Alcoholism & Alcohol Dependence

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Defining Alcoholism

What Is Alcoholism?

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The term alcoholism refers to the consumption of alcohol to the extent that the person is unable to manage their own drinking habits or patterns, resulting in side-effects that are detrimental to the quality of life and health of the alcoholic, or those around them.

An alcoholic is someone who continues to compulsively abuse alcohol in this way, despite the negative consequences to their lives and health.

Someone with an alcohol problem will usually exhibit:

  • A compulsion to drink, beyond the emotional addiction to alcohol
  • A mental obsession around access to alcohol, and securing access to the next drink
  • An automatic emotional response to use alcohol in order to handle stressors
  • Behaviour patterns to ensure continued access to alcohol. In more extreme instances, this may be at the cost of relationships, jobs, or other important factors
  • Denial of the extent of their problem, and outright refusal to learn about or get help for alcohol addiction

Alcohol Use Disorder

Since "alcoholic" is perceived by many as an unhelpful word, alcoholism is often referred to as "alcohol use disorder" in the medical world.

The extent to which someone is suffering from Alcohol Use Disorder, is defined by DSM-5 criteria, as the number of symptoms they experience from a list; where:

  • Mild Alcohol Use Disorder = 2-3 symptoms 
  • Moderate Alcohol Use Disorder = 4-5 symptoms 
  • Severe Alcohol Use Disorder = 6 or more symptoms 

Under these guidelines, an alcoholic is someone who fulfils any 2 or more criteria from this range, within the same 12 month time span:

DSM-5 Criteria For Alcohol Use Disorder

1) Consuming more alcohol over time, or for longer than you intended.

2) Having a desire to stop drinking, but being unable to achieve this in practice.

3) Excessive time spent on obtaining, using, or recovering from alcohol use.

4) Experiencing cravings and strong urges to consume alcohol.

5) Being unable to fulfil obligations at home, school, or work, because of alcohol use.

6) Continuing to use alcohol, even when it causes relationship or social problems.

7) Neglecting important activities at work, socially, or recreationally, because of hamful substance use.

8) Exposure of self to risk, or danger, because of repeated alcohol use.

9) Continuing to consume alcohol, even when you know you have a somatic or psychological problem that could have been due to alcohol.

10) Needing more alcohol to get the same euphoric effect (developing tolerance).

11) Development of withdrawal symptoms, which can be relieved by drinking more alcohol.

What Is Binge Drinking?

Binge drinking refers to a pattern of excessive but temporary drinking for condensed periods over time. Binge drinkers may exhibit signs of long standing alcohol addiction, but rationalise their drinking due to celebrations or other external ocassions.

Binge drinking is considered a significant precursor to, and risk factor for, alcohol use disorder.

Binge drinking can be classed as:

  • Men - 5 or more drinks per one day during the past month
  • Women -  4 or more drinks per one day during the past month

What Is Heavy Drinking?

Heavy drinking can be classed as:

  • Men - 15 or more drinks per week
  • Women - 8 or more drinks per week

SAMHSA define heavy drinking as binge drinking for 5 or more days in the last month. [1]

Warning Signs Of Alcoholism

Based on our knowledge of working with thousands of clients since 2005 at our services, if you answer yes to 2 or more of the following questions, you may have an alcohol problem.

This is based on qualitative research data through subjective encounters with our client group at our center / program, as opposed to quantitative research data.

  • Can you consume alcohol on occasion without later craving the same sensations you achieved from the initial experience?
  • Are you thinking about consuming alcohol during your role at work, family time, or romantic life?
  • Do your everyday thoughts include obsessing about alcohol, or when your next drink will be?
  • Does consuming alcohol, or thoughts of alcohol, impede upon your other daily duties?
  • Has your pattern of alcohol use progressed beyond occasional or become more frequent?
  • Does your alcohol use habitually co-incide with, or after difficulties at work, relationship problems, children, finances, etc?
  • Does your ability to deal with certain problems or situations depend upon alcohol use?
  • Do you show signs of irritability before or during drinking?
  • Are there challenges at home or work as a because of your drinking?
  • Do you worry about having access to alcohol?
  • Is the amount of alcohol you consume slowly increasing over time, without any external event prompting this?
  • Do you promise to yourself or others to quit or reduce your drinking, then later go back on those promises?
  • Do you prioritise drinking over other duties like your personal appearance, hygiene, health, and other needs?
  • Do you set out to drink a little, but end up drinking a lot?

