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Dealing with Dependence

Many think of dependency, sometimes described as ‘addiction’ or ‘alcoholism’, as the province of the ‘down and out’. Yet, in reality, there is a much larger number of those who have drink-related problems without becoming dependent or whose dependency is not easily visible to those around them.

Dependency is a state which is not easily defined. It can be physical or psychological or both.

It may be a constant state or related to intermittent activity, (e.g. binge drinking). It can be triggered by a personal crisis (e.g. debt or family loss).

Whereas alcohol dependence is a significant issue involving literally millions, the results of tobacco dependence are also challenging. One hundred and twenty thousand people die before their time in the UK every year, and their health is compromised long before death occurs. These people have families and friends. Millions of people will therefore be affected by dependence on tobacco products. Hundreds of thousands are affected by dependence on illegal drugs.

Dependence is a concept that is measured in degrees rather than by any absolute scale. However, there are certain common features.

The UK Alcohol Forum has published a more specific AUDIT (Alcohol Use Disorders Identification Test) which has ten basic questions scored on a points basis.

Can anyone become dependent? Are some people genetically predisposed to dependence or is it a result of human weakness and depravity? Is the problem medical or moral? And might there be a spiritual dimension? The answer can be ‘yes’ to all of these questions at different times.

Professor Griffiths Edwards writes (in Alcohol; the ambiguous molecule ­ published by Penguin books

“…proneness to develop alcohol dependence does not have any single master explanation to cover any single individual. It is not a matter of some people being doomed to alcohol dependence by their genes while the rest of us can drink with impunity. And for any one individual, no single causal explanation is likely to suffice. The conclusion must be that the reasons why X and not Y develops dependence on this drug will involve the varied contributions of many different factors, acting together over time.”

What is dependence?

  • Substance used in larger amounts, or activity performed over a longer period than the person intended.
  • A persistent desire or one or more unsuccessful attempts to cut down or stop.
  • A lot of time spent focussed on the substance or activity; preparing, procuring, performing or using and then recovery.
  • Impaired function when expected to fulfil obligations at work, school, etc, due to intoxication or withdrawal.
  • Persisting with use or activity, though knowing the harmful consequences, physically, psychologically and socially.
  • Tolerance: A need to increase use to achieve the same ‘high’.
  • Characteristic withdrawal symptoms, or need to use or do something similar to relieve the symptoms.
  • (Compiled from Diagnostic & Statistical Manual IV, [American Psychiatric Association] and International Classification of Diseases 10 [World Health Organisation])

Helping Dependent People

For those wanting to learn more, a great deal has been written about dependence and recovery with a range of sometimes contradictory theories and practices. To do anything more than highlight this here would be to run the risk of incompleteness. For example, some models rely on a person reaching a ‘moment of brokenness’ whilst others would suggest early intervention can work to prevent the grief that this brings. The truth appears to be that both these approaches can be successful and the critical factor is which method will be best for an individual.

For people who have begun to drink heavily, or in a potentially problematic way, or for whom early signs of alcohol-related problems have developed, there is now extensive research evidence to show that a ‘brief intervention’ can be very effective. Typically, a brief intervention involves a relatively short chat with a doctor or nurse or other health professional, perhaps accompanied by provision of a leaflet or a short booklet. For the great majority of people in these circumstances, such an intervention appears to be very effective. In such circumstances, most people immediately realise the need to reduce their drinking and take the necessary steps to do so. Such interventions are inexpensive financially and in terms of people’s time. They provide enormous benefits in terms of improved health and in other ways. However, they clearly do not address all needs and when such intervention has been ineffective, or only partly effective, it is important that someone is given the opportunity to receive a full assessment and more intensive advice and support.

For those interested in alcohol issues, Professor Edwards’ book is well worth reading. Reasonably priced (in paperback) and easy to read, it explains concepts that also help with the general understanding of dependency issues. (Alcohol the ambiguous molecule; Professor Griffiths Edwards, Penguin Books).

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