Overcoming Alcohol Dependence: A How-to Guide

Alcohol abuse has burdened the United States in many ways, imposing a significant financial burden associated with lost productivity, treatment, and other factors. The National Institute on Drug Abuse (NIDA) reports that in any given year, more than 17 million people have a potential diagnosis of an alcohol use disorder, the diagnostic label that is now used instead of older diagnostic terms like alcohol abuse and alcohol dependence.

The diagnosis of an alcohol use disorder is a clinical diagnosis that occurs when an individual has developed either a significant problem with abusing alcohol or is considered to have an addiction to alcohol.

Physical dependence begins with the development of tolerance to alcohol (needing more alcohol to achieve the same buzz or high). The diagnosis of physical dependence is made when the person begins to experience withdrawal symptoms once they have stopped using alcohol.

Depending on the severity level of the alcohol use disorder, withdrawal symptoms can occur within a few hours after stopping the use of alcohol or a few days after discontinuation.

Is Physical Dependence on Alcohol the Same Thing as Having an Addiction?

In the United States, the American Psychiatric Association (APA) provides the criteria that are used to diagnose substance use disorders like an alcohol use disorder. The development of physical dependence on alcohol is not necessarily considered to be the same thing as having an addiction because a person can be diagnosed with an alcohol use disorder and not display withdrawal symptoms.

The development of tolerance and withdrawal can be symptoms that an individual has an alcohol use disorder, but they are neither necessary nor sufficient for this diagnosis.

In addition, many sources refer to withdrawal syndromes as discontinuation syndromes, indicating that the symptoms occur with a person stops use of the substance. Whenever the term alcohol discontinuation syndrome is mentioned in an article, research journal, or another source, the term refers to withdrawal from alcohol.

Categories of Alcohol Withdrawal

Older research indicates that withdrawal from alcohol can be divided into two categories: a mild alcohol withdrawal syndrome and a moderate-to-severe alcohol withdrawal syndrome. Unfortunately, there is actually no way to predict with certainty who will develop either syndrome.

Some individuals who are diagnosed with a mild alcohol use disorder according to APA standards may actually display symptoms that would be associated with severe alcohol withdrawal, whereas others who have very severe alcohol use disorders may only display mild withdrawal symptoms.

There may be some other factors that can contribute to the severity of an individual’s withdrawal from alcohol, such as:

Factors Affecting Withdrawal

• A person’s genetic makeup
• The frequency and amount of alcohol a person drinks
• Personal factors like one’s sex, weight, co-occurring medical conditions, and other factors

None of these above factors can guarantee that someone will develop a physical dependence on alcohol, and none can be used to determine the severity of the withdrawal symptoms they will experience. If present, these factors can increase the risk for an individual to develop withdrawal symptoms when they discontinue their use of alcohol.

In general, there are differences between mild and moderate-to-severe alcohol withdrawal.

• The onset of withdrawal symptoms in mild cases occurs longer after the person stopped drinking than it does for individuals with moderate-to-severe withdrawal symptoms.
• Mild withdrawal from alcohol usually only lasts between 24 to 48 hours after discontinuation, whereas moderate-to-severe withdrawal from alcohol can last for weeks after discontinuation.
• Mild alcohol withdrawal symptoms are typically less intense than moderate-to-severe alcohol withdrawal symptoms.
• Individuals undergoing mild withdrawal from alcohol will not experience problems with hallucinations and confusion (delirium tremens) or seizures, whereas individuals with moderate-to-severe alcohol withdrawal are at significant risk for these symptoms.

Delirium tremens, also called DTs, is a condition that occurs when someone with an alcohol use disorder experiences a significant drop in their blood-alcohol concentration (BAC) and displays numerous neurological symptoms that can include significant confusion, psychosis (delusions and visual hallucinations), disorientation, and potential seizures. Individuals with mild alcohol withdrawal symptoms are not under significant risk to develop seizures, but anyone withdrawing from alcohol may be at risk for seizures.

