When is it really considered alcoholism?


Alcohol can easily go from being a luxury food to a highly dangerous drug. The transition into an addiction is not a one-way street. Strict withdrawal and the right relapse prophylaxis are crucial.

Brief overview

  • Signs: Strong desire for alcohol, loss of control, increased quantities, withdrawal symptoms, neglect of interests and contacts, continued consumption despite negative consequences
  • Possible consequences: Damage to the liver, pancreas, stomach and intestines, the cardiovascular system, cognitive deficits, fears, depression, suicidal thoughts, job loss, destruction of social relationships
  • Causes: Genetic predisposition, stress, psychological stress, emotional instability, problematic handling of alcohol in family and friends
  • Diagnosis: Information from close people, questionnaires, blood tests (liver values), examination of possible typical secondary diseases of alcohol addiction
  • Therapy: Inpatient or outpatient, cognitive behavioral therapy, individual therapy, group therapy, mindfulness training, stress management training, therapy goal: abstinence
  • Forecast: Addiction is lifelong, with disease insight and therapy good chances of abstinence even with isolated relapses, untreated severe secondary diseases, shortened lifespan

Alcoholism: signs

Alcohol addiction (also: ethylism, drunkenness) is not a character weakness, but a serious mental illness. It can hit anyone: people from all walks of life, young and old, women and men. In Germany, almost all adults consume more or less alcohol. Some drink dangerously large amounts but are still not addicted. At what point does the addiction begin?

When are you an alcoholic?

The six main signs of addiction also apply to alcohol addicts. If three of these apply within a year, the person concerned is considered to be an addict according to the definition of alcoholism.

Strong demand

The central symptom of alcohol addiction is an almost uncontrollable craving for alcohol. It can be a permanent condition or it can suddenly attack the person concerned.

Loss of control

Alcoholics lose control of when and how much they drink. Loss of control is a major indicator of alcohol addiction. After the first glass, there is no stopping many until they are very intoxicated. Against their better judgment, they also drink in situations in which it is inappropriate or dangerous - for example during working hours or when they still have to drive.

Alcohol: this is how it endangers other people

  • Passive drinking: Numerous victims

    Alcohol is not only harmful to those who drink themselves. As a result of accidents and violence under the influence of alcohol or drinking during pregnancy, people die or sometimes suffer from the consequences for the rest of their lives. The number of victims is alarmingly high.
  • Pregnancy: The child drinks with you

    A glass won't do any harm? Because of: Alcohol is a neurotoxin. If it affects the child's brain before birth, it leaves behind permanent damage. How severe these are depends on how often, how much and at what time during pregnancy the mother drinks, but also on the child's genes. In any case, drinking during pregnancy is like playing Russian roulette. A study shows how many children are affected.
  • Fetal alcohol syndrome

    12,650 children were born in 2014 with a fetal alcohol spectrum disorder (FASD). Of these, 3000 showed the most severe degree of expression, the full picture of Fetal Alcohol Syndrome (FAS). The consequences are intellectual disabilities, changes in the face, and growth and development disorders. Severely affected children cannot learn and are often difficult to control. Most of the time they are dependent on help for the rest of their lives. There are also premature births and miscarriages.
  • Every fourth pregnant woman drinks

    These dramatic consequences of drinking alcohol during pregnancy are all the more tragic as they are 100 percent preventable. Nevertheless, every fourth pregnant woman in Germany drinks alcohol at least now and then. Contrary to many prejudices, it is not predominantly women from difficult social backgrounds, but in particular educated women with a higher social status who do not give up alcohol despite their pregnancy.
  • Drink driving kills

    Alcohol reduces concentration, responsiveness and coordination. In Germany there is therefore a blood alcohol limit of 0.3. Still, far too many people get behind the wheel of the car after being drunk. In 2014, 1,214 bystanders died in road traffic as a result of accidents in which an intoxicated driver was involved. That is 45 percent of all third parties involved in fatal accidents. The drivers who themselves died as a result of their alcohol consumption were not counted.
  • Deadly violence

