Alcohol addiction

What is alcohol addiction?

Alcohol addiction, known medically as alcohol use disorder or alcohol dependence, is when drinking becomes difficult to control even though it is causing harm. It develops gradually. What starts as social or occasional drinking can, over months or years, turn into a pattern where alcohol feels necessary to relax, sleep, socialise or simply feel normal.

It is not a sign of weak willpower or bad character. Regular heavy drinking changes the brain’s reward and stress systems. The brain adapts to alcohol, so a person needs more to get the same effect (tolerance) and feels unwell without it (withdrawal). This is why promises to “just stop” so often fail, and why medical treatment helps.

Alcohol problems are very common in India. A national survey led by AIIMS found that about 16 crore people aged 10–75 drink alcohol, and more than 5.7 crore are affected by harmful or dependent use. Yet only about one in 38 people with alcohol dependence reported getting any treatment.

Signs to look out for

You or someone close to you may have a problem with alcohol if you notice several of these:

• Drinking more, or for longer, than intended
• Wanting to cut down, or trying to, without success
• Strong cravings or urges to drink
• Needing more alcohol to feel its effect
• Shaking, sweating, nausea, restlessness or poor sleep when not drinking, or drinking in the morning to feel steady
• Spending a lot of time drinking, getting alcohol or recovering from it
• Missing work, college or family responsibilities because of drinking
• Continuing to drink despite arguments at home, health problems or advice from a doctor
• Giving up activities or people you used to enjoy
• Drinking in risky situations, such as before driving
• Hiding bottles, lying about how much you drink, or feeling guilty about it

Doctors assess how many of these apply and how much drinking is affecting health and daily life. Problems range from harmful drinking, where alcohol is already causing damage, to dependence, where the body and brain have adapted to it.

How much drinking is too much?

There is no amount of alcohol that is completely safe for health; the risk rises with every drink. What matters for addiction is less the exact quantity and more the pattern and the loss of control.

A simple, widely used check is the AUDIT questionnaire, developed by the World Health Organization. It asks 10 questions about how often and how much you drink, and the problems it causes. Higher scores suggest risky or harmful drinking and possible dependence. It is a screening tool, not a diagnosis; a psychiatrist can go through the results with you.

Why does it happen?

There is rarely a single cause. Several factors usually combine:

• Genes and family history. Alcohol problems in a parent or sibling increase the risk.
• Starting young. People who begin drinking in their teens are more likely to develop dependence.
• Stress and emotional pain. Work pressure, relationship problems, loneliness, loss or trauma can lead to drinking as a way to cope.
• Mental health conditions. Depression, anxiety, ADHD, bipolar disorder and sleep problems often go hand in hand with drinking.
• Social environment. Frequent drinking in the peer group or workplace, and easy availability, make heavy drinking seem normal.

How alcohol affects the body and mind

Long-term heavy drinking can affect almost every part of the body:

• Liver: fatty liver, alcohol-related hepatitis and cirrhosis
• Stomach and pancreas: gastritis, bleeding and pancreatitis
• Heart and blood vessels: high blood pressure, irregular heartbeat and a weakened heart muscle
• Brain and nerves: memory problems, poor balance, tingling or numbness in the hands and feet, and in severe cases lasting brain damage
• Cancer: alcohol raises the risk of several cancers, including of the mouth, throat, food pipe, liver, bowel and breast
• Mental health: low mood, anxiety, irritability, poor sleep and a higher risk of self-harm

Worldwide, alcohol causes about 2.6 million deaths a year. The encouraging news is that many of these effects improve, sometimes dramatically, once drinking stops.

Alcohol withdrawal: why stopping suddenly can be risky

When someone who drinks heavily every day suddenly stops, the brain, used to alcohol’s calming effect, becomes over-active. Symptoms usually begin within 6 to 24 hours of the last drink:

• Shaking hands, sweating and a fast heartbeat
• Nausea, vomiting and loss of appetite
• Anxiety, restlessness and irritability
• Poor sleep and vivid dreams

In more severe cases, withdrawal can cause fits (seizures), usually within the first two days, or delirium tremens, a state of severe confusion, fear, shaking and seeing or hearing things that are not there. Delirium tremens is a medical emergency.

