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What is alcohol dependence?

The term alcohol dependence refers to the desire to drink and the inability to quit drinking. This is when a person becomes physically or psychologically dependent on the consumption of alcohol. As of 2013, this term was reclassified as ‘alcohol use disorder’.

Alcohol dependence can be identified if you suffer three of seven key indicators over the course of a 12-month period. These are:

  • Excessive use

This is the use of alcohol in larger quantities and for longer periods of time than the individual had intended.

  • Neglect of other activities

Previous commitments, recreational or occupational, are limited or given up due to the use of alcohol.

  • Unsuccessful efforts to cut down

Impaired control is when the individual carries out ongoing and failed efforts to control their consumption of the substance.

  • Persistence of use

Despite awareness of the physical and psychological harm being inflicted by the consumption of alcohol, the individual persists with use.

  • Time consumption

A large amount of the individual’s time is spent thinking about, obtaining and drinking alcohol and then recovering from the effects of consumption.

  • Withdrawal

Alcohol dependence has been developed if the individual experiences withdrawal symptoms when consumption has ceased.

  • Tolerance

This is characterised by the need for increased amounts of alcohol to feel its effects.

The fundamental characteristics of someone with a dependence on alcohol are the irresistible urge to drink, the inability to quit and continuing to consume alcohol despite the consequences. Withdrawal and tolerance are also key and we will cover those later.

Alcohol Dependence Scale (ADS)

An example of a study which has been used to measure the severity of alcohol dependency in the past is The Alcohol Dependence Scale. This is a 25-item multiple-choice questionnaire developed by Harvey Skinner and Barbara Allen in 1982 and was procured from the Alcohol Use Inventory (Horn, Wanberg, & Foster, 1974).

It covers questions regarding the individual’s past 12 months and gathers scores from 0 to 47 relating to the severity of that person’s alcohol dependency.

The scale suggests the following scores should be interpreted as:

  • Low levels of dependence – 1-13

This is characterised by displaying psychological rather than physical dependence.

  • Moderate levels of dependence – 14-21

This is characterised by psychological dependence and also signs of physical dependence.

  • Substantial levels of dependence – 22-30

With scores this high, it is thought physical dependence and psychosocial problems are likely

  • Severe levels of dependence – 31-47

Physical dependence and physical illnesses or medical problems will be highly probable when scores reach this highest scale.

The example of this scaling system gives insight into the differing severities of alcohol dependence. The ADS shows that this is not a simple issue, but rather an extremely complex one, with many layers and considerations.

The difference between alcohol dependence and abuse

To put it in simple terms, alcohol abuse is drinking too much on a regular basis and alcohol dependence is being unable to quit. To ensure you have alcohol awareness, it’s important to understand the difference and the severity of each stage. A sufferer of an alcohol abuse problem can usually continue their everyday life, even though they are experiencing the negative effects.

On the other hand, the life of someone who is dependent on alcohol will be ruled by the substance. Alcohol abuse and alcohol dependence are considered to be progressive stages along the spectrum of issues relating to alcohol consumption. So let’s take a deeper look.

Alcohol abuse

The use of alcohol is considered to reach the abuse stage when an individual begins to experience negative impacts as a result of their drinking. Alcohol abuse is widely considered to be the beginning stage of addiction and dependence.

Abuse behaviours include binge drinking, choosing alcohol over participating in other activities or even if the consumption of alcohol is having a negative influence on your work and relationships. If you identify with any of these behaviours you could be on a dangerous path towards addiction and dependence.

Alcohol dependence

Alcohol dependence is the most serious form of alcohol addiction and will have likely begun with the individual first abusing the substance in some way.

It encompasses the person’s physical dependence on alcohol, their tolerance to alcohol and also the fact they will experience alcohol withdrawal.

Tolerance and how alcohol changes the brain

We will now attempt to understand why physical tolerance builds and why the body becomes physically dependent on alcohol. If you regularly drink large quantities of alcohol your body will require more of the substance in order to experience the effects of alcohol. In turn, this consumption on such a large scale will turn into a dependence.

Tolerance for alcohol can be attributed to a number of factors including ethnicity, body type, your metabolism, and the one we’ll be investigating – alcoholism. This is the main cause of a higher tolerance for alcohol. The body of an alcoholic has developed in order to adapt to the usual volumes of alcohol it receives.

So, why and how does alcohol change the brain and how does that create dependence?

Alcohol suppresses neurotransmitters which are essentially the body’s chemical messengers. When alcohol is consumed regularly, at high levels and over a long period of time, the receptors adapt. This means alcoholics develop resistance to alcohol.

The brain compensates for these chemical changes to restore balance and attempt proper function – these changes are believed to be the reason for alcohol dependence. If the individual stops drinking alcohol after the brain has already adapted, it will need to adjust again – which could then lead to problems associated with alcohol withdrawal.


Alcohol withdrawal is one of the most important aspects to consider when it comes to alcohol dependence – if you experience any of the below symptoms when consumption has ceased, you have a dependency.

The unpleasant withdrawal symptoms you could experience will be at their most intense between 24 to 72 hours after your last drink. Unfortunately, these withdrawals may last for weeks, depending on the severity of the dependence.

Withdrawal symptoms you could experience include:

  • Nausea
  • Hallucinations
  • Tremors
  • Fever
  • Sweating
  • Confusion
  • Insomnia
  • Irritability
  • Anxiety and depression
  • Seizures – in very serious cases

Seek help for alcohol dependence

Do you feel as though you’re suffering from a problem relating to alcohol dependency? Recovery from alcohol addiction can be a long process and doesn’t just end with your last drink. We’re here to offer expert alcohol addiction help at Port of Call – speak to our team today to take your steps towards recovery.

About the author: Martin Preston

Martin is our Founder and Chief Executive. Martin is himself in long term recovery and started Port of Call to help families navigate treatment options. In 2020 Martin will open Delamere Health Ltd, the UK’s first purpose built addiction treatment clinic.

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