    Alcohol is disinhibited and makes some people aggressive and violent. It therefore plays a role in many violent disputes - from bar brawls to domestic violence. In 2014, 55 people died in Germany because an intoxicated counterpart had inflicted violence on them. That is 14.9 percent of all fatalities from violence. Those victims who survived an alcohol-related brawl injured were not counted.
  • Psychological consequences of alcohol

    Added to this are the emotional injuries that people inflict on others when they are exposed to alcohol. Relatives, especially children, suffer from violence or neglect and can develop mental disorders.

Tolerance development

As a result of excessive consumption, the body develops a tolerance to alcohol over time. Those affected then need ever larger amounts in order to feel the desired effect. A sign of alcoholism is therefore that those affected seem to tolerate significantly more alcohol than non-dependent users. However, this does not mean that the higher the amount you drink is less damaging to your body.

Withdrawal symptoms

If an alcoholic with physical dependence drinks less alcohol or no alcohol at all, withdrawal symptoms appear. These include tremors, sweating, difficulty sleeping, anxiety, and depressed mood. Only a new dose of alcohol can initially relieve the withdrawal symptoms. This vicious circle is difficult to break.

What is feared with withdrawal is what is known as delirium. It can be accompanied by hallucinations. Delirium can cause life-threatening circulatory disorders.

Neglect of other interests

The constant circling of thoughts about obtaining and consuming alcohol and the time it takes to drink and intoxicate causes alcoholics to neglect their duties and interests. Friends and family are also fading into the background.

Persistent consumption despite harmful consequences

Alcoholics do not stop drinking even if the consumption has already harmful physical, emotional or social effects. You drink despite the threat of job loss, separation from your partner or a sick liver.

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Lack of insight into the disease

Alcoholics no longer drink for pleasure, but out of an internal compulsion or even a physical need. That is why attempts to reduce consumption regularly fail.

Still, most alcoholics are initially convinced that you could stop anytime. Often they actually succeed in this over days or weeks. This strengthens her belief that she is not dependent.

But as soon as they pick up their glasses again, the next relapse and loss of control is usually inevitable. Their failure increases their frustration and makes them even more drowning.

Feelings of shame, secrecy

Despite their obvious problems, most alcoholics refuse to be addicted to alcohol. The reason for this may be the extreme stigma that people with alcohol problems face. The alcoholics themselves often share the corresponding prejudices (“I'm not a bum”).

In addition, there is the fear of the necessary consequences - namely, having to do without alcohol. Many people with alcoholism drink increasingly clandestinely as soon as the environment speaks to them about the problem.

Types of alcohol addiction

Depending on the drinking behavior, one can differentiate between different types of alcohol addiction.

Mirror drinkers

The so-called mirror drinker consumes rather small amounts of alcohol, but continuously throughout the day. This type maintains a certain concentration of alcohol in the blood so as not to experience any withdrawal symptoms.

Heavy drinkers

In contrast to this, there is the binge drinker who cannot curb his drinking behavior and continues to drink every time until he is very intoxicated. He gets used to an increasing amount of alcohol. This form of chronic alcohol abuse (chronic alcohol abuse) is the most common.

Conflict drinkers

Far less common is the conflict drinker, who only drinks excessively when problems or conflicts arise. This type uses alcohol to overcome difficulties.

Episodic drinker

The episodic drinker consumes alcohol excessively at times and then remains abstinent for a few weeks. This drinking behavior is also known as dipsomania.

Functional alcoholics

Alcohol sickness is not always obvious. Some sufferers hide their alcohol addiction for years so cleverly that nobody notices. Many manage to continue performing even demanding tasks.

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Recognize dangerous alcohol consumption

Alcohol addiction develops insidiously. The following signs indicate that you are developing alcohol addiction. Then they should seek advice so as not to slip into addiction.

