Alcohol dependence

Alcohol dependence is a brain disease that is characterized by alcohol-induced disturbances in brain structure, neurochemistry and behavior.

Alcohol dependence overview
Alcohol dependence is a medical and behavioural disease, with a high risk of a chronic, relapsing and progressive course.1 Extensive research over the past 20 years has contributed to understanding the disease, moving alcohol dependence away from a moral character flaw to a medical condition that can and should be treated.2
Alcohol is toxic to most organs of the body, and the level of consumption is strongly correlated with the risk for long-term morbidity and mortality3. Alcohol is a causal factor in more than 60 types of disease and injury.4 Excessive alcohol consumption is also associated with a large cost to society due to violence, lost productivity, and healthcare costs4.

Genetic and environmental factors are important in the initiation of alcohol consumption. Family, peers and society determine the level of exposure to stress and alcohol. Susceptibility to develop a loss of control over alcohol consumption is genetically predisposed and genetic factors contribute an estimated 60% of the disease risk 5,6. The risk of alcohol dependence increases with alcohol consumption7. Alcohol consumption is estimated to cause from 20% to 50% of cirrhosis of the liver, epilepsy, poisonings, road traffic accidents, violence and several types of cancer4.

A central characteristic of alcohol dependence is the often overpowering desire to consume alcohol. Patients experience difficulties in controlling the consumption of alcohol and continue consuming alcohol despite harmful consequences8. Often the patients experiencing withdrawal symptoms, such as nausea, sweating, and shaking, when abstaining from drinking9.

Excessive alcohol consumption is common in many parts of the world, especially Europe.4 Alcohol dependence is one of the most common mental illnesses in Europe10. More than 14 million people in the EU are alcohol dependent in any year10.
The total costs due to alcohol dependence in Europe have been estimated at €58 billion11.
In Europe, average diagnosis rate of alcohol abuse and dependence is 15%12. From these patients very few are being treated in Europe. The median treatment gap for alcohol abuse and dependence is 92% meaning that only 8% are treated13.

Seeking diagnosis and care
People who think that they might be alcohol-dependent can receive help from their doctor. Diagnosis considers biological signs, and behavioural and social factors14. Information from family, friends and work colleagues can also be important for diagnosis.
Treatment for alcohol dependence consists of behavioural therapy, which is generally provided alongside medicines.2 Both abstinence and reduction goals should be considered as part of a comprehensive treatment approach for patients with alcohol dependence15,16. Support from those close to the patient is also very important.
All types of treatment for alcohol dependence should only be received following professional medical advice.

1. WHO, ASAM website 2012
2. Gunzerath L, Hewitt BG, Li TK, Warren KR. Alcohol research: past, present, and future. Ann N Y Acad Sci 2011; 1216: 1–23.
3. Rehm et al. Eur Addict Res 2003;9:147-156
4. WHO. Global status report on alcohol and health, 2011
5. Vengeliene et al. Br J Pharmacol 2008; 154(2):299-315
6. Schukit. Ch. 98. In: Davis et al (eds). Neuropsychopharmacology: The Fith Generation of Progress. 2002
7. Dawson & Archer. Addiction 1993;88: 1509-1518
8. WHO, ICD-10, F10-19
9. Alcoholism. May 2010. Accessed 08/08 2012
10. Wittchen et al. Eur Neuropsychopharmacol 2011;21(9):655-679
11. Gustavsson et al. Eur Neuropsychopharmacol 2011;21(10):718-779
12. Mukherjee & Sosa. Special report. Alcohol Addiction, Decision Resources, 2010
13. Kohn et al. Bull World Health Organ 2004;82(11):858-866
14. American Psychiatric Association (APA). Diagnosis and Statistical Manual of Mental Disorders. Fourth Edition. Text Revision. DSM-IV-TRTM. 2000 American Psychiatric Association
15. EMA. Guideline on the development of medicinal products, 2012
16. NICE. Clinical guideline 115, 2011



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