Alcohol: Still the Main Drug of Addiction

The majority of Australians drink alcohol - approximately 85.5% (AIHW 2016).

Drinking is associated with a wide range of our social and cultural activities and is often actively encouraged. Alcohol generally plays a prominent role in occasions such as celebrations, sporting events, during meals, clubbing and at house parties. It can be viewed as ‘un-Australian’ to turn down a drink. Our heavy drinking culture dates back as far as colonisation - for a period, convicts were paid partially in rum (Moodie 2013).

When alcohol is absorbed into the bloodstream, short term effects on the brain, such as a sense of relaxation and reduced inhibition, can be seen within about five minutes (This can vary from person to person, depending on their body mass and state of health) (NSW Ministry of Health 2017). Consumed in excess, however, alcohol consumption can quickly lead to nausea, vomiting. The long-term adverse effects are much more serious, even deadly.

Alcohol Use Disorder (Not ‘Alcoholism’)

Alcohol use disorder (AUD) is the medical diagnosis for prolonged and severe drinking that is causing problems in a person’s life. Alcoholism is the colloquial term for this disorder. It is extremely prevalent and a serious medical issue that can have fatal consequences.

To have an addiction is to have a dependence on a substance or activity. As opposed to someone who simply wants something, a person with an addiction will have physical cravings for the substance they’re addicted to (ReachOut n.d.).

Alcohol in Australia

In 35% of drug treatment episodes in 2017-18, alcohol was the primary drug of concern - making it the most commonly treated drug in Australia (AIHW 2016).

A recent study found that 1 in 6 Australians consumed alcohol at levels that placed them at lifetime risk of an alcohol-related injury (AIHW 2016).

Alcohol was the only drug where the approval of regular use (by an adult) was higher than disapproval (46% approved; 22% disapproved) (AIH 2017).

There were 1,366 alcohol-induced deaths recorded in 2017. There were an additional 2,820 (alcohol-related) deaths where alcohol was listed as a contributing factor to mortality (ABS 2018).

Alcohol Use Disorder as Defined by the DSM-5

In 2013, the DSM-5 made changes to the categorisation of alcohol use disorder. DSM-5 now integrates the two DSM-IV disorders, alcohol abuse and alcohol dependence, into a single disorder called alcohol use disorder (AUD) including mild, moderate, and severe sub-classifications (NIH 2016).

The 11 Symptoms of Alcohol Use Disorder as Listed in the DSM-V

• Alcohol is consumed in large amounts or over a longer period than was initially intended.
• There is a persistent desire or unsuccessful efforts to cut down or control drinking.
• A lot of time is spent drinking or recovering from the effects of alcohol.
• A person wants a drink so badly they cannot think of anything else.
• They find that drinking or being sick from drinking often interferes with taking care of home or family, or causes job or school problems.
• They continue to drink even though it is causing trouble with family or friends.
• They have given up on or cut-back activities that were important or interesting to them, or gave them pleasure, in order to drink.
• More than once they have engaged in situations while or immediately after drinking that increased the chances of getting hurt (for example swimming, using machinery, or having unsafe sex).
• They continued to drink even when it was making them feel depressed or anxious or added to another health problem, or after having a memory blackout.
• Have to drink more than they previously did to get the intended effect, or found that the usual number of drinks had much less effect than before.
• Experience withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure, or sensed things that were not there.

(NIH 2016)

The presence of at least two of these symptoms indicates an alcohol use disorder. The presence of two to three is considered mild. Four to five is moderate and six or more is severe (NIH 2016).

The Effects of Alcohol Consumption

Short-term

• Reduced inhibitions;
• Loss of alertness or coordination and reduced reaction rates;
• Impaired memory and judgement;
• Double or blurred vision;
• Disturbed sleep patterns;
• Disturbed sexual function;
• Nausea, shakiness and vomiting.

(NSW Ministry of Health 2017)

Long-term

• Brain damage and dementia;
• Liver cirrhosis;
• Oral, throat and breast cancers;
• Forms of heart disease and stroke.

(NSW Ministry of Health 2017)

At-Risk Groups

Based on recent statistics, the following groups are at greater risk of forming a dependence on alcohol:

• First Nations People;
• People with mental health conditions;
• Younger people.

(AIHW 2020)

Which Types of Drinks Have the Highest Alcohol Content?

Some alcoholic drinks have a higher concentration of alcohol than others. In Australia:

• Beer contains 0.9% to 6% alcohol.
• Wine contains 12% to 14%.
• Fortified wines such as sherry and port contain 18% to 20%.
• Spirits such as scotch, rum, vodka and bourbon contain 40% to 50%.

