Alcoholism is a serious mental illness. The development from consumption to abuse to addiction is insidious. Characteristic of addiction are, among other things, a strong desire for alcohol, increasing consumption and the occurrence of withdrawal symptoms. Read all about the signs and consequences of alcoholism and how to get the addiction under control here.
ICD codes for Alcoholism: F10
Alcohol can easily go from being a stimulant to a highly dangerous drug. However, the transition to addiction is not a one-way street. Strict withdrawal and the right relapse prophylaxis are crucial.
• Signs: Strong cravings for alcohol, loss of control, excess, withdrawal symptoms, neglect of interests and contacts, continued consumption despite negative consequences.
• Possible consequences: damage to the liver, pancreas, stomach and intestines, cardiovascular system, cognitive deficits, anxiety, depression, suicidal thoughts, job loss, destruction of social relationships.
• Causes: Genetic predisposition, stress, mental stress, mental instability, problematic use of alcohol in family and friends.
• Diagnostics: Information from people close to you, questionnaire, blood test (liver values), test for possible typical secondary diseases of alcohol addiction.
• Therapy: Inpatient or outpatient, cognitive behavioral therapy, individual therapy, group therapy, mindfulness training, stress management training, therapy goal: abstinence.
• Prognosis: Addiction is lifelong, with insight into the disease and therapy, good chances of abstinence even in the case of isolated relapses, untreated serious secondary diseases, shortened lifespan.
Signs of alcoholism
Alcohol dependence (also: ethylism, drunkenness) is not a weakness of character, but a serious mental illness. She can meet anyone: people from all walks of life, young and old, women and men. In Germany almost all adults consume more or less alcohol. Some drink dangerously large amounts but are not dependent. At what point does addiction begin?
When are you an alcoholic?
The six main signs of addiction also apply to alcohol dependents. If three of these occur within a year, the person concerned is considered an addict according to the definition of alcoholism.
The central symptom of alcohol addiction is an almost uncontrollable craving for alcohol. It may be a permanent condition or it may come upon the sufferer suddenly.
Loss of control
Alcoholics lose control over when and how much they drink. Loss of control is an important sign of alcohol addiction. After the first glass there is no holding back for many until they are heavily intoxicated. They also drink against their better judgment in situations where it is inappropriate or dangerous – for example during work hours or when they still have to drive.
As a result of excessive consumption, the body develops a tolerance to alcohol over time. Those affected then need larger and larger amounts in order to feel the desired effect. A sign of alcoholism is therefore also that those affected seem to tolerate significantly more alcohol than non-dependent consumers. But that doesn’t mean that drinking more is less damaging to your body.
If an alcoholic with physical dependence drinks less or no alcohol at all, withdrawal symptoms appear. These include tremors, sweating, trouble sleeping, anxiety, and depressed mood. Only a new dose of alcohol can initially alleviate the withdrawal symptoms. This vicious circle is difficult to break.
What is feared during withdrawal is the so-called delirium. It can be accompanied by hallucinations. Delirium can cause life-threatening circulatory disorders.
Neglect of other interests
The constant preoccupation with obtaining and consuming alcohol and the time taken up by drinking and intoxication causes alcoholics to neglect their responsibilities and interests. Friends and family are also taking a backseat.
Continued use despite harmful consequences
Alcoholics do not stop drinking even if consumption has already caused harmful physical, mental or social effects. They drink despite the threat of losing their job, separation from their partner or a diseased liver.
Lack of insight into illness
Alcoholics no longer drink for pleasure, but out of an inner compulsion or even a physical need. That is why attempts to reduce consumption regularly fail.
However, most alcoholics are initially convinced that they can quit at any time. They often succeed in doing this for days or weeks. This reinforces their belief that they are not dependent.
But as soon as they reach for the glass again, the next relapse with a loss of control is usually inevitable. Her failure increases her frustration and keeps her drinking all the more.
In spite of their obvious problems, most alcoholics are very reluctant to be addicted to alcohol. The reason for this may be the extreme stigmatization that people with alcohol problems face. The alcoholics themselves often share the corresponding prejudices (“I’m not a bum”).
Added to this is the fear of the necessary consequences – namely having to do without alcohol. Many people with alcoholism, once the environment draws them to the problem, drink in secret.
