Alcohol dependence

Alcohol dependence, which is also known as alcoholism or alcohol addiction, describes the most serious form of high-risk drinking, with a strong - often uncontrollable - desire to drink. It means drinking at a level that causes harm to your health.

It’s estimated that in England alone, there were more than 600,000 dependent drinkers in 2019.¹

What is alcohol dependence?

Being dependent on alcohol means a person feels they’re not able to function or survive without it and that drinking becomes an important - or sometimes the most important - factor in their life.

People who are becoming dependent on alcohol notice they need to drink more to get the same effect. They often give priority to drinking over other activities or obligations (such as work or family life), or continue drinking despite harmful consequences - for example, liver disease or depression caused by drinking. Alcohol dependence also causes physical withdrawal symptoms when you stop drinking.^2,3

If you think you may be dependent on alcohol, you should consult your doctor or another medical professional before stopping drinking. You could speak to a health professional at your GP surgery, or there are also a number of national alcohol support services that you can confidentially self-refer to for advice and support.

Worried you might be dependent? Take the Drinkaware Drinking Check, our confidential assessment

Health problems caused by alcohol dependence

The risk of developing a range of health problems increases the more you drink on a regular basis.

Drinking alcohol can lead to a range of serious health problems and being dependent on alcohol is likely to increase your risks. These include cancers of the mouth, throat and breast, and other serious medical conditions including bowel cancer, breast cancer, pancreatitis, high blood pressure, stroke and coronary alcohol-related heart disease.⁴

Prolonged heavy drinking damages your liver. An estimated seven out of 10 people with alcoholic liver disease (when the liver is damaged by alcohol misuse) have an alcohol dependency problem.⁵

These alcohol-related health problems can affect non-dependent drinkers too. That’s why, to keep health risks from alcohol to a low level, the UK Chief Medical Officers (CMOs) advise it is safest not to drink more than 14 units a week on a regular basis.

Find out more about the physical problems caused by alcohol

Mental health

People who are dependent on alcohol often experience poor mental health.

Anxiety, depression and suicidal feelings can all develop when you’re alcohol dependent. This is partly because regular, heavy drinking interferes with chemicals in our brains that are needed for good mental health.⁶

Being dependent on alcohol can also affect your relationships with your partner, family and friends, or affect your work and cause financial problems. These issues can contribute to depression and anxiety too. 

Alcohol can also make you more aggressive.⁷ If you use alcohol to try and improve your mood, you may be starting a vicious cycle.

• Find out more about the mental health problems caused by alcohol

Alcohol withdrawal

People who are seriously dependent on alcohol can also experience physical symptoms of alcohol withdrawal like shaking, sweating or nausea when their blood alcohol level drops – for example, before their first drink of the day. In this situation it can be dangerous to stop drinking completely or too quickly without medical support.

• Find out more about alcohol withdrawal symptoms, and how to get help

How can I tell if I’m dependent on alcohol?

It might be surprising to hear that you don’t always have to be drinking to extreme levels to become dependent on alcohol. Anyone who is drinking regularly could have a degree of alcohol dependency.

An early signs of dependence is needing more alcohol to achieve the desired effect. Increased tolerance is a physiological response we have to certain drugs: the more you consume, the more you need to have the same effect.

As dependence gets more established, you might find you end up spending most of your time thinking about alcohol or engaging in activities necessary to obtain, consume, or recover from the effects of drinking^. 

Then, as dependence takes over, it’s possible you will find you get the shakes if you don’t have a drink, and so feel the need to keep drinking to avoid experiencing very unpleasant withdrawal symptoms.

If you're worried you may be becoming alcohol dependent, or are concerned about someone else's drinking, warning signs to look out for include:

• Often feeling the need to have a drink
• Getting into trouble because of drinking
• Other people warning about how much you/ they are drinking
• Thinking your/ their drinking is causing problems

If you’re worried that you have any of these symptoms, talk to a health professional at your GP surgery or seek further information from one of the organisations at the bottom of this page.

Other warning signs

Even if you don’t recognise the symptoms above, there are varying degrees of alcohol dependence.

If you find that you ‘need’ to share a bottle of wine with your partner most nights of the week, or always go for a few pints after work just to unwind, you’re likely to be drinking at a level that could affect your long-term health.

