Alcoholism: a common problem in families? Causes, symptoms and stages

Alcoholism: a common problem in families? Causes, symptoms and stages
Photo source: Getty images

Alcoholism is a chronic, often slow-onset disease. It manifests itself as a physical and psychological dependence on alcohol. It is also sometimes referred to as alcohol dependence.


Alcoholism is statistically one of the most widespread types of addiction. Worldwide, there are an estimated 380 million people addicted to alcohol. Every adult in the world drinks an average of 9-10 litres of alcohol per year.

What is alcoholism?

Alcoholism is defined as a heterogeneous entity with an overall clinical picture including physical and psychological manifestations accompanying long-term alcohol abuse, not necessarily related to alcohol dependence alone.

Interesting fact: The term was coined by Magnus Huss in 1849, yet alcoholism did not begin to be officially considered a medical problem until 100 years later.

In the early 1980s, the term alcoholism replaced the term alcohol dependence syndrome according to the International Classification of Diseases.

Alcohol dependence syndrome refers to a set of physical, psychological, and intellectual phenomena. Alcohol use takes on a higher priority for the individual than other forms of behaviour that were more valued at the time.

The main characteristic is a strong, irresistible desire to consume alcohol, also referred to as craving.

According to the International Classification of Diseases, alcohol dependence syndrome is characterised by the presence of at least three of the six symptoms simultaneously and for at least one month or recurrent for 12 months.

ICD-10 - F10.2 = Mental and behavioural disorder due to alcohol use: dependence syndrome. Disordines mentales a disordines morum propter usum alcholis - syndroma dependentiae.

Symptoms of alcohol dependence syndrome:

  • An irresistible urge to drink alcohol
  • Inability to adjust the amount of alcohol at any given time
  • Need to drink a certain amount of alcohol to achieve euphoria
  • Physical withdrawal symptoms (nausea, vomiting, tremors) with inability to get to the point of alcohol consumption
  • Need to drink alcohol just to feel comfortable
  • Loss of interest in established habits, hobbies, family
  • Memory lapses (inability to remember what happened in the drunken state)
  • Drinking alone, hiding when consuming or hiding bottles of alcohol

Young people and women are more likely to develop alcohol dependence syndrome. People with a positive family history (with a history of alcoholism in their parents) are at higher risk of developing dependence.

Woman with a glass of wine
Nowadays, young women are often the ones who are addicted to alcohol. Source: Getty Images.

The biggest prima facie advantage of alcohol is that it has a pleasant effect on a person in small quantities, 0.6-0.8‰ at the beginning. It increases self-esteem, positive pleasant feelings, euphoria, sociability, reduces anxiety and depression. It breaks down inhibitions, increases sex drive and sociability.

When this dose is exceeded, the negative effects of alcohol set in very quickly and without warning signs.

Table of alcohol consumption by severity

Low-risk drinking Drinking average daily doses, below the risk drinking level. The daily limit for men is 4 standard drinks and for women 3 standard drinks. According to the NIAAA (National Institute on Alcohol Abuse and Alcoholism) it is 14 g, while the actual doses consumed range from 4 to 30 g.
Risky drinking Drinking with an increased risk of causing harm, although the harm may not yet be present and at the stage of manifestation. Represents the stretch between low-risk drinking and harmful drinking. The 'drinking pattern' represents a range of daily doses of 40-60 g for men and 20-40 g for women - as indicated by WHO
Moderated drinking WHO states = drinking an amount of alcohol that does not cause problems. Also referred to as 'light and moderate drinking'. Drinking 'moderate' doses or drinking that does not result in exceeding 0.55 per mille
Heavy drinking Drinking an amount of alcohol per day that exceeds moderate or social drinking. WHO defines as drinking alcoholic beverages in quantities equivalent to daily consumption > 60 g of pure alcohol men = 5-6 drinks and > 40 g women = 3-4 drinks
Binge drinking Drinking to intoxicate - drunkenness, usually with periods of abstinence. Also referred to as "binge drinking", heavy episodic drinking "binge"

It is said that relationships should be cultivated with people, not alcohol. Despite constant education, alcoholism is on the rise. It is not avoided by children, adolescents or adults.