Types of alcohol addiction
There are different types of alcohol addiction depending on the drinking behavior.
The so-called mirror drinker consumes rather small amounts of alcohol, but continuously throughout the day. This type maintains a certain concentration of alcohol in the blood so as not to experience withdrawal symptoms.
In contrast, there is the binge drinker, who cannot control his drinking behavior and continues to drink to the point of intoxication each time. He gets used to an ever-increasing amount of alcohol. This form of chronic alcohol abuse (chronic alcohol abuse) is the most common.
Much rarer is the conflict drinker, who only drinks excessively when problems or conflicts arise. This type uses alcohol to overcome difficulties.
The episodic drinker consumes alcohol excessively at times and then remains abstinent for several weeks. This drinking behavior is also known as dipsomania.
Alcoholism is not always obvious. Some of those affected hide their alcohol addiction so cleverly for years that nobody notices anything about it. Many manage to continue to perform even demanding tasks.
Identify dangerous alcohol use
Alcohol addiction develops gradually. The following signs indicate that you are developing an alcohol addiction. Then they should seek advice so as not to become dependent.
• They drink more and more often.
• They drink increasingly large amounts.
• They like to drink alone.
• You drink more than you intended.
• They drink so much that memory gaps appear.
• They keep drinking despite negative consequences.
• You hide how much you drink.
• Other people ask you about your drinking habits.
Alcoholism – the consequences
Alcohol consumption has both acute and long-term effects. In the long term, there is a risk of serious organ damage and mental illness. In addition, every area of life is affected by alcoholism: work, family, friends and leisure time.
Short term effects of alcohol
Alcohol can lift mood and reduce inhibitions in the short term. But it also makes some people weepy, others aggressive. Depending on the amount and type of alcohol drink, as well as body weight and drinking habits, alcohol consumption will sooner or later lead to impaired perception and coordination problems.
Alcohol spreads rapidly through the blood throughout the body to the brain. Even those who tolerate a lot without getting drunk damage their organs. Because the liver can only break down about 15 grams of alcohol per hour. Anything beyond that initially remains in the blood. The breakdown of alcohol also produces toxins that impair health in the long term.
Long-term physical effects of alcohol
Alcohol and its breakdown products are toxic. In the long term, they damage all organs of the body.
The liver, which has to work hard all the time in people who drink a lot, stores more fat, enlarges and transforms into what is known as fatty liver. This often goes unnoticed for a long time because the liver itself cannot feel pain. However, it sometimes becomes noticeable through a feeling of pressure in the upper abdomen. Pain only occurs when the liver becomes inflamed.
After some time, liver cells die off: cirrhosis of the liver (shriveled liver) develops. It is a progressive, life-threatening disease. The risk of liver cancer also increases.
Effects on the brain
The brain also suffers massively. With every sip of alcohol, brain cells are lost (brain atrophy).
This also triples the risk of other forms of dementia, such as Alzheimer’s and vascular dementia, which often start earlier than usual.
In heavy alcoholics, the damage to the brain can also trigger alcohol-related dementia, known as Korsakoff syndrome. Those affected then suffer from disorientation and memory loss. Korsakoff syndrome is caused by a lack of vitamin B1. Because alcoholics often do not eat enough. Alcoholic beverages contain a lot of calories, but not the necessary nutrients.
Because alcohol passes through the entire digestive tract, it wreaks havoc everywhere. These include increased gum inflammation, reflux (heartburn), gastritis and ulcers, damage to the small intestine mucosa.
Gastrointestinal problems such as vomiting, diarrhea and anorexia are other consequences of alcoholism.
Heavy alcohol consumption can cause inflammation of the pancreas (pancreatitis). The acute form is very painful and can be life-threatening, a chronic course with diarrhea weakens the body.
Varicose veins of the esophagus
Due to the destruction of the liver, the blood from the abdominal cavity has to find a new way to the heart. Some of it is no longer routed through the portal vein to the heart, but through veins along the esophagus. These expand pathologically (esophageal varices) and can burst. The so-called esophageal variceal bleeding into the esophagus can lead to life-threatening blood loss.
Heart and vascular damage
Long-term consequences of alcohol addiction are also cardiovascular diseases. Alcohol damages the heart muscle and blood vessels. High blood pressure, cardiac arrhythmias, and heart muscle disease are more common among alcoholics. Vascular changes are expressed, among other things, in the typical red discoloration of the skin of alcoholics and in the so-called drinker’s nose.
