Alcoholism

Alcoholism is a chronic condition characterised by the continued consumption of alcoholic beverages despite harmful physical, psychological or social consequences. In medical and clinical contexts, the terms alcohol use disorder (AUD) or alcohol dependence are preferred, as alcoholism and alcoholic are often viewed as stigmatising. According to the World Health Organization, an estimated 283 million people worldwide live with alcohol use disorders, making it a global public-health concern.
Heavy and long-term alcohol consumption can damage every major organ system and is strongly associated with premature mortality, chronic disease and accidents. Alcohol misuse appears throughout recorded history, and modern diagnostic frameworks recognise AUD as both a physical disorder involving tolerance and dependence and a mental illness involving impaired control and compulsive use.

Signs and Symptoms

Alcoholism develops gradually and manifests through behavioural, physical and psychological changes. Common signs include:

• Increasing tolerance, requiring greater amounts of alcohol to achieve the same effect
• Physical dependence, producing cravings and withdrawal symptoms when drinking stops
• Frequent intoxication and the prioritisation of drinking over other activities
• Blackouts, or episodes of amnesia while intoxicated
• Personality or mood changes, often including irritability or depression
• Neglect of responsibilities, including work, academic or family obligations
• Social or economic problems associated with drinking
• Denial and rationalisation, even in the presence of clear harm

Binge drinking—consuming large quantities in a short period—is the most common harmful pattern. For men, this often means five or more drinks on a single occasion; for women, four or more.

Short-Term Effects

Short-term effects depend on blood alcohol concentration (BAC):

• 0.03–0.12%: euphoria, sociability, lowered inhibitions, impaired judgement and coordination
• 0.09–0.25%: lethargy, sedation, imbalance, blurred vision
• 0.18–0.30%: confusion, slurred speech, dizziness and vomiting
• 0.25–0.40%: stupor, unconsciousness, dangerous respiratory depression
• >0.35%: coma and life-threatening alcohol poisoning

Accidents, violence and impaired driving are major risks at all intoxication levels.

Long-Term Effects

Long-term or heavy alcohol use contributes to significant chronic health problems, including:

• Liver disease: fatty liver, alcoholic hepatitis, cirrhosis
• Neurological damage: alcohol-related dementia, peripheral neuropathy, Wernicke–Korsakoff syndrome
• Cardiovascular disorders: hypertension, arrhythmias, cardiomyopathy and stroke
• Pancreatitis and digestive-system disorders
• Cancers, particularly of the breast, liver and head and neck
• Immune suppression, increasing susceptibility to infections
• Endocrine and reproductive disorders, including anovulation in women
• Skeletal fragility, contributing to bone fractures

Women tend to develop alcohol-related complications more quickly and experience higher mortality rates compared with men. Overall, alcoholism reduces life expectancy by approximately ten years.

Effects on Mental Health and Behaviour

Alcohol misuse is strongly linked with mental health disorders. Heavy drinkers frequently experience:

• Major depression
• Anxiety disorders
• Increased risk of suicide
• Cognitive impairment and memory problems

Alcohol is also associated with heightened rates of both violent and non-violent crime, and during pregnancy it poses serious risks to the developing foetus, including foetal alcohol spectrum disorders.

Causes and Risk Factors

The development of alcohol use disorder arises from an interaction of genetic, environmental and psychological factors. Genetics and environment each contribute roughly half of overall risk.
Key influences include:

• Family history: individuals with a first-degree relative with AUD are three to four times more likely to develop the disorder
• Stress and anxiety, which may drive self-medication
• Cultural, social and behavioural factors, including peer norms
• Availability and affordability of alcohol
• Biological and psychological responses to alcohol’s effects
• Use to relieve withdrawal symptoms, reinforcing dependence

Although many carriers of genetic risk factors never develop alcoholism, early exposure and high-risk environments increase vulnerability.

Diagnosis

Diagnosis usually begins with screening questionnaires that assess drinking patterns, impairment and dependence. A comprehensive clinical assessment follows, evaluating physical health, psychological state and social circumstances. Diagnostic criteria identify patterns of compulsive use, tolerance, withdrawal and persistent alcohol-related harm.

Treatment

Treatment approaches vary according to the severity of the disorder and the presence of co-occurring mental or physical conditions.

• Detoxification: medically supervised withdrawal is essential because abrupt cessation can cause dangerous complications such as seizures or delirium tremens. Benzodiazepines, such as diazepam, are commonly used to manage symptoms.
• Medications:
  • Acamprosate, which helps maintain abstinence
  • Disulfiram, which creates an aversive reaction to alcohol
  • Other pharmacotherapies, depending on individual needs
• Psychosocial and behavioural interventions:
  • Individual or group therapy
  • Cognitive–behavioural approaches
  • Relapse-prevention training
  • Motivational interviewing
• Mutual-aid organisations: Alcoholics Anonymous (AA) remains the most prominent abstinence-based support group. A 2020 review found that clinical interventions promoting participation in AA (known as Twelve-Step Facilitation, TSF) often achieved higher abstinence rates than other treatments and tended to lower healthcare costs.