Alcohol and alcohol dependence

Enjoying a beer in front of the TV after work, having a glass of wine with a meal and perhaps a shot of something stronger afterwards, or raising a glass of champagne to celebrate a birthday or an achievement – for many people, alcohol is part of daily life.   
 
While drinking a little alcohol now and again seems harmless, around 20 percent of adults in Germany consume more alcohol than recommended. Age, gender, and education background are not factors in the consumption of alcohol. As larger volumes of alcohol can lead to problems, many people would like to change their drinking habits – although this is not always easy to do. 

Most countries have recommendations regarding low-risk alcohol consumption. In this context, “low-risk” means a level of alcohol consumption that involves little to no risk to health. However, these recommendations are only intended to serve as rough guidelines for healthy adults who don’t have any issues with alcohol. 
 
The German Center for Addiction Issues (DHS) makes the following recommendations: 

• For women: a maximum limit of 12 grams of alcohol per day. This is equivalent to a small beer (0.3 liters) or a small glass of wine (0.125 liters), for example.
• For men: a maximum limit of 24 grams of alcohol per day. This is equivalent to two small beers (0.6 liters) or a large glass of wine (0.25 liters), for example.
• Breaks: No alcohol should be consumed on at least two days of the week.  

Abstaining from alcohol at least twice a week is intended to avoid developing dependence. After all, the following two points are undisputed: 

• Alcohol has no health benefits.
• Higher alcohol consumption means higher risks to health.  

If the recommended limits are exceeded to some extent from time to time, this does not imply a drinking problem. For most people, alcohol consumption varies from day to day. For example, they may drink less on weekdays and a little more over the weekend. It is also perfectly fine to adhere to weekly rather than daily limits – provided that binge drinking is avoided.

Studies have shown that there is little to no impact on health if weekly alcohol consumption does not exceed 100 grams. 100 grams of alcohol is roughly equivalent to 5 bottles of beer.

When does alcohol consumption become harmful? For more detailed information, visit gesundheitsinformation.de.

Binge drinking means drinking a large volume of alcohol in one drinking session. This means having 6 or more alcoholic drinks, for example, 1.5 liters of beer or 0.6 liters of wine. 
 
Binge drinking is problematic. Alcohol removes inhibitions and makes people more likely to take risks. This can cause them to have accidents or to do things that they later regret. Consuming a large volume of alcohol can also cause alcohol poisoning. 

Binge drinking is widespread in Germany. Around 40 percent of men and 25 percent of women indulge in binge drinking at least once a month. 

A wide range of drinking problems exist. Some people, for example, are delta drinkers, who drink moderately every day without ever becoming intoxicated. Most of these individuals have already become dependent on alcohol. They require a daily dose of alcohol in their bloodstream to avoid experiencing withdrawal symptoms, such as shaking. Another type comprises episodic drinkers, who drink rarely but binge heavily whenever they do. These individuals become so drunk that they put themselves in danger. 
 
Various factors determine whether a person will have a problem with alcohol. In addition to the volumes consumed, the main determinants are drinking habits and the significance that alcohol holds in the person's life. The following questions may help you to assess your own risk of becoming alcohol-dependent: 

• Do you frequently think about alcohol? Do you feel guilty about your consumption of alcohol?
• Do you often drink to forget about your worries and problems or to “function” in everyday life?
• Do you tend to binge drink? Do you lose control over how much you drink?
• Have you ever experienced difficulties due to alcohol? Do your drinking habits cause arguments, e.g., between you and your partner? Do hangovers make you late for work?
• Have you ever tried to reduce your alcohol consumption but been unable to? 

If you answered “yes” to one or more of these questions, this could indicate a problem with your drinking habits. In particular, if you are suffering from mental illness of any kind – such as anxiety or depression – it is essential to seek help with your problems, rather than compounding them with alcohol.

Even if you answered “no” to each of the questions above, this doesn’t necessarily mean that your alcohol consumption isn’t causing you any harm. Various questionnaires have been developed to help identify a possible alcohol addiction. These tests seek to identify risky drinking behavior at an early stage in order to prevent damage to health.

If a test indicates a problem with alcohol, then you need to change something. One of the first things you can do is find an online self-help programme.

One example is www.selbsthilfealkohol.de.

You can also contact an addiction advice center anonymously or speak in confidence with a trusted primary care physician.

To assess your own drinking habits, you can use the AUDIT questionnaire on the gesundheitsinformation.de website, which is recommended by experts in the field.