In the long term, alcohol also increases the risk of cancer. In addition to liver cancer, there is also a risk of tumors in the mouth, throat, esophagus and stomach. In women, there is a significantly increased risk of breast cancer.
Reduced life expectancy
The life expectancy of alcoholics is reduced by 10 to 15 years.
Problems in work and private life
The effects of alcohol do not only affect health: In addition to the physical and mental consequences described, there are also problems with the environment.
At some point, alcoholics become unable to carry out their day-to-day tasks. The deeper they slip into alcohol addiction, the more likely they are to lose their jobs. This affects not only the financial but also the interpersonal situation.
Relationships with partners, children or friends often break down in the case of alcoholism.
Relatives often suffer just as much from the addiction as the person affected. Family, friends and hobbies are neglected. The sick person becomes a burden for the friend, partner and parent, and the addiction becomes a terrible center of life for everyone involved. Relatives often develop a so-called codependency.
Mental alcoholism symptoms
Alcohol changes personality. Under the influence of alcohol, some become subdued or tearful, while others behave aggressively or even violently. Aggression can be directed at strangers as well as at one’s own family. Many crimes are committed under the influence of alcohol.
Alcoholics often suffer from mood swings and depression. In severe cases, hallucinations and delusions occur. Alcoholics often suffer from insomnia and severe anxiety. Feelings of guilt and inferiority also accompany alcohol addiction.
Alcohol addiction and other mental illnesses
In many cases, alcohol addiction does not occur alone, but is accompanied by another mental disorder (comorbidity). The most common are anxiety disorders, such as panic disorders or phobias. Many alcoholics also suffer from depression. Alcoholics are also common among schizophrenic patients.
It is often difficult to determine whether a mental disorder has led to alcohol addiction or whether alcohol has caused or aggravated mental problems. In combination with a mental disorder, the suicide risk of alcohol dependents is increased. Both diseases must therefore be treated as quickly as possible.
Alcohol during pregnancy
Alcohol is particularly dangerous for the unborn child. Because if the mother drinks alcohol during pregnancy, it affects the physical and mental development of the fetus. The damage is irreversible and accompanies the child for a lifetime.
With fetal alcohol syndrome, the children show, among other things, behavioral problems as well as mental and physical impairments that can be very serious.
Even small amounts of alcohol can harm the child. Women should therefore avoid alcohol completely during pregnancy.
Alcohol addiction: causes and risk factors
Most people in world drink alcohol, many in harmful quantities. However, only some of them are addicted to alcohol.
Exactly how alcohol dependence develops has not yet been fully explained. However, several factors always come together for this. Both genetic and psychosocial influences play an important role.
Is alcoholism hereditary? Studies of family and twin research show that there is a genetic risk for alcohol addiction. Identical twins have a significantly increased risk of becoming alcoholic if one twin is affected. If both parents are alcohol dependent, about 30 percent of the children later also develop an alcohol addiction.
Consumer behavior in the family
In addition to the genes of the parents, their relationship to alcohol also plays a role. When children learn that drinking a lot is fun or even arouses admiration, or that alcohol is used to solve problems, they quickly take it as a bad example. If later there is also a lot of drinking in one’s own circle of friends, the effect is intensified.
Roots in childhood
Traumatic or stressful experiences often form the basis for the development of an addiction. Those most at risk are those who have experienced abuse or loss in childhood, such as the death of a parent. The bond with the mother is also crucial for the further development of the child. Children whose mothers do not respond to their needs or children without a permanent caregiver are more susceptible to alcoholism later on.
Alcohol among friends
Another factor comes into play, especially during puberty: peer pressure. Adolescence is a complicated phase in which young people try to develop personality and self-image and to connect with their peers. Peer pressure can become a trigger for drinking. If you don’t drink, you risk being excluded from the group.
Young people often rate alcohol positively. Being “hard hydrated” is considered a sign of strength. However, people who have this characteristic and who tolerate alcohol well are even more at risk of becoming addicted to alcohol than those who can hardly tolerate it. Because the latter automatically drink less.
Alcohol as a life support
Another risk of alcohol abuse is the initially positive effects of consumption. Under the influence of alcohol, inhibitions and fears are reduced in the short term. For more insecure people or people in difficult phases of life, the risk of alcohol abuse increases.