Depending on their relationship to alcohol, we divide people into:

  • Abstinent - Does not come into contact with alcohol. Does not drink it for its taste or to quench his thirst. Has never come into contact with alcohol.
  • Consumer - Drink alcohol to quench thirst, but in such quantity that their mental activity is not affected (1 beer after a long hike).
  • Drinkers drink alcohol not only to thirst and for its taste, but mainly to induce a state of mental and physical well-being, called euphoria. The drinker becomes a heavy drinker, often ending tragically, addicted to alcohol.
  • Alcoholic - Alcohol for its taste has no meaning for them. The main and most important effect is intoxication. In alcoholic drink they seek a source of amusement, relief, a means of removing mental tension.

What is alcohol?

Alcohol is a readily available legal social drug. Although its sale is restricted by age, the recorded consumption by younger individuals is no exception.

Alcohol is palatable, tolerated by society, offered, affordable. It contains a concentrated high amount of calories but little energy. It has pleasant effects on the human psyche. It relieves tension, relaxes and improves mood, facilitates networking, brings people together.

However, we must not forget that:
Alcohol is a heavy, insidious and slow-acting drug.
It easily penetrates various organs and the brain.
When drinking alcoholic beverages, people often do not realise that they are not just quenching their thirst, but cultivating a habit of drinking it.

Alcohol metabolism

Large amounts of alcohol are absorbed quickly (in about 30-60 minutes). It is absorbed through the stomach and small intestine in the same form it is absorbed through the skin. Alcohol is rapidly absorbed into all body fluids and organs.

Absorption is faster fasting or when fasting.

Delayed absorption of alcohol can be affected by food (especially fats), diseases of the digestive tract and metabolism, medications, decreased intestinal motility, which can prolong absorption for 2-6 hours.

Alcohol metabolism depends on weight, health, race, sex, age, frequency of drinking. Degradation in the liver occurs at a constant rate of 10-12 mg/hr. Ethanol is oxidized in the liver mainly with the help of the enzyme alcohol dehydrogenase.

The highest possible blood alcohol concentration in a healthy individual is reached 30-120 minutes after ingestion. The average decrease in blood alcohol level in adults is 15-20 mg/dl/hr, in children 28 mg/dl/hr, in chronic alcoholics 30-40 mg/dl/hr.


The predisposition to become addicted is greater in some individuals than in others. The causes are mostly psychosomatic, supported by social influences. The theory of genetic predisposition is supported by the family history of alcoholism, as well as by known genetic information and changes that take place and add up over a lifetime with alcohol.

Alcohol affects the transmission of transmitters, especially dopamine and endorphins (happiness hormones).

Knowing the cause is essential. If we only remove the habit but the cause remains, the person will return to the same cycle of addiction and start again. Permanent change is achieved by combining the removal of the cause and the breaking of the habit.

Table of the most common causes of alcohol consumption and subsequent addiction

Fear Fear of an uncertain future, fear of a bad financial situation, fear of death, fear of losing a loved one, fear of personal failure... Many people deal with fear with alcohol. Alcohol brings with it for some people an escape from reality, at least for a short time
Despair Difficult, seemingly unmanageable life situations and the reality that no matter how hard one tries, one cannot turn the situation around, brings many people to the bottom, where they reach for the bottle
Excessive stress or strain Affecting people especially in high functions with a great deal of responsibility. Alcohol as a means of relaxation then quickly becomes addictive and dependent
Loneliness An unfulfilled desire for marriage or parenthood, a long-standing problem finding a partner. Lonely people experience a sense of futility. No matter how hard they try, life does not make sense to them, and so they find fulfilment in alcohol.
Life's disappointments Divorce, loss of a job, feeling rejected by a partner, parents. A disappointed person needs comfort, new hope. Alcohol can offer itself in those moments as a new "faithful friend" who never disappoints
Physical pain Chronic pain in various parts of the body of different origins really plagues people who suffer from it. Often a possible health problem, these people reach for alcohol
The desire for admiration It's very paradoxical, but many people drink to "prove" something to someone
Boredom and the desire for "real" fun Especially young people who are bored, who do not have enough hobbies and activities or who want to do something interesting, to have fun, reach for alcohol.
Bad habit Serving alcohol to visitors or 'only' drinking in front of the TV in the evening


The most visible manifestation of the effect of alcohol on a person is drunkenness, i.e. a loss of mental and physical balance and a state of alcohol poisoning, which can end in death. It occurs especially in young people and when large quantities are drunk suddenly.

