Alcohol dependency is the most serious form of risky drinking and describes a strong, often uncontrollable, desire to drink. It is sometimes referred to as ‘alcoholism” or alcohol use disorder (AUD). If you are worried about your own drinking or a loved one, please visit the Drinkaware support page for more information on the various support services available to you.
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 are likely to be drinking at a level that could affect your long-term health.
If you find it very difficult to enjoy yourself or relax without having a drink, you could become psychologically dependent on alcohol which can include mood swings and increased anxiety. Physical dependence can follow too, which is when your body shows withdrawal symptoms, such as sweating, shaking and nausea.
What is Alcohol use disorder (AUD)
Alcohol use disorder (AUD) is a medical condition characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. It encompasses the conditions that some people refer to as alcohol abuse, alcohol dependence and alcohol addiction. AUD severity levels are classified as mild, moderate, or severe1.
Language – why it matters.
It may not seem harmful to use the words alcoholism or alcoholic when speaking of someone who is experiencing alcohol related issues, but the stigma associated with the terms alcoholism and alcoholic can decrease a person’s willingness to seeking support and the language we use can act as a barrier to seek health support. Stigmas are negative attitudes towards people based on certain distinguishing factors2.
In order to reduce the stigma associated with alcohol dependency and to empower and support people to seek help when needed it is important that we use language that is supportive and empathetic to the experiences of the individual.
Risk factors for alcohol dependence
A person may become dependent on alcohol or misuse alcohol for various reasons, but there are some known risk factors that can increase a person’s chances of becoming dependent on alcohol:
- A family history of alcohol dependence
- Starting to drink at an early age
- Experiences of abuse, neglect or trauma in childhood
- Having an already existing mental health condition
- The misuse of other substances such as tobacco, illegal drugs, or prescription medicine
- Living in an environment or culture with easy access to alcohol or where alcohol is consumed regularly, and excessive drinking is regarded as normal
- A stressful event such as bereavement, job loss, which can trigger heavy drinking that may lead to alcohol dependence.3
What is alcohol tolerance
Alcohol tolerance can occur if you drink regularly. Over time regular drinking can lead a person to need more volumes of alcohol to feel the same effects. For example, you may find that you need to drink more to get ‘drunk’ or ‘get a buzz,’ this is a sign that your body has become tolerant to certain levels of alcohol. The Drinkaware Annual Barometer Survey in 2022 found that 23% of Irish adults drink alcohol to ‘get a buzz’ and 14% drink alcohol to ‘get drunk’.
Alcohol tolerance develops over time and can be serious, if you are drinking more but not feeling the same effects it can lead a person to increase their drinking levels, or to believe that their drinking levels are safe because they are not getting drunk or feeling the effects from the alcohol as strongly.
Being conscious and mindful of how much you drink is important so that you don’t start to gradually increase and become tolerant to risky levels of drinking. Drinking less can help you reverse your tolerance to alcohol and reduce your risk of serious health harm4.
Visit the tips to drink less webpage for advice on how to cut down on your alcohol use.
Signs of alcohol dependency
A person may be alcohol dependent if they:
- Often feel the need to have a drink
- Get into trouble because of their drinking, this could be issues within their personal relationships, workplace issues such as absenteeism, or issues with the law because of their behaviour when they drink
- People telling the person that they are concerned about their drinking, or people expressing a desire for the person to refrain from drinking
- Thinking that your drinking is causing you problems.
Alcohol dependency is diagnosed by doctors by exploring how a person regulates their drinking and if the person has a strong internal drive to drink alcohol5.
- Lack of control over your drinking: Not being able to control how long you spend drinking or how many drinks you are having. Drinking alcohol at inappropriate times or during inappropriate occasions and not being able to stop drinking once you have started. Knowing and understanding what a standard drink is, and the HSE low-risk weekly alcohol guidelines will provide guidance on how many drinks you are having and if the amount you are drinking could be putting your health at risk.
- Placing an increasing priority on drinking alcohol: This could be prioritising alcohol over other responsibilities, such as family life or work. If drinking alcohol is taking priority over your health, or you continue to drink alcohol after you have experienced negative consequences.
- Experiencing unwanted physical and mental effects from alcohol: If you notice that your tolerance is increasing, and you are drinking more alcohol than before to experience the same effects. If you experience withdrawal symptoms, or you are using alcohol to alleviate withdrawal symptoms.
Audit C Screening for alcohol misuse:
The Alcohol Use Disorders Identification Test-Concise (AUDIT-C) is a brief alcohol screening instrument that reliably identifies persons who are hazardous drinkers or have active alcohol use disorders (including alcohol abuse or dependence). The AUDIT-C is a modified version of the 10 question AUDIT instrument.
POSSIBLE IMPACTS OF ALCOHOL DEPENDENCY
Regularly drinking above the HSE low-risk weekly alcohol guidelines and binge drinking can put your health at risk. Alcohol dependency can vary from mild, moderate to severe7, and the impacts on health can vary also8:
- Liver disease
- Digestive problems
- Heart problems
- Diabetes complications
- Increased risk of certain cancers
- Weakened immune system
- Sex life & fertility
- Fetal alcohol syndrome disorder (FASD)
- Bone damage
- Damage to the brain
- Eye problems
When someone in a family is drinking alcohol too much or too often, their behaviour can affect the entire family. Research highlights that 1 in 10 Irish parents reported that children experienced one or more harms as a result of someone else’s drinking in the past twelve months9.
