Alcoholism (alcohol addiction): Signs, consequences, help

Alcoholism is a serious mental illness. The development from consumption to abuse to dependence is gradual. Characteristic of addiction are, among other things, a strong craving for alcohol, increasing consumption and the appearance of withdrawal symptoms. Read all about the signs and consequences of alcoholism and how to control the addiction here

Alcohol can easily change from a stimulant to a highly dangerous drug. But the transition to addiction is not a one-way street. Strict withdrawal and proper relapse prevention are crucial.

Brief overview

• Signs: Strong desire for alcohol, loss of control, increase in quantity, withdrawal symptoms, neglect of interests and contacts, continued consumption despite negative consequences
• Possible consequences: Damage to liver, pancreas, stomach and intestines, cardiovascular system, cognitive deficits, anxiety, depression, suicidal thoughts, loss of job, destruction of social relationships
• Causes: Genetic predisposition, stress, psychological strain, emotional instability, problematic handling of alcohol in the family and circle of friends
• Diagnostics: Information from close relatives, questionnaire, blood test (liver values), examination for possible typical secondary diseases of alcohol addiction
• Therapy: Inpatient or outpatient, cognitive behavioural therapy, individual therapy, group therapy, mindfulness training, stress management training, therapy goal: abstinence
• Prognosis: Addiction is lifelong, good chances of abstinence even in isolated relapses if the disease is understood and treated, severe secondary diseases if untreated, shortened life span

Alcoholism: Signs

Alcohol addiction (also: ethylism, drunkenness) is not a weakness of character, but a serious mental illness. It can affect anyone: People from all walks of life, young and old, women and men. In Germany almost all adults consume more or less alcohol. Some drink dangerously large quantities, but are nevertheless not addicted. At what point does the addiction begin?

When is one an alcoholic?

The six main signs of addiction also apply to alcohol addicts. If three of them occur within a year, the person concerned is considered an addict by the definition of alcoholism.

Strong craving

The central symptom of an alcohol addiction is an almost uncontrollable craving for alcohol. It can be a permanent condition or it can suddenly attack the person concerned.

Loss of control

Alcoholics lose control over when and how much they drink. The loss of control is an important sign of alcohol addiction. After the first glass there is no stopping for many until they are heavily intoxicated. Against their better judgment, they also drink in situations where it is inappropriate or dangerous – for example during working hours or when they still have to drive.

Tolerance development

Through excessive consumption, the body develops a tolerance for alcohol over time. Those affected then need ever larger quantities to feel the desired effect. A sign of alcoholism is therefore also that those affected seem to be able to tolerate considerably more alcohol than non-dependent consumers. This does not mean, however, that the higher drinking amount does less damage to their body.

Withdrawal symptoms

If an alcoholic with physical dependence drinks less or no alcohol at all, withdrawal symptoms appear. These include trembling, sweating, insomnia, anxiety and depressed mood. Only a new dose of alcohol can initially relieve the withdrawal symptoms. This vicious circle is difficult to break.

The so-called delirium is feared during withdrawal. It can be accompanied by hallucinations. Delirium can cause life-threatening circulatory problems.

Neglect of other interests

The constant circling of thoughts about the procurement and consumption of alcohol and the time taken up by drinking and intoxication make alcoholics neglect their duties and interests. Friends and family also take a back seat.

Continued consumption despite harmful consequences

Alcoholics do not stop drinking even if the consumption already has harmful physical, psychological or social effects. They drink despite the threat of losing their job, separation from their partner or a diseased liver.

Lack of awareness of illness

Alcoholics no longer drink for pleasure, but out of an inner compulsion or even a physical need. This is why attempts to reduce consumption regularly fail.

Nevertheless, most alcoholics are initially convinced that they could stop at any time. Often they actually manage to do so for days or weeks. This strengthens their belief that they are not dependent.

But as soon as they reach for a glass again, the next relapse with loss of control is usually pre-programmed. Their failure increases their frustration and makes them drink even more.

Feelings of shame, secrecy

In spite of their obvious problems, most alcoholics are far from being alcohol dependent. The reason for this may be the extreme stigmatisation that people with alcohol problems face. These prejudices are often shared by the alcoholics themselves (“I’m not a bum”).

