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Alcohol dependence and how to cut down

Published by Bupa's health information team, healthinfo@bupa.com, April 2008

Alcohol dependence is surprisingly common in the UK, affecting an estimated one in 13 people. It can be very difficult to beat, but many people - especially those who seek outside help and support for their problem - do manage to overcome their dependence in the end.

What is alcohol dependence?

Alcohol is an addictive drug and people who become addicted are said to be alcohol dependent. Nobody really knows why some people become alcohol dependent and others don't, but your risk is thought to be influenced by the interplay of a number of factors including:

  • availability of alcohol and social acceptability - countries where alcohol is freely available and socially accepted have higher alcohol dependency rates
  • life circumstances - traumatic life experiences can increase the likelihood of alcohol dependence
  • genetics - several genes linked with alcohol dependence have been identified and it often runs in families, though this may reflect attitudes towards drinking
  • personality - people who are impulsive, anxious or prone to depression may be more likely to develop problems with alcohol

People who live alone, especially men, are particularly at risk of alcohol dependency, as are people who live alone with one parent, and students of both sexes. However, it's important to note that many people have some or all of the risk factors mentioned above and yet are not alcohol dependent.

Am I alcohol dependent?

One sign of alcohol dependency is a high tolerance to alcohol. People who drink heavily get used to alcohol and need to drink more and more in order to achieve the same effect. Other possible signs include needing a drink in the morning, and getting withdrawal symptoms if you stop drinking suddenly, such as trembling, jitteriness and sweating.

Doctors sometimes use simple questionnaires to assess whether someone is alcohol dependent. One of these, known as the CAGE questionnaire, consists of four simple questions:

  • Have you ever thought of Cutting down?
  • Have you ever been Annoyed by people telling you to cut down?
  • Have you ever felt Guilty about your drinking?
  • Do you need an Eye-opener in the morning to get you going?

If your answer is yes to two or more of these questions, it's very likely that you are alcohol dependent.

What help is available?

Whether you simply want to cut down on your drinking or want to give up completely, there are plenty of ways to address your problem.

Go it alone

Some people decide to stop drinking or cut down on their own. While this may work for some, it isn't as successful as seeking help. Roughly one third of people who try to control their drinking on their own are at least partly successful, compared with two thirds of people who receive treatment.

The Royal College of Psychiatrists suggests you keep a diary of your drinking and then cut down or stop if you find you are drinking too much. This will allow you to analyse when and why you tend to drink. It helps if you tell a friend or relative what you are doing and ask for their support, as well.

If you are a very heavy drinker, suddenly stopping all alcohol intake can be dangerous as it can cause withdrawal symptoms such as fits or hallucinations. You should seek medical supervision if you drink heavily and plan on stopping.

See your GP

Studies show that a brief chat or series of chats with a GP or alcohol counsellor can often be enough to help people control their drinking. Your GP will be very used to dealing with people who have problems with alcohol and will also be able to tell you about other sources of help and support, such as counselling. It's especially important to see your GP if you are suffering from other health problems, such as depression.

Use the internet

Down Your Drink is an internet-based self-help programme, run by the charity Alcohol Concern. It's based on the latest methods for reducing alcohol intake.

Visit your local alcohol advice centre

Advice centres are often run by the NHS and there are more than 500 around the UK. Most accept self-referrals and provide a range of services including counselling, self-help groups and support for family members. Many are happy for people to drop in, but you may need to ring and make an appointment. Alcohol Concern has a directory of local alcohol services on its website.

Try a self-help group

The best-known self-help network for alcohol dependent people is Alcoholics Anonymous (AA), which has more than 3,000 groups in the UK and is based on a 12-step programme. People attend meetings in which recovered alcoholics describe their personal experiences in giving up alcohol, and the local group supports one another. You may be able to find a local self-help group via your GP or alcohol advice centre.

Residential care

This is often used by people who have undergone detoxification. Often called 'rehab' (rehabilitation), this can take place in NHS hospitals or care homes, but many people use private residential centres. Residential alcohol treatments units vary widely in their approach, but they all work with their clients to help them change their lifestyle and avoid a relapse. Therapies used may include counselling, behavioural therapy, lectures, group therapy, and discussion groups.

Will I need to detox?

This may be necessary if your dependence on alcohol is severe. Detoxification - a planned withdrawal from alcohol - can be dangerous, and should always be done under medical supervision. Detoxification, or detox, can sometimes be done at home, but can also be provided on hospital wards, in NHS alcohol treatment centres or in some private residential centres.

Further information

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