'Alcoholism', also commonly referred to as alcohol dependence and alcohol addiction, describes the repeated use of and dependence upon alcoholic substances. This is thought to be caused by a cognitive and physiological dependence that can eventually lead to extensive tissue damage and disease across the body.
The NHS estimates that there are about 29 million people struggling with alcoholism in Europe.
Alcohol is Europe's most widely available and frequently abused drug. In excess, alcohol is known to cause a large range of physical, mental and social problems due to its harmful and behaviour-altering properties, including liver disease, cognitive impairment, risk of accident and heightened crime.
Men should never exceed the recommended limit of 3-4 units of alcohol a day, and women are advised to stick to a maximum of 2-3.
On this page
- Alcohol abuse
- Why do we like drinking alcohol?
- Recognising your drinking habits
- Symptoms of alcoholism
- How does alcoholism develop?
- Causes of alcoholism
Alcoholism is a form of alcohol abuse, which covers two other (comparatively less severe but still problematic) forms of problem drinking:
- Hazardous drinking - when there is a risk of physical or psychological harm. Hazardous drinkers regularly exceed the daily limit and often drink large amounts at a time, which is known as binge drinking.
- Harmful drinking - a harmful drinker is a person who regularly exceeds the weekly recommended alcohol limit and experiences resulting health problems, whether that be injury or illness.
Why do we like drinking alcohol?
Many of us enjoy a drink every now and then. Drinking alcohol is a traditional part of many human cultures and has been since the Neolithic era over 10 thousand years ago, when early humans consumed fermented fruit for its pleasurably mind-altering effects.
Drunkenness, or alcohol intoxication, occurs as the concentration of alcohol in the blood increases, effecting the central nervous system and gradually decreases a person's response to stimuli. The behaviour we exhibit while we drink is thought to develop in six separate stages according to the concentration of alcohol in the blood:
Stage 1: Euphoria - stage one usually occurs during or straight after the first glass. You will feel happy or 'slightly merry', which will cause your inhibitions to weaken. You'll feel more confident, you may say things or do things you wouldn't usually do and say, or feel a heightened sense of affection towards others. During this stage the length of your attention span will decrease and your reactions will slow down considerably.
Stage 2: Excitement - at this stage you will begin to lose control of your emotions and you may experience a reduction in your ability to your perceive, judge, store memories or properly comprehend anything. Your reactions will slow, your vision will blur and you will find it increasingly difficult to keep your balance. At this point you may begin to feel a little drowsy.
Stage 3: Confusion - now the initial 'merriment' of your intoxication will have long dissipated and you may start to feel unreasonably emotional, confused and dizzy. Your ability to correctly perceive colour, form, dimensions and motion will go and you will also lose your ability to feel pain. You will find it difficult to coordinate your muscles effectively, causing you to stagger or slur as you talk. Other individuals will find it difficult to understand what you are saying and you may appear apathetic, lethargic, or unresponsive.
Stage 3: Stupor - now you will be approaching a complete loss of motor functions. You may stop responding altogether and you will be unable to stand or walk. You are likely to vomit, lose control of your bowels or bladder, and fall into a stupor.
Stage 4: Coma - at this stage you will be completely unconscious, your body temperature may rise or fall dramatically, and you may experience problems with your breathing and circulation.
Stage 5: Death - at this point you will die from respiratory arrest, where the body ceases to breathe.
Although it seems obvious that we should stop drinking once we've got to the 'euphoria' stage, how many of us actually do? The problem is: with impaired judgement comes the inability to make sensible decisions, like putting down your glass and going home. The more we drink, the more we want to continue drinking, making it very easy for a casual after-work drink to become a 10 hour stint that ends in the local kebab shop.
Recognising your drinking habits
What kind of drinker are you? Do you enjoy a drink once in a while with family and friends? Do you drink for the sake of getting drunk? Do you drink because it makes everything feel better? Understanding your own drinking habits will help you recognise where you might need to change your habits.
Consider the following questions carefully and honestly:
- How much do you spend on alcohol every week? If you adhere to the daily recommended alcohol guidelines you should be spending no more than an £30 on alcohol throughout the week (approximate).
- Why do you drink alcohol? For escapism? For fun? Because your friends do? Because there's nothing else to do? Because you crave it?
- Does your drinking ever effect your personal relationships? Does it cause arguments? Rifts? Do you ever say things you wish you'd never said?
- How do you feel when you don't drink alcohol? Do you feel empty, agitated, anxious? Or do you not even think about it?
People who abuse alcohol, whether they drink too much or drink for the wrong reasons, are not necessarily addicted to it. So what is the difference between a drinker and an alcoholic?
Symptoms of alcoholism
Alcoholics find that, without alcohol, they cannot function in the same way any more. Symptoms of alcoholism include:
- Feeling a strong and overwhelming desire for alcohol that distracts from everyday activities.
