Alcoholism

Alcoholism is the dependent relationship of a person to alcohol in expectation of a rewarding experience. Psychological, cultural, religious and social factors may affect both the patterns of alcohol use and the likelihood that alcohol problems will develop. The manner of the development of alcohol dependence varies from person to person - in terms of the duration and pattern of alcohol use, the order of the appearance of symptoms, the extent of physical addiction and complications.

Drinking may be part of student social life. What is important is that each individual recognises how alcohol affects them - as it affect people differently - and takes responsibility for this.

When does alcohol become a problem?
The intake of alcohol among the population in general can be represented as a continuum. At one end are 'teetotallers' who never take alcohol. At the other end are 'dependent drinkers' who abuse alcohol on a regular basis and expose themselves to the risk of dependence. A crucial fact in developing a harmful dependence is that it presupposes regular, heavy drinking. A prior history of non-problem drinking does not necessarily protect from the possible development of dependence which can be triggered by excessive use in the face of stress and adversity.

On the extreme end of this continuum, a person uses alcohol to survive and feel normal rather than to feel euphoric. In between the extremes are 'social drinkers' and 'habitual drinkers'. 'Social drinkers' are those who view consumption as a pleasurable experience. The key features of their pattern of consumption are choice and balance. Their desired end state is relaxation, with mild disinhibition and conviviality. Such drinkers avoid consumption when faced with stress or events requiring optimal performance. 'Habitual drinkers' are alcohol abusers. They use it to achieve rapid relaxation but they do not necessarily see it as a means of achieving an emotional or personality change. Their drinking may impact on their ability to drive, work and their personal relationships. They can eliminate alcohol use without undue difficulty if required, so while they are heavy drinkers, they would not be described as alcohol dependent.

What are the basic symptoms of alcohol dependence?
There are a number, including:

• Elevated Tolerance
  The person apparently functions normally following consumption of amounts of alcohol that would be toxic for a non-drinker. (S)he needs a markedly increased amount of alcohol to achieve the desired effect.
• Blackouts
  Temporary memory loss occurs where the person has been able to function but is unable to recall details of behaviour, and this happens on a regular basis.
• Euphoric Recall
  This is produced by the initial relaxing feeling of alcohol use, and is subsequently used as a defence mechanism. It provides a firm boost to the denial system of a dependent drinker as (s)he associates drinking with a sense of enjoyment despite adverse consequences in reality.
• Emotional Compulsion/Mental Obsession
  The person experiences growing anticipation for and preoccupation with the use of alcohol and begins to change lifestyle, which now revolves around alcohol. There is a rigid regularity about the use and the activity is allocated priority status.
• Loss of Choice
  Elevated tolerance combined with emotional compulsion lead to loss of choice. The person begins to experience loss of control over alcohol and becomes unable to predict the outcome once (s)he begins using it.

The dependence process
It is recognised that regardless of a person's psychological and social functioning, or exposure to stressors, prior to drinking, the dependence process itself imposes a behavioural and emotional dysfunction. This has the following characteristics:

1. Alcohol is used to provide either avoidance or relief of painful emotion, or the experience of euphoria.
2. The person behaves in ways that violate his or her value system. Formerly central relationships, tasks and interests become secondary to alcohol use.
3. The conflict between the normal values and behaviour of the person and the new behaviour (eg: evasion of responsibilities, unwillingness to reciprocate in emotional relationships, manipulation) creates intense emotional pain. Feelings of shame, guilt, self-hatred, powerlessness and lowered self-esteem become chronic and further reinforce the drinking response. As the reaction of others is usually negative, alcohol becomes the preferred method of restoring emotional normality and the person increasingly alienates his or her support systems. At this stage, the alcohol-dependent person experiences a deterioration of his or her health, emotional stability and interpersonal relationships, and may even lose the desire to live.
4. The person is unconsciously motivated to use several psychological defence mechanisms to resolve conflict. In essence, the conflict is not really resolved but removed from conscious awareness. These defences serve two primary purposes:
   • To protect the addiction by denying, blaming, rationalising or attacking, the person protects his or her relationship with alcohol from any external threat
   • To protect his or her self-esteem the person uses repression, projection and displacement

This loss of insight becomes a growing delusion, or sense of being "out of touch with in reality". It accounts for the person's distorted perception, impaired judgement and inability to recognise the addiction. It also explains why an alcohol-dependent person is so unlikely to seek help spontaneously.

Additional signs of problematic alcohol use are tardiness and absenteeism at work, lying, mood swings, alcoholic breath, slurred speech, poor co-ordination, neglect of physical appearance, aggression, legal problems (including traffic violations, fighting, disorderly conduct) impaired attention or short-term memory.

If someone close to you has an alcohol problem

1. Eliminate any sense of personal responsibility for causing the problem and accept that you are powerless to stop his or her excessive drinking. Allow him or her to take responsibility for his or her own actions.
2. See yourself as an important source of influence in the life of the person with the problem, By stopping attempts to control him or her, you can regain influence.
3. Refuse to protect the addiction by eliminating false loyalty to the dependent person. You can be most effective if you take care of yourself and work towards getting him or her into treatment.
4. Stop hiding the problem from family and friends out of a sense of loyalty to the dependent person, especially if you value their support.
5. Take emotional support for yourself.

The goals of treatment
Optimal treatment takes into consideration both the psychological dynamics and the physiological factors. Therapy targets three main areas:

• Abstinence
• Personal growth
• Change of lifestyle

Often other family members also need to be involved in the therapy process. During the first twelve months after detoxification, the individual is particularly vulnerable to having a relapse.

The National University of Ireland, Galway Student Counselling Service wishes to thank the  counselling service of  The University of Limerick for granting permission to reproduce this fact sheet.