Alcohol as a happy drug
The processes in the brain also play an important role in the development of alcohol addiction. Because alcohol increases the release of the neurotransmitter dopamine, which activates the reward system in the brain. Dopamine creates feelings of happiness. For example, it is also released when we eat something.
But alcohol activates the dopamine receptors even more than food. Drinking alcohol is therefore rewarded with feelings of happiness. People who use this too frequently become less sensitive to dopamine—they need larger amounts. When they drink less or no alcohol, they develop cravings. This is also known as craving.
Alcohol addiction: investigations and diagnosis
Harmful use or alcohol addiction? Based on certain criteria, the doctor or therapist can decide what applies to a person and plan further treatment accordingly. Your family doctor will be the first point of contact to help you.
Studies in alcohol addiction
If alcohol addiction is suspected, the doctor will first have a detailed discussion with the person concerned. The family doctor could ask the following questions in an initial consultation:
• Do you often feel the need to drink alcohol?
• How much alcohol do you drink per day/week?
• Do you find yourself thinking about alcohol often?
• Have you ever tried to reduce your alcohol consumption?
• What positive or negative effects does alcohol have on you?
External withdrawal symptoms such as sweating, tremors or reddening of the skin can be a sign of alcohol addiction. With the help of a blood test, the doctor can find further indications of increased alcohol consumption. The blood count also provides information about the condition of the liver. In addition, the doctor will carry out a comprehensive physical examination to determine further possible consequential damage.
Diagnosis: abuse or alcohol dependence (ICD-10)
If the suspicion of alcohol dependence is confirmed, your family doctor will refer you to outpatient specialists or a clinic. They carry out an accurate diagnosis and draw up an individual treatment plan to combat alcohol addiction.
Diagnostic criteria for alcoholism
The criteria of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) are usually used to diagnose alcohol addiction.
A distinction is made between the harmful use of alcohol, which is referred to as alcohol abuse or alcohol abuse, and alcohol dependence. For the diagnosis, according to the ICD-10 for alcohol dependence, at least three of the following criteria must occur simultaneously in one year:
• There is a strong desire to drink alcohol.
• People have no control over when or how much they drink.
• If alcohol consumption is reduced or stopped, withdrawal symptoms (e.g. sweating or tremors) occur.
• A tolerance to the alcohol develops, so that the amount has to be increased more and more in order to feel an effect.
• Dealing with alcohol takes up a lot of time and leads to the neglect of other interests.
• Although alcohol consumption has negative consequences, those affected do not stop drinking.
Alcohol addiction: alcohol withdrawal
In the case of physical dependence, detoxification must take place first. Before the actual alcoholism therapy, those affected must undergo medically supervised alcohol withdrawal, a so-called detoxification. Alcohol withdrawal can be accompanied by mild to severe physical withdrawal symptoms. In severe cases, withdrawal can even be life-threatening. Therefore, it should always be medically supervised. The actual withdrawal therapy only follows after the physical withdrawal.
In milder cases, this can be done on an outpatient basis. The patient then appears daily for a period of time for breath testing for alcohol. A doctor will also check withdrawal symptoms, such as tremors, sweating, difficulty concentrating, and high blood pressure. A urine test may also be done at the end, which can detect alcohol for a much longer time.
In more severe cases, inpatient detoxification is required. On the one hand, patients who cannot manage to give up alcohol on their own cannot get hold of alcohol here. On the other hand, the dreaded delirium tremens can also occur during withdrawal. It can be accompanied by anxiety, confusion and hallucinations.
Dangerous physical symptoms such as epileptic seizures, rise in blood pressure and racing pulse can be better controlled here. Under inpatient medical supervision, the delirium can be intercepted with medication and treated in good time.
Alcohol addiction: treatment
Even if addicted people can no longer suppress their alcohol addiction, very few seek help with alcohol addiction immediately. For one thing, the shame is very great. On the other hand, the thought of having to do without alcohol is unimaginable for many.
But alcoholism is a life-threatening disease. It can only be managed alone in the rarest of cases. Therefore, if you fear drinking too much, do not hesitate to seek alcohol addiction help.
Abstinence or Reduced Drinking?