- Unable to control your drinking - you crave a drink every day and when you start you find it difficult to stop.
- Your body builds up a tolerance to alcohol so you require more and more of it to feel the same effects.
- You drink first thing in the morning or during the night.
- You spend a lot of time in the pub.
- You neglect other areas of your life, such as hobbies, work or family.
- You experience Delirium Tremens (DTs) - this is a severe withdrawal reaction that occurs about 2 or 3 days after the last alcoholic drink and can cause tremors, confusion, delusions (seeing and hearing things that aren't there) and convulsions. It can lead to dehydration and is in some cases fatal.
How does alcoholism develop?
Alcoholism is a form of addiction. Addiction is thought to be a by-product of what is known by scientists as the brain's 'reward system'. The 'reward system' has evolved over many thousands of years as a way of encouraging us to keep carrying out particularly strenuous activities, such as hunting and mating. On a very basic level, if we didn't derive some form of pleasure or satisfaction from these activities, why would we continue to do them? The humans who had a stronger reward system were more likely to put more effort into these activities, and therefore more likely to get the best pick of both the food and the opposite sexes, heightening their chances of survival and passing this reward system on to future generations.
The reward system
Experts believe that the rush of pleasure we feel after certain activities (the reward) is caused by a flood of dopamine, the so called 'feel-good' hormone produced by the brain. Dopamine is thought to play an important role in motivation and reinforcement, encouraging us to repeat certain behaviours. This explains why many people become addicted to activities and substances that involve a 'buzz' or a 'high', such as sex, gambling and junk food. We come to associate certain stimuli with the feeling of the reward, such as the smell of alcohol or the feel of a bottle in the hand. This is known as a motivational stimuli and explains why just walking past a pub can provoke an alcoholic's craving, and walking past a bakery can provoke a food addict's.
Alcohol and dopamine
It is thought that certain substances such as alcohol, nicotine and cocaine hijack the dopamine system and stimulate the feeling of reward. Alcohol is also thought to directly affect the dopamine system by encouraging it to produce bigger doses of dopamine.
Causes of alcoholism
There is no one cause of alcoholism. The reasons people become dependent on alcohol are diverse and personal and differ from individual to individual. Some theories include:
Some studies suggest that alcoholism runs in families. In one study, over a third of alcoholics had relatives who were also alcoholics4, suggesting that some people might be more at risk of developing alcoholism than others, depending on their family history.
Personality and experience
Some people might be more prone to develop alcoholism than others simply because the things they have experienced make them more likely to rely on the effects of alcohol. Sometimes an addiction can be caused by a particularly traumatic life event, such as the death of a close friend or relative. Alcohol is commonly used as a form of escapism, just as the popular phrase 'drown your sorrows' might suggest. Personal causes of alcoholism include:
- Boredom - many young people tend to drink alcohol due to boredom.
- Anxiety - alcohol can calm the nerves (ever heard of 'Dutch courage'?)
- Depression - depression can cause people to lose all emotion and feeling, which can cause them to seek alternative ways to feel pleasure. Because alcohol can exaggerate our emotions, many depressed people will reach for the drink.
Effects of alcoholism
Like most forms of addiction, alcoholism can have a number of different effects on a person's appearance, body and mind, as well as on their personal and professional relationships.
Effects of alcoholism on appearance
Depending on how longstanding their addiction is, alcoholics can even start to look different. They may look unkempt, bedraggled, ill, or malnourished. Alcoholism effects:
Alcohol dries out the skin and causes wrinkles, premature ageing, acne, rosacea and eventual facial disfiguration, known as rhynophyma. Alcohol is also known to dilate the capillaries (the thread-like veins just beneath the skin), causing them to break and cause a red irritation, especially on the nose.
Alcohol is a diuretic (increasing the passing of urine) which can cause dehydration, which in turn causes the hair to become dry, brittle and prone to breakage.
The blood vessels in the eye are likely to break and cause blood-shot looking eyes. When alcoholism effects the liver, the whites of the eyes can turn a yellowish colour.
The excessive consumption of alcohol can also cause dark circles on the skin beneath the eyes.
According to the Department of Health, drinking just 5 pints of beer a week is the equivalent of eating 221 donuts a year3. Alcohol is extremely fattening because it is essentially sugar. It can cause rapid weight gain which leads to other health problems such as diabetes, high blood pressure and heart disease.
Alcoholics tend to emit a sour smell which is secreted through their sweat glands. This is the smell of the liver trying hard to process an overload of alcohol.
Effects of alcoholism on the body
Long term health effects of alcoholism on the body include:
- breast cancer
- heart disease
- high blood pressure
- damage to the heart muscle
- cancer of the liver
- alcohol poisoning.
