What is alcohol disorder

What is an alcohol addiction?

The physical dependence is characterized by physical withdrawal symptoms during drinking breaks and the emotional dependence by the compelling desire to continue consuming alcohol.

Alcohol addiction must be differentiated from both alcohol intoxication and the harmful consumption of alcohol. The transitions from repeated intoxication to harmful consumption to addiction are fluid, however.

Alcohol addiction does not arise overnight, but usually develops slowly. No one who consumes alcoholic beverages is safe from addiction.

Alcohol intoxication (acute alcohol intoxication, acute alcohol intoxication, drunkenness) occurs as a direct consequence of consuming large amounts of alcohol. Depending on the amount of drinking and the development of tolerance, different degrees of severity of alcohol intoxication develop. In the easiest stage a cheerful mood sets in. Fears and inhibitions are reduced and the need for exercise is increased.

Disturbances in language, gait, coordination, attention and judgment already begin in the medium dose range. There are gaps in memory. At even higher doses, irritability, aggressiveness, fatigue and impaired consciousness up to coma (deep unconsciousness) can finally occur.

Harmful use of alcohol is used when the consumption of alcohol leads to impairment of health. The impairment can manifest itself both in the physical area (for example as an increase in liver values, stomach ulcer, high blood pressure) and in the psychological area (for example in the form of depression, feelings of inferiority).

Alcohol addiction exists if three or more of the following criteria are present at the same time within a year:

  • A strong desire or some kind of compulsion to drink alcohol
  • Reduced ability to control the beginning, the end and the amount of consumption
  • Physical withdrawal symptoms, for example sweating and tremors, after stopping or reducing consumption
  • Tolerance development, that is, in order to achieve the desired effect, increasingly larger amounts of alcohol have to be drunk
  • Progressive neglect of other amusements or interests in favor of alcohol consumption. More time is invested in procuring alcohol, consuming alcohol or recovering from the consequences
  • Continued consumption of alcohol despite harmful consequences in the physical, mental-psychological or social area against better knowledge

What are the consequences of alcohol addiction?

Alcohol is a poison that basically damages all organ systems of the body as well as the psyche. Alcohol addiction is life threatening.

There are approximately 74,000 alcohol-related deaths each year. Every day there are around 200 deaths from excessive alcohol consumption. Alcohol-related deaths accounted for 25 percent of all deaths between the ages of 35 and 65 for men and 13 percent for women (a total of 21 percent). The life expectancy of alcohol addicts is statistically reduced by around 15 percent. This corresponds to a shortening of the lifespan by around twelve years.

The damage that occurs differs from person to person and from body organ to body organ. Physical damage can occur with regular consumption even if the person concerned cannot be classified as alcohol-dependent.

General symptoms

  • Reduced general condition
  • Loss of appetite
  • Weight loss
  • Reddened skin on the face
  • Increased tendency to sweat
  • sleep disorders

Neuropsychiatric symptoms (symptoms affecting the nervous system and psyche)

A withdrawal situation usually begins four to twelve hours after drinking has stopped or has been reduced and reaches its peak on the second day. It is characterized by restlessness, irritability, anxiety, sweating, sweating, tremors, nausea and vomiting, racing heart, headache, insomnia, speech disorders, double vision and a general feeling of illness. Depressive moods and even thoughts of suicide occur. Often there are also seizures, which can be life-threatening.

Delirium is the most severe form of alcohol withdrawal syndrome. In addition to pronounced withdrawal symptoms, disorientation, impaired consciousness up to coma, sweating, tremors and visual and acoustic hallucinations (the famous "white mice") occur. In addition, there is a fever and a rise in blood pressure. Disorders of cardiovascular regulation and breathing can quickly become life-threatening if left untreated. The withdrawal delirium requires immediate medical treatment.

  • Central nervous system (brain and spinal cord):

Nerve cells in the brain die off due to the toxic effects of alcohol. The consequences can be gait and coordination disorders, changes in personality (e.g. irritability and jealousy) as well as concentration and memory disorders up to dementia (severe mental weakness). Epileptic fits (convulsions) are also a common consequence of excessive alcohol consumption.

  • Peripheral nervous system (nerves outside the brain and spinal cord):

Between 20 and 30 percent of alcoholics suffer from abnormal sensations (tingling, "pins and needles"), numbness, pain and muscle weakness caused by nerve damage (polyneuropathy). The legs are particularly affected. In pronounced cases, the ability to walk may be restricted.