Alcoholism Signs & Symptoms

Since alcohol addiction is behavioural, the signs of alcoholism can be recognised as behaviours, alongside how these behaviours usually manifest physically, later.

Emotional & Behavioural

  • Consuming larger amounts of alcohol, over time
  • Drinking alcohol alone, deliberately
  • Habitual rationalisation, excusing drinking behaviour
  • Angry outbursts when challenged on drinking behaviours or actions whilst under the influence of alcohol
  • Neglecting appearance, daily responsibilities such as paying bills, etc


The impact of alcoholism on the body is normally proportionate to the amount of alcohol consumed, and the pattern or frequency of usage.

Effects can include:

  • Loss of appetite and weight reduction
  • Fatty liver, including cirrhosis, in later stages
  • Compromised brain and neurotransmitter balance
  • Nervous system damage, including peripheral nervous system
  • Heart disease
  • Pancreatitis
  • Increased risk of stroke, cancer, dementia, seizures

Short Term Effects Of Alcohol Abuse

Blood Alcohol Concentration

Although dependent on the past, Blood Alcohol Concentration (BAC) counts of up to .12% usually develop into increased sociability, elevated mood, and somewhat delayed motor feedback.

As alcohol consumption increases, and BAC count rises, effects can vary from co-ordination and balance problems, to coma, and danger to life.

Health Effects Of Alcohol Abuse

Alcohol abuse causes many health conditions. Some health conditions include; Liver damage, starting with fatty deposits, progress in later stages of alcoholism to cirrhosis, hepatic portal vein blockage, and ascites.

Alongside alcohol abuse run increased risks of pancreatitis or pancreatic cancer, stroke, memory loss (short term and long term memory), diabetes, heart problems, hepatitis, anemia, gout, gastritis, ovarian or prostate cancer, and central or peripheral nervous system dysfunction, significantly damaging to a persons health. 

Diagnostic Tests / Tools For Alcoholism FAST Alcohol Screening Program 

FAST is a Gov resource which provides the best start to testing, it is a small questionnaire used by emergency departments in the UK. It consists of a sub-set of questions from the major AUDIT (Alcohol Use Disorder Identification Test).

A score of 3 or more on the first or all 4 questions indicates a positive result, requiring completion of the remaining AUDIT questions.


The remaining six questions in the AUDIT indicate risk or likelihood of alcohol dependence.

National Institute on Alcohol Abuse and Alcoholism (NIAAA) 11 Point Checklist

In the United States, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) provide the following checklist for categorisation of alcohol use disorder as mild, moderate, or severe, including the following statements: 

How many times in the past year have you:

  • Drank more or longer than you'd planned?
  • Wanted to stop drinking but couldn't?
  • Spent a lot of time drinking and/or being sick afterwards?
  • Craved drink?
  • Found drinking to interfere with family, friends, work, or school?
  • Continued to drink despite problems?
  • Foregone doing something you love in favor of drinking?
  • Found yourself in dangerous situations while or after drinking?
  • Had blackouts or other medical problems caused or worsened by drinking?
  • Increased alcohol units because you've built up a “tolerance”?
  • Experienced withdrawal symptoms when you didn't drink?

*Taken from the National Institute on Alcohol Abuse and Alcoholism (NIAAA)


The CAGE questionnaire is a easily applicable group of questions, most often used in primary care settings.

  • C - Have you ever felt you should cut down on your drinking?
  • A - Have people annoyed you by criticizing your drinking?
  • G - Have you ever felt bad or guilty about your drinking?
  • E - Eye opener: Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

Two positive responses to any of the above questions indicates existence of an alcohol problem that should be further explored.

