I'm Sam and have strong interest in substance use and abuse and the psychology of behavioral problems.
Alcohol can definitely be a problem substance if it’s not used responsibly. Most of us know – often firsthand – the havoc that alcohol can wreak on a person’s brain and body. Unfortunately, many of us also know firsthand the damage that an alcoholic can cause to their friends and family.
There are a lot of different terms related to alcohol and it can be confusing for someone if they don’t know all the definitions. Alcohol abuse, alcohol addiction, alcohol dependence, binge drinking… these things all have different meanings, and if you hope to fully understand or help out somebody whose drinking has become a problem, you’ll want to know what they all mean.
Today we’ll be focusing on alcohol dependency, which is the most severe form of addiction that a person can have to alcohol.
- What Is Alcohol Dependence?
- What Causes Alcohol Dependence
- Reduce Chances for Substance Dependency
- What is Alcohol Dependence Like
- Body and Brain
- How to Help Someone
1. What Is Alcohol Dependence?
Chemical dependency is a state in which somebody requires a substance to function – in this case, the substance is alcohol. People who are dependent on alcohol are so severely addicted to the substance that they need it to engage in social functions, go to work, and interact with their families at the same level they did before.
By definition, the term alcohol dependence (which has been reclassified as alcohol use disorder) is the state of being physically or psychologically dependent on alcohol. This is different than being simply addicted to alcohol, especially in regard to psychological addiction. Someone who is psychologically addicted to alcohol may feel that they require it to engage in social situations, but they may not drink frequently enough to become physically dependent.
To meet the criteria of alcohol dependence, according to the DSM-IV, you must display at least three of the following during the period of a year:
- A developed tolerance to alcohol.
- Withdrawal symptoms when not drinking.
- Consistent desire or attempts to quit that fail.
- Using more alcohol or for longer than intended.
- Spending considerable time acquiring alcohol or the means to do so.
- Alcohol has damaged your social, work, or recreational experiences.
- Being aware that alcohol has been a problem but continuing to drink.
Not everyone considered to be dependent on alcohol must meet the physiological symptoms of dependency. According to these rules, somebody who binges drinks once a month could still be considered dependent on alcohol.
Dependency often involves much more serious implications, though, and is different from alcohol abuse. Alcohol abuse doesn’t necessitate withdrawal and tolerance as often. The medical community makes two main distinctions between alcohol dependence and alcoholism:
- Only Addictive Substance
Alcohol dependence refers to a condition in which alcohol is the only addictive substance that a person consumes, frequently exempting nicotine. Alcoholism refers to a condition in which the user may be addicted to multiple substances.
- More Physical Than Alcoholism
Alcohol dependence is often seen to be more physical than alcoholism. Dependence is often acknowledged to be controllable if the user learns to restrict and moderate their consumption. Alcoholism, on the other hand, generally refers to a drinking condition that can’t be remedied unless the user abstains completely.
2. What Causes Alcohol Dependence
Alcohol dependence has a large number of possible causes. The cause is no indication of the severity of dependence that may develop.
Genetic Predisposition for Addiction
People may be genetically predisposed to become alcoholics if it runs in their family. This is hotly debated, but the fact remains that if you live in a family of alcoholics, you will be more often exposed and could trigger your genetic weak spot. Some people will avoid alcohol at all costs, because they know the risk. Others end up just like their family members.
Coping Mechanism / To Relax
Using alcohol as a blanket for stress can lead to alcohol dependence. For example, drinking after a breakup may numb the feelings for a night, but you will have to come to terms with them eventually. Some might continue to drink instead of acknowledging their feelings and develop a spiral of addiction.
Alcohol-dependent people tend to have higher rates of other mental problems. Depression, anxiety, PTSD, and other addictions (especially to illegal drugs) can lead to alcoholism, mostly to cover up feelings, but in the case of addictions, so the user can switch to a drug with fewer legal repercussions.
Knowing this is important for families because it will help them be able to prevent their children from developing alcohol problems. Understanding addiction and the causes of it can be a very effective method for helping parents protect their children from addiction.
3. Reduce Chances for Substance Dependency
If you’re worried about you or someone you know becoming alcohol dependent, you can do some things to reduce the chances of developing a serious dependency.
Reduce Drinking Frequency
Reduce the frequency of your drinking. This might sound like a no-brainer, but it’s very, very easy for somebody with the “I can handle it” mentality to slip into an addiction. In fact, most people who have dependency problems initially thought they were strong enough to avoid addiction. In the case of drugs and alcohol, thinking that you can’t handle it is better if it keeps you away.
Frequent drinking also speeds up the development of tolerance, which is a condition in which the user requires more and more alcohol to get the same effects. Tolerance often becomes an issue right before dependency and if the frequency isn’t reduced, it will lead into it.
If you have ever drunk, or considered drinking, to cover up an emotional problem or deal with the stress associated with a situation, find other methods of dealing with your stress. This is a form of self-medicating and almost always leads to addiction.
4. What is Alcohol Dependence Like
Alcohol dependence is a very difficult situation, not only for the person who is dependent, but for their friends and family. Anyone who has lived with or loved someone who is dependent on a substance knows why. Dependency often causes many of the following:
Different Personalities (Manic-Miserable)
The dependent individual may seem like they have completely different personalities. Most alcoholics would naturally behave very differently when they’re not drinking and feel terrible compared to when they’ve drunk enough and feel fine. Severely dependent alcoholics also have a lower threshold for resisting their emotions. After drinking, one night they may be elated, happy, and even manic. The next, they may be miserable and violent, starting arguments for seemingly no reason.
