Noah Vinter
Alcohol dependence is a complex condition that can manifest physically and mentally. It involves a person's relationship with alcohol, where they experience intense cravings and continue drinking despite recognising its negative impact on their life. Alcohol dependence is characterised by symptoms such as tolerance, withdrawal, and prioritising drinking over other activities. It can affect people of all ages, but it is commonly reported in individuals in their 20s, 30s, and those aged 60 and older. The treatment goal for alcohol dependence is to achieve abstinence and address the underlying psychological aspects, fostering self-esteem, confidence, and healthier relationships. It is important to seek professional help when dealing with alcohol dependence, as quitting cold turkey can be dangerous.
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What You'll Learn
Alcohol Use Disorder (AUD)
The development of AUD is influenced by various factors, including the amount, frequency, and rate of alcohol consumption. Additionally, genetics and family history play a significant role, with hereditability accounting for approximately 60%. Parental drinking patterns can also impact the likelihood of their children developing AUD. Certain mental health conditions, such as depression, post-traumatic stress disorder (PTSD), and attention-deficit/hyperactivity disorder (ADHD), are associated with an increased risk of AUD. Individuals with a history of childhood trauma are also more vulnerable to developing AUD.
The diagnostic criteria for AUD are outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). To be diagnosed with AUD, an individual must meet at least two of the specified criteria within a 12-month period. Healthcare providers conduct physical examinations to identify symptoms and determine the severity of the disorder, which can be mild, moderate, or severe. Treatment options for AUD include behavioural therapies, mutual-support groups, and medications.
It is important to note that physical alcohol dependence and AUD are linked. If you are physically dependent on alcohol, you may feel unable to function without it and experience obsessive thoughts about drinking. However, physical dependence alone does not necessarily indicate alcohol addiction. Nevertheless, seeking proper treatment is crucial to prevent the development of addiction.
Withdrawal symptoms associated with AUD include trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, dysphoria, malaise, feeling low, or even seizures. These symptoms can be dangerous, and it is not recommended to quit alcohol abruptly ("cold turkey"). Instead, individuals should seek professional help from medical providers, mental health professionals, or addiction counsellors to safely detox from alcohol.
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Physical symptoms of withdrawal
Physical alcohol dependence is a chronic, relapsing cycle that can begin at any age, but it is commonly reported in people in their 20s and 30s and those aged 60 and older. It can be extremely dangerous to quit alcohol "cold turkey". Instead, it is recommended to seek medical help and undergo a medically supervised alcohol detox.
The physical symptoms of alcohol withdrawal can range from mild to severe, with the most severe being life-threatening. Symptoms tend to occur within 8 hours after the last drink but can also occur days later. They typically peak by 24 to 72 hours but may persist for weeks or even months. The severity of these symptoms depends on several factors, including body chemistry, the presence of coexisting physical or mental health conditions, medications, and the use of other substances.
Some of the physical symptoms of alcohol withdrawal include:
- Sleep changes
- Mood swings
- Fatigue
- Seizures
- Hallucinations
- Racing heart
- Sweating
- Nausea
- Shaking
- Restlessness
- High blood pressure
- Increased body temperature
- Abnormal blood levels of different chemicals in the body
Delirium tremens is a severe form of alcohol withdrawal that can be life-threatening. It can cause serious medical issues such as seizures and hallucinations, requiring immediate medical care. People with moderate-to-severe alcohol withdrawal symptoms should be treated at a hospital or a specialised facility.
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Psychological symptoms of withdrawal
Alcohol withdrawal syndrome (AWS) is a set of symptoms that can occur when a person with alcohol use disorder (AUD) suddenly stops or significantly reduces their alcohol intake. The severity of AWS depends on several factors, including the degree of alcohol intake, the length of time the individual has been drinking, and their previous history of alcohol withdrawal.
The psychological symptoms of alcohol withdrawal can range from mild to severe and life-threatening. They are caused by the central nervous system entering a "fight or flight" mode as alcohol leaves the system. Mild psychological symptoms of AWS include:
- Anxiety
- Nervousness
- Irritability
- Insomnia
- Mood changes
- Fatigue
More severe psychological symptoms of AWS include:
- Alcoholic hallucinosis: Transient visual, auditory, or tactile hallucinations.
