alcoholism

and Christiane Fux, medical editor

Julia Dobmeier is currently completing her master's degree in clinical psychology. Since the beginning of her studies, she has been particularly interested in the treatment and research of mental illnesses. In doing so, they are particularly motivated by the idea of enabling those affected to enjoy a higher quality of life by conveying knowledge in a way that is easy to understand.

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Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

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Alcoholism is a serious mental illness. The development from consumption to abuse and addiction is creeping. Characteristic of the addiction are, among other things, a strong desire for alcohol, increasing consumption and the occurrence of withdrawal symptoms. Read everything about the signs and consequences of alcoholism and how to get the addiction under control.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. F10

Alcohol can easily go from being a luxury food to a highly dangerous drug. The transition into an addiction is not a one-way street. Strict withdrawal and the right relapse prophylaxis are crucial.

Brief overview

Signs: Strong desire for alcohol, loss of control, increase in quantities, withdrawal symptoms, neglect of interests and contacts, continued consumption despite negative consequences
Possible consequences: damage to the liver, pancreas, stomach and intestines, cardiovascular system, cognitive deficits, fears, depression, suicidal thoughts, job loss, destruction of social relationships
Causes: Genetic predisposition, stress, psychological stress, emotional instability, problematic use of alcohol in family and friends
Diagnostics: information from close people, questionnaires, blood tests (liver values), examination for possible typical secondary diseases of alcohol addiction
Therapy: inpatient or outpatient, cognitive behavioral therapy, individual therapy, group therapy, mindfulness training, stress management training, therapy goal: abstinence
Prognosis: Addiction is lifelong, with insight into the disease and therapy good chances of abstinence even with isolated relapses, untreated severe secondary diseases, shortened lifespan

Alcoholism: signs

Alcohol addiction (also: ethylism, drunkenness) is not a character weakness, but a serious mental illness. It can hit anyone: people from all walks of life, young and old, women and men. In Germany, almost all adults consume more or less alcohol. Some drink dangerously large amounts but are still not addicted. At what point does the addiction begin?

When are you an alcoholic?

The six main signs of addiction also apply to alcohol addicts. If three of these apply within a year, the person concerned is considered to be an addict according to the definition of alcoholism.

Strong demand

The central symptom of alcohol addiction is an almost uncontrollable craving for alcohol. It can be a permanent condition or it can suddenly attack the person concerned.

Loss of control

Alcoholics lose control of when and how much they drink. Loss of control is a major indicator of alcohol addiction. After the first glass, there is no stopping many until they are very intoxicated. Against their better judgment, they also drink in situations in which it is inappropriate or dangerous - for example during working hours or when they still have to drive.

Tolerance development

As a result of excessive consumption, the body develops a tolerance to alcohol over time. Those affected then need ever larger amounts in order to feel the desired effect. A sign of alcoholism is therefore that those affected seem to tolerate significantly more alcohol than non-dependent users. However, this does not mean that the higher amount you drink is less damaging to your body.

Withdrawal symptoms

If an alcoholic with physical dependence drinks less alcohol or no alcohol at all, withdrawal symptoms appear. These include tremors, sweating, difficulty sleeping, anxiety, and depressed mood. Only a new dose of alcohol can initially relieve the withdrawal symptoms. This vicious circle is difficult to break.

What is feared with withdrawal is what is known as delirium. It can be accompanied by hallucinations. Delirium can cause life-threatening circulatory disorders.

Neglect of other interests

The constant circling of thoughts about obtaining and consuming alcohol and the time it takes to drink and intoxicate causes alcoholics to neglect their duties and interests. Friends and family are also fading into the background.

Persistent consumption despite harmful consequences

Alcoholics do not stop drinking even if the consumption has already harmful physical, emotional or social effects. You drink despite the threat of job loss, separation from your partner or a sick liver.

Lack of insight into the disease

Alcoholics no longer drink for pleasure, but out of an internal compulsion or even a physical need. That is why attempts to reduce consumption regularly fail.

