Alcohol Dependence

Diagnostic Criteria

Alcohol abuse: A destructive pattern of alcohol use, leading to significant social, occupational, or medical impairment.

Must have three (or more) of the following, occurring when the alcohol use was at its worst:

1. Alcohol tolerance: Either need for markedly increased amounts of alcohol to achieve intoxication, or markedly diminished effect with continued use of the same amount of alcohol.

2. Alcohol withdrawal symptoms: Either (a) or (b).

   (a) Two (or more) of the following, developing within several hours to a few days of reduction in heavy or prolonged alcohol use:

   • sweating or rapid pulse
   • increased hand tremor
   • insomnia
   • nausea or vomiting
   • physical agitation
   • anxiety
   • transient visual, tactile, or auditory hallucinations or illusions
   • grand mal seizures

   (b) Alcohol is taken to relieve or avoid withdrawal symptoms.

3. Alcohol was often taken in larger amounts or over a longer period than was intended
4. Persistent desire or unsuccessful efforts to cut down or control alcohol use
5. Great deal of time spent in using alcohol, or recovering from hangovers
6. Important social, occupational, or recreational activities given up or reduced because of alcohol use.
7. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been worsened by alcohol (e.g., continued drinking despite knowing that an ulcer was made worse by drinking alcohol)

How to cut down on your drinking

If you are drinking too much, you can improve your life and health by cutting down. How do you know if you drink too much? Read these questions and answer ‘yes’ or ‘no’: Do you drink alone when you feel angry or sad?

Does your drinking ever make you late for work?
Does your drinking worry your family?
Do you ever drink after telling yourself you won't?
Do you ever forget what you did while you were drinking?
Do you ever get headaches or have a hang-over after you have been drinking?

If you answered ‘yes’ to any of these questions, you may have a drinking problem. Check with your doctor to be sure. Your doctor will be able to tell you whether you should cut down or abstain. If you are alcoholic or have other medical problems, you should not just cut down on your drinking — you should stop drinking completely. Your doctor will advise you about what is right for you.

If your doctor tells you to cut down on your drinking, these steps can help you. You might find that some strategies are more useful than others. Remember you can have the support of your family and/or friends to overcome your alcohol problem.

1. Write your reasons for changing

Why do you want to drink less? There are many reasons why you may want to cut down or stop drinking. First think carefully about your reasons for wanting to change. Then have a look at the list below and mark those that apply to you. If you have other reasons write them and discuss them with your doctor and/or counsellor.

• you will feel better
• you will have more energy
• you will lose excess weight
• you will sleep better
• you will save money
• you won't have any hangovers
• you will work better
• your performance at work will improve
• your health will improve
• your family life will improve
• your memory will improve
• there will be less conflict at home
• you won't be thinking about your next drink all the time
• you will prevent serious health problems

2. Set a drinking goal

Choose a limit for how much you will drink. You may choose to cut down or not to drink at all. Talk to you doctor about what is right for you.

Here are some suggestions about setting goals:

if you are trying to stop drinking altogether, it is important to set a definite 'quit date'

if you are trying to reduce your drinking, it will help if you plan on which days you will drink alcohol and how many drinks you will have on each of these days. Make sure that you have at least two alcohol-free days in a week

it also helps to record the number of drinks that you have each day. Keeping a record will remind you to cut down and it will help you to keep track of whether you are following your goals.

Now - write your drinking goal on a piece of paper. Put it where you can see it, such as on your refrigerator or bathroom mirror. Your paper might look like this:

DRINKING GOAL

I will start on this day ………………………………..

I will not drink more than …………drinks in one day

I will not drink more than ………...drinks in one week

OR

I will stop drinking alcohol.

3. Keep a ‘diary’ of your drinking

To help you reach your goal, keep a "diary" of your drinking. For example, write down every time you have a drink for one week. Try to keep your diary for 3 or 4 weeks. This will show you how much you drink and when. You may be surprised. How different is your goal from the amount you drink now? Use the "drinking diary" below to write down when you drink.

Week:
	Number of drinks	Type of drinks	Place consumed
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Now you know why you want to drink less and you have a goal. There are many ways you can help yourself cut down. Try these tips.

4. Tips for cutting down

Watch it at home

Keep a small amount or no alcohol at home. Don't keep temptations around.