(NSW Ministry of Health 2017)

This means that for the same volume of liquid, both wine and spirits will affect you faster than beer.

Withdrawal From Alcohol

Withdrawal from chronic alcohol use should be completed inline with medical advice and/or supervision due to the life-threatening nature of its effects.

The body goes through significant changes as prolonged and heavy alcohol use stops, this is known as alcohol withdrawal.

Symptoms of withdrawal from alcohol include:

• Trembling;
• Sweating;
• Nausea;
• Headaches;
• Insomnia;
• Anxiety.

(Harvard Health Publishing 2019; SA Health n.d.)

The effects of withdrawal are prominent when alcohol consumption ceases abruptly. Withdrawal syndrome is a hyper-excitable reaction of the central nervous system (CNS) as a result of the lack of the sedative effect of alcohol following long-term exposure to high quantities of alcohol (SA Health n.d.).

Over time, the brain changes its own chemistry to balance the effects of the alcohol. It produces stimulating chemicals such as serotonin or norepinephrine (similar to adrenaline), in greater quantities (Harvard Health Publishing 2019).

Note that most hospitals and health services have their own policies and procedures relating to the management and treatment of alcohol withdrawal including the Alcohol Withdrawal Scale (AWS).

Tips for Cutting Down Alcohol Consumption

• Setting a drink limit and sticking to it.
• Counting drinks, keeping in mind that drinks at a bar or restaurant might contain more than one standard drink.
• Drinking water before drinking alcohol to quench thirst.
• Drinking slowly.
• Eating before and while drinking.
• Finishing a drink before the next is started, trying not to top up drinks as it is possible to lose track of how many drinks have been consumed.
• Drinking a non-alcoholic drink between drinks.
• These tips considered, it is vital not to cease the consumption in the event of previous heavy usage without medical advice or supervision.

(Healthdirect 2017)

If you’re in crisis and need support, call Lifeline on 13 11 14. Lifeline is open 24 hours a day, 7 days a week.

Additional Resources

• Alcohol and Drug Foundation, Help and Support Services, https://adf.org.au/help-support/
• Alcoholics Anonymous Australia, https://aa.org.au/
• Wernicke–Korsakoff Syndrome (WKS), https://www.ausmed.com.au/cpd/articles/wernicke-korsakoff-syndrome
• Drug and Alcohol Withdrawal: An Insight, https://www.ausmed.com.au/cpd/articles/drug-and-alcohol-withdrawal

References

• Australian Bureau of Statistics (ABS) 2018, Causes of Death, Australia, 2017, ABS cat. no. 3303.0. Canberra, viewed 17 February 2020.
• Australian Institute of Health and Welfare (AIHW) 2017, National Drug Strategy Household Survey 2016: Detailed Findings, AIHW, viewed 17 February 2020, https://www.aihw.gov.au/reports/illicit-use-of-drugs/ndshs-2016-detailed/contents/table-of-contents
• Australian Institute of Health and Welfare (AIHW) 2020, Alcohol, Tobacco and Other Drugs in Australia, AIHW, viewed 17 February 2020, https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/drug-types/alcohol
• Alcohol and Drug Foundation, Why Do People Use Alcohol and Other Drugs, Alcohol and other Drugs Foundation, viewed 17 February 2020, https://adf.org.au/insights/why-do-people-use-alcohol-and-other-drugs/
• Harvard Health Publishing 2019, Alcohol Withdrawal, Harvard Health Publishing, viewed 17 February 2020, https://www.health.harvard.edu/a_to_z/alcohol-withdrawal-a-to-z
• Healthdirect 2017, Managing Your Alcohol Intake, Healthdirect, viewed 17 February 2020, https://www.healthdirect.gov.au/managing-your-alcohol-intake
• Moodie, R, ‘A Brief History of Alcohol Consumption in Australia’, The Conversation, viewed 18 February 2020, https://theconversation.com/a-brief-history-of-alcohol-consumption-in-australia-10580
• National Institute on Alcohol Abuse and Alcoholism 2016, Alcohol Use Disorder: A Comparison Between DSM-IV and DSM-5, NIH, viewed 17 February 2020, https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-use-disorder-comparison-between-dsm
• NSW Ministry of Health 2017, A Quick Guide to Drugs and Alcohol, 3rd ed. Sydney: National Drug and Alcohol Research Centre.
• ReachOut n.d., What is Alcohol Addiction, ReachOut, viewed 17 February 2020, https://au.reachout.com/articles/alcohol-addiction
• SA Health n.d., Alcohol Withdrawal Management, SA Health, viewed 17 February 2020, https://www.sahealth.sa.gov.au/wps