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Alcohol problems: Overview

Key points

  • Problem drinking has multiple causes: genetic, physiological, psychological and social.
  • Most people who are classified as "at-risk" drinkers will modify their drinking without a structured treatment program.
  • 80% of people who have completed treatment will have at least one relapse in the year after treatment.

Classification

Alcohol use and alcohol use problems may be classified as:

  • low risk
  • at risk / problem drinking
  • abuse
  • dependence.

Most alcohol-related illnesses, social problems, accidents and deaths are caused by problem drinking. This term describes alcohol use that causes problems in a person's life, but does not include physical dependence. Problem drinking is four times as common as severe alcohol dependence.

Physical dependence involves tolerance to alcohol's effects, and withdrawal symptoms when drinking is stopped. As tolerance develops, the person needs more and more alcohol to produce the desired effect.

Symptoms

Signs and symptoms of alcohol use problems vary. Some people experience more severe symptoms than others, and some people have signs and symptoms that come and go over time.

Signs of problem drinking

  • drinking alone
  • feeling guilty after drinking
  • experiencing temporary memory loss after drinking
  • waking up from a night of drinking with memory loss about the night before
  • engaging in behaviour while drinking that leads to going to the hospital, getting arrested or losing a job
  • developing financial difficulties.

Signs of more severe drinking problems

  • hallucinations
  • sweating
  • blackouts
  • mood swings
  • depression and/or anxiety
  • insomnia
  • chronic fatigue
  • tremors
  • memory loss
  • diarrhea
  • erectile dysfunction
  • recurrent intoxication.

Causes

Problem drinking has many causes. Genetic, physiological, psychological and social factors play a role:

  • Psychological traits such as impulsiveness, low self-esteem and a need for approval may prompt inappropriate drinking.
  • Some people drink to cope with or "medicate" emotional problems.
  • Social and environmental factors such as peer pressure and the easy availability of alcohol can affect drinking. Poverty and physical or sexual abuse increase a person's risk of developing alcohol dependence.
  • Genetic factors make some people especially vulnerable to alcohol dependence. However, a family history of alcohol problems doesn't mean that children of parents with alcohol problems will automatically grow up to develop these problems.
  • Heavy drinking can cause physiological changes that make more drinking the only way to avoid discomfort. People with alcohol dependence may drink partly to reduce or avoid withdrawal symptoms.

Prognosis

  • Most people who are considered "at-risk" drinkers will modify their drinking without a structured treatment program.
  • People who do not have stable housing, employment and family relationships are more likely to relapse.
  • Among people in treatment programs:
    • 80% have at least one relapse in the year after treatment
    • About 30% continue to have alcohol problems over a 10-year period, about 30% show improvement and 30% have a good outcome (either abstinence or controlled drinking).

Evidence summary

National Institute for Health and Clinical Excellence. (2011). Alcohol-Use Disorders: Diagnosis, Assessment and Management of Harmful Drinking and Alcohol Dependence (Clinical Guideline 115). London, UK: Author.


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