Effects of alcoholism on the mind
Not only does alcoholism have an effect on appearance and physical health, it can also seriously harm the mind.
Alcoholism is thought to increase the risk of:
- personality breakdown
- memory loss
- mood swings
- decreased sex drive
- suicidal thoughts
Although there is a clear link between alcoholism and mental health problems, it is as yet unclear whether mental health problems raise the risk of alcoholism, or if alcoholism raises the risk of mental health problems. One UK study found that 43% of people with a mental health problem also suffered from alcoholism1.
Only 1% of the general UK household population admit to being moderately to severely dependent on alcohol. However, this figure rises to 2% for households containing a person with a neurotic disorder, 5% for those with any kind of phobia and 6% for those containing two or more people with neurotic disorders.
People may use alcohol to help with the symptoms of the following:
- manic depressive illnesses
Effects of alcoholism on relationships
Alcoholics not only seriously impair their own physical and mental health, they also effect the health of the world and people around them.
Addiction is extremely powerful. It can dominate a person's thoughts and determine their actions. It can take over a personality and change the direction of a person's life. Understandably, this is incredibly difficult for spouses, children, parents and friends of alcoholics to deal with. It is hard to know how to help someone with a dependency. Often they will deny their addiction, making it even harder to encourage them to seek professional support.
- Sex - Alcoholism causes impotence and lowered libido, making sex difficult if not impossible. This can be frustrating for partners and has the potential to cause big rifts in relationships. For couples who want babies, the long-term effects of alcoholism can be even more harrowing, because alcohol reduces testosterone production and can lead to sterility.
- Trust - Alcoholics who are in denial will often lie about where they have been or what they have been doing, causing irredeemable feelings of betrayal, which of course encourages conflict between loved ones.
- Neglect - Alcoholics usually begin to neglect their normal lifestyles in favour of drinking. This might include the neglect of friends or family. In some cases, such as parenthood, neglect could result in a prison sentence.
- Work - The effects of alcoholism, including depression, illness and cognitive impairment could cause work standards to drop and result in unemployment.
How can counselling help with alcoholism?
The first step towards recovering from alcoholism is to admit to the problem. Addicts are often brilliant at convincing themselves they don't have a problem or that they're doing everything they possibly can to fight it. For instance, they might say:
- If I drink before 9am it doesn't count.
- Other people in the pub drink just as much as me.
- If it wasn't alcohol, it would be something else.
- My life isn't going to get better, I may as well drink.
- I just don't care enough to stop.
- I'll give up tomorrow.
- Other people get diseases, but I won't.
These are all examples of ways an alcoholic might try to justify their actions. However, these patterns of thought are unhealthy and may make an alcoholic more likely to continue inflicting damage on him or herself.
One of the most effective forms of alcoholism treatment is cognitive behavioural therapy (CBT), which tackles patterns of thinking and behaviour in an attempt to break certain emotional or psychological ties to habitual behaviours. By understanding the underlying feelings and thought processes that cause their addictions, alcoholics can gradually learn to control the impulse to drink. Soon, they will find new ways to address their problems and insecurities, without having to turn to alcohol. Counsellors can offer the professional support and guidance that struggling alcoholics need to turn their lives around. To find out more or to book a counselling session, simply use our search tool, browse the huge database of policy approved professionals and contact the counsellor most suited to your needs.
What should I be looking for in a counsellor or psychotherapist?
Whilst there are no laws stipulating a required level of training for counsellors working in alcohol addiction, the National Institute for Health and Clinical Excellence (NICE) have put together some clinical guidelines outlining recommendations about psychological treatments, treatment with medicines and what kind of services help individuals with an alcohol addiction.
Key recommendations in regards to treatments for adults (aged 18 or over) who misuse alcohol include:
- Planned withdrawal from alcohol, which can help people to safely stop drinking.
- Psychological treatments and medication, which can help people to stay alcohol-free or reduce their drinking to a less harmful level.
NICE also say: 'If you drink in a way that is harmful, or have mild alcohol dependence, you should be offered a psychological treatment. This should be specifically focused on the alcohol problem and how it affects your thoughts, behaviour and relationships. If psychological treatment on its own does not help you, you may be offered medication (acamprosate or naltrexone) at the same time as a psychological treatment.'
For more information, please see the full NICE guidelines:
- Drinkline – the National Alcohol Helpline 0800 9178282
- Alcoholics Anonymous - 0845 7697555
- Al-anon Family Groups UK and Eire – Support group for family and friends
- Giveupdrinking - Information if you think you may be drinking too much
- Drink Aware - The facts about drinking.
- NHS Alcohol Tracker - Track how much you drink.
1IAS, 'Factsheets: Mental Health'
2NHS, 'Health Lifestyles, 'Statistics on Alcohol in England'
3Drink Aware, 'Effects of Alcohol'
4Open Learn, 'Addiction Article'
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