Dependence on alcohol

Alcohol dependence manifests when the central nervous system adapts to the presence of alcohol in the body. People who are dependent on alcohol experience withdrawal symptoms when drinking slows down or stops. More on alcohol dependence here.

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Often, people drink to try and reduce symptoms of underlying emotional or psychological disorders (also known as self-medicating). But in the long term, alcohol makes these disorders worse because it interferes with the chemical balance in our brains.

What happens to cause alcohol dependence and how can it be treated? We review here. Then, we invite your questions about physical dependence on alcohol at the end.

Alcohol dependence vs. alcohol abuse

Alcohol dependence and alcohol abuse are two types of problem drinking. But these two conditions manifest specific symptoms and require different types of treatment. So what are the differences between abusing alcohol and being dependent on alcohol?

Alcohol abuse occurs when a person drinks too much and too often but is not physically dependent on alcohol. In addition to its physical effects, this abuse can lead to dangerous behavior such as driving a car after drinking, or to legal problems such as an arrest for drunk driving. Alcohol abuse can also involve trouble with personal relationships and with taking care of home or work responsibilities. People who abuse alcohol often continue to drink, even though they know it may cause these problems.

Alcohol dependence is diagnosed when, upon slowing down or stopping drinking, a person experiences withdrawal symptoms. When they stop drinking, an alcohol dependent person can get nauseated, sweaty, shaky, and restless. These withdrawal symptoms cause them to start drinking again, even though doing so can lead to physical or mental problems. This is why alcohol dependence is considered a more serious problem than alcohol abuse. It is an indication of the presence of alcoholism, a lifelong disease in which people have a strong need to drink, cannot control their drinking once they start, and need to drink greater amounts of alcohol over time.

Alcohol dependence time: How long to be dependent on alcohol?

When you’re drinking on most days, you can become psychologically dependent on alcohol. Breaking your drinking cycle is an important way to test for and tackle dependence on alcohol. Try taking some days off from drinking. It can prevent your body from becoming accustomed to alcohol and help to lower or reset your tolerance.

If you drink regularly, your body builds up a tolerance to alcohol. Tolerance is a physiological response we have to any drug: the more you consume, the more your body needs to have the same effect. Regular drinking induces certain enzymes in your liver that break up (metabolize) alcohol. If you drink heavily over weeks or months, levels of these enzymes go up, your tolerance builds and you need more alcohol to get the same effects.

Brain systems get tolerant to alcohol too, and although you may be able to walk a straight line after drinking quite a lot, this means the brain has adapted so that next day the brain cells expect alcohol. Keep in mind that it is never advised that you go cold turkey off alcohol if you’ve become dependent on it.

Dependence on alcohol symptoms

  1. Illnesses from alcohol use, such as alcoholic liver disease
  2. Needing more and more alcohol to feel drunk
  3. The presence of alcohol withdrawal symptoms when you haven’t had a drink for a while

The primary symptom of dependence on alcohol is a set of “withdrawal” symptoms that occur when you slow down or stop drinking completely. Alcohol withdrawal symptoms usually occur within 8 hours after the last drink, but can occur days later. Symptoms of alcohol withdrawal usually peak in 24 – 72 hours after your last drink, but may persist for weeks. Common symptoms of alcohol withdrawal include:

  • anxiety or nervousness
  • confusion
  • depression
  • fatigue
  • irritability
  • jumpiness or shakiness
  • mood swings
  • nightmares
  • not thinking clearly
  • sweating
  • tremor of the hands or other body parts

Other symptoms which occur during alcohol withdrawal can include: clammy skin; enlarged (dilated) pupils; headache; insomnia (sleeping difficulty); loss of appetite; nausea and vomiting; pallor; and rapid heart rate. A severe form of alcohol withdrawal called delirium tremens can cause more severe symptoms that require medical treatment including seeing or feeling things that aren’t there (hallucinations) and/or seizures.

Physical dependence on alcohol

Physical dependence on alcohol occurs when a person’s body has adapted to chronic drinking, and manifests as physical symptoms when s/he stopped drinking. NOTE: A person can be psychologically dependent on alcohol without being physically dependent, but a person can’t be physically dependent without being psychologically dependent. Chronic alcoholism occurs when physical and psychological symptoms of dependence are present. Alcoholism is treatable and controllable, but not curable.

Psychological dependence on alcohol

Psychological dependence on alcohol include drinking in order to function “normally” and feel good. If you use alcohol to try and improve your mood, you may be starting a vicious cycle. Anxiety, depression and suicidal feelings can all develop when you’re psychologically dependent on alcohol. This is because regular, heavy drinking interferes with neurotransmitters in our brains that are needed for good mental health.

Being dependent on alcohol can also affect your relationships with your partner, family and friends. It might mean you don’t perform well at work and if that continues for any length of time you could face losing your job, leading to financial problems as well. If you think your mental health is suffering because of your drinking, but you feel you’re not able to stop, ask for professional help. Non-judgmental assistance is available all over the country.

Alcohol dependence withdrawal

If you suspect that you are dependent on alcohol, never try to quit drinking cold turkey. Always seek medical assistance. Permanent and life-long abstinence from alcohol is the best treatment for those who have gone through withdrawal. It is important that after alcohol dependence withdrawal a person goes home to a living situation that helps support them in staying sober. Some areas have housing options that provide a supportive environment for those trying to stay sober.

Moderate to severe alcohol dependence withdrawal

People with moderate-to-severe alcohol detox symptoms may need inpatient treatment at a hospital or other facility that treats alcohol withdrawal. You will be watched closely for hallucinations and other signs of delirium tremens. Treatments for alcohol dependence and withdrawal may include:

  1. Administration of anti-seizure or anti-psychotic medications if necessary
  2. Monitoring of blood pressure, body temperature, heart rate, and blood levels of different chemicals in the body
  3. Fluids or medications through a vein (by IV)
  4. Sedation using medication called benzodiazepines until withdrawal is complete

Mild to moderate alcohol dependence withdrawal

If you are experiencing mild-to-moderate alcohol withdrawal symptoms, you can often be treated in an outpatient setting. You will need someone to commit to staying with you during this process and who can keep an eye on you. Daily visits to your health care provider are often needed until you are stable. Treatment for mild alcohol dependence usually includes:

  1. Blood tests
  2. Patient and family counseling to discuss the long-term issue of alcoholism
  3. Sedative drugs or drugs which address cravings for alcohol to help ease withdrawal symptoms
  4. Testing and treatment for other medical problems linked to alcohol use

Alcohol dependence questions

Still have questions about alcohol dependence? Please leave your questions in the comments section below. We do our best to respond to you personally and promptly.

Reference Sources: NCBI: Alcoholism and alcohol abuse
NIH Senior Health: If you drink
NCBI: Alcohol withdrawal
Go Ask Alice: Is drinking addiction psychological or physical?
About the author
Lee Weber is a published author, medical writer, and woman in long-term recovery from addiction. Her latest book, The Definitive Guide to Addiction Interventions is set to reach university bookstores in early 2019.
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