Change the way you drink

• quench your thirst with non-alcoholic drinks before having an alcoholic drink
• avoid salty snacks when you are drinking
• eat before drinking; It will make you feel more full and then you will drink less
• have one or more non-alcoholic drinks before each alcoholic drink
• try to take small sips of your drink, avoid gulping, drink slowly
• dilute your drinks, e.g. add soda to wine and mixers to spirits
• take a break of one hour between drinks.

Take a break from alcohol

Pick a day or two each week when you will not drink at all. Then, try to stop drinking for one week. Think about how you feel physically and emotionally on these days. When you succeed and feel better, you may find it easier to cut down for good.

Learn how to say NO

You do not have to drink when other people drink. You do not have to take a drink that is given to you. Practice ways to say no politely. For example, you can tell people you feel better when you drink less. Stay away from people who give you a hard time about not drinking.

Stay active

What would you like to do instead of drinking? Use the time and money spent on drinking to do something fun with your family or friends. Go out to eat, see a film, or play sports or a game.

Get support

Cutting down on your drinking may be difficult at times. Ask your family and friends for support to help you reach your goal. Talk to your doctor if you are having trouble cutting down. Get the help you need to reach your goal.

Watch out for temptations

Watch out for people, places or times that make you drink, even if you do not want to. Stay away from people who drink a lot or bars where you used to go. Plan ahead of time what you will do to avoid drinking when you are tempted. Do not drink when you are angry or upset or have a bad day. Section 5 below "Dealing with difficult times" will help you with this.

5. Dealing with difficult times

Changing habits like drinking can be difficult. There will be times when you may drink more than what you have planned or there might be times when it is very difficult not to drink or limit your drinking.

Now look at the list below. Mark the situations or feelings that tend to make you drink more. If you have other similar situations, write them below. Then discuss your list with your physician, counsellor, family member or a close friend.

Now you have the list of the most difficult times for you to resist drinking. If it is at all possible avoiding difficult situations will be very useful. Your initial strategy should be to reduce the temptation to drink.

However, in the long term, avoiding difficult situations may not be practical so it is also important to work out strategies to cope with difficult situations. Take a look at some of the strategies below and mark those that would be useful to you:

• If you have the habit of going to pubs after work or have the habit of meeting your friends there try to organise a different social activity, e.g. going to see a film, or going to a gym or a park
• If you drink mainly at night try to keep yourself busy, go to places where you cannot drink, e.g., movies
• If you drink when you are with friends who drink heavily try to avoid contact with these friends
• If you drink when you are alone reduce the amount of time that you spend alone, e.g. join a club or a support group or increase time doing activities with family members
• If you drink when you are bored try to plan enjoyable activities, e.g. shows, movies, exercise, hobbies etc.
• If you drink when you are stressed learn relaxation techniques or engage in relaxing activities, e.g. gardening
• If you drink when you feel depressed or if you think that drinking calms your anxiety you must consult your doctor about it

6. Important things to remember

• Keep your drinking at a level which is within the safe limits
• Remember to have two alcohol-free days a week
• Be realistic; you may want to plan your drinks for social occasions
• Remember not to drink more than your limit.

7. A word about set backs

Most people do not cut down or give up drinking all at once. There may be times when you will find it difficult to stick to your goals. You might find that you had a few more drinks than you had planned to drink.

Do not get discouraged — do not think of yourself as a failure. Learn from each occasion. Keep on trying

If you cannot achieve your goals it is important that you ask yourself 'why not?’ or 'what went wrong?’. That might help you plan different strategies in the future. 

8. About detoxification

If you are physically dependent on alcohol, the first part of treatment is called detoxification. Detoxification refers to a period of time when you stop taking alcohol. As a result your body has to re-adjust to a normal state without alcohol and you are likely to experience symptoms of alcohol withdrawal. The most common symptoms include nausea, shaking, sweating, irregular heart beat, anxiety and fatigue. These symptoms gradually improve over 3 to 5 days. People who have been drinking very heavily for a long time may experience more serious symptoms such as fits, confusion about the day, time or where they are. They may experience hallucinations, that is, seeing or hearing things that do not exist. For most people who are moderately dependent upon alcohol, it is safe to withdraw from alcohol as an out patient or at home, under the supervision of a doctor. Others need to be in a hospital setting. Discuss which is best for you with your doctor. Medication can help to reduce unpleasant symptoms of withdrawal during the withdrawal phase, though if you experience only mild withdrawal symptoms, you may need only support, lots of fluids and nutrition. There is no medication that will cure an alcohol problem.

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