Alcohol dependence and withdrawal

For some people alcohol can be part of many occasions but like many drugs it’s addictive, both physically and psychologically.

The NHS estimates that around 9% of men in the UK and 3% of UK women show signs of alcohol dependence¹. This means that drinking alcohol becomes an important, or sometimes the most important, factor in their life and they feel they’re unable to function without it.

What is alcohol dependence?

Alcohol dependence, sometimes known as ‘alcoholism’, is the most serious form of drinking problem and describes a strong, often uncontrollable, desire to drink.

Drinking plays an important part in the day to day life of alcohol dependent people, which could lead to building up a physical tolerance or experiencing withdrawal symptoms if they stop.

There are varying degrees of alcohol dependence and they don’t always involve excessive levels of drinking. If you find that you ‘need’ to share a bottle of wine with your partner most nights of the week, or always go for a few pints after work, just to unwind, you’re likely to be drinking at a level that could affect your long-term health.

You could also be becoming dependent on alcohol. If you find it very difficult to enjoy yourself or relax without having a drink, you could have become psychologically dependent on alcohol. Physical dependence can follow too, that is your body shows withdrawal symptoms, such as sweating, shaking and nausea, when your blood alcohol level falls.

Take our Alcohol Self-Assessment

Alcohol abuse or alcohol dependence?

The terms alcohol abuse and alcohol dependence are often used interchangeably, when in fact medically speaking, there is clear distinction between the two. Both involve the serious misuse of alcohol likely to cause real damage to health and wellbeing. But while people with alcohol abuse problems usually manage to carry on their lives with some semblance of normality, once dependence kicks in, the alcohol takes over.

Alcohol abuse refers to regular excessive drinking which has a more tangible negative effect on people’s lives². Examples of this include failing to fulfil work, family or social obligations as a result of recurrent drinking; encounters with the law or emergency services arising from excessive alcohol use or regularly combining alcohol with physically hazardous situations, such as driving or operating machinery. 

If you are worried that you are abusing or misusing alcohol, visit our page on binge drinking.

As outlined above, when dependence sets in, alcohol takes over the central role in someone’s life and they usually end up giving up important activities and relationships because of their drinking. One of the early signs of dependence is when you need more alcohol to achieve the desired effect. As dependence gets more established, people end up spending most of their time thinking about alcohol or engaging in activities necessary to obtain, use, or recover from the effects of drinking.  Then, as dependence takes over, people notice that they get the shakes if they don’t have a drink. And so they simply have to keep drinking to avoid experiencing these withdrawal symptoms.

Signs and symptoms of alcohol dependence

If you're worried that you may be becoming alcohol dependent or are concerned about someone else's drinking, look out for these four warning signs and symptoms:

1. Worrying about where your next drink is coming from and planning social, family and work events around alcohol.
2. Finding you have a compulsive need to drink and finding it hard to stop once you start.
3. Waking up and drinking – or feeling the need to have a drink in the morning.
4. Suffering from withdrawal symptoms, such as sweating, shaking and nausea, which stop once you drink alcohol.

If you’re worried that you have any of these symptoms of alcohol dependence, talk to your GP or seek further information from one of the organisations at the bottom of this page.

What causes alcohol dependence?

Usually several different factors contribute to someone becoming alcohol dependent.

Alcohol dependence can run in families. It’s partly down to your genes, but is also influenced by your family’s attitudes to alcohol and the environment you grow up in.

Stressful events, such as bereavement or losing a job, can also trigger heavy drinking, which can then lead to alcohol dependence.

People who are alcohol dependent have higher rates of other psychiatric disorders than people in the general population – particularly depression, anxiety, post-traumatic stress disorder, psychosis and drug misuse. Often, people drink to try and reduce the symptoms (sometimes known as ‘self-medicating’), but in the long term alcohol makes these disorders worse because it interferes with the chemical balance in our brains.

Some people believe that there’s such thing as an ‘addictive personality’ which leads to alcohol dependence. But there’s not much strong evidence to support this view.

How to reduce your risk of becoming alcohol dependent

Taking regular breaks from alcohol is the best way to lower your risk of becoming dependent on it. If you drink regularly, your body builds up a tolerance to alcohol. Tolerance is a physiological response we have to any drug: the more you consume, the more your body needs to have the same effect. Regular drinking induces certain enzymes in your liver that break up (metabolise) alcohol. If you drink heavily over weeks or months, levels of these enzymes go up, your tolerance builds and you need more alcohol to get the same effects 3.