Loss of interest occurs. Things that used to make the person happy move into the background. Anxiety and depression are common with alcohol addiction. They are triggered directly by alcohol and indirectly by the social consequences of the disease. Ten to 15 percent of those affected take their own lives.

Consequential damage to the digestive system

If you continue to consume alcohol, the first thing you will see is fatty liver, which usually does not cause any symptoms. Subsequently, inflammation of the liver (alcoholic hepatitis) up to cirrhosis of the liver (conversion of liver tissue into connective tissue) can develop. Liver cirrhosis is associated with an increasing loss of function of the liver tissue and ultimately leads to death from liver failure.

In addition, cirrhosis of the liver can lead to varicose veins in the esophagus. If these tear, there is an acute risk of bleeding. The risk of liver cancer is also five to 15 times higher.

A damaging effect on the liver occurs in men after consuming around 20 to 24 grams of pure alcohol (this corresponds to around 0.2 to 0.25 liters of wine or 0.5 to 0.6 liters of beer) per day. Women are much more sensitive to alcohol. For them, the critical limit is ten to twelve grams of pure alcohol (0.1 liter of wine or 0.25 liter of beer) per day.

There is an increased risk of inflammation, ulcers, and cancer. There are more tears in the mucous membrane of the esophagus.

The absorption of vital nutrients (for example vitamin B and folic acid) is disturbed, so that deficiency diseases can develop.

It can lead to a very painful and life-threatening chronic inflammation of the organ (inflammation of the pancreas, pancreatitis). This can also lead to the development of diabetes mellitus.

Further consequential damage

Some research shows that moderate alcohol consumption (less than 20 g / day for men and women) may have a protective effect against coronary artery disease. However, the greater the consumption, the greater the risk of sudden cardiac death and cardiac arrhythmias.

Furthermore, the heart muscle is damaged with a pathological enlargement of the heart (dilated cardiomyopathy), which leads to reduced performance. Alcohol also increases blood pressure and thus the risk of stroke.

The reduced blood formation results in anemia, and impaired blood clotting increases the risk of bleeding.

In men it can lead to erectile dysfunction, in women to menstrual disorders and in both sexes to a decrease in sexual desire.

Alcohol consumption during pregnancy can damage the embryo, which can be manifested by short stature, mental retardation and heart defects, among other things.

Alcohol consumption increases the risk of developing cancer. This applies in particular to tumor diseases of the oral cavity, throat, esophagus, liver, colon and rectum and, in women, of the breast.

Social consequences

The social consequences of alcohol addiction include family problems, difficulties at work, loss of driver's license, and social isolation from the loss of friends and acquaintances. In many cases, alcohol addiction is associated with social decline.

The financial consequences for society due to absenteeism, declining work performance, alcohol-related accidents and direct illness costs caused by alcoholic people were estimated at around 26.7 billion euros in 2013. For this reason, too, alcohol is a major socio-medical problem.

How common is alcohol addiction?

Alcohol addiction is common. There are around 1.9 million alcohol addicts in Germany. The number of unreported cases of alcohol addiction is high.

In Germany, around three percent of adults are considered to be alcohol-dependent. Of the 18- to 24-year-olds, around six percent are now alcohol-dependent.

Another three to four percent engage in abusive alcohol consumption.

According to the Epidemiological Addiction Survey, a total of 9.5 million people consume alcohol in ways that pose a health risk. That is, their consumption goes hand in hand with the increased likelihood of future harm from alcohol. The limit value is assumed to be an alcohol consumption that is above the tolerable upper alcohol level (TOAM) of ten to twelve grams per day for women and 20 to 24 grams per day for men.

In psychiatric clinics, alcohol addicts represent the largest group of patients with around 30 percent. In general hospitals, there are also around ten to 20 percent alcohol addicts.

Alcohol consumption among children and adolescents has increased sharply in recent years. The drinking style in this age group is striking: Komatrinken is particularly popular, as it quickly leads to alcohol poisoning due to the rapid ingestion of large amounts of alcohol. According to current federal statistics, a total of around 26,600 children and adolescents between the ages of ten and 20 ended up in hospital with alcohol poisoning.

How is alcohol addiction diagnosed?

Indications of an alcohol problem are behavioral problems and the physical characteristics of the person affected as described above.

The doctor makes the diagnosis on the basis of a detailed discussion, physical examination, and laboratory findings.

In the conversation, he takes into account the current complaints, previous illnesses and the life and family history of the person concerned. In addition, the doctor asks about the development of alcohol consumption and mental illness.

Blood values ​​that indicate chronic alcohol abuse are the mean cell volume of red blood cells (MCV), the enzyme gamma-GT and the carbohydrate-deficient transferrin (CDT).

