or with friends or family because of your alcohol use
• spending a lot of time and energy drinking alcohol or getting over its effects.

Alcoholism is one of the most common illnesses seen by healthcare providers.

How does it occur?

The cause of alcohol dependence is not known. It is more likely if you have:

• family members who are dependent on alcohol
• stress that is ongoing
• family and friends who drink regularly
• depression, bipolar disorder, schizophrenia, or anxiety.

What are the symptoms?

Alcohol dependence takes many forms including:

• drinking from time to time
• drinking all the time
• binge drinking.

When you drink alcohol regularly, it changes how your body works. Your liver processes the alcohol faster. You need to drink more to keep the same amount of alcohol in the blood. Alcohol users often drink to avoid withdrawal symptoms.

People who are dependent on alcohol may:

• try to hide evidence of drinking
• promise to give up drinking but not follow through
• drink stronger alcoholic beverages or start to drink earlier in the day
• have long periods of being drunk
• drink alone
• have problems at work
• have problems in relationships
• miss work
• black out
• lose interest in food
• have mood changes (be angry, irritable, violent)
• have personality changes (be jealous, distrustful)
• repeatedly drive while drunk
• hurt themselves or others while drunk
• be careless about their appearance
• be confused and have memory problems, or be unable to think quickly or concentrate
• have money problems caused by drinking.

Physical symptoms may include:

• nausea or shaking in the morning
• poor eating habits
• stomach pain
• cramps or diarrhea
• numbness or tingling
• weakness in the legs and hands
• red eyes, face, or palms
• unsteady walking or falls
• new and worsening medical problems.

How is it diagnosed?

Many healthcare providers may not consider the possibility of alcohol dependence or they tend to overlook it. You or a family member may need to bring up the subject.

The diagnosis of alcohol dependence is based on how you use alcohol and the effects of alcohol on your life or family. Your healthcare provider will take a careful medical history of your symptoms. Especially important are how and when you drink alcohol. Your healthcare provider will ask about:

• your history of using drugs and alcohol
• your ability to function socially
• your work history
• your family history
• prior and current emotional or mental problems
• thoughts of suicide.

Your healthcare provider will examine you to look for medical problems caused by alcohol use. Lab tests of your urine and blood may be done.

How is it treated?

You must stop drinking alcohol. Your healthcare provider can help you quit drinking and recover from problems caused by alcohol. Psychotherapy and social programs will also aid in your recovery. It might help if family members are included in your treatment program.

After immediate withdrawal from alcohol (detoxification), you may need long-term treatment. You may need to stay in the hospital at first or you may be treated as an outpatient. You will also need to go to Alcoholics Anonymous (AA) meetings one or more times per week, at least at the beginning of treatment.

Your healthcare provider may prescribe a medicine for you called Antabuse (disulfiram). This medicine will cause you to have severe nausea and vomiting if you drink alcohol and thus will discourage you from drinking. Other medicines for treating alcohol dependence are naltrexone and acamprosate. Naltrexone can help you overcome cravings for alcohol. It blocks the feelings of pleasure that drinking gives you. Acamprosate helps to relieve the withdrawal symptoms which happen when a person stops drinking. These medicines are most effective when you also get counseling, for example, from 12-Step support groups.

Antabuse is not recommended for use in older adults or people with medical problems because of the increased risk of serious side effects.

How long will the effects last?

You may feel a need or desire for alcohol throughout your life. Alcohol counseling and treatment can help you recognize and change the behavior patterns that usually cause you to start drinking.

If you stop drinking, related health problems can often be controlled or prevented. However, severe damage, such as injury to your liver or pancreas, may be lasting and possibly fatal.

How can I take care of myself?

Make sure you seek medical help. Recovery from alcohol dependence almost always requires the help and support of others. Make sure you get this support. People and resources in your community that can help you include your healthcare provider, pastor, AA, mental health centers, and alcohol or substance abuse treatment programs.

Follow your healthcare provider's advice for treatment of any other medical problems. Stay away from places where people drink alcohol.

You should also work to improve your general health.

• Exercise 30 minutes three times a week.
• Participate in relaxing recreation activities at least once or twice a week.
• Do progressive relaxation exercises daily.
• Imagine, or call to mind, your positive life experiences often.
• Eat a healthy diet.
• Get 7 to 9 hours of rest per night.
• Practice deep breathing exercises during times of high stress.
• Talk with friends and develop other support systems.
• Drink little or no caffeine.
• Listen to music to help you relax.
• Develop and maintain an attitude that things will work out.
• Ask for help at home and work when the load is too great to handle.
• Seek professional help to talk through anxiety-producing life events. Ask for help so that you can find positive ways to cope.