Health Tests

The Liver Function Test (LFT) is a health test which can show deranged attributes such as Bilirubin levels, or high blood levels of the enzyme Gamma Glutamyl Transferase which can indicate damaged bile duct consistent with alcoholism.

Reasons People Drink

Indulging in the odd drink for a celebration is different to how someone in active addiction drinks alcohol.

So why are people content to abuse alcohol in an addictive way?


Like any drug, during the early stages, alcohol causes the user to feel pleasant sensations such as relaxation, euphoria, increased sociability, etc.

In the long run, the neurotransmitter mechanisms which are triggered by alcohol become 'habituated', meaning it needs greater and greater amounts of the harmful substance for the person to feel the same cascading effects on other centres.

This leaves the person chasing the original sense of gratification wanting to feel what they first experienced, although these are never achievable in reality.

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The brain and nervous system ultimately become used to the external substance abuse of alcohol, and expect it to be ongoing, for the processes of generating other neurotransmitters, and signalling other systems.

If alcohol is suddenly removed from the system, or not enough is there, this develops into side-effects consistent with under-representation of certain neurotransmitters and modulators, meaning effects such as trembling, headache, blood pressure changes, cardiac and breathing issues, etc, appear.

When an alcohol addiction goes unchecked in this way for long enough, withdrawal from alcohol for even a little time, can lead to chronic symptoms, without warning.

At this point drinking is not in order to attain pleasurable feelings, but to avoid much more serious withdrawal symptoms which can be a health risk. The person is now alcohol dependent.

Co-occurring Mental Health Issues

Some will start to use alcohol to compensate for mental health disorders which are really at the center of the issue.  In the absence of other solutions, e.g. a medical diagnosis of non-complex anxiety or depression disorders, or an issue with coping skills or isolation/loss of connection with others.

In some instances, they have been diagnosed by a medical professional with a challenging psychological complaint such as bipolar disorder, one of the personality disorders, an eating disorder, or similar. 

In these instances, it becomes very difficult to know which came first - the emotional issue, or the addiction.

Sometimes, complications mean that the issue has become compounded by alcohol, but, pre-dated alcohol use.

Other's struggle is such that it seems as though alcohol use in some ways causes the emotional issue.

Individuals with a confirmed medical diagnosis of a complex mental health issue like this, can find themselves in a position where mental health workers / medical staff refuse to progress treatment for (e.g.) anxiety or depression, until the addiction is resolved which leads to further complications.

However, they can feel that taking away the coping mechanism of alcohol, will increase anxiety or depression to an unmanageable degree and damage their mental health.


Causes Of Alcoholism


Upbringing & Beliefs

In our own work, therapeutic breakthroughs with alcoholics often reveal that self-esteem problems formed early on can lie beneath the continuous use of a coping mechanism like alcohol.

Exposure to alcohol use from a young age may increase possibility of alcohol use in adulthood, and children can develop a conclusion about alcohol such that "the way to deal with stress, is to use alcohol."

Secondary beliefs children develop from observational learning can also corroborate the normalisation of drinking alcohol. When young people witness the rationalisation of the side-effects of alcohol use, this can perpetuate false beliefs around alcohol, and allow the abuse of the harmful substance abuse to continue unchallenged.

Psychological Factors

Continuous stress raises blood cortisol levels which can in turn increase probability of alcohol abuse, especially where alcohol has previously been used as a coping mechanism. [2]

A background of trauma including abuse can indicate a higher risk for alcoholism, or other addictions, in order to handle unresolved emotional problems.

A history of depression or other more complicated mental health problems, such as bipolar disorder, schizophrenia, or borderline personality disorder, may coincide with greater incidence of alcohol addiction.

