Addiction and Recovery Information for Individuals, Families and Health Professionals

Alcohol Abuse, Alcohol Addiction and Alcoholism

A Simple Alcoholism Test: Signs of Alcoholism and Alcohol Abuse

If you answer yes to three of the following four question, you are probably an alcoholic.

  • Do you have six or more drinks at least once a month?
  • Do you sometimes have trouble saying no to alcohol? Do you sometimes drink more than you would like to drink? Does one drink lead to more drinks sometimes?
  • Do you sometimes feel guilt about how much you drank or what you did?
  • Do you sometimes hide or minimize your drinking to others?

Why do you want to know if you are an alcoholic? Are you concerned? Are other people concerned? Have you ever asked yourself, “Am I an alcoholic?” You probably already suspect the answer. Maybe you’re afraid to admit it. This is your chance to do something about it. Click here for a more detailed alcohol dependence test.

Is there a difference between alcoholism, alcohol dependence, and alcohol abuse? All these terms mean the same thing in the DSM 5 (The Diagnostic Manual of the American Psychiatric Association) and ICD-10 (International Classification of the World Health Organization). These names have fallen in and out of favor over the years, in an effort to avoid negative associations, but they are equivalent.

Stages of Alcoholism: The Functioning Alcoholic

In the early stage of alcoholism you regularly drink too much, but you haven’t suffered many consequences. This is when it’s easiest to make a change.

The middle stage of alcoholism is the classic functioning alcoholic. You still have a job and your relationships are intact, but your life is beginning to suffer because of your drinking. This is the most common scenario. You don't have to suffer major losses to have an addiction. Late stage alcoholism is the non-functioning alcoholic. You have either lost your job, or your job is suffering because of drinking. It's what people think alcoholism is like, but this stereotype is rare.

Alcoholism is a progressive disease. The consequences of get worse over time. It's never easy to quit. But if you have already suffered some consequences and don't want them to get worse, there's never a better time to quit than now.

How Common are Alcoholism or Alcohol Abuse?

  • Approximately 60 percent of drinkers, drink less than 4 drinks on the days they drink.
  • Only 10 percent of drinkers, have 5 or more drinks more than half the days they drink.(1)

What is Moderate Alcohol Use?

  • The US Department of Health and Human Services guidelines suggest no more than 1 drink per day for women and no more than 2 drinks per day for men. A drink is defined as 12 oz of beer, 5 oz of wine, or 1.5 oz of spirits.
  • The World Health Organization guidelines suggest no more than 2 drinks per day, and no more than 5 drinking days per week. They also suggest at least 2 non-drinking days per week.

Alcohol Withdrawal

Alcohol withdrawal occurs because your brain works much like a spring. Alcohol is a brain depressant that stimulates the GABA neurotransmitter in the brain, whose function is to balance adrenaline in check. GABA and adrenaline are supposed to be in equal balance. When you drink regularly, your brain develops tolerance to alcohol. It sees that the alcohol you’re drinking is counteracting the effects of adrenaline, therefore your brain needs less GABA neurotransmitter, and it begins to produce less.

Your brain now requires alcohol to stay in balance. When you suddenly stop drinking it is like taking the weight off the spring. You brain chemistry is out of balance. It has an excess of adrenaline, and not enough GABA. The spring rebounds and the excess of adrenaline is what causes the withdrawal symptoms.

Alcohol Withdrawal Symptoms

These are some of the symptoms of alcohol withdrawal:

  • Anxiety
  • Irritability
  • Insomnia
  • Shaky hands
  • Sweating
  • Muscle tension/ Tightness in the chest
  • Headache
  • Nausea/ Vomiting
  • Palpitations

Suddenly stopping alcohol can lead to seizures, strokes, or heart attacks in high risk patients. A medically supervised detox can minimize your withdrawal symptoms and reduce the risk of dangerous complications. Some of the dangerous symptoms of alcohol and tranquillizer withdrawal are:

  • Grand mal seizures
  • Heart attacks
  • Strokes
  • Hallucinations
  • Delirium tremens (DTs)

Alcohol Detox: What is detoxification?

