Alcoholism, also known as alcohol addiction or alcohol dependence, describes the repeated use of and dependence upon alcoholic substances. It is a progressive illness, where sufferers are unable to control their compulsion to drink in excess. They will be preoccupied with alcohol and will continue drinking even when it starts to cause problems.

Alcoholism is thought to be caused by cognitive and physiological dependence. It can lead to extensive tissue damage and disease across the body. Common side effects of alcohol abuse include mental health and social problems, liver disease and risk of accident/crime.

On this page, we'll explore alcoholism, including the signs and how it develops. We'll also discuss how counselling - particularly CBT - can help to break destructive drinking habits.

Alcohol abuse

Alcoholism is a form of alcohol abuse. This refers to a pattern of drinking that is considered to have an increased or high risk - meaning it is very likely to cause harm to your health. Current guidelines say that men and women should not exceed more than 14 units of alcohol a week on a regular basis.

Alcohol is widely available in Europe and is the most frequently abused substance.

There are many different forms of alcohol abuse, but alcohol dependence is considered to be the most severe and problematic. When dependence sets in, alcohol takes over. It becomes the central importance of a person's life.

On the other hand, binge drinking and hazardous drinking tends to be something people do while being able to carry on their lives with some semblance of normality. No form of alcohol abuse is completely risk-free, but alcoholism is harmful enough to affect the quality of life - for both the sufferer and their friends and family.

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What happens when we drink? 

When we drink, alcohol is absorbed into the body via the stomach and small intestines. Once in the bloodstream, it flows through the body, reaching the brain, heart, muscles and other tissues. This happens very quickly and can have a temporary pleasant effect.

Drunkenness, or alcohol intoxication, occurs as the concentration of alcohol in the blood increases. This affects the central nervous system and gradually decreases our response to stimuli. As we drink, our behaviour changes.

A state of feeling happy or 'slightly merry' occurs during or straight after the first drink. This causes our inhibitions to weaken and makes us feel more confident. Although it seems obvious that we should stop drinking once we've reached this stage, the problem is, with impaired judgement comes the inability to make sensible decisions - like putting the glass down. The more we drink, the more we want to continue drinking.

So, the initial euphoric state of intoxication can quickly progress, to the point where we lose control of our bodies - and, sometimes, our minds. Too much alcohol and we may experience a complete loss of motor functions, becoming unresponsive, and unable to stand or walk. Vomiting, losing control of our bowels or bladder is common and even falling into a state of unconsciousness.

What effect does alcohol have on our mental health?

The link between alcohol and our mental health is twofold. Mental health problems can not only result from drinking too much alcohol but, often, mental ill-health can be the cause of drinking too much in the first instance. This is often referred to as self-medicating; using alcohol to change our mood, to help us sleep, to help us forget about our problems, or to temporarily alleviate feelings of anxiety and depression.

However, in reality, alcohol can make existing mental health problems worse.

Research suggests that alcohol problems are more common among people with more severe mental health problems. Also, people who consume high amounts of alcohol are vulnerable to an increased risk of developing mental health problems. Alcoholism is thought to increase the risk of:

Recognising you have a drinking problem 

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 make changes.

Each time I got drunk, I would justify the reason or blame external events and people for influencing me. I was in denial. When a persistent loved one constantly challenged my excuses, it eventually led me to question my truth and going through the slow realisation and acceptance that my drinking was dysfunctional.

- Counsellor Gina Easom describes her own issues with alcohol.

Consider the following questions carefully to identify if you have a drinking problem:

  • How much do you spend on alcohol every week? Do you track how much you spend on it - are you ever shocked by how much you spend on alcohol?
  • 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 affect 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?

It's important to remember that 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 someone who is living with alcoholism?

Signs of alcoholism

People who are struggling with alcohol dependence feel that, without alcohol, they cannot function in the same way. Drinking takes a high priority in their life.

Below are some common symptoms which may indicate you have a drinking problem:

  • Feeling a strong 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.
  • Worrying about when you're next going to be able to drink and planning social events around alcohol.
  • You are in denial about your drinking - downplaying the negative consequences or complaining that friends and family are exaggerating your problem.
  • If you try to stop drinking, you experience withdrawal symptoms such as irritability, shakiness, trembling, nausea, anxiety, fatigue and insomnia.