Still, most alcoholics are initially convinced that you could stop anytime. Often they actually succeed in this over days or weeks. This strengthens her belief that she is not dependent.

But as soon as they pick up their glasses again, the next relapse and loss of control is usually inevitable. Their failure increases their frustration and makes them even more drowning.

Feelings of shame, secrecy

Despite their obvious problems, most alcoholics refuse to be addicted to alcohol. The reason for this may be the extreme stigma that people with alcohol problems face. The alcoholics themselves often share the corresponding prejudices (“I'm not a bum”).

In addition, there is the fear of the necessary consequences - namely, having to do without alcohol. Many people with alcoholism drink increasingly clandestinely as soon as the environment speaks to them about the problem.

Types of alcohol addiction

Depending on the drinking behavior, one can differentiate between different types of alcohol addiction.

Mirror drinkers

The so-called mirror drinker consumes rather small amounts of alcohol, but continuously throughout the day. This type maintains a certain concentration of alcohol in the blood so as not to experience any withdrawal symptoms.

Heavy drinkers

In contrast to this, there is the binge drinker who cannot curb his drinking behavior and continues to drink every time until he is very intoxicated. He gets used to an increasing amount of alcohol. This form of chronic alcohol abuse (chronic alcohol abuse) is the most common.

Conflict drinkers

Far less common is the conflict drinker, who only drinks excessively when problems or conflicts arise. This type uses alcohol to overcome difficulties.

Episodic drinker

The episodic drinker consumes alcohol excessively at times and then remains abstinent for a few weeks. This drinking behavior is also known as dipsomania.

Functional alcoholics

Alcohol sickness is not always obvious. Some sufferers hide their alcohol addiction for years so cleverly that nobody notices. Many manage to continue performing even demanding tasks.

Recognize dangerous alcohol consumption

Alcohol addiction develops insidiously. The following signs indicate that you are developing alcohol addiction. Then they should seek advice so as not to slip into addiction.

You drink more and more often.
You drink increasingly larger amounts.
You like to drink alone.
You're drinking more than you intended.
You drink so much that memory gaps occur.
You keep drinking despite negative consequences.
They're hiding how much you drink.
You will be asked about your drinking habits by others.

Alcoholism - the Consequences

Alcohol consumption has both acute and long-term effects. In the long term, there is a threat of severe organ damage and mental illness. In addition, every area of life is affected by alcoholism: work, family, friends and leisure.

Effects of Alcohol Abuse

Excessive consumption of alcohol damages almost all organs

Short-term effects of alcohol

Alcohol can lift mood and reduce inhibitions in the short term. But it also makes some weepy, others aggressive. Depending on the amount and type of alcoholic drink as well as body weight and drinking habits, sooner or later perception disorders and coordination difficulties occur when consuming alcohol.

Alcohol quickly spreads throughout the body to the brain via the blood. Even those who can take a lot without getting drunk damage their organs. Because the liver can only break down about 15 grams of alcohol per hour. Anything beyond that initially remains in the blood. When alcohol is broken down, toxins are also produced, which in the long term have a negative impact on health.

Long-term physical effects of alcohol

Alcohol and its breakdown products are poisonous. In the long term, they damage all organs in the body.

Liver damage

The liver, which constantly has to work hard for heavy drinkers, stores more fat, enlarges and transforms itself into what is known as fatty liver. This often goes unnoticed for a long time, because the liver itself cannot feel any pain. However, it is sometimes noticeable through a feeling of pressure in the upper abdomen. Pain only occurs when the liver becomes inflamed.

After a while, liver cells die: cirrhosis of the liver develops (shrunken liver). This is a steadily progressive, life-threatening disease. The risk of liver cancer also increases.

Effects on the brain

The brain also suffers massively. Brain cells are lost with every sip of alcohol (brain atrophy).

This also triples the risk of other forms of dementia such as Alzheimer's and vascular dementia, which often set in earlier than usual.

