Key alcohol dependence FAQs - with answers to the following questions:
- What causes alcohol dependence?
- Why do people relapse after detox from alcohol?
- Do people need long-term treatment for alcohol dependence?
- Is controlled drinking an option for someone dependent on alcohol?
- What makes relapse most likely?
What causes alcohol dependence?
Nature, nurture and learned behaviour all play a part in alcohol dependence. From an evolutionary perspective, consuming alcohol can confer benefits in certain circumstances. As humans and primates we learnt to identify ripe fruits for their sugar and fermented sugar (alcohol) content. In this way humans learned that it was possible to consume food and water that would otherwise be toxic if mixed with alcohol. When mixed with water the alcohol content confers the benefit of providing a safer form of rehydration as it kills dangerous bacteria and also helps to preserve nutrients. Drinking alcohol can also provide perceived solutions to problems in certain circumstances, and this motivates further 'learned behaviour'. It is a normal human trait to develop and shape habitual behaviour as part of our ability to learn and develop skills. However, in some people habit can lead to a certain point where all personal control becomes lost. In some cases a situation develops where the brain actually needs alcohol in order to be able to function - this is alcohol dependence.
Why do people relapse after detox from alcohol?
The process of understanding how to adopt positive behaviours is complex. It requires long term work, well beyond the usual timeframe for alcohol detoxification, which normally only lasts for between seven and ten days. Long-term aftercare support has been demonstrated to improve outcomes and should also involve families, friends and important others.
Do people have to have long-term treatment for alcohol dependence?
Not necessarily. What is important is to commence treatment with an an initial short period of pre-habilitation. This should include an initial term of stabilised drinking and the introduction of methods to start implementing the lifestyle changes necessary for long-term abstinence. This ideal approach requires planning and the provision of support mechanisms within the immediate social environment. Following this pre-habilitation phase, subsequent treatment options may involve either the gradual reduction of alcohol or a full medical detoxification. Continued aftercare treatment is essential to reduce the risk of relapse. Psychological and if required, pharmacological treatment is often needed in collaboration with mutual aid groups such as AA.
Is controlled drinking an option for someone who is dependent on alcohol?
Controlled drinking can only be an option for a person who is not dependent on alcohol. For dependent drinkers lifelong abstinence is the easiest and most appropriate option. Partial controlled drinking though can be used at an early stage with the ultimate goal of achieving abstinence.
What makes relapse most likely?
Stress. This is because most people with alcohol dependence have an underlying anxiety or mood disorder. They use alcohol as a form of self-medication. Alcohol use combined with frequent attempts at stopping, and / or detoxing and relapsing only increases the stress levels and in turn reduces the ability to cope with stress. Learning appropriate coping skills and developing resilience are therefore important in this context.