Alcohol Dependence

Alcohol Dependence

What is the condition?

Alcohol dependence, sometimes known as alcoholism, is the most serious form of drinking problem and describes a strong, often uncontrollable desire to drink. People who are physically dependent on alcohol typically drink every day, often needing to drink in the morning to stop them from feeling unwell. They are very tolerant to alcohol and can drink large amounts. They need alcohol to feel ‘normal.’

What causes alcohol dependence?

Excessive drinking over prolonged periods of time can increase the body’s tolerance to alcohol. The body starts to become reliant on alcohol to function, causing physical dependency. Once a person is dependent on alcohol, they experience withdrawal symptoms if their alcohol intake suddenly reduces.

How is it diagnosed?

There is no specific test to diagnose alcohol dependency, but all patients referred to the alcohol team will receive a full alcohol assessment, which will include questions about alcohol, as well as their physical health, mental health, and social situation. However, anyone who experiences withdrawal symptoms as a result of their drinking will be diagnosed as alcohol dependent.

What are the symptoms?

Symptoms of physical alcohol dependence include drinking or craving alcohol as soon as you wake up, planning lifestyle around alcohol, finding it hard to stop drinking once you have started and experiencing withdrawal symptoms, such as sweating and shaking if you do not drink alcohol.

How is it treated?

Whilst in A&E you will be given medication to control any withdrawal symptoms, alongside intravenous vitamin replacement. If you do not require an admission to hospital, you will be discharged, advised to resume drinking alcohol, and offered referral to the alcohol team. They will then contact you to discuss further treatment options and support.

If you are admitted this medication will continue and you will be seen by the alcohol team who will be able to discuss further options and support.

Treatment Options

Reduction

Your health will improve if you reduce your drinking, but it is vital that you do this slowly to avoid withdrawal symptoms. A member of the alcohol team will help you to work out how many units you drink each day and advise on a slow reduction (usually by two – three units every four days). Try to avoid drinking out of habit, instead have a drink when you are beginning to experience withdrawal symptoms. If you feel unwell due to withdrawal symptoms or because you have cut down too quickly, you will need to increase your drinking to control this. Some people can reduce their drinking to a point they can stop completely, but others require a detox.

Detoxification (detox)

You will be given medication to control any withdrawal symptoms. This medication will make it safe for you to stop drinking completely. You must want to be alcohol free (abstinent) for a detox to be appropriate. There are options on where you can receive a detox:

• Community based detox
• Inpatient detox
• Hospital outpatient detox

This will depend on the severity of your alcohol dependency as well as your social support, physical health and mental health. A member of the alcohol team will advise you on the most appropriate option for your needs.

What are the side effects?

Patients who are physically dependent on alcohol usually require a detox. The detox is tailored to the individual needs of the patient but occasionally can result in the individual feeling over sedated (very drowsy) or under sedated (feel anxious and agitated). Severe withdrawal symptoms can occur on rare occasions and include symptoms such as hallucinations.

What are the risks of not getting treatment?

If you continue to drink excessive amounts of alcohol you are at great risk of experiencing long term physical and psychological health problems, such as liver disease, diabetes, high blood pressure, depression and anxiety. Patients who try to detox without medical assistance can experience severe withdrawal symptoms and alcohol related seizures which can be fatal.

Self-help

If you are dependent on alcohol, you are advised to detox only with medical assistance. Whilst you are waiting for a detox, you could reduce your alcohol intake slowly by no more than two to three units every four days. The alcohol team will be able to advise you on this. It would help if you could increase your intake of non-alcoholic drinks throughout the day and eat nutritious food daily.

Post detox abstinence

Following your detox, it is vital that you realise that your brain will remain sensitive to alcohol. If you start drinking again, even if you are motivated to keep your drinking at a low level, your high tolerance to alcohol can come back within a few days and you will return to dependency.

This is why you will be advised to not drink any alcohol post detox, even in moderation.

There is support available to help you live an alcohol free life including group support, peer support, 1:1 support and rehab. A member of the alcohol team can arrange this for you.

Common symptoms of withdrawal include:

Tremors (‘the shakes’)

Sweating

Nausea

Anxiety

Irritability

Insomnia

(Visual hallucinations and seizures (fits) can occur in severe withdrawal).

Medical Warning – if you have physical withdrawal symptoms, it is vital that you do not suddenly stop drinking or reduce your alcohol intake rapidly.

Can this condition be prevented?

Alcohol dependence can be prevented by following the government’s guidelines for safe drinking, which is 14 units of alcohol per week with at least three alcohol-free days every week.

Contact details

• Contact the Alcohol Team for advice on all alcohol related issues.

Tel: 01905 763333 ext: 30665 (with answerphone)

(Monday – Friday, 8.00 am – 4.00 pm)

• For Worcestershire residents, Cranstoun offer support and treatment.

Tel: 0300 303 8200, (www.cranstoun.org)

• For Warwickshire residents, CGL offer support and treatment.

Tel: 01926 353513,

(https://changegrowlive.org/drug-alcohol-service-warwickshire/leamington-spa)

• Alcoholics Anonymous (AA) provide peer support. There are numerous meetings, Tel: 0800 9177 650

or visit www.alcoholics-anonymous.org.uk/AA-Meetings/Find-a-Meeting for details.                              

• Drinkline, national free helpline, Tel: 0300 123 1110
• CGL and Cranstoun offer support and treatment. They also offer support for family members and friends affected by someone else’s drinking. You can self- refer by phoning the numbers above.
• Al-anon offer peer support for family members and friends. There are numerous meetings, Tel: 020 7403 0888

or visit www.al-anonuk.org.uk/meetings for details.

Further information

You can also visit NHS Choice website for more information about Alcohol Misuse: https://www.nhs.uk/conditions/alcohol- misuse/

Sources used for the information in this leaflet

• NICE CG100 Alcohol use disorders: Diagnosis and clinical management of alcohol related physical health complications. 2010 (updated 2017)
• NICE CG115 Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence 2011

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience

We know that being admitted to hospital can bea difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you. 

Feedback

Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)

If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:

Telephone Patient Services: 0300 123 1732 or via email at: wah-tr.PALS@nhs.net

Opening times:

The PALS telephone lines are open Monday to Thursday from  8.30am to 4.30pm and Friday: 8.30am to 4.00pm. Please be aware that a voicemail service is in use at busy times, but messages will be returned as quickly as possible.

If you are unable to understand this leaflet, please communicate with a member of staff.

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