In severe alcoholics, the damage to the brain can also trigger alcohol-related dementia, which can trigger Korsakoff's syndrome. Those affected then suffer from disorientation and memory loss. Korsakoff's syndrome is caused by a lack of vitamin B1. Because alcoholics often do not eat enough. Although alcoholic beverages are high in calories, they do not contain the necessary nutrients.

Digestive tract

Since alcohol passes through the entire digestive tract, it causes damage everywhere. These include increased inflammation of the gums, reflux (heartburn), gastric mucosal inflammation and ulcers, damage to the small intestine and the lining of the large intestine.

Gastrointestinal problems such as vomiting, diarrhea and appetite disorders are other consequences of alcoholism.

pancreas

Heavy alcohol consumption can cause inflammation of the pancreas (pancreatitis). The acute form is very painful and can be life-threatening; a chronic course with diarrhea weakens the body.

Varicose veins of the esophagus

As the liver is destroyed, the blood from the abdomen has to find a new route to the heart. Part of it is no longer conveyed to the heart via the portal vein, but via veins along the esophagus. These expand pathologically (esophageal varices) and can burst. The so-called esophageal variceal bleeding into the esophagus can lead to life-threatening blood loss.

Heart and vascular damage

Long-term consequences of alcohol addiction are also cardiovascular diseases. The alcohol damages the heart muscle and blood vessels. High blood pressure, cardiac arrhythmias, and heart muscle diseases are more common in alcoholics. Vascular changes are expressed, among other things, in the typical red color of the skin of alcoholics and in what is known as the drinker's nose.

cancer

In the long term, alcohol also increases the risk of cancer. In addition to liver cancer, there is also a risk of tumors in the mouth, throat, esophagus and stomach. In women, there is also a significantly increased risk of breast cancer.

Reduced life expectancy

The life expectancy of alcoholics is reduced by 10 to 15 years.

Long-term psychosocial effects

Problems in work and personal life

The effects of alcohol do not only affect health: In addition to the physical and mental consequences described, there are environmental problems.

At some point, alcoholics are no longer able to carry out their everyday tasks. The deeper they slide into alcohol addiction, the more likely they are to lose their job. This not only affects the financial situation, but also the interpersonal situation.

Relationships with partners, children or friends are often broken in alcoholism.

Relatives often suffer from the addiction as well as the person affected. Family, friends and hobbies are neglected. The sick person becomes a burden from friend, partner and parent, addiction becomes the terrible center of life for everyone involved. Relatives often develop what is known as codependency.

What is this all about and how to escape it can be read in the text Codependency.

Mental alcoholism symptoms

Alcohol changes personality. Under the influence of alcohol some become subdued or weepy, others act aggressive or even violent. The aggression can be directed against strangers as well as against one's own family. Many crimes are committed under the influence of alcohol.

Alcoholics also often suffer from mood swings and depression. In severe cases, hallucinations and delusions occur. Alcoholics often suffer from insomnia and severe anxiety. Feelings of guilt and inferiority also accompany alcohol addiction.

Alcohol addiction and other mental illnesses

In many cases, alcohol addiction does not occur alone, but is accompanied by another mental disorder (comorbidity). The most common are anxiety disorders, such as panic disorders or phobias. Many alcoholics also suffer from depression. Alcoholics are also common among schizophrenic patients.

It is often difficult to determine whether a mental disorder led to alcohol addiction or whether the alcohol caused or aggravated mental problems. In combination with a mental disorder, the risk of suicide for alcohol addicts is increased. That is why both diseases must be treated as quickly as possible.

Alcohol During Pregnancy

Alcohol is particularly dangerous for the unborn child. Because if the mother drinks alcohol during pregnancy, it affects the physical and mental development of the fetus. The damage is irreversible and accompanies the child for a lifetime.

In the case of fetal alcohol syndrome, the children show behavioral problems as well as mental and physical impairments that can be very serious.

