'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 a cognitive and physiological dependence. It can lead to extensive tissue damage and disease across the body. Common side effects of alcohol abuse include mental and social problems, liver disease and risk of accident/crime.
Alcohol is widely available in Europe and is the most frequently abused substance. The NHS estimates that there are about 29 million people struggling with alcoholism in Europe. In the UK alone, 9% of men and 4% of women show signs of alcohol abuse.
On this page we'll talk through alcoholism, including the symptoms and how it develops. We will also discuss how counselling - particularly CBT - can help to break destructive drinking habits.
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 should never exceed the recommended limit of three to four units of alcohol a day, while women are advised to stick to a maximum of two to three.
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 quality of life - for both the sufferer and their friends and family.
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. This is thought to occur in six separate stages - according to the concentration of alcohol in the blood.
Stage one: Euphoria - A state of feeling happy or 'slightly merry' which occurs during or straight after the first drink. This causes our inhibitions to weaken, and makes us feel more confident. During this phase we may start to do things or say things we wouldn't usually do and say. We may also experience a heightened sense of attraction towards others. Our attention span will decrease and our reactions will slow down considerably.
Stage two: Excitement - This is the stage where we begin to lose control of our emotions. We find it more difficult to perceive, judge and store memories. Our reactions are slow and our vision may blur. During this stage we will find it increasingly difficult to keep our balance and drowsiness will kick in.
Stage three: Confusion - At this point the initial merriment of intoxication will have long dissipated. We may start to feel unreasonably emotional, dizzy and confused, and our ability to correctly perceive colour, form, dimensions and motion will have disappeared. We will also find it difficult to coordinate our muscles, which can lead to staggering as we walk or slurring as we talk. Others will struggle to understand what we're saying and we may appear apathetic or lethargic.
Stage four: Stupor - This is where we approach a complete loss of motor functions. We are likely to be unresponsive, and unable to stand or walk. Vomiting, losing control of our bowels or bladder is common, and then we fall into a stupor.
Stage five: Coma - A state of unconsciousness. Our body temperature may rise or fall dramatically, and there may be problems with breathing and circulation.
Stage six: Death - At this point it is possible to 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 the 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.
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.
Consider the following questions carefully and honestly to identify if you have a drinking problem:
- 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 £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 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?
Symptoms 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 and they have no control over how much they consume.
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 of 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.
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 this 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.
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:
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.
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.
Personal causes of alcoholism can include:
- Boredom - Many young people tend to drink out of boredom.
- Anxiety - Alcohol can calm the nerves.
- Depression and other mental health problems - It's common for people with mental health issues to have problems with alcohol and other substances.
- Age - People who begin drinking at a young age are more likely to develop alcohol dependence.
Effects of alcoholism
Alcohol dependence can have a number of different effects on a person's body and mind, appearance as well as their personal and professional relationships.
Effects of alcoholism on appearance
- Skin - Premature ageing, wrinkles and rosacea are common side effects of alcohol abuse. Alcohol is dehydrating and dilates capillaries under the skin, causing them to break. This leaves red irritation - especially around the nose.
- Hair - The dehydrating effects of alcohol can leave hair dry, brittle and prone to breakage.
- Eyes - Blood vessels in the eyes are likely to break, which causes blood-shot looking eyes. Alcohol abuse can also cause the whites of eyes to turn a yellowish colour.
- Weight - According to the Department of Health, drinking just five pints of beer a week is the equivalent of eating 221 doughnuts a year. Alcohol is extremely fattening because it is essentially sugar. It can cause rapid weight gain, which is linked to other health problems such as diabetes, high blood pressure and heart disease.
Effects of alcoholism on the body
Long-term health problems that alcoholism can cause 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
There is a clear link between alcoholism and mental health problems. However, it is not known 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 alcoholism.
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.
Effects of alcoholism on relationships
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. Often they will deny their addiction, making it even harder to encourage them to seek professional support.
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.
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 Care 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 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:
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