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If you are alcohol dependent you have a strong desire for alcohol. Sometimes the desire is overwhelming. You have great difficulty in controlling your drinking. In addition, your body is so used to lots of alcohol that you start to develop ‘withdrawal’ symptoms 3-8 hours after your last drink, as the effect of the alcohol wears off. So, even if you want to stop drinking, it is difficult because of the withdrawal symptoms.

The withdrawal symptoms include: feeling sick, trembling, sweating, craving for alcohol, and just feeling awful. Convulsions occur in a small number of cases.

As a result, you drink alcohol regularly and ‘depend’ on it to prevent these symptoms. If you do not have any more alcohol the withdrawal symptoms usually last 5-7 days, but a craving for alcohol may persist longer. The severity of dependence can vary. It can develop gradually and become more severe. You may be developing alcohol dependence if you:

• need a drink every day.
• drink alone often.
• need a drink to stop trembling (the shakes).
• drink early, or first thing in the morning (to avoid withdrawal symptoms).
• often have a strong desire to drink alcohol.
• spend a lot of you time in activities where alcohol is available. For example, if you spend a lot of time at the social club or pub.
• neglect other interests or pleasures because of alcohol drinking.

If you are alcohol dependent you are usually ‘tolerant’ to the effect of alcohol. This means that you need more alcohol to notice any effects and to become drunk. This can make things worse as it tends to make you drink even more.

If you are alcohol dependent you may get drunk regularly. However, you may not get drunk. You may drink small amounts regularly to keep the withdrawal symptoms away. You may then be able to ‘hide’ your problem from others. However, you are still at serious risk of developing conditions due to heavy drinking (liver damage, cancers, etc).

Delirium tremens (’DTs’)
This is a more severe withdrawal reaction after stopping alcohol. It occurs in about 1 in 20 people who have alcohol withdrawal symptoms about 2-3 days after their last drink. Symptoms include: marked tremor (the shakes) and delirium (agitation, confusion, and seeing and hearing things that are not there). Some people have convulsions. Complications can develop such as dehydration and other serious physical problems. It is fatal in some cases.

There are roughly four ‘levels’ of alcohol drinking - social, heavy, problem and dependent. As a rule, each level increases the risk to your health and safety.

Social drinking
Most people drink some alcohol. However, even a small amount of alcohol can be dangerous if you drive, operate machinery, or take some types of medication.

Heavy drinking
This is drinking above the recommended ’safe’ limits which are:

• Men should drink no more than 21 units of alcohol per week (and no more than four units in any one day).
• Women should drink no more than 14 units of alcohol per week (and no more than three units in any one day).

One unit of alcohol is in about half a pint of beer, or two thirds of a small glass of wine, or one small pub measure of spirits. See leaflet called ‘Alcohol and Sensible Drinking‘ for details.

Drinking above the recommended safe limit increases your risk of developing diseases such as cirrhosis (liver damage), damage to the pancreas, certain cancers, heart problems, sexual problems, and other conditions. About 1 in 4 men, and about 1 in 7 women, drink more than the safe limit. In general, the more you drink, the greater the risk.

For example, if a man drinks five units each day (not greatly over the recommended limit) then, on average, he doubles his risk of developing liver disease, raised blood pressure, some cancers, and of having a violent death.

Problem (harmful) drinking
This is where you continue to drink heavily even though you have caused harm, or are causing harm or problems to yourself, family, or society. For example, you may:

• have cirrhosis or another alcohol related condition.
• binge drink and get drunk quite often. This may cause you to lose time off work, or behave in an antisocial way when you drink. But note: not everybody with problem drinking binges or gets drunk. Many people with an alcohol related condition such as cirrhosis drink small amounts frequently, but do not get drunk.
• spend more money on alcohol than you can afford.
• have problems with your relationships or at work because of your drinking.

Many problem drinkers are not dependent on alcohol. They could stop drinking without withdrawal symptoms if they wanted to. But, for one reason or another, they continue to drink heavily.

Alcohol dependence (addiction)
This is a serious situation where you drink every day, and need to drink to prevent unpleasant withdrawal symptoms (see below). In the UK about 2 in 100 women, and about 7 in 100 men, are alcohol dependent.

Hot Toddys, Bailey’s Irish coffee and egg nog - all cocktails that are holiday fan favorites. The holidays always seem like the perfect opportunity to indulge, and drinking alcohol and celebrations seem to go hand in hand. While enjoying your favorite cocktail is never a bad thing, throwing back one too many may not be a good thing for your waistline or for your overall health. If you’re tired of the negative effects of alcohol and want to stop drinking.

Did you know that there are seven calories per gram of alcohol in your alcoholic beverages? That’s more calories per gram than what is supplied by carbohydrates and protein, and only two calories less than a gram of fat. Not only is the calorie-count of some cocktails enough to make you want to put down the bottle, but if you’re drinking becomes too frequent, you could be posing all kinds of health and social problems for yourself.

