How to recognise a drinking problem

If the unwanted effects of drinking are harming your life in some way – your health, your relationships with those you care about, your work – then you have a drinking problem. If you are beginning to need alcohol and find it hard to take it or leave it, or it is becoming difficult to control the amount that you drink, then you are becoming ‘dependent’ on alcohol and that can cause other problems to develop. Ask yourself the following questions and be frank about the answers.

Are there changes in relationships?

The pleasant releasing effect of drinking allows you to ‘let your hair down’ – which can also alienate people and hurtful things can be said. After drinking, as the level of alcohol in your blood falls, you can get bad-tempered and irritable. Drinkers can get touchy – seeing slights where none was intended. Bottled up envy or jealousy may come out in a destructive way. If large quantities of alcohol are drunk, the memory can be patchy for some of these moments – moments that may have been very upsetting for others.

Commitments may be skipped, or even forgotten: a father lets his son down over a promised outing to a football match; a mother loses interest in her teenage daughter’s fashion pursuits. There may be repercussions throughout the family – children become defiant, sulky or unhappy. They do less well at school. The spouse grows cold or distant, hurt by things said, and by the arguments that develop about the drinking. Friendships are sometimes damaged in a similar way. People who drink a lot may also develop a habit of phoning friends when intoxicated, perhaps at unsociable hours, and pouring out their troubles in an insensitive way.

Are there changes in my work performance?

Frequent lateness at work or sick leave can signal that an employee is drinking too much, resulting in hangovers the next day.

Employers may overlook odd days off, but colleagues who have to bear the brunt of absences may be less patient. Drinkers often think that no-one notices extended lunch breaks (to get a drink) or the smell of alcohol on their breath.

Have I become dependent?

Has life become more oriented around places, occasions and company where there is going to be a drink? Previous hobbies or interests may get displaced in favour of drinking. Instead of just wanting a drink the feeling is of actually needing a drink. This is due to a mixture of habit and a chemical process, to which some people may be more prone than others. When people with this pattern of drinking try to cut down, they may find it very difficult. The thought of a drink is strongly triggered in situations where they used to drink or when they are with the same friends.

How dependent have I become?

Early signs of dependence

In the early stages, our brain cells become used to alcohol, so that a rebound of sudden tension or anxiety occurs if brain cells are deprived of alcohol when the next drink is not there. This feeling may be mistaken for anxiety about going to work, worry about the family or some other connection that the person has made. Drinkers may not readily see, or wish to see, the connection between these feelings and the fact that they have got into a very regular pattern of drinking in recent weeks or months. Another sign of early dependence in drinkers is when they drink much more than they intend. They may say they feel that they cannot control their drinking as well as they used to – although they may have had poor control from early in their drinking days.

Friends and family may recognise the trouble, but remain helpless because people who are developing a drink problem often see things differently, because they have become attached to drinking and do not want to admit that it is time to cut back.

Alcohol dependence

A person who is dependent on alcohol has an irresistible compulsion to drink, which takes priority over almost everything else in life. There are a number of signs that this is happening and these are listed below.

Early signs of dependence

Drinking pattern tending to be the same each day
Setting a limit but not sticking to it
Giving up activities that do not involve drink
Having some problems caused by drinking but not noticing, and/or letting it happen again
A larger amount needed to give the same effect

Later signs of dependence

Sleep problems
Nervous, sickly, sweaty or shaky in the morning
Regularly having a drink within three hours of waking
Sometimes severe withdrawal symptoms: epileptic seizures, when people suddenly lose consciousness hours or days after stopping drinking, perhaps with jerking of the arms and legs and interrupted breathing; and delirium tremens, when people become confused, not knowing where they are or whom they are with, and can have hallucinations

Later signs of dependence

When the problem goes to the next stage, the rebound feelings may be accompanied by tremor of the hands or fingers, especially in the morning when the blood alcohol level is low. A feeling of butterflies in the stomach may be there too, or nausea when the teeth are brushed or breakfast contemplated. A drink settles this – and so drinking in the morning becomes a habit. The rebound symptoms are also called withdrawal symptoms. If someone has been drinking 16 or more units per day, for several weeks, and then stops for some reason, these can be very unpleasant. At their severest, an epileptic fit can occur, or a temporary delirious state when the person loses touch with reality and has hallucinations (delirium tremens or ‘DTs’). It is very important to avoid such a severe reaction and medication from a doctor can prevent it, if taken at the point when drinking stops. A mysterious feature of dependence on alcohol is the ease with which the cycle of abstinence, drinking and dependence can be repeated. If a person stops drinking for some days, weeks or even months and then takes another drink, the vicious circle starts all over again. The person has a period of wanting to drink, then drinking, followed by stopping and withdrawal symptoms returning. After another few days or weeks, the cycle starts all over again.

Is dependence an illness?

People dependent on alcohol drink in response to triggers – for example, avoiding withdrawal symptoms, or in certain emotional states. The memories of pleasurable feelings from alcohol have been laid down deep in the brain.

This pattern of drinking from habit has been seen in animals studied in scientific laboratories. Some families of animals pass on a genetic tendency to alcohol dependence – so there is strong evidence for the involvement of biological factors. Someone who is dependent on alcohol has tremendous struggles about whether or not to drink, which most of us never know. But, although there may be a biological basis to this, his or her recovery will depend on how hard an effort is made, as well as how much help is received.

KEY POINTS

Dependence on alcohol means beginning to ‘need’ it on some occasions, or repeatedly failing to control the amount
Some dependent drinkers get withdrawal symptoms when they cut down or go without
There is a chemical basis to dependence on alcohol, but change means wanting to change and making an effort