Detoxification, or detox, involves taking a short course of medication to help reduce or prevent withdrawal symptoms. Medications such as Valium (diazepam), Librium (chlordiazepoxide), or Ativan (lorazepam), the benzodiazepine family, are usually used for detox.

Detox can be done as either inpatient or outpatient depending on the person’s health, the amount of drinking, and their past history of withdrawal. Detox is always done under close supervision. A common plan for outpatient detox is to prescribe a high dose of medication on the first day, and then gradually reduce the dose over the next 5-7 days. People with serious alcohol abuse may be admitted to hospital.

This is general medical information, and not tailored to the needs of a specific individual.

Effects of Alcohol - Alcohol Facts

Liver Damage: Alcoholic Hepatitis

There are three stages of liver damage: elevated liver enzymes, fatty liver, and cirrhosis.

The most common form of liver damage is elevated liver enzymes. Your doctor can do a simple blood test to check for three liver enzymes (AST, ALT, and GGT). These are usually elevated by heavy drinking over a short period of time, usually weeks or months. This type of damage is most commonly seen in young people and is associated with binge drinking. It is potentially reversible if you stop drinking.

Your liver is designed to filter toxins from your blood, therefore it's designed to repair itself. All you have to do is stop drinking and it will gradually go back to normal.

How do liver enzyme tests work? The enzymes AST, ALT, and GGT normally occur inside liver cells. If your liver is damaged, the enzymes are released into your blood stream and show up in your blood test. Therefore the higher the enzyme count, the greater the liver damage. The most accurate of these tests for alcoholic liver damage is GGT.

The second most common form of liver damage is a ‘fatty’ liver. This can be identified by blood tests and a liver ultrasound, and is also reversible with abstinence. However, fatty liver damage has a greater risk of turning into cirrhosis with continued alcohol abuse.

Repeated liver damage can cause cirrhosis. Your liver is a remarkable organ, but it can only repair itself so many times. After a while your liver won't be able to repair itself and it will turn into scar tissue. Cirrhosis is just the medical term that means part of your liver has turned into scar tissue.

Signs of Cirrhosis

  • Yellowing skin and whites of the eyes (jaundice)
  • Swelling abdomen (due to fluid accumulation) (Your liver produces many of the proteins in your blood. When it is damaged, it produces fewer blood proteins, therefore the fluid in your blood vessels gradually seeps out and accumulates in your abdomen.)

But there is good news. Your liver is a big organ and you have more liver than you need. People can lose 30% of their liver in a car accident and still lead normal lives. So if you have less than 30% cirrhosis and you stop drinking, you can lead a normal life. Your doctor can do an ultrasound to see if you have cirrhosis, and estimate what percent cirrhosis you may have.

Alcoholic neuropathy

Nerve damage that is due to excessive drinking is called alcoholic neuropathy. Alcohol is toxic to nerves cells. This results in brain damage and peripheral nerve damage. A significant part of alcoholic neuropathy is also caused by the poor nutrition associated with alcoholism.

Alcoholic neuropathy usually has a reversible and irreversible component. The reversible components is caused by the poor nutrition, and can be treated by thiamine (vitamin B1), folic acid, and vitamin B12. The irreversible component is caused by the direct poisoning of nerve cells, and there is no known cure. Up to half of heavy long-term alcohol abusers develop alcoholic neuropathy.

Symptoms of Alcoholic Neuropathy

  • Numbness or pins and needles (paresthesia) in the arms and legs. This is usually in the hands and feet in what is called a “stocking glove distribution.”
  • Pain in the arms and legs
  • Muscle cramps and muscle weakness
  • Impotence (in men)
  • In severe cases, nerves that regulate internal body functions (autonomic nerves) may be affected.