Every single injury and death caused by drunk driving is totally preventable. Unfortunately, over twenty percent of all traffic fatalities in the United State each year are caused by drunk drivers. 1 Thus, drunk driving remains a serious national problem that tragically affects thousands of victims annually.

Don’t drink and drive and don’t ride with anyone who has too much to drink. Remember, it is usually themselves and their passengers who are harmed by drunk drivers. The risk of collision for high Blood Alcohol Content drivers is several hundred times higher than for a non-drinking driver. 

If you haven’t had anything to drink, volunteer to be a designated driver. And never condone or approve of excessive alcohol consumption. Intoxicated behavior is potentially dangerous and never amusing. Don’t ever let your friends drive drunk. Take their keys, have them stay the night, have them ride home with someone else, call a cab, or do whatever else is necessary - but don’t let them drive!

Create a setting conducive to easy, comfortable socializing: soft, gentle music; low levels of noise; comfortable seating. This encourages conversation and social interaction rather than heavy drinking.

Serve food before beginning to serve drinks. This de-emphasizes the importance of alcohol and also sends the message that intoxication is not desirable.

Have a responsible bartender. If you plan to ask a friend or relative to act as bartender, make sure that person is not a drink pusher who encourages excessive consumption.

Don’t have an "open bar." A responsible person needs to supervise consumption to ensure that no one drinks too much. You have both a moral and a legal responsibility to make sure that none of your guests drink too much.

Pace the drinks. Serve drinks at regular reasonable intervals. A drink-an-hour schedule is a good guide.

Push snacks. Make sure that people are eating.

Be sure to offer a diversity of attractive non-alcohol drinks.

Respect anyone’s choice not to drink. Remember that about one-third of American adults choose not to drink and that a guest’s reason for not drinking is the business of the guest only, not of the host. Never put anyone on the defense for not drinking.

End your gathering properly. Decide when you want the party to end and stop serving drinks well before that time. Then begin serving coffee along with substantial snacks. This provides essential non-drinking time before your guests leave.

Protect others and yourself by never driving if you think, or anyone else thinks, that you might have had too much to drink. It’s always best to use a designated driver.

Craving alcohol is a complicated process that involves several different factors. We are usually first introduced to alcohol at a young age (in our teens). Since no-one under the age of 21 (in the US) is allowed to purchase alcohol, it becomes "cool" and desirable for young adults under 21 to give drinking a try.

Later on people grab a bottle of booze to feel better, gain more confidence in a social setting or to forget about their problems. Since the alcohol makes them feel better, at least temporarily, they start to crave it.

Consuming alcohol on a regular basis also becomes a habit after a while, just like driving down a familiar road. If there is a problem, or a social setting that calls for alcohol, you may be grabbing that bottle of beer or glass of wine without even thinking about it.

Once you get in the habit of drinking alcohol on a more or less regular basis, your body gets used to the alcohol in the blood stream and reacts with withdrawal symptoms when you stop drinking. These withdrawal symptoms can range from mild to severe.

If you just crave the occasional glass of wine or beer, make sure you are aware of the craving and make a conscious choice to have a glass, or skip it. Don’t let your cravings or emotions make the decision for you.

If you find yourself addicted to alcohol and are unable to not give in to the cravings, please seek professional help. Alcohol addiction is very serious and the earlier you seek treatment, the easier it will be to kick the habit and take control over your alcohol cravings.

What can help me to reduce or stop drinking alcohol?

No-one can make you stop or cut down drinking. You have to be committed and determined to do this yourself. However, it can be difficult, and one or more of the following may help.

Accepting the problem
Some people deny to themselves that they have a problem. The sort of thoughts that people deceive themselves with include: "I can cope", "I’m only drinking what all my mates drink", "I can stop anytime". Accepting that you may have a problem, and seeking help where necessary, are often the biggest steps to cutting back on alcohol, or cutting it out completely.

Self help
Some people are helped by books, websites, leaflets and their own determination. It is thought that about 1 in 3 people who have a problem with alcohol return to sensible drinking, or stop drinking, without any professional help. See the end of this leaflet for a list of resources.

Talking treatments
Some people are helped by counselling and advice from a practice nurse or doctor. Sometimes a referral to a specially trained counsellor may be advised. They can help you to talk through the issues in more detail and help you to plan how to manage your drinking. In some cases, more intensive talking treatments such as cognitive-behaviour therapy (CBT) may be appropriate. CBT helps you to change certain ways that you think, feel and behave, and may help some people with alcohol related problems.

Treating other illnesses
Alcohol may seem to be a ‘quick’ answer to the relief of stress, anxiety, depression, or other mental health problems. However, the effect is short-lived and drinking a lot of alcohol often makes these conditions worse. If you feel that these conditions are the underlying problem then see your doctor. Medication and talking treatments such as CBT often work well for these conditions, and are a much better long-term option than heavy drinking.

Detoxification (’detox’)
This is an option if you are alcohol dependent.