  • You drink more and more often.
  • You drink increasingly larger amounts.
  • You like to drink alone.
  • You're drinking more than you intended.
  • You drink so much that memory gaps occur.
  • You keep drinking despite negative consequences.
  • They're hiding how much you drink.
  • You will be asked about your drinking habits by others.

Alcoholism - the Consequences

Alcohol consumption has both acute and long-term effects. In the long term, there is a threat of severe organ damage and mental illness. In addition, every area of ​​life is affected by alcoholism: work, family, friends and leisure.

Short-term effects of alcohol

Alcohol can lift mood and reduce inhibitions in the short term. But it also makes some weepy, others aggressive. Depending on the amount and type of alcoholic drink as well as body weight and drinking habits, sooner or later perception disorders and coordination difficulties occur when consuming alcohol.

Alcohol is quickly distributed throughout the body to the brain via the blood. Even those who can take a lot without getting drunk damage their organs. Because the liver can only break down about 15 grams of alcohol per hour. Anything beyond that initially remains in the blood. When alcohol is broken down, toxins are also produced, which in the long term are harmful to health.

Long-term physical effects of alcohol

Alcohol and its breakdown products are poisonous. In the long term, they damage all organs in the body.

Liver damage

The liver, which constantly has to do hard work with heavy drinkers, stores more fat, enlarges and changes to what is known as fatty liver. This often goes unnoticed for a long time, because the liver itself cannot feel any pain. However, it is sometimes noticeable through a feeling of pressure in the upper abdomen. Pain only occurs when the liver becomes inflamed.

After a while, liver cells die: cirrhosis of the liver develops (shrunken liver). This is a steadily progressive, life-threatening disease. The risk of liver cancer also increases.

Effects on the brain

The brain also suffers massively. Brain cells are lost with every sip of alcohol (brain atrophy).

The risk of other forms of dementia, such as Alzheimer's and vascular dementia, which often set in earlier than usual, is tripled.

In severe alcoholics, the damage to the brain can also trigger alcohol-related dementia, which can trigger Korsakoff's syndrome. Those affected then suffer from disorientation and memory loss. Korsakoff's syndrome is caused by a lack of vitamin B1. Because alcoholics often do not eat enough. Although alcoholic beverages are high in calories, they do not contain the necessary nutrients.

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Digestive tract

Since alcohol passes through the entire digestive tract, it causes damage everywhere. These include increased inflammation of the gums, reflux (heartburn), gastric mucosal inflammation and ulcers, damage to the small intestine and the lining of the large intestine.

Gastrointestinal problems such as vomiting, diarrhea and appetite disorders are other consequences of alcoholism.


Heavy alcohol consumption can cause inflammation of the pancreas (pancreatitis). The acute form is very painful and can be life-threatening, a chronic course with diarrhea weakens the body.

Varicose veins of the esophagus

As the liver is destroyed, the blood from the abdomen has to find a new route to the heart. Part of it is no longer conveyed to the heart via the portal vein, but via veins along the esophagus. These expand pathologically (esophageal varices) and can burst. The so-called esophageal variceal bleeding into the esophagus can lead to life-threatening blood loss.

Heart and vascular damage

Long-term consequences of alcohol addiction are also cardiovascular diseases. The alcohol damages the heart muscle and blood vessels. High blood pressure, cardiac arrhythmias, and heart muscle diseases are more common in alcoholics. Vascular changes are expressed, among other things, in the typical red coloring of the skin of alcoholics and in what is known as the drinker's nose.

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Even healthy people who consume a lot of alcohol put their hearts at risk. You are threatened with a heart attack, heart failure and atrial fibrillation. Of


In the long term, alcohol also increases the risk of cancer. In addition to liver cancer, there is also a risk of tumors in the mouth, throat, esophagus and stomach. In women, there is also a significantly increased risk of breast cancer.