Social Group

  • Poor social connectedness - At our center we've witnessed definite social patterns attached to alcohol abuse. Specifically, poor social connections, lack of accountability to others, and voluntary self-isolating behaviour can lead to an increase in alcohol abuse.
  • Peers - Where they demonstrate drinking as a coping mechanism, and enable the use of alcohol, pressure to drink can increase where it is perceived that not drinking may risk being ostracised from the crowd.
  • Enablers - Family and/or close friends can often act - unintentionally - as enablers in assisting the alcoholic to carry on drinking.

This often manifests as a desire to help a loved-one avoid discomfort in the short haul, e.g. attached to an event. In this way, the alcoholic can gain access to money or resources needed to carry on abusing alcohol, in order to overcome a challenges.

However, this action only ends in the alcoholic concluding that:

  • They can access alcohol when needed, as a means to get away from problems or responsibilities
  • They will be enabled by others, in doing so
  • That using alcohol in this way, as a coping mechanism, is not only acceptable, but endorsed.

Later, when the addiction has spiralled out of control, these beliefs will often lead to manipulative or other malicious behaviour, in order for the alcoholic to carry on accessing alcohol.

 Thus, the cycle has been lengthened, and the addiction enabled, by the family members.

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KEY takeaway

What family members and loved ones need to realise here, is that at this point in the addiction cycle, alcohol has become the *only* way the alcoholic knows how to cope.

It used to be *one* way to get by, but now, it's the *only* way out.

Once the shame of a series of such events begins to compound each other, it's easy to see how a mild addiction escalates into a serious the emotional discomfort of admitting dependence would mean accepting responsibility for behaviours during addiction, and their consequences.

And, for most people, this is too much to bear, especially if access to alcohol is still readily available.


Hereditary or genetic factors may render some people pre-disposed to addiction to alcohol or other harmful  substances, e.g. if the person has a parent or other relative who had problems with alcohol.

Existing evidence indicates that alcoholism is 50-60% genetically determined. [3]

High Functioning Alcoholism

What Is This Type Of Alcoholic?

Such people are often professionals, they can be thought of as someone who may have a job that pays well, a family and established social bonds, yet still uses alcohol in a way that has detrimental effects on their lives.

Sometimes such people have an emotional deficit that they use alcohol to compensate for, e.g. the workaholic who believes "I'm never good enough," and uses alcohol to numb the emotional residue of the belief, as well as the toll the excess work takes on his body and close relationships.

These people are caught in the same cycle as anyone else suffering from addiction, but their conduct may be perceived as more socially acceptable to others, based on their apparent ability to perform well in different aspects.

Signs Of Alcohlism At This Level


At this level the alcoholic is content to use the external signs of his/her success as a reason to deny problematic drinking behaviour. 

Nevertheless, no matter how outwardly successful the person is, heavy abuse of alcohol over time, will ultimately catch up with the person in the form of physical and emotional problems.

Statistics On Alcohol Addiction

The WHO (World Health Organisation) reports an estimated 3.3 million deaths each year globally as a result of alcohol misuse, with 380 million people worldwide suffering from alcoholism. [4]

Alcoholism is least common in Africa, affecting only 1% of the population; whereas, Eastern Europe is worst affected, with 139,000 deaths from alcoholism in 2013 (same source). [5]

10% of all dementia diagnosis are secondary to alcoholism. [6]

Up to 25% of alcoholics suffer from chronic psychiatric problems. [7]

Around 12% of American adults have an alcohol problem at some point during their life. [8]

Over 50% of all suicide is connected to alcohol or drug addiction. [9]

47% of liver disease death in 2015 was correlated with alcohol use of adults. [10]

*Numbers indicate external references to statistics research

Alcohol Poisoning

Alcohol poisoning occurs where alcohol intake has reached levels such that vital organs such as the brain and heart, begin shutting down, which can lead to a risk of death.

2,200 people per year, or 6 people daily, die due to alcohol poisoning. [11]

Is Alcoholism Preventable?

Problem drinking in adults most often develops slowly, over time. And since moderate alcohol intake is generally not a sign of emotional or somatic dependence if its brief, someone's poor use of alcohol can be difficult to perceive clearly, until it's much more advanced.

Nevertheless, there are ways to minimise the risk of alcoholism appearing as an issue in your or others' lives.