Brain systems get tolerant to alcohol too, and although you may be able to walk a straight line after drinking quite a lot, this means the brain has adapted so that next day the brain cells ‘expect’ alcohol. Withdrawal symptoms such as anxiety and jitteriness occur, and you can find yourself drinking alcohol just to relieve that.

When you’re drinking most days you can become psychologically dependent on alcohol too.

Breaking your drinking cycle is an important way to test for – and tackle – this kind of dependence. It can prevent your body from becoming accustomed to alcohol and help to lower or ‘reset’ your tolerance.

Effects of alcohol dependence on the body

Being alcohol dependent can lead to a whole range of serious health problems. If you’re dependent on alcohol, you increase your risk of developing high blood pressure, stroke, coronary alcohol-related heart disease and alcohol-related liver disease.

Prolonged heavy drinking damages your liver. An estimated seven out of 10 people with alcoholic liver disease (when the liver is damaged by alcohol misuse) have an alcohol dependency problem⁵.

Alcohol dependence can contribute to mental health problems

Anxiety, depression and suicidal feelings can all develop when you’re alcohol dependent. This is because regular, heavy drinking interferes with neurotransmitters in our brains that are needed for good mental health. 

Being dependent on alcohol can affect your relationships with your partner, family and friends. It might mean you don’t perform so well at work and if that continues for any length of time you could face losing your job, leading to financial problems as well. These issues can also contribute to depression and anxiety. Alcohol can also make you more aggressive. If you use alcohol to try and improve your mood, you may be starting a vicious cycle.

If you think your mental health is suffering because of your drinking, but you feel you’re not able to stop, ask for professional help. Start with a visit to your GP or by contacting one of the organisations listed at the end of this page.

Alcohol can even make you more aggressive

Alcohol withdrawal symptoms

If you’re dependent on alcohol, you can experience alcohol withdrawal symptoms if you suddenly stop drinking.

Withdrawal symptoms can be physical and psychological

Physical alcohol withdrawal symptoms include:

• hand tremors (‘the shakes’)
• sweating
• nausea
• visual hallucinations (seeing things that are not actually real)
• seizures (fits) in the most serious cases

Psychological alcohol withdrawal symptoms include:

• depression
• anxiety
• irritability
• restlessness
• insomnia (difficulty sleeping)

Severely dependent drinkers usually experience very strong alcohol withdrawal symptoms. Sometimes people drink to avoid these symptoms, a pattern known as ‘relief drinking’⁶.

It can take between three months and a year to fully recover from the effects of alcohol withdrawal. Even then, the brain remains abnormally sensitive to alcohol⁷. So if you start drinking again, your high tolerance to alcohol and withdrawal symptoms can come back within a few days⁸. It's why doctors usually recommend that you don't start drinking again, even in moderation.

More about alcohol withdrawal symptoms

Alcohol dependence in the UK

The NHS estimates that around 9% of men in the UK and 3% of UK women show signs of alcohol dependence⁹.

In England in 2014, 194,706 prescriptions for drugs to treat alcohol dependency were prescribed¹⁰.

In England in 2013 there were 6,592 alcohol-related deaths¹¹.

Staying in control

Drinking within the low risk unit guidelines will help you keep your drinking under control. Here are three ways you can cut back:

Try alternative ways to deal with stress other than alcohol. Instead of reaching for a beer or glass of wine after a hard day, go for a run, swim or to a yoga class, or a talk to a friend about what’s worrying you.

Keep track of what you’re drinking. Your liver can't tell you if you're drinking too much, but MyDrinkaware can. It can even help you cut down.

Give alcohol-free days a go. If you drink regularly, your body starts to build up a tolerance to alcohol. This is one of the main reasons why many medical experts recommend taking regular days off from drinking to ensure you don't become addicted to alcohol. Test out having a break for yourself and see what positive results you notice.

Further information

Your GP can help you figure out if you should make any changes in your drinking, and offer help and advice along the way.

If you’re concerned about someone’s drinking, or your own, Drinkline runs a free, confidential helpline. Call 0300 123 1110.

Alcoholics Anonymous: If you need help with a drinking problem you can phone the national helpline on 0800 9177650 or email help@alcoholics-anonymous.org.uk

Addaction: For all general enquiries and concerns, you can email Addaction on info@addaction.org.uk. To find your nearest service in England or Scotland, visit the Service Finder” section of the website www.addaction.org.uk