Reduced life expectancy

The life expectancy of alcoholics is reduced by 10 to 15 years.

Long-term psychosocial effects

Problems in work and personal life

The effects of alcohol do not only affect health: In addition to the physical and mental consequences described, there are environmental problems.

At some point, alcoholics are no longer able to carry out their everyday tasks. The deeper they slide into alcoholism, the more likely they are to lose their job. This not only affects the financial situation, but also the interpersonal situation.

Relationships with partners, children or friends often fall apart in alcoholism.

Relatives often suffer from the addiction as well as the person affected. Family, friends and hobbies are neglected. The sick person becomes a burden from friend, partner and parent, addiction becomes a terrible center of life for everyone involved. Relatives often develop what is known as codependency.

What is this all about and how to escape it can be read in the text Codependency.

Mental alcoholism symptoms

Alcohol changes personality. Under the influence of alcohol, some become subdued or weepy, others act aggressive or even violent. The aggression can be directed against strangers as well as against one's own family. Many crimes are committed under the influence of alcohol.

Alcoholics also often suffer from mood swings and depression. In severe cases, hallucinations and delusions occur. Alcoholics often suffer from insomnia and severe anxiety. Feelings of guilt and inferiority also accompany alcohol addiction.

Alcohol addiction and other mental illnesses

In many cases, alcohol addiction does not occur alone but is accompanied by another mental disorder (comorbidity). The most common are anxiety disorders, such as panic disorders or phobias. Many alcoholics also suffer from depression. Alcoholics are also common among schizophrenic patients.

It is often difficult to determine whether a mental disorder led to alcohol addiction or whether the alcohol caused or aggravated mental problems. In combination with a mental disorder, the risk of suicide for alcohol addicts is increased. That is why both diseases must be treated as quickly as possible.

Alcohol During Pregnancy

Alcohol is particularly dangerous for the unborn child. Because if the mother drinks alcohol during pregnancy, it affects the physical and mental development of the fetus. The damage is irreversible and accompanies the child for a lifetime.

In the case of fetal alcohol syndrome, the children show behavioral problems as well as mental and physical impairments that can be very serious.

Even small amounts of alcohol can harm the child. Women should therefore completely avoid alcohol during pregnancy.

Read more about the effects of alcohol on the unborn child in the text Fetal Alcohol Syndrome.

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Alcohol addiction: causes and risk factors

Most people in Germany drink alcohol, many of them in harmful quantities. However, only a fraction of them, around two million, are alcohol dependent.

Exactly how alcohol dependency develops has not yet been fully explained. However, several factors always come together. Both genetic and psychosocial influences play an important role in this.

Genetic Influences

Is Alcoholism Hereditary? Family and twin studies studies show that there is a genetic risk for alcohol addiction. Identical twins have a significantly higher risk of becoming alcoholic if one twin is affected. If both parents are addicted to alcohol, around 30 percent of children will later develop alcohol addiction as well.

Consumer behavior in the family

In addition to the parents' genes, their relationship to alcohol also plays a role. If the children learn that drinking a lot is funny or even arouses admiration or that alcohol is used to cope with problems, they quickly take this as a bad example. If people drink a lot later in their own circle of friends, the effect increases.

Roots in childhood

Traumatic or stressful experiences often form the basis for the development of an addiction disease. At particular risk are people who experienced abuse or loss in childhood, such as the death of a parent. The bond with the mother is also decisive for the further development of the child. Children whose mothers do not respond to their needs or children without a permanent caregiver are more prone to alcoholism later.

Alcohol among friends

Another factor is added, especially during puberty: peer pressure. Puberty is a complicated phase in which young people try to develop personality and self-image and to connect with their peers. Peer pressure can be a trigger for drinking. If you don't drink, you run the risk of being excluded from the group.

