Alcohol Dependence (Alcoholism)

What is alcohol dependence?

Alcohol dependence (alcoholism) is a condition marked by some combination of:

• physical dependence on alcohol
• loss of control over the use of alcohol
• continued use of alcohol despite knowing that it is harmful to your mental and physical health.

If your body is dependent on alcohol, you might need to drink more and more alcohol to feel as high as you used to feel drinking less. Another sign of physical dependence is that you have bodily changes such as shakes or sweats when you stop drinking.

Signs that you have lost control over your use of alcohol include:

• trying to limit your drinking but being unable to
• spending a lot of time and energy getting or using alcohol or getting over its effects.

Alcoholism is one of the most common illnesses seen by doctors. It is especially serious in older people, who often have other medical problems that are made worse by alcohol use.

How does it occur?

Many factors may lead to alcohol dependence. Examples of such factors are:

• family members who are dependent on alcohol
• stress that is ongoing
• family environment
• mental illness such as depression, bipolar disorder, schizophrenia, or anxiety
• the addictive nature of alcohol.

Two out of three older alcoholics have always been heavy users. One of the three started drinking later in life, often after retirement. Starting to drink late in life is often due to grief, loneliness, depression, or boredom.

What are the symptoms?

Alcohol dependence takes many forms including:

• drinking from time to time
• drinking all the time
• binge drinking.

Many alcoholics become able to drink ever larger amounts of alcohol before feeling or seeming drunk. Alcohol users often drink to avoid withdrawal symptoms.

People who are dependent on alcohol may:

• try to hide evidence of drinking
• promise to give up drinking
• drink stronger alcoholic beverages or start to drink earlier in the day
• have long periods of being drunk
• drink alone
• have problems at work
• miss work
• black out
• lose interest in food
• have mood changes (be angry, irritable, violent)
• have personality changes (be jealous, distrustful)
• repeatedly drive while drunk
• hurt themselves or others while drunk
• be careless about their appearance
• be confused and have memory problems, lose the ability to think quickly or concentrate
• have money problems caused by drinking.

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 doctors 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 doctor will take a careful medical history of your symptoms. Especially important are how and when you drink alcohol. The doctor 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.

The doctor will examine you to look for medical problems caused by alcohol use. Lab tests of your urine and blood may be done. The most frequent and severe effects of alcoholism are not medical problems, however, but problems with emotions, relationships, accidents, and work.

How is it treated?

You must stop drinking alcohol. Your doctor can help you quit drinking and recover from disorders related to alcohol. Psychotherapy and social programs will also aid in your recovery. It might help if family members are included in your treatment program.

After immediate withdrawal from alcohol (detoxification), you may need long-term treatment. You may need to stay in the hospital at first or you may be treated as an outpatient. Going to Alcoholics Anonymous (AA) meetings or a similar program once or more a week plays a very important role in treatment, at least at the beginning.

How long will the effects last?

You may feel a need or desire for alcohol throughout your life. One of the most important aspects of alcohol counseling and treatment is to learn the behavior patterns that usually cause you to start drinking. Recognizing these patterns and changing them is important.

If you stop drinking, related health problems can often be controlled or prevented. However, severe damage, such as 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 physician, pastor, AA, mental health centers, and alcohol or substance abuse treatment programs.

Follow your doctor's advice for treatment of any other medical problems. Avoid situations where alcohol is consumed.

You should also work to improve your general health. Eating a balanced diet and getting regular exercise are important parts of being healthy.

For more information, contact:

• Alcoholics Anonymous (AA)
  P.O. Box 459
  New York, NY 10163
  212-870-3400
  http://www.alcoholics-anonymous.org/
• National Mental Health Association (NMHA)
  1-800-969-NMHA (1-800-969-6642)
  http://www.NMHA.org.