It is extremely difficult for habitual, excessive drinkers to stop or reduce their alcohol consumption if they have been regularly drinking alcohol for months or years.
Research indicates that alcohol dependence can develop very quickly, early signs of physical dependence can develop in anyone who has consumed 6 alcoholic drinks a day for 1 week.
Once a person has reached this stage it will gradually become more difficult with each passing day to give up alcohol. The longer the person has been drinking heavily the greater the dependency, and the harder it will be to give up.
Anyone wishing to stop, or reduce their drinking is likely to find it very difficult as with most addictive disorders patients are unable to control their alcohol use, this is because of the way the body has adapted to the presence of a psychoactive substance like alcohol.
It is likely that heavy drinkers will have developed physical alcohol dependence, particularly if they have been drinking at high levels for several years.
This means their body and brain have probably developed an increased ability to tolerate alcohol, meaning their capacity to consume higher levels of alcohol has increased compared to what they previously were.
Their increased tolerance toward alcohol means it requires more alcohol for them to feel the same physical effects they initially experienced when first consuming alcohol.
For example, if it previously required 6-8 pints of beer for someone to become inebriated it will now take 12-14 pints of beer.
If a person drinks at high levels it is likely that they have a physical dependency if they begin to experience strong withdrawal symptoms when they go for a period of 12-24 hours without consuming alcohol. Symptoms of alcohol withdrawal include headaches, nausea, anxiety, low mood and insomnia. (4)
The reason therefore why alcohol is so difficult to give up is because the unpleasant symptoms that occur during withdrawal can be eliminated immediately by drinking more alcohol as the withdrawal symptoms produce strong cravings and an urge to drink that is hard to resist.
The psychological concept of negative reinforcement develops quickly in dependent drinkers and this strengthens the likelihood that a person will drink alcohol again as the act of drinking alcohol is reinforced by the fact it eliminates negative experiences (withdrawal symptoms). (10)
Alcohol withdrawal develops when drinkers who have been consistently drinking high levels of alcohol decide to stop drinking alcohol.
As alcohol is a psychoactive drug that has a depressive effect on the central nervous system giving up alcohol suddenly after months of heavy use tends to be problematic and will have physical consequences known as withdrawal symptoms for the patient.
The reason that withdrawal symptoms appear is that after a period of heavy, sustained drinking our brain and internal physiology has slowly adapted to the presence of alcohol and makes adjustments to allow us to carry on functioning at an optimal level.
Alcohol, after all, is a psychoactive substance that affects the chemical and biological processes in our brain, so it needs to make internal physical and neurochemical changes to ensure that continuous alcohol consumption has a minimal effect on us.
Having adapted to alcohol if a person then decides to stop drinking the body and central nervous system are thrown into a state of confusion as it has become used to functioning with alcohol present.
The result of this confusion is reflected in the withdrawal symptoms our body will begin to generate in response. (10)
There are several withdrawal symptoms associated with the high blood alcohol levels that accompany physical dependence, these include:
As well as becoming physically dependent on alcohol most people develop a psychological dependence on alcohol which is one reason why detox treatment alone is not sufficient to help people stop drinking alcohol.
Research has suggested that people drink alcohol for various psychological and emotional reasons, for example, to help cope with stress, to relax, to improve their mood, or to help facilitate smoother social interactions.
People who drink alcohol for any of these reasons are unconsciously becoming psychologically dependent on alcohol as they are relying on alcohol to achieve a psychological state.
The first stage in stopping alcohol consumption is acknowledging that you are drinking more than you want to and you would like to stop. This is an important step as denial and the inability to admit that you have lost control of your drinking will only maintain the addictive behaviour.
As soon as a person accepts this the better their overall outcome will be, it is not a coincidence that the first of the 12 AA steps is acknowledging powerlessness over your drinking behaviour.
There are three areas to an alcohol addiction treatment programme, there is the pharmacological aspect of treatment which addresses patients’ physical dependence on alcohol and there are also psychological interventions that help clients process traumatic life experiences and negative life events that led to their psychological dependence on alcohol.
There is also the relapse prevention element which helps clients gain important psychological skills to manage negative feelings and powerful cravings and to help them find meaning in their life away from alcohol. (4)
People who continuously drink alcohol at high levels will likely be diagnosed as having a severe or moderate alcohol use disorder and because of the increased risk and medical complications involved in withdrawing suddenly from heavy alcohol use patients should be monitored carefully by experienced professionals during the early stages of rehab.