Young people often rate alcohol positively. To be “drinkable” is a sign of strength. However, people who have this characteristic and who can tolerate alcohol well are even more at risk of becoming dependent on alcohol than those who cannot tolerate much. Because the latter automatically drink less.

Alcohol as a way of life

Another risk of alcohol abuse are the initially positive effects of consumption. Under the influence of alcohol, inhibitions and fears are briefly reduced. For rather insecure people or people in difficult phases of life, the risk of alcohol abuse increases.

Alcohol as a drug of happiness

The processes in the brain also play an important role in the development of alcohol addiction. Because alcohol increases the release of the neurotransmitter dopamine, which activates the reward system in the brain. Dopamine creates feelings of happiness. It is also poured out when we eat something, for example.

But alcohol activates the dopamine receptors much more strongly than food. So drinking alcohol is rewarded with feelings of happiness. People who call this up too often become less sensitive to dopamine - they need larger amounts. When they drink less or no alcohol they develop cravings. This is also known as craving.

Alcohol addiction: examinations and diagnosis

Harmful use or alcohol addiction? Based on certain criteria, the doctor or therapist can decide what applies to a person and plan further treatment accordingly. Your family doctor will be your first point of contact.

Research into alcohol addiction

If alcohol addiction is suspected, the doctor will first have a detailed discussion with the person concerned. The family doctor could ask the following questions in an initial consultation:

  • Do you feel the need to drink alcohol frequently?
  • How much alcohol do you drink a day / week?
  • Do you get the impression that you think about alcohol often?
  • Have you ever tried to reduce your alcohol consumption?
  • What positive or negative effects does alcohol have on you?

External withdrawal symptoms, such as sweating, tremors or reddening of the skin, can be signs of alcohol addiction. With the help of a blood test, the doctor can find further evidence of increased alcohol consumption. The blood count also provides information about the condition of the liver. In addition, the doctor will perform a comprehensive physical examination to determine any other possible consequential damage.

Diagnosis: Abuse or Alcohol Dependence (ICD-10)

If the suspicion of alcohol dependence is confirmed, the family doctor will refer you to outpatient specialists or a clinic. They carry out an accurate diagnosis and create an individual treatment plan to combat alcohol addiction.

Diagnostic criteria for alcoholism

The criteria of the international statistical classification of diseases and related health problems (ICD-10) are usually used to diagnose alcohol addiction.

A distinction is made between the harmful use of alcohol, which is referred to as alcohol abuse or alcohol abuse, and alcohol dependence. According to the ICD-10 for alcohol dependence, at least three of the following criteria must occur simultaneously in one year for the diagnosis:

  • There is a strong desire to drink alcohol.
  • People have no control over when or how much they drink.
  • If alcohol consumption is reduced or stopped, withdrawal symptoms occur (e.g. sweating or tremors).
  • There is a tolerance to the alcohol, so that the amount has to be increased more and more in order to feel an effect.
  • Dealing with alcohol takes a lot of time and leads to the neglect of other interests.
  • Although alcohol consumption has negative consequences, people do not stop drinking.
"The line between healthy and sick is fluid"
The mentally ill are often confronted with rejection and prejudice. The difference between sick and healthy is much smaller than you might think.

Alcohol addiction: alcohol withdrawal

In the case of physical dependence, detoxification must first take place. Before the actual alcoholism therapy, those affected have to go through a medically supervised alcohol withdrawal, a so-called detoxification. Withdrawal from alcohol can be associated with mild to severe physical withdrawal symptoms. With severe addiction, withdrawal can even be life-threatening. Therefore, it should always be supervised by a doctor. Only after the physical withdrawal does the actual weaning therapy follow.

Outpatient withdrawal

In milder cases, this is possible on an outpatient basis. The patient then appears daily for a certain period of time to check the breath for alcohol. A doctor will also check for withdrawal symptoms such as tremors, sweating, difficulty concentrating, and high blood pressure. There may also be a urine test at the end