Added to this is the fear of the necessary consequences – namely having to give up alcohol. Many people with alcoholism drink in secret as soon as the environment alerts them to the problem.

Types of alcohol addiction

Depending on the drinking behaviour one can distinguish different types of alcohol addiction.

Mirror drinker

The so-called mirror drinker consumes rather small amounts of alcohol, but continuously throughout the day. This type maintains a certain concentration of alcohol in the blood to avoid withdrawal symptoms.

Intoxicated drinker

In contrast, there is the intoxicated drinker, who cannot control his drinking behaviour and continues to drink until he is intoxicated. He gets used to an ever increasing amount of alcohol. This form of chronic alcohol abuse (chronic alcohol abuse) occurs most frequently.

Conflict drinker

Much rarer is the conflict drinker, who only drinks excessively when problems or conflicts arise. This type uses alcohol to overcome difficulties.

Episodic drinker

The episodic drinker consumes alcohol excessively at times and then remains abstinent for a few weeks. This drinking behaviour is also known as dipsomania.

Functional alcoholics

An alcoholism is not always obvious. Some sufferers hide their alcohol addiction for years so cleverly that nobody notices. Many succeed in continuing to perform even demanding activities.

Recognizing dangerous alcohol consumption

An alcohol addiction develops insidiously. The following signs indicate that you are developing an alcohol addiction. Then you should seek counselling to avoid slipping into addiction.

• They’re drinking more and more.
• They are drinking increasing amounts.
• They like to drink alone.
• You drink so much that memory lapses occur.
• They continue to drink despite the negative consequences.
• You hide how much you drink.
• You are approached by others about your drinking behaviour.

Alcohol addiction: Causes and risk factors

Most people in Germany drink alcohol, many also drink in harmful quantities. However, only a fraction of them are alcohol addicts, namely around two million.

The exact causes of alcohol dependency have not yet been fully explained. However, several factors always come together. Both genetic and psychosocial influences play an important role.

Genetic influences

Is alcoholism hereditary? Studies of family and twin research show that there is a genetic risk for alcohol addiction. Identical twins have a significantly increased risk of becoming alcoholic if one twin is affected. If both parents are addicted to alcohol, about 30 percent of the children later also develop alcohol addiction.

Consumer behaviour in the family

Besides the genes of the parents, their relationship to alcohol also plays a role. When children learn that drinking a lot is fun or even causes admiration or that alcohol is used to overcome problems, they quickly take it as a bad example. If later on they also drink a lot in their own circle of friends, the effect is intensified.

Roots in childhood

Traumatic or stressful experiences often form the basis for the development of an addiction. Particularly at risk are people who have experienced abuse or loss in childhood, such as the death of a parent. The bond with the mother is also decisive for the further development of the child. Children whose mothers do not respond to their needs or children without a permanent caregiver are later more susceptible to alcoholism.

Alcohol among friends

Especially during puberty, another factor is added: peer pressure. Puberty is a complicated phase in which young people try to develop their personality and self-image and to connect with their peers. Peer pressure can become a trigger for drinking. Anyone who does not drink with them risks being excluded from the group.

Young people often have a positive attitude towards alcohol. Being “fit to drink” is considered a sign of strength. However, people who have this characteristic and can tolerate alcohol well are even more at risk of becoming alcohol-dependent than those who cannot tolerate much alcohol. Because the latter automatically drink less.

Alcohol as an aid to life

Another risk for alcohol abuse is the initially positive effects of consumption. Under the influence of alcohol, inhibitions and anxieties are reduced in the short term. For rather insecure people or people in difficult phases of life, the risk of alcohol abuse therefore increases.

Alcohol as a drug for happiness

The processes in the brain also play an important role in the development of alcohol addiction. This is because alcohol increases the release of the neutransmitter dopamine, which activates the reward system in the brain. Dopamine creates feelings of happiness. It is also released, for example, when we eat something.

But alcohol activates the dopamine receptors even more than food. Drinking alcohol is therefore rewarded with feelings of happiness. People who drink alcohol too often become less sensitive to dopamine – they need larger amounts. If they drink less or no alcohol, they develop a strong craving. This is also known as craving.