Alcohol dependence can result in aggression, irritability, verbal and emotional abuse, rudeness, domineering behaviour and domestic abuse. Physical aggression may occur and may range from threatening behaviour to pushing, punching, hitting and other violent behaviours. These behaviours can cause severe stress, chaos and strain for the person’s family. Those who have an alcohol use disorder are over 4 times more likely than the general population to have answered that their drinking caused harm to home life / marriage10.
If you are concerned that a member of the family is drinking too much, too often or is alcohol dependent and it is impacting your family life, you should know you are not alone and there are supports there for you. It’s important that family members remember that it is not their fault that the person is drinking too much and to seek support.
Alcohol dependency can impact both the person who is engaging in the drinking and the people they work with. Increased levels of absenteeism, risks to the health and safety of the individual and their co-workers and a reduced ability to perform duties can lead to disciplinary action from employers and ultimately result in dismissal.
The negative impact on workers from co-workers whom they consider to be fairly heavy drinkers has shown that one in ten (10%) reported experiencing at least one of the work-related harms – ability to do job was negatively affected, had to work extra hours, had an accident, or had a close call at work11.
ALCOHOL WITHDRAWAL SYMPTOMS
Alcohol withdrawal symptoms can vary from mild to severe and can be both physical and psychological. Typical symptoms can include12:
- Hand tremors (‘the shakes’)
- A pulse rate above 100 beats per minute
- Loss of appetite
- Insomnia (difficulty sleeping)
Severe symptoms can include hallucinations, seizures, or delirium tremens (‘DTs’).
Delirium tremens is a severe indication of alcohol withdrawal. Symptoms include:
- Severe disorientation
- Increased heart rate, blood pressure and breathing problems
- Uncontrollable restless behaviour.
HOW CAN I TALK TO A LOVED ONE ABOUT THEIR DRINKING?
It can be a difficult and worrying conversation to start with a loved one who you are concerned is drinking too much or drinking to a risky level.
There are support services you can reach out to for support, remember you are not alone. But if you want to start the conversation here is some advice:
- Always start the conversation from a place of understanding and compassion
- Make sure you choose a time when the person has not been drinking
- Familiarise yourself with the facts, what a standard drink is, what the HSE low-risk weekly alcohol guidelines are and what binge drinking is
- Encourage your loved one to open up. Are they stressed, lonely or feeling anxious? There are many reasons why a person may engage in risky drinking, and the reasons why are important if the person is going to make positive changes
- Ask them how they feel about their drinking levels, ‘Are you happy with the amount you are drinking at the moment?’
- When speaking about your feelings, explain that these are your feelings, ‘I feel that your drinking has gotten a bit out of hand, do you think you should cut back a bit?’
- Explain the concerns you have for them and their drinking, if you have examples of when alcohol has negatively affected them reference this, for example, ‘you are very anxious the day after you have been drinking, do you think it is having a negative effect on you?
- Be prepared that they may become defensive, angry, or upset. They may even refuse to talk about the situation
- Remember there is support out there, sometimes it will not be possible to have this conversation with your loved one while on your own, make sure you feel safe before you speak to them or seek the support you need before you start the conversation.
IF YOU HAVE CONCERNS ABOUT A LOVED ONE’S DRINKING:
Visit the Drinkaware support page for information on organisations that are there to help support you.
1 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5); American Psychiatric Association, 2013
2 Words matter when discussing alcohol issues. https://niaaa.scienceblog.com/394/words-matter-when-discussing-alcohol-issues-a-new-stigma-free-vocabulary-for-better-aud-outcomes/
3 What can increase your risk. https://www2.hse.ie/wellbeing/alcohol/dependence/what-can-increase-your-risk.html
4 How to reduce your drinking. https://www.drinkaware.co.uk/advice/how-to-reduce-your-drinking/how-to-take-a-break-and-reset-your-tolerance
5 Health effects of alcohol. https://www.drinkaware.co.uk/facts/health-effects-of-alcohol/mental-health/alcohol-dependence
6 AUDIT: The Alcohol Use Disorders Identification Test Guidelines for Use in Primary Care; 2nd Ed; Babor et al (2001)
7 Alcohol use disorder. https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243
8 Alcohol use disorder. https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243
9 Hope A. (2013). Alcohol’s harm to others in Ireland. Dublin: Health Service Executive
10 Mongan et al, 2019–20 Irish National Drug and Alcohol Survey, 2021 2019–20. https://www.hrb.ie/publications/publication/the-2019-20-irish-national-drug-and-alcohol-survey-main-findings/returnPage/1/
11 Hope A. (2013). Alcohol’s harm to others in Ireland. Dublin: Health Service Executive
12 Alcohol withdrawal symptoms. https://www.drinkaware.co.uk/facts/health-effects-of-alcohol/mental-health/alcohol-withdrawal-symptoms
13 Helping someone with a drinking problem. https://www.helpguide.org/articles/addictions/helping-someone-with-a-drinking-problem.htm
14 Helping someone with a drinking problem. https://www.helpguide.org/articles/addictions/helping-someone-with-a-drinking-problem.htm
15 How to talk to someone about their drinking problem. https://www2.hse.ie/wellbeing/alcohol/coping-with-difficult-situations/how-to-talk-to-someone-about-their-problem-drinking.html
The content of this webpage has been reviewed by Dr. Gaël Le Roux, Lecturer in Addiction Studies, Technological University Dublin.