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Alcohol dependence

An illness characterised by habitual, compulsive, long term, excessive alcohol consumption and the development of withdrawal symptoms when drinking is stopped abruptly.

Causes

Causative factors that interact in the development of alcohol dependence include environment, personality and the addictive nature of alcohol. Those with insecure, inadequate or immature personality are at a higher risk. Environmental factors are also important, especially when the ready availability, affordability and widespread social exceptance of alcohol. Genetic factors can play a part in causing alcohol dependence in some cases, but it is now commonly believed that anyone, irrespective of environment, personality or genetic background is capable of becoming dependent. Stress is usually a major factor in precipitating heavy drinking.

Development of dependence

Alcohol dependence often develops in four main stages that can occur over a number of years and merge imperceptibly. In the initial phase, tolerance (being able to drink more alcohol before experiencing effects) builds up in the heavy social drinker. In the second phase, the drinker can experience memory lapses relating to events during drinking episodes. In the third phase there is loss of control over alcohol consumption. The last phase is characterised by long binges of intoxication and mental or physical problems.

Symptoms and effects

Behavioural symptoms will vary. They can include grandiose, furtive or aggressive behaviour; personality changes (such as jealousy, irritability or uncontrolled anger); neglect of food intake and personal appearance and hygiene; and extended periods of intoxication.

Physical symptoms can include vomiting, nausea, shaking in the morning; cramps; abdominal pain; tingling or numbness; weakness in the hands and legs; enlarged blood vessels in the face; irregular pulse; confusion; unsteadiness; incontinence and memory lapses. Sudden withdrawal from alcohol can lead to delirium treatment (hallucinations, convulsions and severe shakes).

Alcohol dependent people are more likely than others to contract a variety of mental and physical disorders.

Treatment

Most problem drinkers require medical assistance in overcoming their physical withdrawal symptoms (detoxification) when they stop drinking alcohol, followed by long term treatment. There are different treatments, which can be combined.

Psychotherapy and cognitive behavioural therapy are psychological treatments that can be used to help alcohol dependence. They are mostly carried out as group therapy’s. Social treatments can offer practical help, such as problems with work, and tend to involve family members in the process. Physical treatment usually includes the use of disulfiram, a drug that sensitises the drinker to alcohol so that he or she experiences horrid side effects when drinking. Other treatments may include benzodiazepine drugs to help control withdrawal symptoms and vitamins to treat any deficiency. Acamprosate may also be given to support and maintain abstinence. Alcoholics anonymous and other self-help organisations do also provide advice and support.


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