The term ‘alcohol abuse’ tends to be used interchangeably with ‘alcoholism’ but there are some key distinctions. ‘Alcohol abuse’ covers a range of behaviours including binge drinking and hazardous drinking. While these can still be harmful, they may only occur occasionally and the person can have a relatively normal life in between episodes.
‘Alcoholism’ – also known as ‘alcohol addiction’ or ‘alcohol dependence’- refers to the obsessive need to consume alcohol or alcoholic substances. It is a recognised and progressive health condition that becomes the central focus of a sufferer’s life and is believed to be caused by a combination of cognitive and physiological factors.
Sufferers are unable to control the urge to drink and will continue even when it causes obvious health problems such as internal organ and tissue damage. Other flow-on effects include an increased risk of mental and social problems and also of accidents, violence and crime.
According to the Australian Bureau of Statistics, in 2013-2014 there were 9.7 litres of pure alcohol available for consumption for every person in Australia. Of all the adults across the country 78.3% drink alcohol, however the overall amount of alcohol consumed per capita in Australia is now at its lowest level since the early 1960’s.
The majority of people who do drink alcohol do so only occasionally or semi-regularly, however those who consume more than 2 standard drinks per day (on average over 12 months) are referred to as lifetime risky drinkers. Single occasion risky drinkers are defined as people consuming 5 or more standard drinks on a single drinking occasion. Drinking less than these recommended maximums reduces the risk of alcohol-related injuries and health issues.
The body absorbs alcohol into the bloodstream through the stomach and small intestines. It then travels through the body to the central nervous system, heart, brain, organs and other tissues. This process is quite quick and often results in a temporary but pleasant feeling.
Intoxication occurs as the concentration of alcohol in the bloodstream increases. It affects the nerves and reduces our responses to stimuli. The more a person drinks, the more their behaviour changes. This is believed to happen in 6 distinct stages.
During or just after the first drink the drinker experiences a feeling of being slightly ‘happy’ or ‘tipsy’ allowing their confidence to increase. They may lower or lose our inhibitions and say or do things outside of their normal character. They may also have a decreased attention span, reaction time and an increased love for everything and everyone around them.
At this point they become over-excited and out of control. Their reaction time becomes even slower, their vision blurry and they may start to stumble and become sleepy. Judgement, memory and perception and memory are also affected.
During this stage the drinker may begin to become dizzy, confused and unreasonably emotional. They lose theri ability to accurately perceive colour, form, motion and dimensions. They can struggle to walk and talk and others may find it hard to understand them. Feelings of lethargy or disconnection may creep in.
Following the loss of coordination the person can completely lose control of motor and bodily functions. They become unresponsive and can fall into a stupor.
During this state of unconsciousness they may have problems with breathing, circulation and body temperature.
If left in a coma for long enough, they can cease to breathe and die from respiratory arrest.
When we look at the full chain of possibilities in this manner, the obvious thing to do would be to stop at the ‘euphoria’ stage but the reality is we often keep going. As our judgement is impaired we lose the ability to make sensible decisions such as saying no to the next drink and going home. Because drinking initially makes us happy and relaxed we want to continue so it often happens that one after-work drink becomes two, three and then suddenly it’s midnight.
Learning to recognise and understand your own drinking habits will help you to identify areas that may need changing. Do you enjoy the occasional drink with family and friends? Do you drink to relieve stress or to feel better? Do you drink just for the sake of it? Read the following questions thoroughly and be honest with your answers to see what kind of drinker you are.
It is possible to abuse alcohol by drinking excessively or for the wrong reasons without necessarily being addicted to it. So are you a drinker or an alcoholic?
Those with alcohol dependency believe that they cannot function effectively without the support of alcohol. They become obsessed with it and can’t control the amount they consume. Some common symptoms of alcoholism include:
Alcoholism – like other forms of addiction- has both physical and psychological forms.
Changes in the chemical patterns of the brain create physical cravings for an emotional high or intense feelings of pleasure. Even the sight, smell or thought of alcohol can spark the craving. Once the person gives in to the craving and has a drink, the desire to have the next one increases. When this pattern continues, the body builds up a tolerance to alcohol and it takes an increasing amount to achieve the same effect. Attempting to stop drinking brings on withdrawal symptoms so the person continues and ends up caught in a vicious cycle of addiction.