- Delirium tremens: Disorientation, impaired attention/consciousness, and hallucinations. Delirium tremens can be fatal if untreated.
It is important to note that alcohol withdrawal can be dangerous, and medical support is often required to help reduce and stop drinking. Treatment for AWS typically involves benzodiazepines such as chlordiazepoxide or diazepam, and thiamine is recommended routinely. Early treatment improves outcomes.
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Risk factors and warning signs
Alcohol dependence can develop at any age, but it is commonly reported in people in their 20s and 30s and those aged 60 and older. Risk factors for developing alcohol dependence include excessive drinking, intense alcohol cravings, and continued alcohol use despite negative consequences.
- Excessive drinking: Drinking more than intended or giving up other activities in favour of drinking alcohol.
- Cravings: Feeling a strong urge to drink and prioritising drinking over other obligations or activities.
- Negative consequences: Continuing to drink despite recognising the negative impact on physical and mental health, work, or family life.
- Tolerance: Needing to drink more to achieve the desired effect.
- Withdrawal symptoms: Experiencing physical or psychological withdrawal symptoms when reducing or stopping alcohol consumption, such as shaking, sweating, nausea, vomiting, diarrhoea, seizures, or hallucinations.
- Coping mechanism: Using alcohol as a way to cope with difficult times, negative feelings, or mental health problems such as depression or anxiety.
- Socialising: Finding it hard to socialise or enjoy yourself without alcohol.
- Increased risk: Family history of alcohol problems, co-occurring mental health disorders, or high levels of stress or trauma.
If you or someone you know is exhibiting these warning signs, it is important to seek professional help from a medical provider, mental health professional, or addiction counsellor. They can provide safe options and resources to support detox and recovery from alcohol dependence.
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Treatment and benefits
Treatment for alcohol use disorder (AUD) depends on the severity of the condition, which can range from mild to moderate to severe. Treatment options include behavioural treatment, medication, therapy, and counselling.
Behavioural treatment involves working with addiction counsellors or psychologists to change drinking behaviour. This can include developing skills to avoid and overcome triggers, such as stress, that might lead to drinking.
Medications can also help deter drinking during times when individuals may be at greater risk of relapse, such as during a divorce or the death of a family member.
Therapy and counselling can help address any accompanying medical and mental health issues. This is important because people with AUD are more likely to suffer from major depression or anxiety over their lifetime.
Inpatient medical treatment or residential rehabilitation may be recommended for severe cases of AUD. This can provide support and tools to help maintain sobriety.
There are also free and confidential helplines, such as SAMHSA's National Helpline, that offer 24/7 treatment referral and information services for individuals and families facing mental and/or substance use disorders. These services can provide referrals to local treatment facilities, support groups, and community-based organisations.
The benefits of treatment for AUD include improved physical health, mental health, relationships, and overall quality of life. Treatment can also lead to sustained recovery and reduced risk of relapse.
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Frequently asked questions
Alcohol dependence, also known as alcohol use disorder (AUD), is when an individual is physically or psychologically dependent on alcohol.
Physical dependence on alcohol can manifest as withdrawal symptoms such as shaking, sweating, nausea, vomiting, diarrhoea, seizures, and hallucinations. Psychological dependence on alcohol can manifest as using alcohol as a coping mechanism for difficult times, negative feelings, or mental health problems. Other signs of alcohol dependence include increased tolerance to alcohol, prioritising drinking over other activities, and experiencing problems due to drinking.
According to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), an individual must meet at least four of the following criteria within a 12-month period to be diagnosed with alcohol dependence: drinking more than intended, unsuccessful attempts to reduce alcohol intake, giving up other activities in favour of drinking, spending excessive time obtaining and drinking alcohol, continuing to drink despite adverse effects, and developing alcohol tolerance.
The goal of treating alcohol dependence is to establish abstinence from drinking and address any underlying mental health issues. Treatment options may include seeking professional help from a medical provider, mental health professional, or addiction counsellor, undergoing detox, and participating in social learning approaches to change drinking patterns. It is important to note that quitting alcohol abruptly can be dangerous, and medical advice should be sought before attempting to detox.