If you find it very difficult to enjoy yourself or relax without having a drink, you could have become dependent on alcohol. 

How doctors diagnose alcohol dependence

Doctors assess whether someone is dependent on alcohol by looking for signs that show their patient can’t regulate their drinking, and that they have a strong internal drive to use alcohol.

The specific symptoms they look for are:⁹

• Impaired control over alcohol use
  This might mean not being able to control how long a drinking session is, how much alcohol you consume when you do drink, how frequently you drink, being unable to stop drinking once you start, or drinking on inappropriate occasions or at inappropriate places.
• Giving increasing priority to alcohol
  If you give precedence to drinking over other daily activities and responsibilities like family or work, if drinking is more important to you than looking after your health, or you carry on drinking despite negative consequences for your health or life.
• Unwanted physical or mental effects from drinking
  Showing signs of increased tolerance to alcohol (having to drink more for the same effect), experiencing withdrawal symptoms, or using alcohol to prevent or alleviate withdrawal symptoms.

A doctor may diagnose alcohol dependence if you show two or more of the above symptoms based on the ongoing pattern of how you use alcohol. Usually this is based on behaviour over the last 12 months or more, but alcohol dependence could be diagnosed based on continuous daily (or almost daily) use of alcohol over a period of at least three months.

Download the free MyDrinkaware app to track your drinking, and cut down

What causes alcohol dependence?

Usually, several different factors contribute to someone becoming alcohol dependent.¹⁰

The society that you live in plays an important role in how likely you are to develop problems with alcohol. For example, how easily available alcohol is, how much it costs, and pressure from friends, family or colleagues to drink.

And alcohol dependence can run in families. It’s partly down to your genes,¹¹ but is also influenced by your family’s attitudes to alcohol and the environment you grow up in.

Stressful events, such as bereavement or losing a job, can also trigger heavy drinking in some people, which can then lead to alcohol dependence.

People who are alcohol dependent have higher rates of other mental health problems than the general population – particularly depression, anxiety, post-traumatic stress disorder, psychosis and drug misuse.¹²

Often, people drink to try and reduce symptoms (sometimes known as ‘self-medicating’), but in the long-term alcohol makes these disorders worse because it interferes with the chemical balance in our brains.

Alcohol support services

How to reduce your risk of becoming alcohol dependent

If you drink regularly, alcohol changes the way your liver works, your brain function and creates dependence - meaning you need to drink more to have the same effect.

Breaking your drinking cycle is an important way to test for – and tackle – dependence. It can prevent your body from becoming accustomed to alcohol and help to lower or ‘reset’ your tolerance.

Taking regular breaks from alcohol is the best way to lower your risk of becoming dependent on it. 

With the right support and motivation, many people can stop drinking or cut down to a lower-risk level of alcohol consumption. But remember, if you’re alcohol dependent, you should get medical advice before stopping completely, so you can do it safely. If you're able to make small reductions first, that’s a good sign.

If you choose to drink, the UK Chief Medical Officers (CMOs) advise that to keep health risks from alcohol to a low level it is safest not to drink more than 14 units a week on a regular basis. If you regularly drink as much as 14 units per week, it's best to have three or more drink free days each week. 

How to take a break and reset your tolerance

Further information

If you’re worried about your drinking, get in touch with your local GP surgery, who will be able to help.  

If you’re simply looking to speak to someone on the phone or chat online for more advice on your own or someone else’s drinking, get in touch with Drinkchat or Drinkline.  

Drinkchat is a free online chat service with trained advisors offering confidential advice. The service is available from 9am-2pm on weekdays.  

• Chat with an advisor 

Drinkline is a free, confidential helpline available from 9am – 8pm on weekdays, and 11am – 4pm at the weekend. Call 0300 123 1110.   

• Call Drinkline

Alcoholics Anonymous

If you need help to stop drinking you can phone the national Alcoholics Anonymous helpline on 0800 9177650 or email help@alcoholics-anonymous.org.uk. You can also find out more information on their website.

We Are With You (formerly Addaction)

For help and advice visit the We Are With You website. To find your nearest service in England or Scotland, visit the Service Finder section of their website.