Alcoholism

 

When does social drinking become alcoholism?

The line between social drinking and alcoholism can be a difficult one to judge.

Alcoholism is not simply related to the amount that someone drinks; though excessive alcohol intake is always present.  Alcoholism begins when an individual is controlled by the need to drink rather, than being in control of their alcohol consumption, or the drinking is causing problems at home or work.

The amount and pattern of drinking varies between individual sufferers. Some feel a need to drink excessively every day, whilst others may abstain for a period of time, but will then binge.  The common factor is the lack of control over the intake of alcohol.

What is a normal alcohol consumption?

The current recommended safe drinking limits are up to 21 units a week for men and up to 14 units a week for women, with no more than four units per day for men, and three for women, on any one day.

One unit of alcohol is the amount found in half a pint of ordinary strength beer, one small glass of wine, one standard single measure of spirits or one small glass of sherry or port.  Remember extra strength lager or beer may contain as much as three times as much alcohol as ordinary lager or beer.

The safe alcohol limit is lower in women than men because their body water content is less: and alcohol will have a greater effect.  The higher the consumption is above the recommended levels the greater the risk of physical disease, dependency, and alcoholism itself.

How does it occur?

It is not known why some people become alcoholic and others do not.  Many factors are involved including the individual's personality, their upbringing (including their parent's attitude to alcohol) and possibly genetic factors.

 

Why does it occur?

Dependence on alcohol is often associated with other problems.  Alcohol may be  used as a coping mechanism to relieve stress, or to drown out problems or worries.

Alcohol is broken down by the liver, which, up to a point, can adapt to an increase in alcohol intake.  This means that a heavy drinker needs an increasing amount of alcohol to achieve the same effect: a vicious circle develops where more and more is drunk each day and physical and psychological dependency develops.

Divorce, separation and being single may increase susceptibility towards alcoholism. Some occupations are also high risk, such as publican, seaman, journalist or doctor.

What are the symptoms?

There are a variety of symptoms.  Each alcoholic is different and therefore only some of these may apply to a particular person:

  • problems at work, home or with the police caused by alcohol.
  • insomnia, aggressive outbursts or depression.
  • a craving for alcohol in the morning.
  • anger if the subject of drinking too much is mentioned.
  • secret drinking and bottles of alcohol being hidden around the house or office.
  • a smell of alcohol on the breath on frequent and inappropriate occasions.
  • a feeling of guilt related to alcohol consumption.
  • periods of blackouts or memory loss following heavy bouts of drinking.
  • trembling, nausea, vomiting, agitation and sometimes hallucinations if drinking is stopped abruptly.  This is known as delirium tremens or the "DT’s".
  • an inability to have just one drink without then drinking to excess.
 

What are the risks if alcoholism is not treated?

It is estimated that alcohol contributes to as many as 40,000 deaths in the UK each year.  Alcoholics have a death rate over twice that of the normal population.  Excessive drinking affects many areas of the body.

The commonest problems are:

  • stomach disorders,
  • liver problems (including jaundice, hepatitis, cirrhosis and liver failure),
  • depression and other emotional disorders,
  • nerve and brain damage,
  • sexual difficulties,
  • vitamin deficiencies,
  • inflammation of the pancreatic gland,
  • weight gain,
  • increased risk of heart disease.

This list does not include the social problems it may cause including marital difficulties, problems at work, car accidents, sometimes leading to the loss of a driving licence.

There are special risks related to women who drink whilst pregnant: alcohol travels across the placenta to the baby and excessive drinking may cause the baby to be malformed.

 

What are the tests?

There are no specific tests to diagnose alcoholism.  Clues to excess alcohol intake include changes in the full blood count (the red blood cells become enlarged), and abnormal liver function tests.

What is the treatment?

The treatment of alcoholism is complex, and depends on the individual’s particular problems.  Some common factors apply to all cases:

Firstly, if there is concern about your own or a relative's drinking habits then seek help early as it is easier to treat at an early stage.

Secondly, the individual must be encouraged to recognise that they have a problem and that they need to obtain help to stop the alcohol dependency.

Finally, having sought help, they must be determined to maintain a change in their drinking habits for the rest of their lives.  This can be the most difficult part since drinking may have become established as a means of coping.  Ingrained behaviour patterns are difficult to break and all too easy to slip back into.

These are some of the commonly used treatments for alcoholism:

Detoxification is needed if the individual suffers from severe withdrawal symptoms without a drink.  Alcohol dependency on this level makes it almost impossible to stop drinking without help.  Such help may involve admission to hospital for "drying out".  Any physical or mental problems can then be treated on the spot.  Usually this is combined with a programme of ongoing support group work, alcohol education and counselling for long-term success.

Psychotherapy or counselling is helpful to enable the sufferer to recognise and sort out the underlying problems that have created the alcohol dependency.  It is not enough simply try and stop the person from drinking.

Group meetings such as Alcoholics Anonymous can provide long-term support.  This helps an individual to maintain abstinence for the rest of their lives.  Very few alcoholics are able to drink any alcohol at all without returning to alcohol dependency.

Medication is used in the acute withdrawal phase to prevent the “DT’s”.  In the longer term, antidepressants help if  depression exists.  Other drugs are used to help maintain abstinence.  Disulfiram has been used for over 50 years in this way by creating very unpleasant side effects if alcohol is drunk whilst taking it.

A recent review (1) concluded that a newer drug, acamprosate, reduces the desire to drink. However, abstinence must be achieved before the acamprosate is started.

 

Where can further information be obtained?

Apart from contacting your own GP the following organisations may be of help:

Alcohol Concern (National Agency on Alcohol Misuse)
Waterbridge House
32-36 Loman Street
London
SE1 0EE
Telephone: 020 7264 0510
Email: alocn@popmail.dircon.co.uk
Website: www.alcoholconcern.org.uk

Alcoholics Anonymous
Head Office
PO Box 1
Stonebow House
Stonebow
York
North Yorkshire
YO1 2NJ
Telephone: 01904 644026
National Helpline: 0845 7697555
London area: 020 7833 0022
Website: www.alcoholics-anonymous.org.uk/

Al-Anon Family Groups (UK and Ireland)
61 Great Dover Street,
London
SE1 4YF.
Telephone: 020 7403 0888 (24hour helpline).
Email: enquiries@al-anonuk.org.uk
Web Page:www.al-anonuk.org.uk

 

Last reviewed November 2010