Arielle Cruz
Alcohol dependence, also known as alcoholism or alcohol addiction, is a chronic relapsing disorder associated with compulsive alcohol drinking, the loss of control over intake, and the emergence of a negative emotional state when alcohol is unavailable. Alcohol dependence can lead to a range of serious physical and mental health issues. Physical alcohol dependence is characterised by obsessive thoughts about alcohol use and intense cravings to drink despite the consequences. Psychological dependence on alcohol is generally meant to describe the emotional and mental processes associated with the development of a substance use disorder.
| Characteristics | Values |
|---|---|
| Physical Dependence | - Withdrawal symptoms when alcohol is discontinued, including tremors, seizures, and delirium tremens (DTs) - Increased tolerance, requiring more alcohol to achieve the desired effect - Physical cravings and a compulsion to drink - Negative impact on physical health, including liver damage, cardiovascular problems, and neurological issues |
| Psychological Dependence | - Preoccupation with alcohol and a strong desire to drink - Inability to stop or control drinking despite negative consequences - Drinking to relieve stress, anxiety, or depression - Using alcohol as a coping mechanism and relying on it to function socially or emotionally - Denial or minimization of the problem, often accompanied by secrecy and isolation |
| Sources | - Alcohol Dependence - Signs and Symptoms of Alcohol Dependence |
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What You'll Learn
Alcohol addiction and the brain
Alcohol addiction, or alcohol dependence, is a chronic relapsing disorder characterised by compulsive alcohol drinking, a loss of control over intake, and negative emotional states when alcohol is not available. It is a spectrum disorder that can range from mild to severe and includes conditions such as alcohol abuse, alcohol dependence, and alcoholism. Alcohol addiction is defined by an impaired ability to stop or control alcohol consumption despite adverse social, occupational, or health consequences.
The brain plays a crucial role in the development and maintenance of alcohol addiction. Alcohol's effects on the brain are twofold: it produces pleasurable feelings and blunts negative emotions. The pleasurable feelings associated with alcohol consumption are primarily mediated by the basal ganglia, a group of structures deeply embedded in the brain that are involved in reward, motivation, and habit formation. Repeated activation of the basal ganglia's reward system reinforces drinking behaviour, making it more likely that a person will continue to drink. Over time, repeated activation of the basal ganglia can lead to changes in brain structure and function that compromise brain function and drive the transition from controlled, occasional use to chronic misuse.
The basal ganglia are not the only brain structures implicated in alcohol addiction. The extended amygdala and the prefrontal cortex also play important roles. The extended amygdala is involved in the brain's stress response system, and its overactivation during alcohol withdrawal can lead to negative emotions such as anxiety, irritability, and unease. The prefrontal cortex, on the other hand, is involved in executive functions such as decision-making and impulse control, which can be impaired in individuals with alcohol addiction, making it difficult for them to stop drinking.
Alcohol addiction is a complex disorder that involves both physiological and psychological factors. While the physical dependence on alcohol is often emphasised, the psychological aspects are equally important. The two are not mutually exclusive, and both contribute to the development and maintenance of alcohol addiction. Psychological dependence on alcohol refers to the emotional and cognitive aspects of addictive behaviours, including cravings, anxiety, and the use of alcohol to cope with negative emotions.
The treatment of alcohol dependence typically involves establishing abstinence from drinking and addressing both the physical and psychological aspects of the addiction. This may include medical support, therapy, and lifestyle changes to promote a healthier physical and mental state.
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Physical withdrawal symptoms
Alcohol dependence, also known as alcoholism or alcohol addiction, is characterised by a strong, often uncontrollable, desire to drink. It is the most serious form of high-risk drinking, where drinking causes harm to one's health. People who are becoming alcohol-dependent notice they need to drink more to get the same effect. They often prioritise drinking over other activities or obligations, such as work or family life, and continue drinking despite harmful consequences.
Alcohol addiction is a chronic relapsing disorder associated with compulsive alcohol drinking, the loss of control over intake, and the emergence of a negative emotional state when alcohol is no longer available. When a person who is addicted to alcohol stops drinking, they experience withdrawal symptoms, which can be physical and emotional.
Alcohol withdrawal is a set of symptoms that can develop if a person stops or significantly reduces alcohol intake after long-term use. Symptoms can range from mild to severe, with the most severe being life-threatening. These symptoms tend to occur within 8 hours after the last drink but can also occur days later. They tend to peak by 24 to 72 hours but may go on for weeks or even months.
Some common physical withdrawal symptoms include:
- Sleep disturbances
- Pain
- Feelings of illness
- Fatigue
- Dehydration
- Electrolyte imbalances
- Abnormal liver function
- Heart disease
If you are concerned about your drinking or someone else's, it is important to seek professional help.
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Psychological withdrawal symptoms
Alcohol dependence, commonly known as alcoholism or alcohol addiction, is characterised by a strong, often uncontrollable, desire to drink. It involves drinking at a level that causes harm to one's health. People with alcohol dependence often experience poor mental health, including anxiety, depression, and suicidal feelings.