Alcohol dependence is a mental illness. It is not a uniform phenomenon. It has several manifestations and forms in individuals.

Alcohol use becomes a problem when it is preferred to all other activities. The addiction may even take many years to develop. A person with this condition cannot control his or her alcohol intake or stop drinking.

Even in extreme life situations (revocation of a driver's license, threat of divorce...).

Significant signs of alcohol dependence:

  • A person prefers to drink alone or in secret
  • Unable to limit the dose and time of alcohol intake
  • Stores and conceals alcohol in various places in the home and even outside the home
  • Memory loss occurs in short periods of time
  • Loss of interest in one's hobbies
  • Frequent urge to drink alcohol
  • Increasing need to drink alcohol
  • Drinking alcohol for a sense of well-being
  • Recurrent and emerging problems in relationships, family, finances or work due to drinking
  • Decline in performance - personal, work, sexual
  • Seeking out places where alcohol is consumed - pubs, bars, meeting more friends who also drink alcohol

Personality changes, emotional roughness or aggressive behaviour directed at those closest to the person are manifested and often intensified in the alcoholic.

Alcohol addiction does not just affect the individual, but affects the lives of the whole family.

Close relatives and partners suffer, and the alcoholic addict has no problem harming his or her own children.


In the vast majority of cases, the alcoholic is unable to recognize his disorder. He also rationalizes his drinking, trying to explain his excessive alcohol consumption to himself in some logical way.

An example of a combined screening tool used in the diagnosis of clinical alcoholism is the Abbreviated Alcoholism Marker Inventory. The diagnostic inventory consists of a selection of items with the greatest diagnostic efficiency: 5 anamnestic, 8 clinical and 2 laboratory items.

Abbreviated alcoholism marker inventory table

  • Hepatopathy
  • Nausea - feeling like vomiting, straining
  • weakness
  • paresthesia (cramps)
  • unsteady gait
Physical examination
  • oedema in the face
  • subicterus
  • conjunctival hyperemia
  • telangiectasia
  • tremor
  • hepatomegaly
  • scars
  • titubation
Laboratory examination GMT, AST

Table of real and potential alcohol pathology

Complications Diagnosis
Infectious Tuberculosis, upper GIT cancer, hepatocellular carcinoma, pancreatic cancer, laryngeal cancer, female breast cancer
Hematological Macrocytosis, thrombocytopenia and rebound thrombocytosis, anemia
Endocrinology DM, alcohol-induced pseudo-Cushing's syndrome
Psychiatric Harmful use, dependence syndrome, withdrawal state, delirium tremens, psychosis, amnestic syndrome, dementia and others, unipolar depression
Pulmonary Pneumonia
Neurological Alcohol-induced nervous system damage, alcohol-related epileptic seizures, alcoholic polyneuropathy, alcoholic myopathy
Cardiovascular Other secondary hypertension, ischaemic heart disease and ischaemic stroke, alcoholic cardiomyopathy, haemorrhagic stroke
Gastroenterology Mallory-Weiss syndrome, alcoholic gastritis, liver disease, alcohol-induced acute pancreatitis, chronic pancreatitis
Rheumatology Gout
Orthopedic Osteoporosis
Congenital Damage to fetus and newborn by maternal drinking, fetal alcohol syndrome
Cutaneous Psoriasis
Traumatological and other Falls, fractures, muscle strains, subdural hematoma and others

Laboratory tests to determine blood levels are an important indicator in the diagnosis of alcohol dependence.

