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Alcohol Dependence

Compulsive regular consumption of alcohol, producing withdrawal symptoms when intake is stopped

  • Most common between the ages of 20 and 40
  • More common in males
  • Sometimes runs in families
  • Stress and occupations that are associated with social drinking are risk factors

A person who is dependent on alcohol has an irresistible compulsion to drink, which takes priority over almost everything else in life. This craving for drink, coupled with withdrawal symptoms when drinking stops, is what separates alcohol dependence from alcohol abuse, a term used to describe regular drinking to excess (see Alcohol and health). About 5 million people in the UK abuse or are dependent on alcohol. Drinking problems are more common in men, particularly between the ages of 20 and 40. In addition to causing damage to the liver and brain, the need to drink to excess regularly is damaging to mental health and may destroy a person’s family and social life and career.

What are the causes?

Alcohol dependence is often the result of a combination of factors. Sometimes, alcohol dependence runs in families, partly as a result of children growing up in an environment of heavy drinking and partly because of an inherited predisposition. People who are shy, anxious, or have a social phobia (see Phobias) or depression may rely heavily on alcohol. Working in an occupation that is associated with social drinking increases the risk of dependence. Stressful events may turn a moderate drinker into a heavy one.

What are the symptoms?

Alcohol dependence may develop after a number of years of moderate to heavy drinking. Symptoms may include:

  • A compulsion to drink and loss of control over the amount consumed.

  • Increased tolerance to the effects of alcohol, leading to greater consumption to achieve the desired effects.

  • Withdrawal symptoms, such as nausea, sweating, and tremor, that start a few hours after the last drink.

In severe cases, withdrawal seizures develop after alcohol is stopped. After about 2 days without alcohol, delirium tremens may develop with symptoms of fever, shakes, seizures, disorientation, and hallucinations. Symptoms last for 3 to 4 days and are usually followed by a deep, prolonged sleep. In extreme cases, shock occurs and may be fatal.

Are there complications?

Alcohol has direct effects on the body and may cause many diseases. Long-term alcohol dependence is the most common cause of severe liver disease (see Alcohol-related liver disease) and may damage the digestive system, causing peptic ulcers.

Heavy drinkers often have a poor diet, which may lead to a deficiency in vitamin B1 (thiamine) that may eventually cause dementia. Rarely, severe thiamine deficiency leads to Wernicke–Korsakoff syndrome, a severe brain disorder that causes confusion and amnesia and may lead to coma. If excessive drinking continues for a prolonged period of time, damage to vital organs may be life-threatening.

Psychiatric problems associated with alcohol dependence include anxiety, depression, delusional disorders, and suicidal behaviour (see Attempted suicide and suicide). Generally, heavy drinkers tend to be self-centred and lack concern for family and friends.

How is it diagnosed?

Before the doctor can make a diagnosis, a person may need to be persuaded to seek help. The doctor will ask about the extent of the person’s drinking and look for evidence of dependence. Blood tests to assess possible damage to the liver and other organs may be arranged.

What is the treatment?

Gradual reduction of alcohol intake or limiting alcohol consumption to social drinking is rarely possible. Instead, the person will be asked to stop drinking completely. In mild to moderate cases, withdrawal can take place at home, provided that adequate support is available. Antianxiety drugs, such as a benzodiazepine, may be prescribed for a short time to reduce agitation and other physical effects of withdrawal.

When heavy drinking is stopped suddenly, withdrawal seizures or delirium tremens may develop. The symptoms of delirium tremens are potentially life-threatening and require admission to hospital or a detoxification unit. Withdrawal symptoms are usually treated with antianxiety drugs.

Treatment for physical problems as a result of long-term alcohol dependence includes ulcer-healing drugs for peptic ulcers and vitamin B1 injections for a thiamine deficiency.

When the symptoms of withdrawal have been treated, the doctor may prescribe drugs that reduce cravings for alcohol or cause unpleasant reactions when it is consumed. Support is given to help prevent a relapse. Individual counselling or group therapy help people to address the problems that contribute to alcohol dependence.

What is the prognosis?

Accepting that there is a problem and receiving emotional support during the effort to give up drinking greatly improve a person’s chance of recovery. Attending a self-help group, such as Alcoholics Anonymous, reduces the risk of relapse. However, after a long period of dependence, several attempts at detoxification may be needed before a person abstains from alcohol altogether.

In about 1 in 5 cases in which delirium tremens develops and is untreated, the condition proves fatal.

From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.

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