Any consequential damage caused by alcoholism can be determined through an extensive physical examination.

For those affected, there are short questionnaires (e.g. Lübeck alcoholism screening test, CAGE questionnaire) that allow a self-assessment of the risk from alcohol. The CAGE questionnaire consists of four questions. If two are answered with "yes", there is a high probability that you are alcohol dependent:

  • Have you ever thought about reducing the amount you drink?
  • Have you ever been annoyed by other people's criticism of your drinking behavior?
  • Did you feel guilty about your drinking habits?
  • Did you drink alcohol in the morning to wake up or concentrate?

What are the causes of alcohol addiction?

When asked why some people become addicted and some don't, there is no definitive answer. Scientists today assume that various factors contribute to the development of alcohol addiction. These include individual factors (e.g. genetic stress, life history), the social environment as well as the specific effect of alcohol on the person affected and the availability of the drug.

There are often strong familial clusters of alcohol problems. Science ascribes this phenomenon on the one hand to the fact that children in these families "learn" the behavior to consume alcohol in large quantities from their role models. On the other hand, a genetic predisposition should also be involved in the accumulation.

A specific "alcoholic personality" is no longer assumed to be the cause of alcohol addiction these days.

How does alcohol addiction work?

Even if the individual courses of the disease often differ greatly, a typical course of the development towards alcohol dependence can be sketched out.

Pre-alcoholic phase

This phase is characterized by occasional to permanent drinking for relief. Those affected use alcohol more and more to solve problems, to relieve tension and to reduce stress. After all, they seek relaxation in alcohol almost every day without becoming intoxicated. This drinking behavior lasts for a few months to years, depending on the circumstances. The body gets used to alcohol more and more. There is a development of tolerance.

Initial phase (prodromal phase)

The thoughts revolve around the alcohol more and more often. The behavior is also changing: those affected drink more often secretly and already in the morning, the first glasses greedily, and stock up on alcohol. They now clearly notice that something is wrong with their drinking behavior and develop feelings of guilt. The first memory gaps occur after even small amounts of alcohol. Those affected try hard to avoid the subject of alcohol in front of other people.

Critical phase

Typical for this phase is the incipient loss of control over drinking, i.e. those affected are unable to freely determine the beginning, amount and end of alcohol consumption. In this phase, the mind is almost entirely focused on the alcohol. Self-pity and self-reproach torment, and attempts to remain abstinent fail several times.

The personality is increasingly changing and conflicts arise in the private and professional spheres, as those affected can no longer hide their alcohol consumption from the outside world. They spend more and more time procuring and consuming alcohol and neglect other interests and social contacts. There are already clear physical symptoms as well as withdrawal symptoms with reduced consumption.

Chronic phase

Alcohol now plays the dominant role. Those affected are often drunk for days. Often they have to drink alcohol in the morning, regardless of the form. The sick can hardly resist the alcohol. You can no longer do even the simplest of activities without consuming alcohol. They are increasingly unable to stop using it, even though physical, psychological and social consequences have already occurred.

Due to the mental deterioration, memory performance as well as the ability to criticize and judge decrease. Physical damage develops and in most cases rapid social decline results.

How is alcohol addiction treated?

Basically, four phases of therapy can be distinguished. At each stage of treatment, the individual situation of the person affected must be taken into account. Diagnosing the disease as early as possible is of crucial importance.

Lifelong abstinence from alcohol is the generally recognized therapeutic goal. Many of those affected are unsure and shy away from seeking advice and treatment, especially at the beginning of an addiction. In spite of their own understanding of the necessity, many sufferers are not (yet) ready to completely give up alcohol consumption. Against this background, the new guideline for the treatment of alcohol-related disorders comes to the conclusion that reducing the amount of drinking should also be recognized as a therapeutic goal for alcohol addicts, at least in the meantime. The associated lowering of inhibitions should lead more people to counseling and treatment than before. Abstinence remains the top priority, but if the person concerned is not yet ready, then the counseling or treatment is initially aimed at a reduction.

Contact and motivation phase

Those affected make initial contact with a counseling center or a doctor. The sick - and ideally also their relatives - should receive detailed information.

In the best case, the motivation to drink turns into a motivation to abstain. The doctor can try to consolidate this motivation. He suggests an individual therapy to the patient and determines the further treatment steps.It can only be successful if the patients are ready for therapy themselves.

Withdrawal phase

During the withdrawal phase, the focus is on physical weaning. The aim is for those affected to stop drinking completely. In addition to physical and medicinal measures, motivational support and education also play a role in the withdrawal phase.