The ideal treatment scenario to aid recovery from alcohol addiction would be to enter a rehab treatment programme run by an established healthcare provider for a period of 4-6 weeks to help them tackle their physical and psychological dependence on alcohol and any co-existing mental health issues they may also have.
A combination of methods are used in residential rehab to help address all the areas of a person’s life that may have contributed to their alcohol abuse, these methods are biological, psychological, social and educational.
The 7-10 days of treatment time will be spent undergoing detox treatment to safely remove the harmful physical traces of alcohol from the body whilst also controlling the effects of alcohol withdrawal syndrome. (13)
There is specific medical treatment available to help patients through alcohol withdrawal safely which can be organised by your GP or the local alcohol support service team in your area.
To help patients reduce their physical dependence on alcohol medical professionals would perform a pharmacological procedure known as detox (detoxification) to help them reduce the high levels of alcohol present in the blood, which plays a significant role in a range of withdrawal symptoms.
The detox process for alcohol dependence should be managed with great caution however with an initial focus on establishing the severity of the patient’s alcohol addiction.
A patient who has developed a severe dependency on alcohol is at risk of experiencing life-threatening symptoms such as brain seizures if they stop drinking alcohol suddenly.
The seizures, tremors and increased irregular heart rate and possible cardiovascular complications are very serious conditions and require constant medical supervision during the first 2-3 days of ceasing alcohol consumption.
The detox treatment aims to replace alcohol with a sedative drug (usually a benzodiazepine) which is decreased gradually in a controlled medical environment with healthcare professionals constantly monitoring key data related to their physical health, including blood pressure due to the damaging effect alcohol has on the cardiovascular system.
Benzodiazepines are a very valuable drug for managing alcohol withdrawal as they tend to be long-acting drugs which are slowly absorbed by the body over a period of 1-2 weeks.
This means that withdrawal symptoms are kept away for longer and clients’ alcohol blood levels slowly decline.
Chlordiazepoxide is the benzodiazepine that is used regularly by medical staff during detox treatment, which is also known by its brand name Librium.
This has been found through clinical research to be the drug that is most effective in reducing the risk of seizures in patients going through alcohol withdrawal and it also reduces the likelihood that patients will become agitated during the detox process. (4,6)
As soon as a client is medically stabilised they can then begin a range of interventions that will help them lessen their psychological dependence on alcohol and process the emotional factors in their lives that drove them to high levels of alcohol use.
These include several individual therapies including Cognitive Behavioural therapy, Dialectical behavioural therapy and motivational interviewing, group therapy sessions and working through the AA’s 12-step programme, all of which will improve their mental health. (2,3,7,9)
These psychological therapies will help clients gain important psychological skills to help them change their thought patterns and the way they tend to respond to stressful situations.
For example, CBT has been adapted into a form of therapy to tackle alcohol abuse as addiction counsellors seek to change the way the client thinks about alcohol.
Many clients have the inaccurate belief that drinking alcohol is the only way that they can reduce their stress levels and by working with a CBT therapist clients can come to realise that there are other ways in which they can reduce the stress that does not involve drinking alcohol.
Many heavy drinkers tend to consume alcohol when they are feeling overwhelmed and experiencing negative emotions, DBT has proven to be an ideal therapy for helping clients deal more effectively with strong emotions when they experience them, instead of turning to alcohol use to cope.
Group therapy is a very beneficial therapy for people with alcohol addiction as many addiction theorists believe that alcohol abuse is a relational disorder that feeds on people’s isolation.
Helping patients connect to other people in a group therapy setting helps them learn to improve their communication skills and personal qualities which they may have lost sight of during their periods of heavy drinking.
The 12-step programme is an essential part of an addiction treatment programme as it is built on one of the founding principles of AA and offers patients a sequence of reflective steps that they need to engage with and work through that will lead them to sobriety and a more fulfilling life.
Rehab centres tend to take advantage of the benefits of holistic therapies to help their clients overcome excessive alcohol consumption.
Holistic treatment helps to restore balance in the body, mind and spirit and research has shown how effective it can be in helping patients process unresolved grief and trauma which has been known to trigger heavy alcohol use.