Even small amounts of alcohol can harm the child. Women should therefore completely avoid alcohol during pregnancy.

Read more about the effects of alcohol on the unborn child in the text Fetal Alcohol Syndrome.

Alcohol addiction: causes and risk factors

Most people in Germany drink alcohol, many of them in harmful quantities. However, only a fraction of them are alcohol dependent, namely around two million.

Exactly how alcohol dependency develops has not yet been fully explained. However, several factors always come together. Both genetic and psychosocial influences play an important role in this.

Genetic Influences

Is Alcoholism Hereditary? Family and twin studies studies show that there is a genetic risk for alcohol addiction. Identical twins have a significantly higher risk of becoming alcoholic if one twin is affected. If both parents are addicted to alcohol, around 30 percent of children will later develop alcohol addiction as well.

Consumer behavior in the family

In addition to the parents' genes, their relationship to alcohol also plays a role. If the children learn that drinking a lot is funny or even arouses admiration or that alcohol is used to cope with problems, they quickly take this as a bad example. If people later drink a lot in their own circle of friends, the effect increases.

Roots in childhood

Traumatic or stressful experiences often form the basis for the development of an addiction disease. At particular risk are people who experienced abuse or loss in childhood, such as the death of a parent. The bond with the mother is also decisive for the further development of the child. Children whose mothers do not respond to their needs or children without a permanent caregiver are more prone to alcoholism later.

Alcohol among friends

There is another factor, especially during puberty: peer pressure. Puberty is a complicated phase in which young people try to develop personality and self-image and to connect with their peers. Peer pressure can be a trigger for drinking. If you don't drink, you run the risk of being excluded from the group.

Young people often rate alcohol positively. To be “drinkable” is a sign of strength. However, people who have this characteristic and who tolerate alcohol well are even more at risk of becoming dependent on alcohol than those who cannot tolerate much. Because the latter automatically drink less.

Alcohol as a way of life

Another risk of alcohol abuse are the initially positive effects of consumption. Under the influence of alcohol, inhibitions and fears are briefly reduced. For rather insecure people or people in difficult phases of life, the risk of alcohol abuse increases.

Alcohol as a drug of happiness

The processes in the brain also play an important role in the development of alcohol addiction. Because alcohol increases the release of the neurotransmitter dopamine, which activates the reward system in the brain. Dopamine creates feelings of happiness. It is also poured out when we eat something, for example.

But alcohol activates the dopamine receptors even more strongly than food. So drinking alcohol is rewarded with feelings of happiness. People who call this up too often become less sensitive to dopamine - they need larger amounts. When they drink less or no alcohol they develop cravings. This is also known as craving.

Alcohol addiction: examinations and diagnosis

Harmful use or alcohol addiction? Based on certain criteria, the doctor or therapist can decide what applies to a person and plan further treatment accordingly. Your family doctor will be the first point of contact to help you.

Research into alcohol addiction

If alcohol addiction is suspected, the doctor will first have a detailed discussion with the person concerned. The family doctor could ask the following questions in an initial consultation:

Do you often feel the need to drink alcohol?
How much alcohol do you drink a day / week?
Do you get the impression that you think about alcohol often?
Have you ever tried to reduce your alcohol consumption?
What positive or negative effects does alcohol have on you?

External withdrawal symptoms, such as sweating, tremors or reddening of the skin, can be signs of alcohol addiction. With the help of a blood test, the doctor can find further evidence of increased alcohol consumption. The blood count also provides information about the condition of the liver. In addition, the doctor will perform a comprehensive physical examination to determine any other possible consequential damage.

Diagnosis: Abuse or Alcohol Dependence (ICD-10)

If the suspicion of alcohol dependency is confirmed, the family doctor will refer you to outpatient specialists or a clinic. They carry out an accurate diagnosis and create an individual treatment plan to combat alcohol addiction.