Those who are not yet dependent on alcohol have a good chance of reducing their consumption again – preferably with guidance.
But once the addiction has developed, it becomes a lifelong companion. The goal of withdrawal therapy is usually complete abstinence from alcohol. However, many alcoholics cannot imagine giving up alcohol completely (at least initially). As a result, in the past they mostly fell out of the grid of offers of help.
Meanwhile, addiction experts have changed their stance. Since 2015, the guidelines on alcohol therapy have also recommended reduced drinking as a possible therapeutic goal for alcoholics who are unable to abstain.
Under certain circumstances, over time, the patient may find it feasible to give up completely – or even easier than reducing drinking. Because the constant self-control of the amount you drink is not easy. The urge for more remains.
For most alcohol withdrawal offers, however, the willingness to abstain is still the basic requirement.
Contact points for alcoholism
The first point of contact is usually the general practitioner. Psychiatrists and therapists offer further help with alcohol addiction, but also public organisations, associations and advice centers that deal with alcoholism.
Psychological withdrawal therapy
Getting out of alcohol addiction requires starting from scratch. It is important to discard old habits, uncover the causes of addiction and find new ways to deal with problems and stress or to create positive feelings.
A withdrawal therapy is always made up of various components that address the different aspects of the addiction and its intensifiers: Individual discussions and group therapy are combined for this purpose. In addition, there are elements such as stress management and mindfulness training.
Addiction treatment is usually based on cognitive behavioral therapy. In individual therapy, the therapist works intensively with the patient to develop new patterns of thought and behavior.
An essential step is to uncover the personal reasons for slipping into alcohol. In order to remain abstinent, the patient must develop new coping strategies for the situations that trigger the addiction together with the therapist. He learns to get away from the automated reaching for the bottle and to find new sources of positive feelings.
Group therapy is the second central component of addiction treatment. The experience of meeting others, people who have experienced addiction first hand, helps to reduce feelings of shame. In a mutual exchange, the patients can benefit from tips and coping strategies of the other and encourage and support each other.
The leading therapist often also addresses central life issues that play a role in addiction: goals in life, partnership, relationship with parents, losses or fears.
Family or systemic therapy
Addiction has often damaged relationships with friends and family. There is often a so-called co-dependency in alcoholism: the relatives supposedly help the sick person, for example by covering them up for outsiders or by tolerating their behavior.
However, family problems may also have contributed to alcohol addiction. Both can be dealt with in family therapy.
The focus is usually on open, respectful communication behavior without assigning blame. This makes it easier for both sides to approach each other again. The relatives learn how to support the patient, but also how to distance themselves.
In mindfulness exercises such as the “Body Scan” the patient directs his full attention to the here and now. He learns to clearly perceive his feelings, both positive and negative, but also to accept them as something temporary. In this way, for example, an impending relapse can be recognized early on, so that the patient can take countermeasures in good time. However, the techniques can also be used to cope with strong addiction pressure.
Stress is a central cause for most alcoholics – and time and again a trigger for relapses. During therapy, the patient learns how to stress less about himself or how to let himself be stressed from outside. Learning a relaxation method such as autogenic training or progressive muscle tension according to Jacobson is also helpful.
Medication for cravings
For people who cannot achieve abstinence with psychotherapy alone, additional medication can help against alcohol addiction:
• The active ingredient naltrexone reduces the positive effects of alcohol. For alcohol dependents, these tablets are often used to prevent alcohol addiction from recurring.
• The active ingredient disulfiram causes a strong intolerance to alcohol. The affected person then suffers from headaches, shortness of breath, reddening of the face, nausea and vomiting when drinking alcohol.
Inpatient or outpatient?
Inpatient treatment: Getting rid of alcohol is difficult. This often works better in a clinic specializing in addiction. On the one hand you are not confronted with drinking people there and it is difficult to get alcohol at all.
For many patients, however, it is particularly important to get away from their usual environment and to concentrate entirely on themselves and overcoming the illness.
In addition, patients who have been ill for a long time and who have been seriously ill often no longer have a job and, apart from their drinking routines, have hardly any daily structure. In the clinic, they have the opportunity to get used to a regular daily routine again, to develop new interests and learn to take responsibility for smaller tasks. Inpatient treatment usually lasts between three and six months.
