Alcohol Addiction

The NHS classifies alcohol use disorder as a medical condition. It should be approached like any other chronic illness with a clinical assessment, medical treatment, and ongoing support.

Alcohol addiction rarely looks like the late-stage picture many people associate with it. Those living with alcohol use disorder often maintain jobs, relationships, and appear – to most people – completely fine.

Alcohol dependence symptoms are often less obvious. The CAGE questionnaire is a brief self-reflection tool used in clinical settings. The four letters stand for the key words in each question. It has no scoring system, and is a straightforward way of noticing patterns.

• Have you ever felt you should ‘Cut down’ on your drinking?
• Have people ‘Annoyed’ you by criticising your drinking?
• Have you ever felt ‘Guilty’ about your drinking?
• Have you ever felt you needed an ‘Eye-opener’, a drink first thing in the morning to get going?

Physical signs:

• Building a tolerance, and needing more alcohol to feel the same effect
• Alcohol withdrawal symptoms when not drinking, such as shaking, sweating, or anxiety
• Needing a drink to feel normal or to get through the day

Psychological signs:

• Craving alcohol, particularly at specific times of day
• Using alcohol to manage stress, low mood, or anxiety
• Feeling guilt or shame after drinking, but continuing anyway

Behavioural signs:

• Hiding how much you drink or drinking in secret
• Giving alcohol priority over work, relationships, or responsibilities
• Continuing to drink despite knowing it is causing harm

Alcohol use disorder typically progresses in three stages:

• In the first stage, alcohol produces pleasure and reduces anxiety. The brain registers this and reinforces the behaviour, strengthening the drive to drink again. Over time, the brain begins to rely on alcohol to produce these effects and adjusts its own chemistry to compensate.
• In the second stage, when you haven’t had a drink, you feel anxious and low. Tolerance has built up, meaning more alcohol is needed to produce the same effect. Without it, you feel worse than you did before you started drinking. You drink not to feel good but to prevent unpleasant or even dangerous withdrawal symptoms.
• In the third stage, the part of the brain responsible for decisions and self-control becomes progressively affected. The drive to drink overrides rational thinking. You plan your day around alcohol and can’t stop or cut down, even when you can see the harm it’s causing.

Alcohol addiction is a complex disease with no single cause. It develops through a mix of biological, psychological, and social factors.

Research consistently finds alcoholism might have a genetic link. Adoption studies confirm that someone raised without exposure to alcohol dependency can still carry a genetic predisposition. But genetic risk is not destiny, and many people with a strong family history never develop it.

Trauma, adverse childhood experiences, mental health conditions, and social environment all play a role. But two people in the same family can have entirely different relationships with alcohol. The causes are really that unique to each individual.

In 2019 to 2020, an estimated 608,416 adults in England had alcohol dependence. Many people with alcohol use disorder have never been formally assessed or diagnosed, which means the real number is likely considerably higher.

Alcohol addiction is not evenly distributed across the UK, and in Scotland, where Castle Craig is based, alcohol-specific death rates have historically been higher than in England.