Diagnostic criteria for alcoholism

The criteria of the international statistical classification of diseases and related health problems (ICD-10) are generally used to diagnose alcohol addiction.

A distinction is made between the harmful use of alcohol, which is referred to as alcohol abuse or alcohol abuse, and alcohol dependence. According to the ICD-10 for alcohol dependence, at least three of the following criteria must occur simultaneously in one year for the diagnosis:

There is a strong desire to drink alcohol.
People have no control over when or how much they drink.
If alcohol consumption is reduced or stopped, withdrawal symptoms occur (e.g. sweating or tremors).
There is a tolerance to the alcohol, so that the amount has to be increased more and more in order to feel an effect.
Dealing with alcohol takes a lot of time and leads to the neglect of other interests.
Although alcohol consumption has negative consequences, people do not stop drinking.

Alcohol addiction: alcohol withdrawal

In the case of physical dependence, detoxification must take place first. Before the actual alcoholism therapy, those affected must go through a medically supervised alcohol withdrawal, a so-called detoxification. Withdrawal from alcohol can be associated with mild to severe physical withdrawal symptoms. With severe dependence, withdrawal can even be life-threatening. Therefore, it should always be supervised by a doctor. Only after the physical withdrawal does the actual weaning therapy follow.

Outpatient withdrawal

In milder cases, this is possible on an outpatient basis. The patient then appears daily for a certain period of time to check the breath for alcohol. A doctor will also check for withdrawal symptoms such as tremors, sweating, difficulty concentrating, and high blood pressure. A urine test may also be done towards the end, which can detect alcohol for much longer.

Inpatient withdrawal

In more severe cases, detoxification must be carried out on an inpatient basis. On the one hand, patients who do not manage to abstain from alcohol on their own have no access to alcohol here. On the other hand, the dreaded delirium tremens can also occur during withdrawal. It can be associated with anxiety, confusion, and hallucinations.

The dangerous physical symptoms such as epileptic seizures, rise in blood pressure and racing pulse can be better controlled here. Under inpatient medical supervision, the delirium can be intercepted with medication and treated in good time.

You can read more on this topic in the article alcohol withdrawal.

Alcohol addiction: treatment

Even if dependent people can no longer suppress their alcohol addiction, very few seek help with alcohol addiction immediately. For one thing, the shame is very great. On the other hand, the thought of having to give up alcohol is inconceivable for many.

But alcoholism is a life-threatening disease. It can only be mastered alone in the rarest of cases. So don't hesitate to seek help with alcohol addiction if you fear drinking too much.

Abstinence or reduced drinking?

Those who are not yet dependent on alcohol have a good chance of reducing their consumption again - preferably with guidance.

But once the addiction arises, it becomes a lifelong companion. The goal of weaning therapy is usually a complete abstinence from alcohol. However, many alcoholics cannot (at least initially) imagine completely giving up alcohol. In the past, this meant that they mostly fell out of the grid of offers of help.

In the meantime, addiction experts have changed their minds. Since 2015, the guidelines on alcohol therapy have also recommended reduced drinking as a possible therapy goal for alcoholics who cannot achieve abstinence.

In the course of time, the patient may find it possible to do without it completely - or even easier than drinking less. Because constant self-control of the amount you drink is not easy. The urge for more remains.

For most offers for alcohol cessation, however, the willingness to abstain is still the basic requirement.

Contact points for alcoholism

The first point of contact is usually the family doctor. Psychiatrists and therapists, but also public organizations, associations and counseling centers that deal with alcoholism offer further help with alcohol addiction.

Psychological weaning therapy

To get out of alcohol addiction, you have to set yourself up from scratch. It is a matter of breaking old habits, uncovering the causes of addiction and finding new ways to deal with problems and stress or to generate positive feelings.

A withdrawal therapy is always made up of various components that address the different aspects of addiction and its reinforcers: Individual discussions and group therapy are combined. In addition, there are elements such as stress management and mindfulness training.