How does alcoholism develop? 

Alcoholism is a form of addiction. There are two common variations of addiction - physical and psychological.

Physical addiction  

People who feel a need to drink for pleasure and an emotional high are considered to have a physical addiction. Just the sight, thought or smell of alcohol can evoke sensations of anticipatory pleasure. Due to chemical changes in the brain, heavy drinkers start to crave the emotional release and pleasure alcohol creates.

Giving in to the craving increases the need to drink again. The body eventually gets used to the presence of alcohol so that it no longer has the same effect. This 'tolerance' only enhances the desire to drink more, and if a person tries to stop they experience intense withdrawal symptoms. This traps them in a destructive cycle of alcohol dependence.

Psychological addiction 

In some cases, people develop alcohol dependence as a way of coping with a psychological issue. Drinking fills a void and helps to block out negative experiences and relieve associated stress. Psychological addictions are not the result of chemical changes in the brain. Individuals drink to excess on a regular basis to numb emotional strain.

This type of alcohol abuse can lead to further problems. Individuals may start to experience intense feelings of shame, despair and guilt. As a result, an increasingly destructive cycle of alcohol dependence develops.

Causes of alcoholism

There is no one cause of alcoholism. There are a number of reasons why someone may develop a drinking problem, and these will be personal to them. Factors that can increase a person's risk of becoming an alcoholic include:

  • Family history - Research suggests that alcoholism runs in families. In one study, over a third of alcoholics had relatives who were also heavy drinkers. This suggests some people might be more at risk if they have a parent or close relatives with a drinking problem.

  • Personal experience - Certain experiences can make someone more likely to become an alcoholic. Alcohol abuse can be a side effect of a traumatic life event, as drinking is often used as a form of escapism.

Alcohol abuse is often imagined to predominantly affect working-class men. But, in reality, alcoholism can affect anyone. In fact, statistics have shown that over recent years, women’s drinking has significantly increased, bringing their drinking habits to an equal level with men’s. 

How can counselling help with alcoholism?

The first step towards recovering from alcohol dependence is to admit to the problem. People struggling with alcohol abuse can easily convince themselves they don't have a problem or that they're doing everything they possibly can to fight it. However, these patterns of thought are unhealthy and may make someone more likely to continue inflicting damage on him or herself.

One of the most effective forms of alcoholism treatment is cognitive behavioural therapy (CBT). This form of counselling tackles patterns of thinking and behaviour in an attempt to break certain emotional or psychological ties to habits. By understanding the underlying feelings and thought processes that cause their addiction, 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.

Supporting someone with alcoholism

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, colleagues, parents and friends to deal with.

It is hard to know how to help someone dependent on alcohol. If you're a carer for a problem drinker, accessing help can be a frustrating experience. Often they will deny their addiction, making it even harder to encourage them to seek professional support. But, alcohol - in excess - is really damaging to our mental and physical well-being and it can have irreversible and devastating effects.

A week went by and I hadn’t heard a peep from mum. When my dad and sister turned up out of the blue to see me, I immediately knew what was wrong. It was a deep internal pain I had never felt before. We were given the autopsy verdict. Mum had died of liver failure due to excessive alcohol consumption.

- James shares his story of losing his mum to alcohol.

There is often a lot of shame associated with alcoholism, which can itself be an obstacle to overcome in receiving help. A good first step is to encourage them to visit their GP. They'll be able to discuss the services and treatments available, such as counselling or hypnotherapy, to help them overcome the addiction.

If you are worried about a loved one, just let them know that you are there for them. Remember, addiction can take over a person’s life, and they may feel like they have no control, so try and support them as much as you can while they work things out.

What should I be looking for in a therapist?

Whilst there are no laws stipulating a required level of training for counsellors working in alcohol addiction, the National Institute for Health and Care Excellence (NICE) has put together some clinical guidelines outlining recommendations about psychological treatments, treatment with medicines and what kind of services help individuals with alcohol addiction. Key recommendations 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.

For children and young people dealing with alcohol addiction, NICE recommend a psychological treatment called cognitive behavioural therapy (CBT), which can help you to stop drinking and stay alcohol-free and well in the future.

For more information, please see the full NICE guidelines: Alcohol use disorders

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