Questions about alcohol addiction
What is alcohol addiction or dependence?
Alcohol can be misused in many ways, from less to more severely. The World health Organization (WHO) states, “Alcohol misuse is a general term for any level of risk, ranging from hazardous drinking to alcohol dependence.”
Alcohol dependence can be equated to alcoholism or alcohol addiction, which many people and health organizations regard as a disease. However, the most recent psychiatric formulation (called DSM-5) avoids both the terms “alcoholism” and “addiction”. DSM-5 views alcohol misuse (called “alcohol use disorder,” or AUD) strictly in terms of severity—from mild, to moderate, to severe (see symptom list below).
In other words, the official modern psychiatric manual looks at alcohol problems in an objective, problem-oriented way. It doesn’t apply a single definitive label to a person or their problematic alcohol use.
Nonetheless, the terms alcoholism and alcohol dependence maintain a hold on both popular and professional, clinical thinking. Being dependent on alcohol implies that a person needs to drink to avoid withdrawal, as indicated by delirium tremens (tremors, agitation, extreme anxiety, hallucination, psychosis, disorientation, delirium and seizure). We may all have a picture in our minds of a skid-row “alcoholic,” someone completely incapacitated by alcohol dependence who will do anything to get a drink. This image occurs only at the most serious, habitual end of the spectrum of alcohol use disorders. It is of little use in the diagnosis and treatment of the vast majority of people who encounter drinking problems in their lives.
People in such an extreme position due to their dependence on alcohol, however rare this is, usually undergo a medical “detox” to safeguard their health. If this kind of dependence characterizes your drinking, you should seek medical clearance for withdrawing from alcohol.
Even in such extreme situations, however, the dependence on alcohol is only a minor part of addressing a person’s issues with alcohol. That is, once the immediate danger of alcohol withdrawal is dealt with securely and medically, the person must still address the position alcohol holds in their lives.
This part of addiction, the role that alcohol plays in a person’s life, can be the most perplexing and frustrating. It involves multifaceted emotional, situational, and life issues that can be deeply rooted. On the one hand, alcohol can so skew people’s perceptions that they do not see the disruption alcohol is causing in their lives.
Whether dependence is present or not, many people have convinced themselves that they need alcohol to go on with their lives. They associate drinking with self-acceptance and emotional security, and rely on it in their key relationships. These attitudes make removing alcohol from the central position it occupies for them difficult for them to imagine.
A final, useful short definition of alcohol addiction or dependence is: “continual drinking although drinking has clearly become harmful, even destructive, for the person and those close to them.”
A Note on Abstinence versus Moderate Drinking and Harm Reduction
The traditional goal in alcoholism treatment has been total abstinence, particularly for alcohol dependence or severe alcohol use disorders. This is no longer the ironclad dictate in all cases. Moderate drinking—or even reduced problematic drinking with health and other safeguards in place—is now considered a legitimate treatment goal. Called “harm reduction,” this approach focuses on reducing risky and harmful drinking. In quite a few cases, even alcohol-dependent drinkers may eventually resume drinking at safe, risk-free levels of consumption.
How do I know if I have a drinking problem?
Only you can evaluate whether, and how severely, alcohol is adversely affecting your life. This level can vary over your lifetime. One way to make this assessment is to consult with someone you are close to, perhaps an intimate partner or family member. They can be objective about your alcohol use and its consequences.
Levels of drinking suggested by official health bodies that avoid all risk include this one, from WHO:
- Men: No more than 4 drinks on any day or 14 per week
- Women: No more than 3 drinks on any given day, or 7 per week
What are the symptoms of alcohol dependence?
Alcohol dependence and addiction include a change in tolerance level or withdrawal (see the final two criteria below). A severe alcohol use disorder simply entails the summation of a large number of problems you encounter seen in the list below.
Here are the symptoms for an AUD in DSM-5. Anyone meeting any two of the 11 criteria during the same 12-month period receives a diagnosis of AUD. The severity of AUD—mild, moderate, or severe—is based on the number of criteria beyond this that are met by affirmative answers to these questions:
- Had times when you ended up drinking more, or longer than you intended?
- More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
- Spent a lot of time drinking? Or being sick or getting over the aftereffects?
- Experienced craving—a strong need, or urge, to drink?
- Found that drinking — or being sick from drinking — often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
- Continued to drink even though it was causing trouble with your family or friends?
- Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
- More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
- Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
- Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
- Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating? Or sensed things that were not there?
What are the effects of alcohol dependence on the body?
Excessive, dependent drinking can manifest in a number of short and long-term negative, harmful effects. Short-term effects include hangover, nausea and illness. Medium-term effects include chronic headaches and anxiety and depression. Long-term effects include physical harms such as liver damage, cardiac disease, pancreatitis, malnutrition, kidney disease, and dementia. However, cutting back or stopping drinking can reverse even serious damage in many or most cases.
Will I suffer from withdrawal from alcohol if I stop drinking?
Not everyone experiences withdrawal from heavy drinking, including even severe AUDs. There is no definitive way to tell in advance. Once again, this is an individual question for you to assess through your own experience. However, if you have been drinking regularly and heavily, the chances you may have some withdrawal symptoms are increased. The severity can vary hugely from headaches and nausea to, in extreme cases, seizures and death.
Delirium tremens is an extreme consequence that may include some of the following symptoms: tremors, agitation, extreme anxiety, hallucinations, psychosis, disorientation, delirium and seizures. If you fear withdrawal, it is reasonable to seek assistance with detox from a doctor, hospital or other medical facility. They can help monitor your vital signs and administer mild medication to make you more comfortable. Some doctors support home detox and will prescribe a course of medications that can help cushion withdrawal responses.
At the same time, research now consistently shows that many or most people quit entirely on their own without support group help or treatment. You may be fine to proceed on your own as long as you pay attention to symptoms such as shaking, sweating, extreme nausea, rapid heartbeat, etc. If any of these symptoms proceed from uncomfortable to alarming, then you should seek medical attention. It’s always a good idea to have accessible a friend or someone objective to help you make a solid judgment call.