Individual therapy

Addiction treatment is usually based on cognitive behavioral therapy. In individual therapy, the therapist worked intensively with the patient to develop new patterns of thought and behavior.

An essential step is to uncover the personal reasons for slipping into alcohol. In order to remain abstinent, the patient and the therapist must develop new coping strategies for the situations that trigger addiction. He learns to get away from the automated reaching for the bottle and to find new sources of positive feelings.

Group therapy

Group therapy is the second central component of addiction treatment. The experience of meeting others, people who have experienced the addiction firsthand, helps to reduce feelings of shame. In mutual exchange, the patients can benefit from tips and coping strategies of the other and encourage and support each other.

The head therapist often also addresses central life issues that play a role in addiction: life goals, partnership, relationship with parents, losses or fears.

Family or systemic therapy

Often the addiction has already damaged relationships with friends and family. Often there is a so-called co-dependency in alcoholism: The relatives supposedly help the sick person, for example by covering him up to outsiders or tolerating his behavior.

However, family problems may also have contributed to alcohol addiction. Both can be worked on as part of family therapy.

The focus is usually on open, respectful communication behavior without assigning blame. This makes it easier for both sides to approach each other again. The relatives learn how to support the sick, but also how to set themselves apart.

Mindfulness training

In mindfulness exercises such as the “body scan”, the patient focuses his full attention on the here and now. He learns to clearly perceive his feelings, both positive and negative, but also to accept them as temporary. In this way, for example, an impending relapse can be recognized at an early stage so that the patient can take countermeasures in good time. The techniques can also be used to cope with strong addictive pressure.

Stress reduction

For most alcoholics, stress is a central cause - and repeatedly a trigger for relapses. In therapy, the patient learns how to stress himself less or how to be stressed from outside. Learning a relaxation method such as autogenic training or progressive muscle tension according to Jacobson is also helpful.

Anti-craving drugs

For people who cannot achieve abstinence with psychotherapy alone, additional drugs for alcohol addiction can help:

The active ingredient naltrexone reduces the positive effects of alcohol. In alcohol addicts, these alcohol addiction tablets are often used to prevent relapse.
The active ingredient disulfiram causes severe intolerance to alcohol. The affected person then suffers from headache, shortness of breath, reddening of the face, nausea and vomiting when drinking alcohol.

Inpatient or outpatient?

Inpatient treatment: Getting rid of alcohol is difficult. Often this works better in a clinic that specializes in addiction. On the one hand, you are not confronted with other people who drink and it is difficult to get any alcohol at all.

For many patients, however, it is above all important to get out of the familiar environment completely and to concentrate fully on themselves and overcoming the disease.

Seriously ill patients who have been ill for many years often no longer work and, apart from their drinking routines, hardly have a daily structure. In the clinic, they have the opportunity to get used to a regular daily routine again, to develop new interests and learn to take responsibility for smaller tasks. Inpatient treatment usually lasts between three and six months.

Outpatient weaning: Outpatient treatment can be useful for patients who are less seriously ill, for example still have a job and are socially well integrated. This can, but does not have to be, part-time.

The advantage is that the patients practice life without alcohol in the "wild" right away. You will learn to refuse alcoholic beverages in good company, not to be tempted by the range of beer, schnapps or wine when shopping, or to cope with stressful situations without alcohol. Outpatient treatment usually lasts nine to twelve months.

Assumption of costs

Alcohol addiction has been recognized as a disease since 1968. Therefore, the treatment is also taken over by the health insurance company, later by the pension provider, for example the Federal Insurance Agency for Salaried Employees. Private health insurances do not always or not always fully cover the costs. The reimbursement depends on the respective contract.

Dealing with relapses

Alcoholism cannot be "erased". Anyone who has ever been addicted to alcohol has to decide again and again against alcohol even after successfully completing an alcoholism therapy. Any glass can cause severe relapse. Even if the first alcoholic drink seems to have no consequences after a long time, consumption is usually back to the old level within a very short time.