Sometimes people form an addiction to alcohol to block out negative emotions or deal with psychological issues. Drinking reduces stress and anxiety, numbs painful feelings and briefly fills an emotional void. This form of addiction does not involve chemical changes in the brain; however it can lead to other mental and behavioural problems such as feelings of guilt, shame and despair. When these become too intense to deal with, the person again turns to alcohol to block everything out.
People become dependent on alcohol for all manner of reasons and the exact cause will be different for everyone. However there are some common factors that increase the risk of alcohol dependence. These include:
There is a lot of evidence to suggest that alcoholism can have a genetic link. Those who have relatives who are heavy drinkers are more likely to develop alcohol dependence themselves.
Sometimes a traumatic experience such as a car accident, death of a loved one or losing a job can lead a person to drink as a way to escape the reality of their situation.
These can include:
Ongoing consumption of alcohol affects many aspects of the body, mind and interactions with others.
Prolonged use of alcohol can cause many long-term physical conditions including:
According to the Australian Bureau of Statistics alcoholic liver disease causes 64% of all deaths from alcohol-caused diseases.
There are very strong and well documented links between mental illness and alcohol dependence. In fact, mental and behavioural disorders are the second highest cause of death from alcohol-caused diseases (24%).
Alcoholism is also known to increase the risk of:
Dual diagnosis or co-morbidity are terms used when a person has been diagnosed with two or more health conditions. Both terms can be used to describe the condition of a person who has both a mental health and an alcoholic disorder.
In Australia, 23% of those with an alcohol disorder also have at least one other mental health condition, 16% have one or more physical condition and 33% suffer from botha mental and physical condition.
While the connection between alcoholism and mental health disorders is proven, what is not known is which condition causes which. It is a little like the chicken and egg conundrum and the reason varies greatly depending on the individual. In some cases the mental illness may have contributed to the alcoholic dependence but in others the stress and anxiety rising from the addiction may lead the person to develop mental health issues.
The effects of dual diagnosis on a person can vary greatly and much depends on the actual combination of conditions and symptoms. For example, those with schizophrenia may find that alcohol abuse may worsen their condition. Other issues that may arise from dual-diagnosis of alcohol and mental health disorders include:
A person with alcoholic dependence often becomes very withdrawn and their thoughts are dominated by the need for their next drink. As a consequence, that person’s family and friends can be neglected or become victims of aggressive or violent behaviour.
When the addiction causes other changes such as social or financial changes, the relationships can be put under further pressure. Friends and family may not know how to help the person with the addiction. Some may deny or downplay its existence, some may be reluctant to interfere as they fear the person’s reaction and some may be willing to help but may not know the best way to do so.
Before any treatment can take place, the person with the problem must be able to admit to it. If they are still in denial or if they believe they have it under control on their own then further treatment becomes difficult if not impossible. The longer the situation continues without being properly addressed, the greater the risk of harmful consequences.
The Australian National Drug Strategy recommends a harm minimisation approach with all forms of treatment for alcohol addiction. This requires practitioners to work to reduce any harm caused by the addiction without necessarily seeking to stop the behaviour as that may sometimes be impractical or impossible.
The most common treatments for alcoholic dependency can be used alone or in conjunction with each other. They include:
Cognitive Behavioural Therapy (CBT) has been proven to be one of the most effective ways to treat and manage alcoholic dependency. It is based on the premise that our thoughts control our actions and therefore it is necessary to uncover the source of negative thought patterns that have led to the addictive behaviour. Once the underlying feelings, beliefs and thought patterns have been identified, they can be analysed and replaced with more positive thoughts and behaviours.
Alcoholics can learn new ways to address their problems in a more constructive manner without the need to drink. Counsellors can help by providing guidance and support while the person works through the process of changing their thoughts and actions leading to a happier and healthier lifestyle.
In Australia there are currently no laws that specify what qualifications or training a counsellor needs to have before being allowed to offer addiction counselling services. However there are a number of tertiary and professional development courses that are available. Practitioners can also apply to be registered with the Australian Counselling Association (ACA), the Psychotherapy and Counselling Federation of Australia (PACFA) and other industry associations.
It is generally recommended that people struggling to overcome addiction undertake a detox program alongside CBT or similar therapy. When that person is in a relationship or has a family then couples or family counselling may be also needed so finding a professional with experience with addiction in these circumstances would be very beneficial.