These include:

  • AST - aspartate aminotransferase, an enzyme present in multiple tissues (heart, brain, kidney, pancreas)
  • ALT - alanine aminotransferase, an enzyme primarily located in the liver
  • GMT - gammaglutamyltransferase, present in the membranes of tissues with excretory or absorptive activity (liver, kidney, pancreas)
  • MCV - mean corpuscular volume
  • CDT - carbohydrate-deficient transferrin (the most specific marker of chronic alcohol withdrawal)

For interesting information, see also the article:
What do liver tests reveal? What do elevated values indicate?

Diagnosis of alcoholism is complex and relies on good interdisciplinary cooperation and communication. Clinical, psychological and psychiatric examination is essential in making a diagnosis.


Alcohol addiction takes time to develop. For some people it takes a few weeks or months, but it can take years to cultivate an addiction. It depends on the individual how long it takes for them to be able to give up alcohol completely.

An alcoholic goes through phases gradually until complete dependence is reached.

We recognize the stages:

  • Stage I - initial (risk) symptomatic
    • Increasing alcohol intake and frequency of drinking
    • tolerance to the amounts consumed increases (the person can afford larger amounts over time to feel satisfied)
    • individual appreciates the positive impact of alcohol on the psyche - normal functioning, good mood, ignoring problems
  • Stage II - prodromal (beginning of addiction) warning
    • feelings of guilt about drinking alcohol set in
    • Beginning of secret drinking and hiding alcohol in and out of the house
    • first palimpsests - memory loss
    • pre-preparation with alcohol (drinking to boost self-esteem)
    • avoidance of discussing alcohol
    • regular drinking
    • increasing tolerance to alcohol
  • Stage III - critical (tipping point)
    • loss of control
    • rationalisation of drinking
    • coping with peer pressure
    • intermittent abstinence
    • change in drinking style
    • narrowing of interests
    • Behaviour focused on alcohol being a primary need
    • mood swings, remorse
    • self-pity, bitterness, jealousy, explosiveness
    • reinterpretation of interpersonal relationships
    • change in family habits, unreliability
    • stocking up on alcohol days in advance
    • neglect of good diet
    • decline in potency, decline in interest in sex life
    • regular drinking in the morning
    • first hospital admission for some complications from alcohol use
  • Stage IV - chronic (last) terminal
    • prolonged drunkenness, without sobering up
    • loss of ethical and moral restraints
    • impaired thinking
    • drinking even with strangers and in an environment far below the social level
    • loss of alcohol tolerance - tremors, dilapidated appearance
    • psychomotor inhibition (impaired ability to move, inability to stand up, walk)
    • obsessive nature of drinking (constant urge to drink)
    • failure to rationalise (no longer even believing previous seemingly rational explanations for their positive relationship with alcohol)
    • true alcoholic psychosis (altered personality, mental disorder)
    • drinking anything containing alcohol, technical devices, alpa, okena

Alcohol and the impact on the family

Alcohol addiction is the disease that has the greatest emotional impact on the family.

Alcoholism produces what is known as a domino effect. It destroys the life of the alcoholic, who in turn destroys the lives of those closest to him, and so it goes on. No one in a family with an alcoholic drinker is immune to the effects of alcoholism. This undeniable truth applies most to children raised by parents, one or both of whom drink.

Children of alcoholics are at risk for consequences resulting from a combination of genetic predisposition and the moral and psychological influences of their environment.

Another manifestation is the emotional instability and emotional instability of the alcoholic, which is reflected in the overall disharmony and psychological well-being of the family.

The father's addiction to alcohol. The children especially suffer from it.
With one parent already addicted, the family's functioning is seriously compromised. Photo source: Getty Images.

Many, though not all, alcoholics are aggressive and disorderly when drunk. This is already a direct threat to the family, both the wife and the children.

The alcoholic does not have the strength or the willpower to go to work regularly as he did before he started drinking. This is related to his unreliability, but is reflected in the deteriorating financial situation of the family.

How it is treated: Alcoholism

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