There are certain situations and activities where it is absolutely essential that no alcohol be consumed, as it could make the person involved liable for prosecution or put others in danger.

It is particularly important to abstain from alcohol when:

• in traffic
• at work
• playing sports

Pregnant women should also avoid alcohol, as it may have severe consequences for the health of the unborn child.

It is also important for individuals who have received treatment for alcohol dependence to continue to abstain from alcohol consumption on an ongoing basis. Otherwise, the risk of relapse is very high. The same applies to people with drug dependence. In many cases, they are more susceptible than others to alcohol dependence. In addition, alcohol removes inhibitions and may lead to renewed drug consumption.

Alcohol can also cause problems in connection with specific diseases. For example, alcohol can intensify or weaken the effects of certain types of medication, such as sleeping tablets and some painkillers.

Drinking less or cutting out drink altogether is no easy task.

To first step to ensuring risk-free alcohol consumption is to recognize how much is being consumed and how often – and this can easily be misjudged. It is therefore helpful to make a record of alcohol consumption over a number of weeks.

Tools are available to support this, such as the app developed by the German Center for Addiction Issues (DHS) to simplify the tracking of drinking habits: trinktagebuch.org.

Of course, a handwritten drinking diary is also an option – perhaps using a pre-printed template to record how many and which alcoholic beverages are consumed.

There are also various helpful strategies that can minimize the risks associated with drinking alcohol. For example, avoid situations where you are likely to feel tempted to drink. When eating out or attending a party, do not allow your glass to be re-filled until you have emptied it – this will help you keep a more accurate record of your consumption. It may also help if you decide in advance to have only one alcoholic drink.

Alcohol dependence is a disease that often develops insidiously.  

Some typical features of alcohol dependence are listed below:  

• a powerful craving for increasing volumes of alcohol to experience its effects
• being unable to stop drinking, despite it having already caused issues, such as absences, warnings, accidents, or conflict
• a loss of interest in other things or a neglect of obligations
• a loss of control over drinking habits – the individual can no longer decide when, how much, how frequently and where they drink
• withdrawal symptoms when alcohol is not consumed – such as shaking or anxiety 

At least three of these criteria must be met for a medical diagnosis of alcohol dependence. 

People with alcohol dependence usually require help. The vast majority are unable to change their drinking behavior on their own. Alcohol dependence is a disease that can be treated – just like a heart attack or osteoarthritis.

With alcohol dependence, it is important to consider that quitting by going “cold turkey” can cause serious complications, including strong seizures. Therefore, it is essential to consult a doctor for advice on withdrawal. Going “cold turkey” means suddenly ceasing alcohol consumption without consulting a doctor.

The likelihood of a relapse is very high after a purely physical withdrawal. For this reason, qualified withdrawal treatment has been developed. It consists of several elements: 

• Physical withdrawal treatment: This involves detoxifying the body – using medication if necessary.
• Treatment of any accompanying or secondary mental and physical diseases and provision of support for social problems: Psychotherapeutic services are particularly beneficial in this regard. Strategies are learned for managing daily life without alcohol.
• Long-term treatment planning: Withdrawal treatment should be followed by long-term treatment to prevent relapses. Part of the therapy includes, for example, regular contact with an advice and counseling service and the treatment of any possible accompanying illnesses, either physical or mental. Many people also benefit from joining a support group, where they can exchange experiences with and enjoy the mutual support of others in a similar situation.

Many people with alcohol dependence ask themselves whether it is possible to reduce their consumption to a low-risk level rather than having to abstain completely. It has not been proven whether reduced or controlled drinking is effective this case. Rather, experience indicates that the risk of relapse is very high after “just one small glass”. Therefore, it is best to abstain from alcohol following withdrawal.

Anyone who wants to change their alcohol consumption can join a self-help program online (e.g. on selbsthilfealkohol.de).

Various advice and counseling services can also be contacted anonymously. In other words, there is no need to provide a name, address, or insurance details. These services also provide advice and support to anyone who is concerned about the drinking habits of a family member.

Many people with alcohol dependence try to keep their drinking problems under control themselves for a long time. It takes them a while to admit to themselves they need help. Shame and feelings of guilt often play a role too. Drinking problems have many causes – it is not a question of fault or personal weakness. Anyone who confronts their problems, deals with them, and seeks help actually demonstrates considerable bravery and a great sense of responsibility. It often takes several attempts to change drinking habits and so no-one who decides to take this path should allow themselves to become discouraged too easily.