Alcohol dependence is characterized by tolerance — the need to drink larger amounts of alcohol to achieve the same effects originally produced by lower doses — and the development of uncomfortable withdrawal symptoms when a person suddenly stops drinking.
Most individuals who are alcohol dependent are physically, psychologically and emotionally reliant on alcohol, and they usually continue to drink despite the adverse consequences. They often experience overpowering cravings and are preoccupied with alcohol.
But alcohol dependence is not the same as alcohol addiction.
According to the National Institute of Drug Abuse, dependence is a state in which the brain functions normally only in the presence of a drug. Within hours or a few days of having their last drink, people dependent on alcohol will experience alcohol withdrawal symptoms that may include hand tremors, nausea or sweating.
Addiction to alcohol, however, is a disease characterized by a compulsion to drink and an inability to control one’s alcohol intake. People who are dependent on alcohol are often addicted to the substance, but it is possible to be dependent and not addicted.
While the American Psychiatric Association used to separate alcohol abuse and alcohol dependence into two distinct disorders, both are now categorized into a single diagnosis called alcohol use disorder. An alcohol use disorder, which can range from problem drinking to alcoholism, can be classified as mild, moderate or severe, depending on a person’s symptoms and drinking behaviors.
No one sets out to become an alcoholic, but regular, heavy drinking can result in alcohol dependence and alcoholism.
When we drink, alcohol enters the brain and disrupts the delicate balance of chemicals called neurotransmitters that keep the body functioning normally. This disruption leads to the numerous behavioral changes and physical signs associated with intoxication, such as euphoria, loss of inhibition, impaired coordination, slurred speech and drowsiness.
Fortunately, these effects are temporary and wear off after the body breaks down the alcohol. But when exposure to alcohol is ongoing, the brain seeks to compensate for these effects, and a complex cascade of long-term chemical changes begin to occur.
To counteract the brain-slowing effects of alcohol, for instance, the brain increases the activity of excitatory neurotransmitters, which stimulate nerve activity and heighten arousal. As these changes occur, people require increasingly larger amounts of alcohol to become intoxicated. As a result, their drinking will often escalate.
At the same time, the drinker will likely begin to experience intense cravings for alcohol and distressing physical withdrawal symptoms, such as sweating, anxiety, tremors, an elevated heart rate and insomnia, when they stop drinking.
To avoid these uncomfortable symptoms, which can occur as soon as six hours after people who are dependent on alcohol consume their last drink, a person may begin drinking frequently or around-the-clock.
Chronic, heavy alcohol use also wreaks havoc on the brain’s reward system, which can alter the way the brain perceives pleasure and limit a person’s ability to control his or her behavior. Over time, these changes, along with the effects of tolerance and withdrawal, can create a vicious cycle of dependence that keeps the person hooked on alcohol.
Unfortunately, alcoholism is wildly undertreated. According to the National Institute on Alcohol Abuse and Alcoholism, approximately 6.7 percent of adults who had an alcohol use disorder in 2015 received treatment. Many alcoholics often wait up to a decade before seeking help.
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