Alcohol Dependence

Understanding Alcohol Dependence

Despite the prevalence of alcohol addiction, many people are unaware that alcohol dependence is a separate condition that may occur without the presence of addiction. Alcohol dependence very often co-occurs with alcohol use disorder but remains a separate condition.

People with alcohol dependence often experience alcohol withdrawal symptoms, which can be life-threatening in severe cases.

Learning the signs of alcohol dependence, how it compares and contrasts to alcohol addiction, and the most effective treatments can be life-saving information.

What Is Alcohol Dependence?

Alcohol dependence occurs when an alcohol user relies physically and/or psychologically on consuming alcohol to function normally.

Dependence can arise when your body or mind depends on alcohol use to function, causing unpleasant or even dangerous withdrawal symptoms when not drinking.

Alcohol dependence can develop in anyone drinking alcohol, regardless of how much you drink. Drinkers who engage in binge drinking are more likely to become dependent, but even moderate or occasional drinkers are at risk.

Alcohol Dependence VS Alcohol Addiction

The difference between alcohol dependence and alcohol addiction has been hotly debated for decades because the two conditions are so similar, with both terms often used interchangeably.

Even the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition) no longer separates dependence and addiction in its criteria. However, many healthcare providers believe the distinction between dependence and addiction is very important.

Alcohol dependence refers to physical reliance, tolerance, and withdrawal from alcohol consumption. These individuals don’t necessarily crave alcohol or engage in risky behavior to obtain it. Instead, they may suffer from negative effects due to alcohol withdrawal symptoms or have extremely high tolerance.

On the other hand, alcohol addiction is a disease characterized by uncontrollable behaviors and compulsions around drinking alcohol despite the negative effects. Most alcoholics have alcohol dependence, but not every person with alcohol dependence will have an alcohol addiction.

What Are the 4 “Types” of Drinkers?

Research from the University of Missouri-Columbia identified four “types” of drinkers using evidence-based addiction science but named with pop culture references. The purpose of the study was to categorize the way certain individuals change while intoxicated.

Regardless of whether the individual has just alcohol dependence or also has an alcohol use disorder, these terms are meant to help classify drinkers as one of the following:

• The Mary Poppins: This type of drinker is usually already outgoing and only gets sweeter and happier with alcohol.
• The Ernest Hemingway: These drinkers do not exhibit any major personality changes when transitioning from sober to drunk.
• The Nutty Professor: This drinker type is usually a natural introvert who loses their inhibitions as they drink, surprising everyone with their excitement and life-of-the-party attitude while drunk.
• The Mr. Hyde: Just like the name suggests, these drinkers almost become someone else while drunk, often engaging in irresponsible, hostile, and possibly violent behavior.

Signs and Symptoms of Alcohol Dependence

Alcohol dependence can develop in those who engage in heavy drinking or those who only drink moderately or occasionally.

Factors like the amount of alcohol, pre-existing health conditions, age, weight, and metabolism can all play a part in whether or not someone has alcohol dependence.

While some of these symptoms are also common in alcohol addiction, this list will only focus on individuals with alcohol dependence, not alcohol addiction (i.e., alcohol use disorder).

Common signs of alcohol dependence include:

• Attempting to stop drinking but failing due to withdrawal symptoms (NOT due to cravings or behavioral issues resulting from drinking)
• Requiring larger amounts of alcohol to achieve the same effect
• Accidental excessive drinking due to high tolerance
• Experiencing physical or mental health problems when trying not to drink
• Needing to drink alcohol to function normally

Effects of Alcohol Dependence

Regardless of whether the person has alcohol dependence, alcohol addiction, or both, the effects of excessive alcohol use are the same. Individuals with alcohol dependence are just as at risk of developing alcohol-related complications as those with alcohol use disorder.