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Delirium tremens will typically resolve within two to three days after the person has discontinued alcohol, but in some individuals, the symptoms may last longer. Due to the potential for seizures and confusion, delirium tremens is an extremely dangerous manifestation of alcohol withdrawal that can potentially be fatal. Due to the potential for seizures during withdrawal, medical detox is required for alcohol withdrawal.

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Recovering From Addiction

Recovering from an alcohol use disorder is a complicated process for most individuals. There are many reasons for this, but the primary reason is that alcohol use is ingrained in American culture and readily available. Everyone is exposed to its presence.

Individuals who develop alcohol use disorders will be tempted to believe they can control their use of alcohol in such a manner that is not problematic for them. Unfortunately, this perception is rarely valid.

Most individuals who have developed any level of an alcohol use disorder are encouraged to enroll in an alcohol treatment program and practice complete abstinence from alcohol and other drugs of abuse.

How to Address Dependence

If you are physically dependent on alcohol, you cannot just stop drinking. Doing so puts you at risk of life-threatening withdrawal symptoms. Instead, you must enlist the help of medical professionals.

Generally, an addiction treatment program will be recommended that includes the following components:

Typical Components of an Addiction Treatment Center

• A formal assessment of functioning in all areas, including psychological functioning, physical health, and social situation
• Physician involvement to address any potential withdrawal symptoms that may occur when the person stops drinking
• The use of medications to control cravings (ReVia [naltrexone]), address withdrawal symptoms (benzodiazepines and other medications), and assist with abstinence (e.g., Antabuse [disulfiram])
• Intensive involvement in behavioral interventions that can include substance use disorder therapy, 12-step groups, and other types of therapies that do not involve the use of medications
• Support from family and friends
• Continued involvement in treatment for a sufficient length of time

Again, those who struggle with alcohol dependence cannot stop drinking suddenly on their own. In many instances, medications may be prescribed during the withdrawal process to mitigate withdrawal symptoms.

A physician should supervise a medical detox program. Individuals should not attempt to treat withdrawal symptoms without being under a physician’s care because of the potential to develop seizures.

In the early stages of recovery, an individual will experience significant cravings to drink and may experience increased effects from alcohol due to decreased tolerance if they have been abstinent for a significant period. This makes alcohol poisoning more likely.

Individuals who relapse in the early stages of recovery, who are not in a formal treatment program, may become demoralized to the point that they may not believe they can recover from their alcohol use disorder. Those in recovery programs can work with therapists and other treatment providers to view their relapse as an opportunity to learn and strengthen their recovery program.

Lifestyle Changes

In addition to getting involved in a formal recovery program, an individual can also engage in other positive lifestyle changes that can assist them in their recovery.

• Develop a healthier lifestyle that includes a balanced diet, regular exercise, and alternatives ways to manage stress.
• Better oneself by strengthening relationships with close friends and family, getting involved in job training, and defining other beneficial goals.
• Avoid contact with individuals who are likely to negatively influence your recovery. Many people in recovery find that they must let go of old “drinking buddies” due to the potential for these associations to interfere with their goals.
• Avoid other situations that might foster a return to drinking, such as places and situations that were typically associated with alcohol use.

Ultimately, physical dependence on alcohol must be addressed by medical professionals. If you are dependent on alcohol, contact an addiction treatment professional to ensure you can safely detox from the substance.

Sources

(April 2017). Trends and Statistics. National Institute on Drug Abuse. from https://www.drugabuse.gov/related-topics/trends-statistics

(April 2004). Alcohol Withdrawal Syndrome. American Family Physician. from https://www.aafp.org/afp/2004/0315/p1443.html

(2010). Alcohol Use Disorders: Diagnosis and Clinical Management of Alcohol-Related Physical Complications. National Clinical Guidelines Centre. from https://www.ncbi.nlm.nih.gov/books/NBK65581/

(December 2018). Delirium Tremens. MedlinePlus. from https://medlineplus.gov/ency/article/000766.htm

(2018). Alcohol Use Disorder: Diagnosis and Treatment. Mayo Clinic. from https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/diagnosis-treatment/drc-20369250