People dependent on substances tend to be dishonest. This dishonesty may not be malicious and could be to help ease the stress of their friends and family by telling them that they’re using less than they actually are. More often than not, though, this dishonesty takes the form of deception and, for the most severely dependent, thievery.
Out of Touch, Being an Empty Shell
Someone dependent on alcohol may lose touch with themselves and their families. When somebody’s life is completely guided by a substance, they become a shell of who they once were. The only way to bring them back out of this shell is to help them find professional alcohol addiction treatment.
All these problems make it hard for the alcoholic, as well as everyone around them, to go about life in a normal fashion. For the dependent alcoholic, they often experience a continually expanding flow of negative emotions. Their self-image declines as they begin to view themselves as an extension of alcohol since they need it to function. This further encourages them to drink in an effort to nullify these painful emotions. However, the feelings often manifest anyways in the form of anger, resentment of sober people, insecurity, and reclusiveness.
While the previous does not necessarily indicate an alcohol dependence, there are several common threads that run among alcoholics. If you notice any of the following, you or someone you care for may be becoming dependent on alcohol.
- Waking up and drinking first thing in the morning, or being extremely uncomfortable and sickly if they don’t have a morning drink.
If you notice excessive sweating, shaking, nausea, anxiety, hallucinations, disorientation, or jaundice, these could indicate symptoms of alcohol withdrawal.
- Constant worry about alcohol and where/when they can obtain it.
- Being unable to attend social or family gatherings without a drink.
- Being unable to attend work without alcohol, or suffering serious harm to their employment.
- Running low on money, or trying to borrow money off friends or family to buy alcohol.
- Drinking in solitude.
5. Body and Brain
You likely already know that alcohol can be very unhealthy for the body. When somebody is drinking to the point of becoming dependent, the effects are greatly exacerbated. Somebody dependent on alcohol may experience the following:
A highly increased chance of stroke and other heart problems
High blood pressure
Liver disease and other complications
Stomach problems and ulcers
Cancer of the stomach or esophagus
A decrease in mental function
Loss of balance and mobility
Weakness and fatigue
We’ve mentioned how alcoholism can be tough on the friends and family of the alcoholic. This is largely due to some of the mental problems that can develop as a result of excessive drinking. These can include:
Loss of cognitive ability (memory, ability to form sentences, thinking power)
Anger issues and instability
Irrational mindset or thought patterns
If somebody dependent on alcohol stops drinking suddenly, they will likely go through alcohol withdrawal. Withdrawal is a large part of the reason that so many alcoholics cannot quit: they need the alcohol to feel normal, and without it, they experience any number of the following symptoms:
Tremors and shaking
Hallucinations (usually auditory)
Extreme anxiety or paranoia
Seizures (in serious cases)
Withdrawal symptoms tend to peak within 48 hours after having your last drink. Withdrawal can last a very long time, stretching out to months, and can even take years to completely disappear. The neurotransmitter systems that alcohol affects are highly sensitive and crucial to our mental function, and the damage alcohol does to them reverses very slowly.
If you stop drinking for a while and then resume (sometimes known as a ‘tolerance break,’ which some users perform so they are able to become intoxicated with less alcohol) you are more likely to develop tolerance rapidly. The chances of developing withdrawal and the severity of withdrawal also increase with repeated stopping and starting.
6. How to Help Someone
If you or someone you care about is dependent on alcohol, there are several things that you should consider. Remember to always be kind and compassionate when you approach the alcoholic about their problem. People with addictions are often very sensitive about them, and this sensitivity frequently manifests as rage or depression.
It’s best to approach someone about their drinking when they’re sober. This is when they will be at their most rational and will be less likely to lash out. They also may be experiencing withdrawals, which could help them commit to stopping.
Ability to Stop Alone or Not
The first thing would be to see if the alcoholic is able to stop drinking on their own. Sometimes they are able to, but most often they will make it a few days and then resume drinking.
Professional Alcohol Treatment
If the alcoholic isn’t able to quit drinking on their own, you should try and get them into rehab or a professional alcohol treatment center. There are many different types of treatment available for different degrees of addiction. Explain the damage and pain that the alcoholic is causing their friends and family, and try to make them understand that you want to help them.
If they will not commit themselves to rehab, you may have to call an intervention specialist. They will try to convince the alcoholic to go to rehab. If this doesn’t work, you may have to cut them off – explain that there’s only so much support you can give. Don’t lend them any more money, don’t enable their drinking. You may even have to kick them out of the house if they live with you. Oftentimes, this is enough to snap an alcoholic into reality and seek help.
If you need help locating a rehab facility near you, do so. You may have to look around for a bit to find one that’s nearby, cost-effective, and reliable. Once you find a rehab facility, set up an appointment with them to decide how you can best help the alcoholic back onto a path to sobriety.
- Petrakis L.I., Gonzalez G., et al. Comorbidity of Alcoholism and Psychiatric Disorders. National Institute on Alcohol Abuse and Alcoholism.
- Lewis M. The Biology of Desire: Why Addiction Is Not a Disease. PublicAffairs, 2015, 256 p.
- Kofoed L., Kania J., et al. Outpatient treatment of patients with substance abuse and coexisting psychiatric disorders. American Journal of Psychiatry, 1986, 143, 867–872.
- Alcohol's Effects on the Body. National Institute on Alcohol Abuse and Alcoholism.
- American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-IV). Arlington, American Psychiatric Publishing.
This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.
© 2021 Sam Shepards