Hypertension: High Blood Pressure

More than two drinks a day has been proven to cause high blood pressure. (2) Studies have also shown that reducing or eliminating alcohol use can lower blood pressure.(3)

Cancer Risk and Alcohol Abuse

Alcohol abuse has been shown to significantly increase the risk of most forms of cancer, including mouth, esophagus, breast, stomach, liver, prostate, and colon cancer.(4)

How does alcohol raise cancer risk? The exact mechanism is not completely understood. It is likely that there are several ways in which alcohol raises the risk. Acetaldehyde, a byproduct of alcohol metabolism is thought to be one of the main cause for alcohol related cancers.(5)

In the case of mouth, esophagus, and stomach cancer, alcohol appears to act as a direct irritant that damages tissues. Alcohol may also allow harmful chemicals, such as tobacco smoke, to enter the digestive tract more easily. This explain why smoking and drinking combined are more deadly than either one alone.

Even moderate smoking and drinking increase the risk of esophageal cancer by 15 times.(6)

Breast Cancer

Breast cancer, the leading cause of death in women, is strongly correlated with alcohol abuse. Drinking more than two drinks a day increases the risk of breast cancer by 50%! (6) This result has been confirmed in studies of over one hundred thousand women.

Depression and Alcohol Abuse

Depression is one of the most common, serious consequences of alcohol abuse. Alcohol abuse doubles the risk of depression. One study looked at 2,945 alcoholics. 15% were depressed before they began abusing alcohol. 26% were depressed while they were using alcohol, and 15% remained depressed once they had stopped drinking for an extended period.(7)

Alcohol and Pregnancy: Fetal Alcohol Syndrome

It has been shown repeatedly that there is no safe amount of alcohol during pregnancy. Alcohol has a number of effects including low birth weight and risk of prematurity. The common serious side effect of alcohol during pregnancy is fetal alcohol syndrome.

Fetal alcohol syndrome (FAS) and alcohol-related neurodevelopmental disorder combined occur in nearly one in 100 live births in the US and Great Britain. (8)

Some of the consequences of fetal alcohol syndrome include:

  • learning disabilities
  • depression
  • obsessive-compulsive disorder
  • physical disabilities such as kidney and internal organ diseases
  • skeletal abnormalities including facial deformities

Less Common but Serious Consequences of Alcohol Abuse

  • Cardiac arrhythmias
  • Impaired immune system
  • Decreased bone density
  • Peripheral nerve damage
  • Gastrointestinal bleeding
  • Heart attacks and cardiomyopathy
  • Strokes

Treatment, Recovery and Relapse Prevention for Alcoholism

If you have decided that you are addicted to alcohol, this is your opportunity to change. Learn more about recovery skills and relapse prevention strategies in the following pages. You can overcome alcoholism. You can change your life.

How Big is a Drink? The Definition of a Standard Alcoholic Drink.

A standard drink is defined as 14 grams of pure alcohol according to the US Department of Health and Human Services. However in Europe the most commonly used standard is 10g of pure alcohol.

  • 1 can of beer (12 oz or 330 ml) at 5% alcohol is one drink
  • 1 glass of wine (5 oz or 140 ml) at 12% alcohol is one drink
  • 1 shot of liquor (1.5 oz or 40 ml) at 40% alcohol is one drink

Note that a 750ml bottle of wine contains 5 drinks. Therefore 2 drinks a day is less than half a bottle of wine a day.

The basic formula for calculating a drink is that each milliliter of pure alcohol weighs 0.79 grams. Therefore, for example, 12 oz of beer or 330 ml of beer x 5% alcohol x 0.79 = 13 grams of pure alcohol.



Last Modified: March 23, 2015

Learn about Alcoholism, alcohol addiction and alcohol dependence. Alcoholic liver damage, alcohol liver disease, elevated liver enzymes, and alcoholic cirrhosis of the liver are discussed. What are Alcohol Withdrawal symptoms? Alcohol Abuse is compared to alcoholism. Alcohol addiction and alcohol dependence and alcoholism are discussed. Learn Alcohol Treatment strategies and alcohol treatment skills. Learn about Alcohol Withdrawal Symptoms and how to overcome them. Liver blood test and alcohol liver disease symptoms are included. Discover Relapse Prevention skills for alcohol addiction and alcoholism and relapse prevention strategies and techniques to overcome alcohol addiction and alcoholism. Overcome Alcohol Post-Acute Withdrawal Symptoms and recover with relapse prevention techniques. The content is provided by Dr. Steven M. Melemis addiction medicine specialist.