Alcohol addiction: Examinations and diagnosis

Harmful use or alcoholism? Based on certain criteria, the doctor or therapist can decide what applies to a person and plan further treatment accordingly. As the first point of contact, your family doctor will be able to help you.

Examinations for alcohol addiction

If an alcohol addiction is suspected, the doctor will first have a detailed conversation with the person concerned. The family doctor could ask the following questions in an initial consultation:

• Do you often feel the need to drink alcohol?
• How much alcohol do you drink per day/week?
• Do you have the impression that you often have to think about alcohol?
• Have you ever tried to reduce your alcohol consumption?
• What positive or negative effects does alcohol have on you?

External withdrawal symptoms, such as sweating, trembling or reddening of the skin, can be a sign of alcohol addiction. With the help of a blood test the doctor can find further indications of increased alcohol consumption. The blood count also provides information about the condition of the liver. In addition, the doctor will carry out a comprehensive physical examination to determine any other possible consequential damage.

Diagnosis: abuse or alcohol dependency (ICD-10)

If the suspicion of an alcohol dependency is confirmed, the family doctor will refer you to outpatient specialists or a clinic. These will make an exact diagnosis and draw up an individual treatment plan to combat the alcohol addiction.

Diagnostic criteria for alcoholism

The criteria used to diagnose alcohol addiction are usually those of the International Statistical Classification of Diseases and Related Health Problems (ICD-10).

A distinction is made between the harmful use of alcohol, known as alcohol abuse or alcohol abuse, and alcohol dependence. According to the ICD-10 for alcohol dependence, at least three of the following criteria must occur simultaneously in one year for a diagnosis to be made:

• There is a strong desire to drink alcohol.
• Those affected have no control over when or how much they drink.
• If alcohol consumption is reduced or stopped, withdrawal symptoms (e.g. sweating or trembling) occur.
• A tolerance for alcohol develops, so that the amount has to be increased more and more to feel an effect.
• Dealing with alcohol takes up a lot of time and leads to the neglect of other interests.
• Although the consumption of alcohol has negative consequences, those affected do not stop drinking.

Alcoholism: Alcohol withdrawal

In the case of physical dependence, a detoxification must be carried out first. Before the actual alcoholism therapy, the affected person must undergo a medically supervised alcohol withdrawal, a so-called detoxification. The withdrawal of alcohol can be accompanied by mild to severe physical withdrawal symptoms. In the case of severe dependence, the withdrawal can even be life-threatening. It should therefore always be carried out under medical supervision. Only after the physical withdrawal does the actual withdrawal therapy follow.

Outpatient withdrawal

In minor cases this is possible on an outpatient basis. The patient then appears daily over a certain period of time to check his breath for alcohol. In addition, a doctor checks the withdrawal symptoms such as trembling, sweating, concentration problems and high blood pressure. It is also possible that a urine test is carried out at the end, which can detect alcohol for a much longer period of time.

Inpatient withdrawal

In more severe cases, in-patient detoxification is necessary. On the one hand, patients who are unable to give up alcohol on their own cannot get hold of alcohol here. On the other hand, withdrawal can also lead to the dreaded delirium tremens. It can be accompanied by anxiety, confusion and hallucinations.

The dangerous physical symptoms such as epileptic seizures, rising blood pressure and racing pulse can be better controlled here. Under inpatient medical supervision, the delirium can be intercepted by medication and treated in time.

You can read more about this topic in the article Alcohol withdrawal.

Alcohol addiction: Treatment

Even though addicted people can no longer suppress their alcohol addiction, very few people seek immediate help with alcohol addiction. For one thing, the shame is very great. On the other hand, the thought of having to give up alcohol is unimaginable for many.

But alcoholism is a life-threatening disease. It can only rarely be managed on its own. Therefore, do not hesitate to seek help with alcohol addiction if you are afraid of drinking too much.

Abstinence or reduced drinking?

Those who are not yet addicted to alcohol have a good chance of reducing their consumption again – preferably under supervision.

But once the addiction has developed, it becomes a lifelong companion. The goal of weaning therapy is usually complete abstinence from alcohol. However, many alcoholics cannot imagine (at least not at first) doing without alcohol completely. In the past, they have thus usually fallen out of the range of help available.