  • Maintain strong social connectedness, especially during stressors and challenges. This means, building good coping mechanisms and a network of people who can assist you both personally and professionally, when problems arise.
  • Interpret mistakes and problems as temporary, and without impact upon who you are, your identity, or other unuseful conclusions that would impact upon self-esteem etc
  • Guard against the development of mental health risk factors such as depression or anxiety, by speaking up , and asking for help, if you need it. It's good to talk. 
  • If you have addiction in your family, be aware of the increased risks associated with this, and be alert to the possibility of skewed perceptions around what is a standard amount of alcohol to consume.
  • Take responsibility for your drinking. Be honest with yourself and others as to how your drinking impacts you. 
  • Ask yourself if alcohol is really an appropriate response, or way to handle certain moments or difficulties.
  • If you think you may have an alcohol problem, get external, qualified, opinion on your drinking attitude.

Treatment Types For Alcoholism

Most, but not all treatments include the concept of abstinence.

Which can be described as, ceasing to drink alcohol permanently, and maintaining it over time.


Interventions usually involve having a group of loved ones gather around the person suffering from alcoholism, to explain and talk about the negative effects their addiction is having, usually with a view to helping them reach a decision about getting external help.

Part of this approach centers around explaining the impact of what may happen to their health, if they do not learn more and do not move forward and seek help.

We released more resources from our professionals about how to help someone in this situation, in our pdf guide "How To Help A Loved One In Denial", available here (PDF Download). Many readers have found this helpful.

Download Now (PDF)

Supervised Detox & Rehabilitation Services

Undertaking a controlled detox from alcohol in supervised health services can assist with the most dangerous elements of withdrawing from alcohol, as a springboard to move forward into the therapy work, and aftercare support, needed for full recovery from alcohol addiction. Alcohol Rehabilitation Centers are an important part of this process.

Alcoholics Anonymous (AA) & Other Mutual Aid Support Groups

Whilst the AA does not offer medically supervised treatment services and progams, their community-driven mutual aid support group links people who wish to learn about Alcoholic Use Disorder and stop drinking. They have been running support groups world-wide, since the 1950s.

AA and other mutual aid groups or centers typically require only that members have an underlying intention to stop drinking. AA do not get involved in any form of treatment, programs, opinion, or funded endeavour in the world of recovery. Links to AA can be found here:


What is the prognosis for an alcoholic?

Full recovery from alcoholism is possible, but requires reversing all of the distructive routines, developed over time, during active addiction. How challenging this is, will depend on a person's past with alcohol, and their emotional reasons for using alcohol as a coping mechanism in the first instance.

This also does not account for the time taken to reverse any somatic manifestations of addiction, such as damage to the organs.

Are the effects of alcoholism reversible?

This will depend on the extent of destruction to the organs. In some extreme instances hospitalisation and close monitoring are required to stabilise responses until the body has a chance to heal.

In other less extreme instances, a more standardised, common regimen of alcohol detox medication can help restore equilibrium to the body and organs.

The psychological recovery from alcoholism will entail greater amounts of emotional work, over an extended time span. This can be thought more as behavioural affect, rather than a one-off exercise.

What medications are used to treat alcohol abuse?

Different types may be used depending on qualified professional advice, and the intended outcome.

  • Medications from the diazepine family, called Chlordiazepoxide or Diazepam, are used to compensate for the absence of alcohol in the system, and the risks of seizure and other complications, during (e.g.) a supervised residential alcohol detox process.
  • Medications such as disulfiram, also known as 'antabuse,' may be used to discourage alcohol use, where symptoms such as nausea or vomiting will be present when the individual consumes alcohol whilst under the effect of the medication.
  • An opiate antagonist  called Naltrexone is sometimes used in a much the same way as disulfiram, as a deterrant, which blocks the euphoric effects of alcohol, and in some cases casues an allergic reaction to alcohol, such as vomiting or diarrhea.

Is drinking every night ok? 

