Alcohol dependence

Also called Alcoholism, Alcohol use disorder

When stopping causes withdrawal, willpower stopped being the relevant question some time ago.

What it is

There is a line people cross without noticing, and it is not the one most families think it is. It isn't about how much, or how early in the day, or whether anyone has lost a job. It's this: does stopping cause physical withdrawal?

Once the answer is yes, the conversation has to change. The body has adapted. Sudden abstinence now causes shaking, sweating, sickness and, in serious cases, seizures and delirium tremens, which kills people. Telling a physically dependent person to just stop is not encouragement. It's dangerous advice.

Around 600,000 people in England are dependent drinkers. Fewer than one in five are in treatment.

Signs you might notice

Drinking first thing, or needing a drink to stop the shakes.

Tolerance climbing, so the same effect costs more.

Time rearranged around drinking, and irritability when that arrangement is threatened.

Money and memory both going missing. Blackouts treated as funny stories.

And a great deal of skilled, exhausting concealment, often by the whole household.

How it can affect day-to-day life

The physical bill arrives eventually: liver disease, high blood pressure, pancreatitis, nerve damage, and a form of memory loss called Korsakoff syndrome that is permanent once established.

But the daily cost lands on the people nearby first. Children take on adult jobs. Partners become managers of an unpredictable system. Everyone learns to read a mood from the sound of a key in the door.

Alcohol also makes almost every other condition on this site harder to treat, because it interacts with medication, disrupts sleep and worsens depression while appearing to relieve it.

Supporting someone well

Never advise a dependent drinker to stop suddenly on their own. Get medical help for a planned, supported withdrawal. This is the single most useful thing in this entry.

Talk about behaviour, not character. "You missed Ellie's assembly" lands. "You're an alcoholic" starts an argument about a word.

Drop the ultimatums you will not keep. Every unenforced threat teaches that the next one is noise.

Look after yourself separately. Al-Anon exists because families need their own support, not as an afterthought.

Expect relapse and plan for it in advance. It is part of the pattern for most people, and treating it as total failure is how somebody stops trying.

Where to get help

Every area of England has a free, confidential alcohol service and you do not need a GP referral. Find yours through the NHS service finder.

Drinkline is free on 0300 123 1110.

If somebody is having a withdrawal seizure, or is confused and hallucinating after stopping, call 999. Delirium tremens is a medical emergency.