Drug-assisted alcohol withdrawal treatment is superior to non-treatment in terms of the severity of the withdrawal symptoms and the frequency of complications. Drug therapy for alcohol withdrawal syndrome should therefore be carried out taking into account the severity of withdrawal and withdrawal complications. Mild alcohol withdrawal syndromes can be treated with medication. Severe and moderate alcohol withdrawal syndromes should be treated pharmacologically.

Benzodiazepines, for example, are effective in reducing the severity and frequency of alcohol withdrawal symptoms and the frequency of serious complications such as delirium and withdrawal seizures.

If no severe withdrawal symptoms are expected, treatment can be carried out on an outpatient basis. However, if you experience withdrawal symptoms and the threat of delirium, the possibility of rapid medical intervention is very important. For this reason, patients with a high risk of withdrawal symptoms need to be hospitalized in an addiction medicine department of a clinic.

Weaning phase

Physical detoxification is followed by psychological weaning, as detoxification alone is usually not enough to treat alcohol addiction. Those affected can carry out the withdrawal treatment in a specialist clinic or on an outpatient basis over a period of several weeks to months.

The aim is to strengthen the desire for abstinence and to learn to live again without alcohol. In order to achieve this, various psychotherapeutic methods, sports therapy, work therapy, social care and much more are promising.

Follow-up and rehabilitation phase

There is a high risk of relapse during the transition from inpatient treatment to everyday life after discharge from the hospital. Those affected can quickly catch up with "old" problems and behaviors.

In this phase, consequent and close-knit outpatient follow-up care, which is provided by addiction clinics, addiction counseling centers or specialist doctors, is particularly important. Another important component is regular participation in self-help groups (for example Alcoholics Anonymous, Blaukreuzler, Guttempler).

Medicines are also available to support patient abstinence efforts that:

  • reduce the desire for alcohol (acamprosate),
  • trigger unpleasant physical reactions to alcohol consumption (disulfiram).

However, the drugs cannot replace treatment and therapy by specialist clinics or contact with self-help groups and addiction counseling centers, they can only supplement them.

Various life situations are associated with a particularly high risk of relapse for those affected. Patients should learn to recognize and prepare for such temptations during their treatment. This includes:

The availability of alcohol (supplies, house bar) or the restaurant atmosphere increase the risk of relapse.

Old behaviors break through and tempt you to have a drink at certain times or occasions or in certain places.

Stress and conflict in the relationship can lead to drinking.

Hopes, worries, social fears, depression or joy also carry a risk of relapse.

Especially when they feel well and healed, patients can relapse because they are prone to misjudging that they have overcome their illness and are able to drink alcohol again in a controlled manner.

What does codependency mean?

The term codependence expresses that alcohol addiction always takes place in a social environment. The environment is part of the disease complex. There are often close interactions between those affected and their caregivers. This creates a certain role behavior.

Although loved ones want addicts to give up alcohol, they occasionally develop behaviors that promote the path to addiction and prolong the illness. This can be the case, for example, when relatives try to solve the sick person's problems, take responsibility for him or her or apologize for his behavior, cover up or try to hide it from the outside world.

Medicine speaks of codependency in such cases. This has to be overcome. The path out of addiction can only begin when the patient is confronted with the negative effects of his illness and takes responsibility for his actions and their consequences himself.

What is the prognosis for alcohol addiction?

An exact prognosis for alcoholism is only possible to a very limited extent at the time of the start of therapy. It is very dependent on individual factors, in particular on physical and psychological damage that has already occurred.

In any case, the prerequisite for healing is sufficient self-motivation, without which therapy cannot be successful.

A medium- and long-term stable improvement of the disease (abstinent alcohol dependence) for at least one year after withdrawal treatment is achieved by 40 to 50 percent of those affected. For those who regularly attend a self-help group, the success rate is even higher at over 70 percent. Strictly speaking, however, treatment for alcoholism lasts a lifetime because of the enormous risk of relapse.

What can i do on my own?

Alcohol can basically become a problem for everyone. Precisely because alcohol is part of social life in Germany, it is often difficult to recognize the beginning of a development of dependency.

As soon as there are concerns that personal consumption is too high or that it is difficult to abstain from alcohol, those affected should consult a qualified advice center or a doctor. The addressing of alcohol addiction by relatives or friends can also be an occasion to question one's own alcohol consumption.

Relatives are often particularly dependent on support and support in order to cope with the stresses of living together with an alcoholic. In addition to those affected, relatives can also turn to counseling centers. There are also special self-help groups for relatives.