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FACT SHEET FIFTEEN IDENTIFYING DEPENDENCY
(Cucumbers
and Gherkins)
Some
alcohol specialists believe that alcohol dependency can happen to anyone who
drinks enough alcohol frequently enough. Others
will tell you that a certain proportion of the population is genetically
pre-disposed to ‘alcoholism’. For
front-line practitioners, the debate is academic and irrelevant. What matters is that anyone who is dependent stops drinking
and stays stopped. (People who have
a problematic relationship with alcohol but are not actually dependent may be
able to learn how to bring their drinking back to sensible levels). (The
vegetable patch analogy refers to the pickling process.
If you’re a cucumber you can become a gherkin, but once you’re a
gherkin you can never go back to being a cucumber!) So how can you tell the difference? Physical
dependency is relatively easy to identify.
It is worth bearing in mind that the word ‘dependence’ came into
vogue after 1972 when the World Health Organisation decided to drop the word
‘addiction’ which they considered to pejorative.
So by ‘physical dependence’ we mean addiction.
Addictions are identified by classic withdrawal symptoms.
When the addicted person cannot obtain a regular supply they go ‘cold
turkey’. When the drinker’s
blood alcohol level falls (usually overnight) they experience typical symptoms, i.e.
the shakes, and anxiety states. Severe
symptoms are epileptiform fitting, visual and/or auditory hallucinations,
delirium tremens. Such symptoms are
often accompanied by heavy sweating at night and peripheral neuropathy (tingling
in the fingers and toes). Dependent
drinkers often experience a sense of urgency in obtaining the first drink of the
day. Physical
dependency is not normally seen in men until they are drinking in excess of 100
units of alcohol per week, although it may be seen at lower levels. (Physical dependency at lower levels may indicate liver
damage; although the intake is less, the blood alcohol remains high as the liver
cannot metabolise it.) It takes the
average male heavy drinker 8-11 years to develop physical dependency.
In women physical dependency is typically seen if they drink in excess of
70 units per week, but again it may be seen at lower levels.
Women can develop a dependency in as little as two to three years. Anyone
who is physically dependent should be referred for specialist assessment as
sudden withdrawal can be unpleasant and potentially fatal. Psychological
dependency normally precedes and accompanies physical dependency.
It would be unusual to find a person who was physically dependent but
wasn’t also psychologically dependent. However,
there are people who are psychologically dependent without having any symptoms
of addiction. They may be binge
drinkers or they may be regular heavy drinkers who use alcohol to self-medicate
or socialise. They will typically
see life without alcohol as boring or unfulfilling, but they may deny that their
drinking is problematic. They may
claim that they can stop drinking or that they have days when they do not drink,
but they are unable or unwilling to consistently control their drinking within
sensible limits and will typically persist in heavy drinking despite the fact
that it is having serious negative consequences for them.
They may tell you that although they can go for days without a drink,
once they start drinking they cannot stop.
Psychologically dependent drinkers also need to stop drinking and stay
stopped. If
you are unsure whether a relative, friend, patient or client is dependent or
not, please consider referring them to apas (or contact us to enquire
about locally accessible services). We
can give the person a thorough assessment, including psychometric testing
which circumvents denial and, where appropriate, can supply you with a verbal or
written account of the assessment findings.
To refer, simply telephone our advice line between 9.00 am and 7.00 pm
any weekday or 9.00 am and 1.00 pm and Saturdays and ask for ‘shared-care’
working, alternatively, you may wish to email us. Alcoline:
0115 941 4747 or Lo-call 0845 762 6316 or email:
apas@apas.org.uk LE49/2/1102 |