Alcohol Addiction

It is thought that alcohol addiction arises from an interaction of genetic, psychological and environmental factors, and the relative contribution of each will vary from one individual to another. Addiction is characterised by dependency, tolerance and withdrawal. Dependency refers to the need to drink regularly in order to function, and to deal with distressing symptoms such as anxiety (psychological) and tremors (physical). Tolerance relates to the need to consume increasing amounts of alcohol to achieve the same effects. Withdrawal refers to the experience of unpleasant symptoms when decreasing or stopping drinking, such as nausea, irritability, difficulty in sleeping and rises in blood pressure; in severe cases seizures, delirium or hallucinations may occur. Alcohol dependence is classified as mild, moderate or severe. Diagnosis will include a judgement as to whether physiological dependence is present.

While not denying that genetic influences may play a part, the dominant view in psychology today is that drinking behaviour is learned and maintained through social learning processes. For example, drinking may come to be associated with certain environmental factors, such as time of day, or specific drinking situations such as being in a pub with work colleagues or friends, or a family gathering. This can lead to changes in thoughts and feelings such as the experience of social anxiety, negative beliefs about the self in relation to others, or positive expectancies about the effects of alcohol in such situations. The drinking behaviour that follows is then reinforced by the positive consequences of drinking, making it more likely that the behaviour will recur in similar future contexts. For example, negative symptoms of depression or social anxiety may disappear, the person may begin to feel more positively about themselves, or be able to forget about their problems. If this response pattern is repeated over a sufficiently long period of time, addictive problems can develop. However, clear conclusions have yet to be drawn as to why some individuals are more vulnerable to developing alcohol problems than others.

People may seek treatment because alcohol consumption itself is the major presenting problem, others because of the consequences of alcohol use such as disruption in relationships, occupational problems, or problems with the criminal justice system. The rates of separation and divorce among heavy drinkers are up to seven times that of the general population. Day to day functioning is often impaired in suffering individuals. Many problems at the individual level can be caused or exacerbated by prolonged heavy drinking. On the cognitive level, memory, reasoning and problem solving abilities may be affected; medical problems include such conditions as liver disease, ulcers and pancreatitis. It is very common for other psychiatric disorders to occur alongside the addictive behaviour, such as anxiety and depression.

There are a variety of different treatment settings and therapeutic options for the sufferer, ranging from self-help groups (eg Alcoholics Anonymous), to various inpatient and outpatient programmes. It is recognised that individuals vary greatly in the degree to which they are aware of their problem severity, and also in their motivation to change; such factors will be assessed early on within therapy so that treatment can be planned accordingly. It is not uncommon for the spouse or some significant other to be involved in the treatment, and a supportive social system is associated with positive treatment results.

Symptoms & Behaviours

Signs of alcohol addiction may include one or more of the following:

  • drinking heavily on a regular basis, and in excess of national health guidelines (i.e. 21 units per week for men; 14 units per week for women)
  • binge drinking; i.e. heavy bouts of drinking interspersed with periods of abstinence
  • loss of control
  • physical tolerance and dependency
  • withdrawal symptoms on cessation of drinking
  • interference with daily functioning
  • legal, occupational or relationship problems as a result of drinking

Withdrawal symptoms from mild to severe may include:

  • night fears
  • trembling
  • nausea and vomiting
  • difficulty sleeping
  • anxiety and irritability
  • elevations in blood pressure
  • seizures
  • delirium
  • hallucinations

Assessment

The two main aims of assessment are to make a diagnosis, and to plan treatment for an individual. To be diagnosed as alcohol dependent, three of the nine criteria listed by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, must be met. These include loss of control, physical tolerance, interference of alcohol with daily functioning, and the presence of withdrawal symptoms on cessation of drinking (please refer to above list). Alcohol dependence is classified as mild, moderate or severe. A judgement will also be made as to whether there is physiological dependence. Treatment planning will consider the severity and extent of an individual's problems, the extent to which they are willing and motivated to change, and an analysis of the environmental factors maintaining the current drinking pattern.

Treatment

If you have a problem with alcohol, it will be a good idea to visit your G.P., who may then refer you on to a local addictions service. You can also (or alternatively) join Alcoholics Anonymous (AA) which opens its doors to anyone with a desire to stop drinking; you will be encouraged to attend meetings in your local area, where support and encouragement will be offered by other members who are nonprofessional, and who have identified themselves as having problems with alcohol.

The G.P. or addictions worker will judge whether or not you are physically dependent upon alcohol (for example if you experience any of the withdrawal symptoms listed above), and if so you may be recommended for a detoxification, either as an in-patient, or within the community. Librium may be prescribed to reduce the severity of withdrawal symptoms as you reduce or cease your consumption of alcohol. This medical treatment may be necessary before psychological therapies can be implemented.

Addictions services tend to offer individual counselling or group therapy, and the trend recently is towards the latter, as group work is being increasingly seen as the most effective way to deal with alcohol problems. Within therapy you will be encouraged to look at the social and environmental factors which may be increasing the likelihood of your drinking. For some people, addressing their alcohol problems may need a radical shift in lifestyle, such as avoiding social drinking at the pub after work, where peer pressure may play a role.

If worry and stress are contributing to your drinking, then alternative responses and ways of coping with stress may be suggested, and you will be encouraged to practice these new strategies, and ways of looking at things, between therapy sessions. Social skills and problem-solving skills may be taught, within the supportive, therapeutic atmosphere. It may be suggested that you involve other people within your support network that may help and encourage you in your efforts to tackle your drink problem. Research has indicated that a supportive spouse, or other family member, can increase the chances of success. In the absence of a close family network, the social support of the therapeutic group may be called upon, whether this be within the context of the addictions services, or within such self-help groups as AA.