The common holistic therapies used which have been backed up by research findings include adventure therapy, equine therapy, art therapy and music therapy. (8,11)
Private clients who can draw on their own funds to cover the cost of addiction treatment can enter residential rehab within a few days and can begin detox shortly afterwards.
Patients who need are applying for NHS funding to cover treatment are at a distinct disadvantage as they will have to wait for their funding application to be reviewed and approved before they can begin treatment which may take months.
AA meetings run weekly throughout the United Kingdom, they offer an opportunity for people concerned about their drinking habits to talk about their feelings and experiences in a safe environment where they will be listened to by men and women who have been through similar experiences, and who will share their own story with the group as well.
You can search the AA website to find details of meetings in your area and are free to turn up at a meeting that suits you, although it is common courtesy to ring the meeting coordinator to inform them of your intention to attend.
There is no hierarchy at the AA, everyone is treated equally with one common goal in mind, namely, to stop drinking alcohol. The AA is a free source of support although minor financial contributions may be required for the hire of the venue and refreshments.
Attending these meetings also helps new attendees understand the nature of the 12-step programme that awaits them which is seen as a necessary part of treatment to help people achieve sobriety. (1,12)
As well as joining a local AA meeting it would be wise to inform your GP of your situation and intentions and he/she can offer you clinical/medical advice and put you in touch with the local alcohol misuse team who will be able to assess your needs and discuss your options for receiving treatment.
SMART Recovery is a national charity and is independent of the NHS and local alcohol rehab services. They run online workshops dedicated to helping people give up or reduce their alcohol intake.
Their workshops aim to teach clients vital cognitive skills so that they can gain greater control of their emotions in stressful situations and become skilled at managing strong alcohol cravings.
SMART Recovery also enhance their learners’ personal development so they can find new things in their life that have meaning for them, so their minds do not become directed towards alcohol use.
These personal development workshops help learners define their life and career goals and develop positive character traits that will help them maintain recovery, such as assertiveness and self-awareness.
If you feel you cannot control your drinking, then now is the time to seek out treatment. You can discover your drinking options by contacting our free helpline today on 0800 140 4690.
(1) Alcoholics Anonymous (2021) What is AA? Available @What is AA? | Alcoholics Anonymous – Great Britain (alcoholics-anonymous.org.uk)
(2) Beck, A Wright, F, Newman, C., Liese, B. (1993) Cognitive therapy of substance use. The Guilford Press. New York.
(3) Dimeff, L., Linehan, M. (2008) Dialectical Behaviour Therapy for Substance Abusers. Addiction Science and Clinical Practice. June 2008.
(4) Coombs, R.H. (ed) (2004) Handbook of Addictive Disorders: A practical guide to diagnosis and treatment. John Wiley & sons. New Jersey.
(5) Harvard Medical School (2022) Eleven ways to curb your drinking.available@11 ways to curb your drinking – Harvard Health
(6) Heather, N. & Stockwell, T. (2004) The Essential Handbook of Treatment and Prevention of Alcohol Problems. John Wiley and Sons. Chichester.
(7) Lewis, J, Dana, R., Blevins, G. (2002) Substance abuse counselling. Brooks Cole, London.
(8) McNiff, S. (2004) Art Heals: How creativity cures the soul. Shambhala. London.
(9) Miller, W. & Rollnick, S. (1991) Motivational Interviewing: Preparing to Change Addictive Behaviour. Guilford Press. New York.
(10) Moss, A.C., dyer, K.H. (2010) Psychology of addictive behaviour. Palgrave MacMillan. Basingstoke.
(11) NHS Nightingale Hospital (2021) Addiction Treatment and Rehabilitation
available online@Addiction treatment and rehabilitation | Nightingale Hospital London
(12) Parks, G., Anderson, B., Marlatt, G.A. (2004) Relapse Prevention Therapy in Heather, N. & Stockwell, T. The Essential Handbook of Treatment and Prevention of Alcohol Problems. John Wiley and Sons. Chichester.
(13) Wild, T.C., Wolfe, J. (2009) The Clinical Course of Addiction Treatment: The Role of Non-Specific Therapeutic Factors in Miller, P. (ed) Evidence-Based Addiction Treatment. Academic Press. London.
(14) Williams, C. (2003) 12 Step Approaches in Peterson, T. & McBride, A. (ed) Working with Substance Misusers: A Guide to Theory and Practice London. Routledge.