The road out of alcohol addiction is long and difficult. The patient is therefore prepared to deal with possible relapses. Relapses are common and it is important that those affected see them not as a personal failure but as part of the learning process. It is then important to recognize what triggers the relapse so that they can be averted in good time in the future.

Support groups

After the therapy, self-help groups make a significant contribution to staying stable. The topic of alcohol addiction remains present through the regular meetings. That protects against relapses. In the group, those affected find support and an understanding that those not affected cannot muster. Some arrange personal mentors whom they can contact in an emergency.

Controlled drinking

For the classic forms of therapy, the will to abstain is still the basic requirement. The so-called “controlled drinking” takes a different approach. It is only intended for those affected who are not yet too deeply addicted and have not been for too long.

The 10-step program was developed years ago by the psychologist Joachim Körkel. Among other things, the patient should recognize on which occasions he drinks, keep a drinking diary and set and learn to stick to fixed drinking goals.

However, the rules are strict: he must determine the time, place, circumstances and amount of drink in advance. The latter should be set so low that it hardly has any effect. Experts criticize that the loss of control is part of the disease and that controlled drinking is therefore a contradiction in terms for addicts.

Alcohol addiction: disease course and prognosis

Drinking alcohol is firmly anchored in society. As a legal drug, alcohol is readily available and readily available, and it is also comparatively inexpensive. He relaxes, lifts the mood and disinhibits. The danger of drinking too much is therefore great.

Risky consumption

The line between enjoyment and danger is fine: more than 24 grams of pure alcohol for men (e.g. two glasses of 0.3l beer) and 12 grams (e.g. a glass of 0.3l beer) per day for women are already considered risky consumption. But even less alcohol can damage sensitive people in the long term.

Alcohol abuse

The transition from harmful use to addiction is fluid. Initially, most people use alcohol to create positive feelings, alleviate anxiety and insecurity, or to hide problems. Consumption increases into harmful use.

This is not yet a dependency. For many, however, there are already problems related to alcohol consumption: trouble with partners, friends or at work, for example.

Those affected decrease in their performance, often fail to meet their obligations or the affected person dies in an intoxication. Other alcoholics manage to hide their addiction for a long time.

Mental addiction

Psychological addiction follows. The person concerned increasingly neglects social life and tasks. Alcohol becomes the center of life. Often the thoughts only revolve around the next glass. At this stage, those affected often hide their drinking. If alcohol is not available, a strong desire for it develops.

Physical addiction

If the body gets used to the alcohol and the person concerned needs larger amounts for the desired effect, this is the beginning of physical dependence. If the addict refrains from alcohol at this stage, physical withdrawal symptoms appear.

They range from sweating and tremors to life-threatening delirium with hallucinations. In severe cases, withdrawal can be fatal, at least if you go it alone. It should therefore be carried out under medical supervision.

Shortened life expectancy

Without therapy, the average life expectancy of an alcoholic is reduced by twelve years. The most common causes of death are suicide, accidents, liver failure, heart disease and cancer.

Despite the consistent use of all therapeutic options, only 45 percent of former alcoholics are still abstinent four years after the end of therapy. However, those who are not deterred by relapses can get their alcohol addiction under control in the long term.

Lifelong topic

If left untreated, alcoholism usually remains a constant companion in life until - often premature death. However, alcoholism in old age is often not recognized. Falls or cognitive deficits are then quickly ascribed to old age instead of addiction.

Additional information

Books:

Alcoholism: warning signals, prevention, therapy (Wilhelm Feuerlein, C.H.Beck, 2008)

Guidelines:

Guideline "Screening, Diagnosis and Treatment of Alcohol-Related Disorders" of the German Society for Addiction Research and Addiction Therapy e.V.

Self-help groups:

Joint service office for anonymous alcoholics interest group e.V .: https://www.anonyme-alkoholiker.de/
Al-Anon family groups, for relatives and friends of alcoholics: http://al-anon.de/

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