Men and women in active alcohol addiction who seek help often ask the question in this way, in the hope that the response will rationalise their drinking. However, the question of "how much is too much" is a qualitative one, as well as a quantitative one. i.e. someone will know if they meet the criteria discussed above, in such as way that they are being impacted upon.

If you are being impacted by alcohol use, and/or, you meet the quantitative guidelines agreed on by recognised bodies, then it is likely you have an alcohol problem, and thus that drinking every night is not ok.

What is the average life expectancy of an alcoholic?

There are a number of individual variables involved in life expectancy which make it impossible to provide a definitive answer to this, e.g. gender, age, co-occurring / related problems, frequency of consumption, co-occurring substance misuse, background of trauma, genetics, family history or trauma, age drinking began for example, college age vs adulthood is very different.

What are the signs that someone may be a problem drinker?

Making excuses about drinking behaviour, prioritising drinking over other things, introducing opportunities to drink into everyday activities, anger upon being challenged about drinking behaviour, denial, escalating expenses around alcohol, more irresponsibility across numerous areas, e.g. finances, diet, health, appearance, lifestyle, etc, are all signs that a person may have a problem with alcohol.

What is it like being an alcoholic?

An alcoholic's daily thought process may revolve around:

  • Experiencing the feeling of being triggered by sensitive subjects/topics/persons/places, possibly related to their early use of alcohol, and believing that the only way to cope with that, is to use alcohol.
  • Fear around maintaining access to alcohol or when they will next be able to drink
  • Guilt around an argument, disagreement, or consequence attached to their attempts to secure alcohol the previous day/night.
  • Shame over the longstanding habit of addiction that is developing, and fear of others finding out.

Once the active addiction has been in situ for some time, these elements are almost entirely automatic, and unconscious, in the course of daily living.

What if the people around an alcoholic don't see it as alcoholism?

Sadly, this happens more frequently than we'd like to imagine. Often well-intentioned family members are content to rationalise or normalise, the behaviour of their loved one in active alcohol addiction, usually in an effort to help the loved one avoid momentary discomfort. 

This could mean assisting the alcoholic, financially, practically, or in other ways, to keep drinking in the way they have become used to.

The unfortunate effect of this is usually "a little gain for long term pain", meaning that the alcoholic then develops a belief that their drinking is "ok", "normal" or somehow acceptable, allowing them to keep up the habit.

Why does an alcoholic want to blame others for his/her addiction?

Persons who have a dependence upon alcohol, worry about the consequences of giving up. They are subconsciously aware of, the external fallout their behaviour has had on others, in efforts to keep up their access to alcohol. 

Thus, admitting personal responsibility and concern for one of these would mean they are responsible for all such actions, and the guilt of this, can be overwhelming.

It is therefore easier, for an alcoholic to assign an external locus of responsibility, than admit responsibility for one event, which could lead to admission of guilt and a tidal wave of emotions which they are not equipped to handle.

What are the potential effects on appearance, of alcohol addiction?

Those who have had active alcohol addiction for a long time usually manifest symptoms of:

  • Red nose and/or swollen face due to vasodilation of capillaries
  • Underweight, due to appetite reduction
  • Conversely, some will show distended abdomen due to liver issues, ascites, or excess glycogen storage, as is often the case with beer drinkers.
  • Dry skin, e.g. psoriasis
  • Yellowing of the eyes

What do alcoholics find enjoyable about drinking so much?

Depending on the stage of addiction they are in, many are not drinking to obtain enjoyment, but to cut out the discomfort of withdrawals, as well as taking responsibility for the destruction their behaviour has inflicted on others.

In this way, a continuous search for, and abuse of alcohol is an escape from pain for the alcoholic, rather than a guilty pleasure.


About the author

Laura Morris

Laura Morris is an experienced clinical practitioner and CQC Registered Manager with over twenty years experience, over ten of which have been as an Independent Nurse Prescriber.

She has held a number of senior leadership roles in the substance use and mental health sector in the NHS, the prison service and in leading social enterprises in the field.

Last Updated: November 9, 2023