In the meantime, addiction experts have changed their attitude. Since 2015, the guidelines for alcohol therapy have also recommended reduced drinking as a possible therapy goal for alcohol patients who cannot manage abstinence.

Under certain circumstances, in the course of time, the patient may find it feasible – or even easier than the reduction in drinking. After all, the constant self-control of the amount drunk is not easy. The urge for more remains.

However, for most offers for alcohol cessation, the willingness to abstain is still the basic requirement.

Contact points for alcoholism

The first contact person is usually the family doctor. Further help with alcohol addiction is provided by psychiatrists and therapists, but also by public organisations, associations and counselling centres dealing with alcoholism.

Psychological weaning therapy

To get out of alcohol addiction, you have to start from scratch. You have to get rid of old habits, uncover the causes of addiction and find new ways to deal with problems and stress or to create positive feelings.

Weaning therapy is always made up of various building blocks that address the different aspects of addiction and its reinforcers: Individual conversations and group therapy are combined. In addition, elements such as stress management and mindfulness training are also included.

Individual therapy

Addiction treatment is usually based on cognitive behavioural therapy. In individual therapy, the therapist works intensively with the patient to develop new patterns of thought and behaviour.

An essential step is to uncover the personal reasons for slipping into alcohol. In order to remain abstinent, the patient must develop new coping strategies for the addiction-triggering situations together with the therapist. He learns to get away from the automatic grip on the bottle and to find new sources for positive feelings.

Group therapy

Group therapy is the second central component of addiction treatment. The experience of meeting others, people who have experienced addiction first-hand, helps to reduce feelings of shame. In a mutual exchange, patients can benefit from each other’s tips and coping strategies and can encourage and support each other.

The leading therapist often also addresses central life issues that play a role in addiction: Life goals, partnership, relationship with parents, losses or fears.

Family or systemic therapy

Often the addiction has already damaged the relationship with friends and family. There is often a so-called co-dependence in the case of alcoholism: the relative supposedly helps the sick person, for example by covering for him or her towards outsiders or by tolerating his or her behaviour.

However, family problems may also have contributed to alcohol addiction. Both can be treated within the framework of family therapy.

The focus is usually on an open, respectful communication behaviour without blame. This makes it easier for both sides to approach each other again. The relatives learn how to support the patient, but also how to set themselves apart.

Mindfulness training

In mindfulness exercises such as the “Body Scan”, the patient focuses his or her full attention on the here and now. He learns to clearly perceive his feelings, positive and negative, but also to accept them as something temporary. In this way, an imminent relapse, for example, can be detected early so that the patient can take countermeasures in good time. The techniques can also be used to overcome strong addictive pressure.

Stress reduction

Stress is a central cause for most alcoholics – and always a trigger for relapses. During therapy, the patient learns how to stress himself or herself less or how to let himself or herself be stressed externally. Learning a relaxation method such as autogenic training or progressive muscle tension according to Jacobson is also helpful.

Medication against cravings

For people who cannot achieve abstinence with psychotherapy alone, additional medication against alcohol addiction can help:

• The active ingredient naltrexone reduces the positive effects of alcohol. For alcohol addicts, these tablets for alcohol addiction are often used as a relapse prevention measure.
• The active substance disulfiram causes a strong intolerance of alcohol. The person affected then suffers from headaches, shortness of breath, redness on the face, nausea and vomiting when drinking alcohol.

Inpatient or outpatient?

Inpatient treatment: It is difficult to get away from alcohol. It is often easier to do so in a clinic specialising in addiction. For one thing, you are not confronted with other people who drink and it is difficult to get alcohol at all.

For many patients, however, it is above all important to get away from their usual environment and concentrate completely on themselves and on overcoming the illness.

Patients who have been ill for a long time and are severely ill often no longer have a job and, apart from their drinking routines, have hardly any daily structure. In the clinic they have the opportunity to get used to a regular daily routine again, to develop new interests and learn to take responsibility for smaller tasks. An inpatient treatment usually lasts between three and six months.