Outpatient weaning: Outpatient treatment can be useful for patients who are less seriously ill, for example, still have a job and are socially well integrated. This can, but does not have to, be part-time.
The advantage is that the patients practice life without alcohol right away in the “wild”. They learn to refuse alcoholic beverages in social gatherings, not to be tempted by the range of beer, liquor or wine when shopping, or to cope with stressful situations without alcohol. Outpatient treatment usually lasts nine to twelve months.
Assumption of costs
Alcohol addiction has been recognized as a disease since 1968. Therefore, the treatment is also taken over by the health insurance company, and later by the pension provider, for example the Federal Insurance Agency for Employees. Private health insurance companies do not always or not always fully cover the costs. The reimbursement depends on the respective contract.
Dealing with relapses
Alcoholism cannot be “erased”. Anyone who has ever been addicted to alcohol has to decide again and again against alcohol, even after successfully completing alcoholism therapy. Each glass can trigger a severe relapse. Even if the first alcoholic drink seems to have no consequences after a long time, consumption usually returns to the old level within a very short time.
Getting out of alcohol addiction is long and difficult. The patient is therefore prepared to deal with possible relapses. Relapses are common and it is important that those affected do not view them as personal failures but as part of the learning process. It is then important to recognize what triggered the relapse in order to avert this in good time in the future.
After the therapy, self-help groups make a significant contribution to staying stable. Through the regular meetings, the topic of alcohol addiction remains present. This protects against relapses. In the group, the person affected finds support and an understanding that those who are not affected cannot muster. Some agree on personal mentors who they can contact in an emergency.
For the classic forms of therapy, the will to abstinence is still the basic requirement. So-called “controlled drinking” takes a different approach. It is only intended for those affected who are not too deep and have not been in the addiction for too long.
The 10-step program was developed years ago by the psychologist Joachim Körkel. Among other things, the patient should recognize the occasions on which he drinks, keep a drinking diary and learn to set and adhere to fixed drinking goals.
However, the rules are strict: He must specify the time, place, circumstances and amount to drink in advance. The latter should be set so low that there is hardly any effect. Experts criticize that the loss of control is part of the disease and that controlled drinking is therefore a contradiction in terms for addicts.
Alcohol addiction: disease course and prognosis
Drinking alcohol is firmly anchored in society. As a legal drug, alcohol is readily available and readily available, and is also comparatively inexpensive. It relaxes, lifts the spirits and uninhibited. The risk of drinking too much is therefore great.
There is a fine line between pleasure and danger: more than 24 grams of pure alcohol for men (eg two glasses of 0.3l beer) and 12 grams (eg one glass of 0.3l beer) daily for women are considered risky consumption. But even less alcohol can damage sensitive people in the long run.
The transition from harmful use to addiction is fluid. First of all, most people use alcohol to create positive feelings, to alleviate fears and insecurity or to hide problems. Consumption escalates into harmful use.
This is not yet a dependency. However, many people are already having problems in connection with alcohol consumption: trouble with partners, friends or at work, for example.
Those affected decrease in their performance, often do not meet their obligations or the affected person has an accident while intoxicated. Other alcoholics manage to hide their addiction for a long time.
Then comes the psychological addiction. The person concerned increasingly neglects social life and tasks. Alcohol becomes the focus of life. Often the only thoughts revolve around the next glass. At this stage, those affected often hide their drinking. If alcohol is not available, a strong craving for it develops.
If the body gets used to the alcohol and the person concerned needs larger amounts for the desired effect, this is the beginning of physical dependence. If the addict abstains from alcohol at this stage, physical withdrawal symptoms appear.
They range from sweating and trembling to life-threatening delirium with hallucinations. In severe cases, withdrawal can be fatal, at least on its own. It should therefore be carried out under medical supervision.
Shortened life expectancy
Without treatment, the average life expectancy of an alcoholic is reduced by twelve years. The most common causes of death are suicide, accidents, liver failure, heart disease and cancer.
Despite consistent use of all therapeutic options, only 45 percent of former alcoholics are still abstinent four years after the end of therapy. However, those who are not deterred by relapses can also get alcohol addiction under control in the long term.
If left untreated, alcoholism usually remains a constant companion in life until death, which is often premature. However, alcoholism in old age often goes undetected. Falls or cognitive deficits are then quickly attributed to old age instead of to addiction.