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The gravity of alcohol addiction

15037966_xlAlcohol is commonly consumed and seen as a harmless beverage in Singapore. According to the 2010 National Health Survey, of the adults aged 18 to 69, 54% are non-drinkers, and 91.3% do not binge drink. The Singapore Mental Health Study (SMHS) conducted in 2010 found that a small percentage of Singaporeans do develop alcohol problems. A lifetime prevalence of alcohol abuse and alcohol dependence is about 3.1% for alcohol abuse and 0.5% for alcohol dependence.

Furthermore, a paper* published in the Annals, Academy of Medicine, Singapore (AAMS) Journal based on findings from the SMHS found that the prevalence of alcohol use disorders (that is, abuse and dependence) is 5.3% in young adults as compared to 3.6% in the general population. The odds of alcohol use disorder in this age group, i.e. 18 to 34 years was twice that of the other age groups (35 to 49, 50 to 64, and those aged 65 years and above).

Diagnosis of Alcohol Addiction

Alcohol addiction, also known as alcohol dependence, is a primary, chronic disease with genetic, psychological and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterised by continuous or periodic impaired control over drinking, preoccupation with alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably, denial.

A diagnosis of alcohol dependence is based on the Diagnostic & Statistical Manual, 4th edition, text revision (DSM-IV-TR). The key feature of alcohol dependence is uncontrollable drinking, indicated by continuous drinking in spite of the obvious negative consequences brought by alcohol drinking. Additionally, physical withdrawal symptoms are the key feature of alcohol addiction that differentiates it from alcohol abuse (harmful use).

Signs and Symptoms of Alcohol Dependence

•   Craving – A strong and continuing compulsion or need to drink

•   Tolerance – The need to drink increasing amounts of alcohol in order to “feel the buzz” or to “get high”

•   Physical dependence – Withdrawal symptoms when a person stops drinking after a period of excessive drinking. Such symptoms include anxiety, sweating, nausea, and “the shakes.”

•   Loss of control – Alcohol is often taken in larger amounts or over a longer period than was intended.

•   There is a persistent desire or there are unsuccessful efforts to cut down or control alcohol use.

•   A great deal of time is spent in activities necessary to obtain alcohol, use alcohol or recover from its effects.

•   Important social, occupational, or recreational activities are given up or reduced because of alcohol use.

•   Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the alcohol (e.g. continued drinking despite recognition that an ulcer was made worse by alcohol consumption).

Alcohol Abuse

Comparatively, binge drinking is a form of alcohol abuse which is seen as a pattern of excessive alcohol use over short periods of time. In alcohol abuse, the drinking would have caused some problems but would not have reached the severity level of addiction yet.

Alcohol abuse may be associated with one or more of the following situations in a twelve-month time period:

•   Going through recurring alcohol-related legal problems. Examples include getting arrested for driving under the influence of alcohol, for damaging someone’s property, or for physically hurting someone while drunk.

•   Drinking in instances that can result in physical injury. Examples include physical injuries while driving a vehicle or operating machinery under the influence of alcohol.

•   Continued drinking in spite of ongoing relationship difficulties that are the result of drinking.

•   Failure to attend to important responsibilities at work, home, or school.

Usually, abuse is the first step of addiction. However, many people would just stop at the level of abuse and never go on to become addicted. As it is difficult to tell who will eventually develop an addiction to alcohol, the best way to prevent this progression while in the stage of abuse is to stop drinking or reduce the amount of drinking.

Low-risk drinking is defined as drinking no more than two standard drinks per day for men, and no more than one standard drink per day for women. Pregnant women are advised to abstain from alcohol completely.

A standard alcoholic drink contains 10 grams of alcohol, and this can be estimated to be:

•          2/3 can (220 ml) regular beer

•          1 glass (100 ml) wine

•          1 nip (30 ml) spirit

Comorbidities with Alcoholism

Long-term excessive alcohol use is associated with a slew of health problems. These include upper gastrointestinal tract problems (esophagitis or esophageal varices); liver problems, pancreatic problems (most common cause of pancreatitis is heavy alcohol use), hypertension and diabetes; and neurological problems such as cognitive impairments, Wernicke-Korsakoff syndrome, and alcohol-related dementia (Rotgets, 2006).

Sudden cessation of drinking after a prolonged period of heavy consumption can lead to delirium tremens, where the person could experience symptoms such as body tremors, mental status changes, agitation, irritability, confusion, and disorientation. He/she may also suffer from seizures that, if not given medical attention, can be life-threatening.

A person with alcohol problems also has a much higher chance of experiencing falls, blackouts, and getting into fights and accidents while intoxicated. Alcohol addiction is often associated with an increased level of conflict in the family as well. Families may experience stress, anger, anxiety, isolation and burnout as a result of having to deal with the person’s excessive alcohol use.

Treatment and Rehabilitation

Treatment for alcohol addiction at the National Addiction Management Service (NAMS) is based on a multi-disciplinary approach. It typically involves medication (to help with withdrawal, sleep problems, cravings and other co-occurring mental health issues), and individual and group counselling. In more severe cases, the client may be referred to a three-week in-patient detoxification and rehabilitation programme.

Recovery from alcohol addiction is possible. Early treatment and family support are important in the process. If you know anyone who has signs of alcohol problems, please encourage them to seek help early.

*Pls note that the information provided in this AAMS paper is on alcohol addiction, not binge drinking – this term was not used in relation to this study.



Beattie, M (1992) Codependent No More. Minnesota: Hazelden Foundation

Kinney, J (2009) Loosening the Grip, A Handbook of Alcohol Information, New York: Mc-Graw-Hill

Rotgets, F (2006) Treating Alcohol Problems, New Jersey: John Wiley & Sons, Inc

Subramaniam, M; Abdin, E;  Vaingankar, J ; Tee, Joseph & Siow A. ( 2012) Prevalence and correlates of alcohol use disorders in the Singapore Mental Health Survey Addiction.

Ms Anne Chui is a Counsellor at the National Addictions Management Service (NAMS), Institute of Mental Health.
Posted by ezyhealth on Dec 4 2013. Filed under Mental Health. You can follow any responses to this entry through the RSS 2.0. Both comments and pings are currently closed.

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