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.

Alcohol dependence is one of the most common illnesses seen by healthcare providers. It is especially serious in older people. Abuse of alcohol may cause health problems or make existing health problems worse.

What is the cause?

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
• ADHD, 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:

• Drink alone or try to hide their drinking.
• Promise to give up drinking.
• Drink stronger alcoholic beverages or start to drink earlier in the day.
• Have problems at work, miss work, or spend too much money.
• Have problems in relationships.
• Black out, be confused, or have memory problems.
• Lose interest in food.
• Have mood changes, such as getting angry or irritable.
• Hurt themselves or others while drunk.

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 are often part of recovery. Family members may be included in your treatment program.

After immediate withdrawal from alcohol (detoxification), there are several options for treatment. You and your treatment team will decide which options make the most sense for you. Support groups such as Alcoholics Anonymous (AA) or a program such as Rational Recovery may be recommended.

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. Other medicines to treat alcohol cravings are being tested. These medicines often work best when used along with therapy and 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, 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 providers, therapists, support groups, 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 situations where people are likely to abuse drugs or alcohol.

• Get support. Talk with family and friends. Consider joining a support group in your area.
• Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax, for example take up a hobby, listen to music, watch movies, take walks. Try deep breathing exercises when you feel stressed.
• Take care of your physical health. Try to get at least 7 to 9 hours of sleep each night. Eat a healthy diet. Limit caffeine. If you smoke, quit. Don’t use alcohol or drugs. Exercise according to your healthcare provider's instructions.
• Avoid situations where people are likely to use alcohol or drugs.
• Check your medicines. To help prevent problems, tell your healthcare provider and pharmacist about all the medicines, natural remedies, vitamins, and other supplements that you take.
• Contact your healthcare provider or therapist if you have any questions or your symptoms seem to be getting worse.