Alcohol dependence (alcoholism): characteristics and patient approach

By Cristiano Antonino On Apr 20, 2023

Alcoholism (or alcohol dependency) is certainly one of the situations that an ambulance crew has to deal with most frequently

In fact, alcohol abuse is extremely widespread and forces calls to emergency numbers in some cases.

An overview, in order to understand the boundaries and to correctly frame the patient, is therefore necessary.

Alcoholism (or alcohol dependence) is characterised by compulsive drinking behaviour and by addiction and tolerance (in order to achieve a desired effect, the person is ‘forced’ to drink increasing quantities of alcoholic beverages).

Stopping consumption causes withdrawal syndrome (characterised by tachycardia, tremors, nausea and vomiting, agitation, hallucinations, convulsions).

The effects of alcoholism severely interfere with a person’s health and his or her working, relational and social life

Like other substance dependence disorders, alcohol dependence should be considered a chronic condition with a high risk of relapse.

Research suggests that patients with alcoholism have difficulty initiating change on their own and that the central problem, as in other addiction problems, is maintaining the change over time (Annis, 1986). Some typical relapse factors are:

‘High-risk’ situations: negative emotional states (anger, anxiety, depression, frustration, boredom), interpersonal situations (especially conflict), social pressure (e.g. being with other people who are drinking) or even positive emotional states (desire to test one’s willpower).
To the extent that a patient is exposed to a ‘high-risk’ situation, whether or not he or she will relapse depends on the ‘coping’ capacity, i.e. the ability to cope with the situation with behavioural, cognitive or emotional regulation strategies.
Expectations about the positive effects of alcohol in coping with intra- or interpersonal malaise (the higher this expectation, the higher the risk of relapse into alcoholism).
Abstinence violation effect, i.e. the attribution of meaning that the patient makes with respect to the abstinence violation: for example, an attribution linked to experiences of personal failure and inadequacy rather than to an as yet incomplete ability to cope with “high-risk” situations is more likely to lead to a second violation and abandonment of alcohol dependence treatment (Larimer, Palmer, & Marlatt, 1999).
Existential variables in generic terms of ‘stress’ (e.g. work, family, etc.).
Cognitive factors that may restore conditions associated with relapse (rationalisation, denial, desire for immediate gratification, craving, etc.).

Cognitive Behavioural Psychotherapy is the approach that scientific evidence recommends as the treatment of first choice (in combination with pharmacological treatment) in alcohol addiction (Guidelines of the American Psychiatric Association, APA).

The first goal of treatment is the cessation of substance abuse behaviour.

This goal can be pursued through the use of various techniques: from the identification and management of ‘trigger stimuli’ (stimuli that immediately precede episodes of alcohol abuse), to the analysis and questioning of dysfunctional beliefs about oneself, others and relationships; from increasing assertiveness and promoting emotional regulation skills to monitoring aspects of impulse ‘dyscontrol’.

A further tool that is successfully used in cognitive behavioural therapy of alcohol dependency is that of the “functional analysis”: carried out together with the patient, its purpose is to focus attention on the factors that immediately precede the alcohol use behaviour and its positive and negative consequences.

From the analysis of individual episodes, the patient is then guided to the discovery of the causal links that favour the onset of a drinking behaviour and of the reinforcing mechanisms that maintain alcoholism over time (i.e. until pathological alcohol dependence is established).

This is done by accompanying patients towards alternative ways of coping with the antecedents of the problem behaviour and supporting them in finding alternative ‘healthy’ ways of achieving the positive effects previously given by alcohol intake (e.g. stress reduction, coping with painful emotional experience, etc.).

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