This is why a planned, medically supervised withdrawal, often called detox, is important. The right support prevents these complications and makes the process far more comfortable.

When to see a psychiatrist

Consider speaking to an addiction psychiatrist if:

• You have tried to cut down or stop and haven’t managed to
• You feel unwell, shaky or anxious when you don’t drink
• Drinking is affecting your health, work, studies or relationships
• You drink to cope with stress, sadness, anxiety or sleeplessness
• Family or friends are worried about your drinking
• You are planning to stop and drink heavily every day

You don’t need to wait until things become severe. Early help is simpler and more effective.

How alcohol addiction is diagnosed

A first consultation is a conversation, not a judgement. The psychiatrist will ask about your drinking pattern, previous attempts to stop, withdrawal symptoms, physical health, mood, sleep, stress, family history and what you would like to change. With your permission, a family member can join part of the discussion.

You may be asked for blood tests, such as liver function tests and a blood count, to check how alcohol has affected your body. Screening questionnaires like AUDIT help measure severity. The diagnosis follows international criteria (ICD-11), and the plan is built around your goals.

Treatment

Treatment is tailored to the person, and it usually combines the following.

1. Safe withdrawal (detox)

For people who are dependent, the first step is to stop drinking safely. Medicines are prescribed for a short, closely monitored period to prevent fits and ease withdrawal symptoms, along with vitamin supplements (especially vitamin B1) that protect the brain and nerves. Many people complete detox at home with regular follow-up; others need a short hospital stay.

2. Medicines that help prevent relapse

After detox, some medicines can reduce cravings, make drinking less rewarding, or discourage drinking. They are not addictive. Your psychiatrist decides whether they suit you based on your health, liver function and goals, and monitors you while you take them. These medicines should never be taken, or given to someone, without a doctor’s supervision.

3. Counselling and talking therapies

Therapy addresses why drinking started and how to stay well. Commonly used approaches include:

• Motivational enhancement: building your own reasons and confidence to change
• Cognitive behavioural therapy (CBT): changing thought patterns and habits linked to drinking
• Relapse prevention: recognising triggers, handling cravings and planning for high-risk situations
• Family sessions: improving communication and helping family members support recovery without blame

Peer support groups, such as Alcoholics Anonymous, can add encouragement and community.

4. Treating other conditions together

Depression, anxiety, ADHD, bipolar disorder and sleep problems are common alongside alcohol use. Treating both at the same time, known as dual diagnosis care, lowers the chance of relapse and improves overall well-being.

Outpatient, online or inpatient care?

• Outpatient care suits most people, with regular consultations while living at home and working.
• Online consultations are convenient for follow-up, family guidance and people living outside Delhi NCR.
• Inpatient or residential rehabilitation may be advised for severe withdrawal, serious medical or mental health problems, repeated relapse, or when home is not a safe place to recover.

Dr. Tarwani sees patients at Sukoon Health in Gurugram and South Delhi, where inpatient rehabilitation is also available, and online.

Recovery and relapse

Recovery is a process, not a single event. The first three to six months after stopping are when relapse is most likely, so regular follow-up during this period matters.

A slip does not mean treatment has failed. Like other long-term health conditions, alcohol addiction can return, and the right response is to learn from what happened and adjust the plan, not to give up. Many people go on to lead healthy, fulfilling lives without alcohol.

For families

Living with someone who drinks can be exhausting, frightening and lonely. A few things help:

• Talk when your loved one is sober, calmly and without labels or blame
• Focus on specific concerns (“I was worried when you drove home last night”) rather than character
• Avoid covering up for them or making excuses, which can delay change
• Look after your own health and seek support for yourself
• Never give medicines secretly. It is unsafe and damages trust

You are welcome to consult Dr. Tarwani first, on your own, to plan the next steps.

Common myths

• “He’s not an addict, he only drinks in the evening.” Dependence is about loss of control and harm, not the time of day or the type of drink.
• “Beer or wine is safe.” All alcoholic drinks contain the same alcohol. What counts is how much.
• “You have to hit rock bottom before treatment works.” Early treatment is easier and more successful.
• “Rehab is the only option.” Most people recover with outpatient care; residential treatment is one option among several.
• “Medicines just replace one addiction with another.” Relapse-prevention medicines are not addictive and are prescribed under supervision.