When a person who is addicted to alcohol stops drinking, they experience withdrawal symptoms, which can be both physical and psychological. The negative feelings associated with alcohol withdrawal stem from two sources. Firstly, a diminished activation in the reward systems of the basal ganglia makes it difficult for people to experience the pleasures of everyday living. Secondly, an increased activation of the brain's stress systems in the extended amygdala contributes to anxiety, irritability, and unease.
- Anxiety
- Nervousness
- Irritability
- Dysphoria
- Emotional pain
- Insomnia
- Hallucinations
- Seizures
The severity and length of alcohol withdrawal vary based on several factors, such as the amount usually consumed and the duration of alcohol use. Withdrawal symptoms typically begin within six to 24 hours of stopping or significantly reducing heavy, long-term alcohol use. Symptoms can increase in intensity depending on the severity of the withdrawal, and they often peak within 24 to 72 hours of the last drink. However, some symptoms may linger for weeks or even months.
If you are experiencing alcohol withdrawal symptoms, it is important to seek medical support to help manage and reduce alcohol consumption. Treatment can include specific prescription medications to alleviate symptoms and lower the risk of severe complications.
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Risk factors and warning signs
Risk Factors
- Genetics: Studies show that people with a family history of alcohol use disorder have an increased risk of developing it.
- Mental Health Conditions: Pre-existing mental health conditions such as depression, post-traumatic stress disorder (PTSD), or attention-deficit/hyperactivity disorder (ADHD) can increase the risk of alcohol dependence.
- Age: Alcohol dependence can begin at any age, but it is commonly reported in individuals in their 20s and 30s, as well as those aged 60 and older. Young people, especially adolescents, are at a higher risk of developing alcohol use disorders due to the potential impact of alcohol on their brain development.
- Social and Environmental Factors: The society and environment one lives in can influence the likelihood of developing alcohol dependence. Factors such as the easy availability of alcohol, its cost, and pressure from peers or colleagues can contribute to increased alcohol consumption.
- Comorbid Illnesses: Certain physical illnesses, such as liver, pancreatic, neurological, circulatory, and gastrointestinal diseases, can be comorbid with alcohol dependence.
Warning Signs
- Increased Alcohol Tolerance: Needing to drink more to achieve the desired effect is a sign of alcohol dependence.
- Withdrawal Symptoms: Experiencing negative physical and emotional withdrawal symptoms when reducing or stopping alcohol consumption. These symptoms can include sleep disturbances, pain, feelings of illness, dysphoria, irritability, anxiety, and emotional pain.
- Prioritising Alcohol: Alcohol becomes a priority over other activities, obligations, or responsibilities. Individuals may continue to drink despite the negative consequences on their health, work, or personal relationships.
- Inability to Stop Drinking: Despite recognising the harmful effects of alcohol, individuals with alcohol dependence are unable to control their consumption and may make unsuccessful attempts to quit.
- Negative Impact on Health: Alcohol dependence can lead to adverse physical and mental health effects, including liver disease and depression.
- Frequent Intoxication: Regular intoxication and "blackouts", where individuals cannot remember what they said or did while drinking, are warning signs.
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Treatment and recovery
The first step towards recovery is recognizing the problem and seeking help. This can be done by contacting a primary care provider, health insurance plan, local health department, employee assistance program, or a specialist organization such as the American Academy of Addiction Psychiatry or the American Psychological Association. These services can provide referrals to treatment facilities, support groups, and community-based organizations.
Treatment options for AUD include behavioral treatment, medication, and support groups. Behavioral treatment involves counseling with addiction counselors or psychologists to change drinking behavior. Medication can also be used to treat AUD, with the U.S. Food & Drug Administration having approved naltrexone and acamprosate for this purpose. Topiramate and gabapentin can also decrease cravings in some people. Support groups, such as Alcoholics Anonymous (AA), provide peer support for people quitting or cutting back on their drinking and can offer a valuable layer of support when combined with treatment led by healthcare providers.
Inpatient medical treatment or residential rehabilitation may be recommended for severe cases. Recovery from AUD often includes sustainable improvements in physical health, mental health, relationships, and other measures of function and well-being. It is important to note that recovery is a journey that is taken one step at a time, and relapse may occur. Exercise, identifying triggers, and seeking support can all help in the recovery process.
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Frequently asked questions
Alcohol dependence, also known as alcoholism or alcohol addiction, is a chronic relapsing disorder characterised by compulsive alcohol drinking, loss of control over intake, and the emergence of a negative emotional state when alcohol is not available.
Physical alcohol dependence is characterised by obsessive thoughts about alcohol use and intense cravings to drink despite the consequences. It is a factor of addiction, but not addiction itself. However, heavy drinking caused by physical dependence can lead to alcohol addiction.
If you suddenly stop or significantly reduce your alcohol intake, your body may experience physical withdrawal symptoms. If these symptoms go away when you continue drinking or if it is very difficult to stop drinking due to the symptoms, your body is likely physically dependent on alcohol.
Psychological dependence on alcohol refers to the emotional and mental processes associated with the development of and recovery from a substance use disorder. It is often associated with the cognitive and emotional aspects of addictive behaviours and the withdrawal process.
You may be psychologically dependent on alcohol if you use it as a normal way of coping with difficult times, socialising, or enjoying yourself. You may also be dependent if you use alcohol to avoid dealing with negative feelings or to cope with mental health problems.