Short-term effects of alcohol dependence and continued alcohol use include:

• Suppression of the nervous system
• Slurred speech
• Poor balance and coordination
• Memory loss or “blackouts”
• Vomiting
• Slowed heart rate and breathing
• Increased risk of falls, accidents, and motor vehicle crashes
• Increase in poor judgment, irresponsible behavior, and violence
• Risk of alcohol poisoning, which is a medical emergency

Long-term effects of alcohol dependence and continued alcohol use include:

• High blood pressure
• Weakened immune system
• Worsened mental health symptoms such as depression, anxiety, paranoia, psychosis, or thoughts of self-injury
• Increased risk of acute and chronic pancreatitis
• Increased risk for heart disease, heart attack, and stroke
• Liver disease, cirrhosis (scarring of the liver), and liver failure
• Bleeding from the stomach or blood in stool
• Increased risk for cancers of the mouth, throat, breast, liver, and colon

Risk Factors for Developing an Alcohol Dependence

There’s no question that alcohol dependence can easily lead to alcohol addiction if not treated. Some alcoholics began with alcohol dependence that slowly advanced into alcohol addiction.

However, the risk factors for alcohol dependence are quite similar to those for alcohol addiction.

Common risk factors for developing alcohol dependence include:

• History of alcohol dependence or alcohol problems in your family
• Drinking too much frequently
• Drinking from an early age
• Having a high tolerance to medications

Treating Alcohol Dependence

The treatment for alcohol dependence shares similarities with the treatment for alcohol addiction—namely in the use of medical detoxification.

Individuals with alcohol dependence who show few or no signs of addiction may only require medical detox or simply outpatient treatments.

Medical Detoxification

Alcohol withdrawal symptoms can be unpleasant and, in many cases, dangerous without medical intervention. In severe cases, patients can develop Alcohol Withdrawal Syndrome (AWS), a condition that may cause seizures or delirium tremens.

Delirium tremens can be fatal if not treated. Common symptoms of delirium tremens include:

• Withdrawal seizures
• Intense tremors
• Severe disorientation
• Inability to regulate blood pressure or heart rate
• Hallucinations or delusions
• Impaired brain function
• Organ failure

While in medical detox for alcohol use, patients will remain under medical supervision and receive medications to manage withdrawal symptoms and related health risks.

Common medications used during alcohol medical detox include:

• Naltrexone: Prevents the pleasurable your brain from feeling pleasure from alcohol, therefore helping to prevent relapse.
• Acamprosate: Works similarly to Naltrexone but is different in that the liver metabolizes it and may be preferred by patients with liver problems.
• Benzodiazepines: Used for their sedative effects to prevent withdrawal seizures. Common benzodiazepines may include:
  • Chlordiazepoxide (Librium®)
  • Diazepam (Valium®)
  • Lorazepam (Ativan®)

• Disulfiram: Assists with relapse prevention by causing an uncomfortable reaction to drinking alcohol.

Intensive Outpatient (IOP)

Many people with alcohol dependence are on the path to becoming an alcoholic and may benefit from the standard treatments for alcohol use disorder.

Individuals with alcohol dependence often don’t require a residential stay and find great success in programs they attend a few hours a week.

Intensive outpatient programs frequently employ the use of one-on-one therapy, group therapy, and relapse prevention strategies.

These mental health treatments can help people with alcohol dependence stop the progression to alcohol addiction and avoid becoming physically dependent on alcohol in the future.

Therapy

In cases where patients with alcohol dependence are beginning to develop some addictive behaviors, therapy may be beneficial.

While therapy is usually the cornerstone of intensive outpatient care, most treatment programs have an endpoint.

By establishing yourself with a therapist, you can receive long-term treatment that addresses not only potential alcohol misuse but also other mental health issues you may be facing.

Get Support and Treatment for Alcohol Dependence

If you or a loved one is showing signs of alcohol dependence, don’t wait until things get worse. Talk to your doctor about the symptoms you’re experiencing when not drinking to rule out other medical conditions and determine what treatment will best suit your situation.

For those who are also developing alcohol addiction, speak with a mental health professional or addiction specialist about your symptoms. Even individuals with only alcohol dependence can benefit from traditional alcohol addiction support groups like Alcoholics Anonymous or SMART Recovery.

Don’t have a doctor? Try the online treatment locator offered by the Substance Abuse and Mental Health Services Administration (SAMHSA) or call the helpline at 1-800-662-4357 (HELP) to see what addiction treatment centers near you offer medical detox for severe alcohol withdrawal symptoms.