Alcoholism

This article was last reviewed on

10 October 2023.

This article waslast modified on 10 October 2023.

What is it?

Alcoholism is a broad term for any drinking of alcohol that results in mental or physical health problems. The disorder was previously divided into two types, alcohol abuse and alcohol dependence, but these are now included in the term alcohol use disorder (AUD) which includes all excessive alcohol drinking that puts your health and safety at risk including binge drinking.

AUD is a major global burden on health services. In the 2018 Health Survey for England: adult health related behaviour [NHS Digital 2019] it was found that 30% of men and 14% women were drinking more than 14 units of alcohol a week which is the limit recommended for sensible drinking.

Symptoms and signs

AUD can be mild, moderate or severe and is based on the number of symptoms experienced:

1] Physical dependence – withdrawal symptoms such as nausea, sweating, shakiness and anxiety after stopping drinking
2] Tolerance - the need to drink greater amounts of alcohol to get high
3] Craving - a strong need or urge to drink which becomes so bad that this becomes an obsession and the person can’t think of anything else
4] Loss of control – not being able to stop or reduce drinking once drinking has begun
5] Safety - using alcohol in situations when not safe to do so such as driving or using machinery
6] Social problems – failing to fulfil obligations or responsibilities at work, school or home due to continuing alcohol use
7] Excessive drinking – spending much time in obtaining alcohol, and being unable to limit the amount of alcohol you drink, or on being sick or getting over the aftereffects
8] Failing to cut down on alcohol intake
9] Interpersonal problems – continuing to drink even though it was causing trouble with family or friends
10] Reducing social and work activities, lacking interest in hobbies
11] Alcohol use is continued despite knowing that a persistent or recurrent physical or psychological problem is most likely to have been caused or exacerbated by alcohol

Long term effects of Alcohol

The long-term use of alcohol is capable of damaging nearly every organ and system in the body. Women tend to be more sensitive to the effects of alcohol and may develop alcohol-related problems sooner and after consuming less alcohol than men do.

The major health risks of alcohol use include:

Neurological conditions, including dementia, stroke and neuropathy
Cardiovascular problems, such as heart attack, weakened and enlarged heart, irregular heart beat, and high blood pressure
Psychiatric conditions, including depression, anxiety, and suicide
Cancer of the mouth, throat, oesophagus, liver, colon, and breast
Liver diseases, including fatty liver (steatosis), inflammation of the liver (hepatitis) and irreversible destruction and scarring of liver (cirrhosis)
Gastrointestinal disease, including inflammation of the pancreas (pancreatitis) and stomach (gastritis)
Birth defects, drinking alcohol in the first 3 months of pregnancy increases the risk of miscarriage, premature birth and a low birthweight. Drinking heavily throughout pregnancy can cause the baby to develop Foetal Alcohol Syndrome (FAS) and the symptoms include poor growth, distinct facial features with learning and behavioural problems
Other conditions include low sugar levels (hypoglycaemia), vitamin deficiency especially vitamin B1 (thiamine), bone thinning (osteoporosis) and a weakened immune system.

About Alcoholism

Laboratory Testing and the use of Alcohol Biomarkers
Various laboratory tests can aid the diagnosis of AUD and some such as Liver Function Tests [LFTs] can help to assess the extent of alcohol damage to different organs. No single laboratory test or combination of tests have been shown to be ideal for screening or diagnosis.

Such tests do not, however, give an indication of alcohol use but the use of alcohol biomarkers can help to gain such information. Indirect alcohol biomarkers are enzymes, proteins or cells which undergo typical changes in response to acute or chronic alcohol consumption. Direct alcohol biomarkers are created when alcohol is metabolised or reacts with substances. These can give information about recent alcohol intake and episodic drinking. Some can also be measured in hair which can provide information about alcohol intake over several months. The major disadvantage of these is that they are expensive to analyse.

Indirect alcohol biomarkers

Gamma-glutamyl transferase (GGT), a liver enzyme that is increased by heavy alcohol intake but also by other forms of liver disease

Mean corpuscular volume (MCV), a measure of the size of red blood cells, which is increased by prolonged heavy drinking but also other causes

Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST), enzymes that can indicate liver damage, which is often related to alcohol use

Carbohydrate-deficient form of transferrin (CDT), a molecule involved in iron transport in blood. CDT is elevated in the blood of heavy drinkers but raised levels can also be found in a number of medical conditions. It is not useful as a screening test for alcohol abuse but may be useful in detecting those who have relapsed

Direct alcohol biomarkers

Besides blood alcohol (ethanol) levels, which can be used in acute suspected poisoning but not a test for AUD, most direct biomarkers are not widely available. Examples include 5–hydroxytryptophol, phosphatidylethanol, fatty acid ethyl esters and ethyl glucuronide. None of these demonstrate 100% specificity and sensitivity.
Treatment for Alcoholism

Throughout the UK, specialist alcohol services are provided by the NHS, the private sector and through voluntary organisations. Some individuals will only need or want to learn to reduce or control their drinking while others will need to abstain from alcohol use. Alcohol services offer a wide range of interventions and treatments including brief interventions, motivational interviews, counselling, detoxification services and self help groups. Detoxification (alcohol withdrawal) can be provided in a number of settings including hospital wards, NHS alcohol treatment units, and residential services.

A variety of drugs can be used to treat alcoholism. Benzodiazepines (Valium or similar drugs) are sometimes used during the first days after drinking stops to help a patient safely withdraw from alcohol. These drugs are not used beyond the first few days, however, because they may be very addictive.

There are three oral medications that have been approved by the National Institute for Health and Care Excellence (NICE) to help people remain sober: disulfiram, naltrexone, and acamprosate. They are prescribed for those who have indicated their intention to abstain from alcohol but require some reinforcement. Disulfiram causes unpleasant symptoms such as nausea, vomiting, and flushing with any amount of drinking. Naltrexone blocks the "high" feeling a person may get from drinking but can cause severe withdrawal symptoms in people who are also dependent on opiates. Acamprosate helps reduce the craving for alcohol.

Just as there is no individual test for screening or diagnosing alcoholism, there is not one single drug that effectively treats alcoholism. In other words, no single drug is available that works in every case because body chemistries are slightly different and reasons for drinking are also different. Developing new and more effective drugs to treat alcoholism is a high priority for researchers.