Outpatient weaning: For patients who are less severely ill, for example still have a job and are socially well integrated, outpatient treatment can be useful. This can, but does not have to take place on a part-time basis.

The advantage is that patients can practice life without alcohol right away in the “wild”. They learn to refuse alcoholic beverages in social gatherings, not to be tempted by the beer, schnapps or wine on offer when shopping or to cope with stressful situations without alcohol. An outpatient treatment usually lasts nine to twelve months.

Dealing with relapses

Alcoholism cannot be “erased”. Anyone who has once been addicted to alcohol has to decide against alcohol again and again, even after successful completion of an alcoholism therapy. Each glass can cause a serious relapse. Even if the first alcoholic drink after a long time seems to have no consequences, consumption usually returns to the old level within a very short time.

The way out of alcohol addiction is long and difficult. The patient is therefore prepared for dealing with possible relapses. Relapses are frequent and it is important that those affected do not regard them as personal failures but as part of the learning process. It is then important to recognise what triggers for the relapse were in order to avert them in time in the future.

Support groups

Self-help groups make a significant contribution to remaining stable after the therapy. Through the regular meetings, the topic of alcohol addiction remains present. This protects against relapses. In the group, the affected person finds support and an understanding that those who are not affected cannot muster. Some arrange for personal mentors who can contact them in an emergency.

Controlled drinking

The will to abstain is still the basic prerequisite for the classical forms of therapy. Another approach is the so-called “controlled drinking”. It is only intended for people who are not yet too deeply and not too long in the addiction.

The 10-step program was developed years ago by the psychologist Joachim Körkel. Among other things, the patient is supposed to recognize the occasions on which he or she drinks, keep a drinking diary and learn to set and adhere to fixed drinking targets.

However, the rules are strict: he must determine the time, place, circumstances and amount of drinking in advance. The latter should be set so low that hardly any effect is achieved. Experts criticise that the loss of control is part of the disease and that controlled drinking is therefore a contradiction in terms for addicts.

Alcohol addiction: course of disease and prognosis

The drinking of alcohol is firmly anchored in society. As a legal drug, alcohol is readily available and readily available at all times and is also comparatively inexpensive. It relaxes, lifts the spirits and uninhibits. The danger of drinking too much is therefore great.

Risky consumption

The line between pleasure and danger is thin: more than 24 grams of pure alcohol for men (e.g. two glasses of beer at 0.3l) and 12 grams (e.g. one glass of beer at 0.3l) daily for women are already considered risky consumption. But even less alcohol can harm sensitive people in the long run.

Alcohol abuse

The transition from harmful use to addiction is fluid. At first, most people use alcohol to create positive feelings, to relieve fears and insecurity or to mask problems. The consumption increases to harmful use.

This is not yet a dependency. However, many people are already experiencing problems related to alcohol consumption: trouble with partners, friends or at work, for example.

Those affected lose their performance, more often fail to meet their obligations or the person affected suffers an accident while intoxicated. Other alcoholics manage to hide their addiction for a long time.

Mental dependence

Psychological dependence follows. The affected person increasingly neglects social life and tasks. Alcohol becomes the centre of life. Thoughts often only revolve around the next glass. At this stage, the affected person often hides the drinking. If no alcohol is available, a strong desire for it develops.

Physical dependence

If the body gets used to alcohol and the person concerned needs larger amounts for the desired effect, this is the beginning of physical dependence. If the addict renounces alcohol at this stage, physical withdrawal symptoms appear.

They range from sweating and trembling to life-threatening delirium with hallucinations. In severe cases, withdrawal can be fatal, at least when taken alone. It should therefore always be carried out under medical supervision.

Reduced life expectancy

Without therapy, the average life expectancy of an alcoholic is reduced by twelve years. The most frequent causes of death are suicide, accidents, liver failure, heart disease and cancer.

Despite consistent use of all therapeutic options, only 45 percent of former alcoholics are still abstinent four years after the end of therapy. However, those who are not deterred by relapses can also get alcohol addiction under control in the long term.

Lifelong issue

Untreated, alcoholism usually remains a constant companion until – often prematurely – death. However, alcoholism in old age is often not recognized. Falls or cognitive deficits are then quickly attributed to old age instead of the addictive disease.