What is alcohol dependence?

If you feel you can't function without a drink, seek help. Alcoholic drinks have been prepared and drunk for thousands of years, and the problems that can accompany excess alcohol intake have undoubtedly been around just as long.

High levels of alcohol consumption can lead to physical illness and psychological and social distress. Alcohol has therefore always had an ambivalent position in society.

In moderation, it can be the oil that makes a social occasion go with a bit more flow or helps a shy person overcome their inhibitions.

Small, regular amounts of alcohol also seem to have a positive effect on the heart and circulation. But too much alcohol is often a recipe for disaster.

The increasing use of alcohol, along with other drugs of abuse, is a serious public health problem across all age ranges, but especially so in the young.

Alcoholism, or alcohol dependence is a medical term with a deliberately more precise meaning than the problems that can occur, sometimes as one-offs, through an uncharacteristic binge.

In alcohol dependence a number of features come together in the behaviour of the person affected.

* Drinking begins to take priority over other activities. It becomes a compulsion.

* Tolerance develops, so it takes more alcohol to produce drunkenness.

* Withdrawal symptoms such as anxiety and tremor develop after a short period without a drink, and are reduced by taking more alcohol.

Often alcohol dependence remains undetected for years. Both the availability of alcohol and the way it is used (the social patterns) appear to be major factors in influencing the likelihood of a person becoming alcohol dependent.

There may also be a genetic component, because alcohol dependence clusters in some families. However, it's hard to be sure that this is not because of learned behaviour.

What problems are caused by too much alcohol?

Excess alcohol can lead to health problems including:

* depression

* liver cirrhosis

* heart failure

* damage to the brain and nervous system.

Along the way there is often damage to relationships, finances and jobs and problems with the law.

Mental health and alcoholism

Mental health problems are common with alcoholism. Each can lead to or reinforce the other.

Depression is a common cause of alcoholism as the depressed person seeks a way out of their problems or a relief from insomnia. Unfortunately, alcohol is itself a depressant, so the problem is only compounded.

Anxiety can be temporarily relieved by alcohol, but this may lead to repeated intake and dependence.

Without adequate attention to the mental health needs of a person with alcohol dependence, little progress will be made. Often alcoholism remains unsuspected even by the doctor, and it may come to light only when medical tests are done for other reasons.

Treating alcoholism

The difficulty of treating alcoholism should not be minimised - it can be very hard, even with support from family, friends and your GP. However, there are a a number of steps you can take including not drinking alcohol on weekdays.

What is the difference between alcohol abuse and alcohol dependence?

Alcohol abuse is described as any "harmful use" of alcohol.

The Diagnostic and Statistical Manual of Mental Disorders IV describes alcohol abusers as those who drink despite recurrent social, interpersonal, and legal problems as a result of alcohol use. Harmful use implies alcohol use that causes either physical or mental damage.

Those who are alcohol dependent meet all of the criteria of alcohol abuse, but the will also exhibit some or all of the following:

• Narrowing of the drinking repertoire (drinking only one brand or type of alcoholic beverage).
• Drink-seeking behavior (only going to social events that will include drinking, or only hanging out with others who drink).
• Alcohol tolerance (having to drink increasing amounts to achieve previous effects).
• Withdrawal symptoms (getting physical symptoms after going a short period without drinking).
• Drinking to relieve or avoid withdrawal symptoms (such as drinking to stop the shakes or to "cure" a hangover).
• Subjective awareness of the compulsion to drink or craving for alcohol (whether they admit it to others or not).
• A return to drinking after a period of abstinence (deciding to quit drinking and not being able to follow through).

Typically, those drinkers who are diagnosed as only alcohol abusers can be helped with a brief intervention, including education concerning the dangers of binge drinking and alcohol poisoning.

Those who have become alcohol dependent generally require outside help to stop drinking, which could include detoxification, medical treatment, counseling and/or self-help group support.

What is going on in the body?

Alcohol is a depressant. At a blood alcohol level of 0.05%, thought, judgment and restraint are affected. At a level of 0.1%, motor skills become clumsy. When the blood alcohol level reaches 0.2%, the entire area of the brain that controls motor function is negatively affected. Alcohol also affects the parts of the brain that control emotions and behavior. At 0.3%, the person is likely to be confused and stuporous. An individual at a blood alcohol level of 0.4% or higher may go into a coma . If blood alcohol levels exceed 0.5%, an individual might choke on vomit or stop breathing.

Prolonged alcohol use can actually alter the genes in the brain. People with alcoholism may have impaired memory, poor concentration, and inability to focus after a distraction.

What are the signs and symptoms of the condition?
Signs and symptoms of alcohol dependency include:

• alcohol withdrawal when drinking stops suddenly. Withdrawal symptoms include nervousness, shaking, irritability , and nausea .
• increased tolerance to alcohol
• alcohol consumed in larger amounts or over a longer period than was intended
• unsuccessful attempts to stop drinking
• considerable time devoted to activities associated with alcohol use or obtaining alcohol
• neglected daily activities
• disregard for consequences of negative behaviors

What are the causes and risks of the condition?
No one knows for sure what causes alcohol abuse and dependence. Factors that increase a person's chance of becoming dependent on alcohol include:

• frequent social situations that encourage drinking
• childhood history of attention deficit hyperactivity disorder or conduct disorder
• personality disorders
• one or both parents dependent upon alcohol
• alcohol abuse by a young adult that begins as weekend or evening drinking

What can be done to prevent the condition?
Teaching people, particularly those who are at risk for the disease, about alcoholism is important. This education needs to be started at a young age.

How is the condition diagnosed?
There is no test to determine if an individual is an alcoholic. But the negative effects of alcohol on the body can be identified with laboratory tests. These laboratory tests will show damage to various organs or body systems.

What are the long-term effects of the condition?
The long-term effects of alcohol dependency include:

• pancreatitis , or inflammation of the pancreas
• heart disease , including coronary artery disease
• neuropathy, or damage to the nerves
• bleeding esophageal varices, or enlarged veins in the tube that connects the windpipe to the stomach
• brain degeneration and alcoholic neuropathy
• cirrhosis of the liver, a chronic disease that causes destruction of liver cells and loss of liver function
• depression , insomnia , anxiety, and suicide
• high blood pressure
• increased incidence of many types of cancer , including breast cancer
• nutritional deficiencies
• Wernicke-Korsakoff's syndrome, a neuropsychiatric disorder caused by thiamine deficiency that results from poor nutrition in alcoholics
• significant damage to occupational, social, and interpersonal areas, including sexual dysfunction

Children and teenagers who abuse alcohol are at increased risk for further drinking problems, depression , other substance abuse, and personality disorders as they get older. Adolescents who drink alcohol heavily can develop significant impairments in their ability to remember new information, and their schoolwork may suffer.

People who are heavy drinkers also tend to smoke and eat an unhealthy diet. This combination puts the person at higher risk for coronary artery disease , stroke , heart attack , diabetes , and other chronic diseases.

What are the risks to others?
If a woman drinks alcohol during pregnancy , her fetus is at great risk for developing fetal alcohol syndrome . or FAS. Drinking reduces judgment, impulse control, and motor control. A person with alcohol dependency places himself or herself and others at risk for accident or emotional injury.

What are the treatments for the condition?
Treatment begins with helping the person to recognize the problem. Alcohol dependency is associated with a tendency to deny the severity of the problem. There is an refusal to admit it to others. Once the person has recognized and admitted a problem, treatment begins with sobriety, or no alcohol intake.

Some individuals who are alcohol dependent will need to be medically detoxified. This is done in a healthcare setting. Potential complications are monitored during the detoxification process. Tranquilizers and sedatives are used 4 to 7 days to control the symptoms of alcohol withdrawal .

Alcohol recovery programs help people identify situations that trigger the desire to drink. These programs also help people develop coping skills and life management systems, so they can live without alcohol . Self-help groups such as Alcoholics Anonymous have been effective in helping thousands of alcoholics remain sober.

Occasionally medications, such as disulfram, that interfere with the metabolism or the effects of alcohol are used as a deterrent.

What are the side effects of the treatments?
Disulfram may cause drowsiness , depression , and erectile dysfunction .

What happens after treatment for the condition?
Individuals who complete treatment for alcohol dependence often will continue some form of counseling or self-help group. A person in alcohol recovery will often voluntarily continue to attend self-help groups indefinitely.

How is the condition monitored?
Alcohol dependence is monitored by healthcare providers, counselors, family, and friends. Any new or worsening symptoms should be reported to the healthcare provider.