Why can't I stop drinking?

What is alcoholism?

After-work beer, a cozy glass of red wine with your meal or digestive schnapps after a heavy meal. In Germany, alcohol is very popular and culturally anchored. According to Statista, 102 l of beer, 20.5 l of wine, 3.4 l of sparkling wine and 5.4 l of spirits were consumed per capita in Germany in 2018. One wonders: what is alcoholism and where are the limits?

Currently around 1.3 million people in Germany are addicted to alcohol.

In order to be considered dependent on alcohol, several diagnostic criteria must be met. The transition from normal, enjoyable alcohol consumption to harmful addiction can be fluid. As with other addictions, alcohol addiction characterizes physical and psychological dependencies on the respective addictive substance. The damage that occurs as a result affects one's own body, mind and also the social environment in which the person concerned is.

When are you addicted to alcohol?

Alcoholism can develop very slowly over a long period of time. The focus of this period, however, is one thing: alcohol. When you are addicted to alcohol, you need alcohol to function and you think about drinking it from morning to night. Other interests and social contacts are neglected, so that life revolves more and more around alcohol. If there is also the will to drink less, but this cannot be implemented because it is too difficult to stop, there is an acute risk of developing alcohol addiction.

Since alcoholism is an addiction, the six main signs of addiction also apply here. At least three of these signs must be present within a month for a diagnosis of addiction syndrome according to the ICD-10 (F10.2) to be obtained. These signs include:

Strong cravings for alcohol

Every addiction is experienced through an intense desire for the addictive substance. This desire is physical as well as psychological. The receptors in the body need the messenger substances and the brain wants to satisfy this physical desire. The desire can be continuous or it can occur suddenly and spontaneously.

Loss of control

The loss of control manifests itself in the fact that people with an alcohol addiction cannot consciously stop drinking. After the first glass there is no stopping, so you continue to drink until you are very intoxicated or even lose consciousness. Alcohol addicts also cannot control in which situations they drink. It can happen that people drink in dangerous (while driving) or inappropriate situations (at work).

Development of tolerance to alcohol

The human body is very resilient, as it can quickly adapt to external conditions and ways of life and get used to them. He develops a so-called tolerance. This means that a larger amount of the respective substance is required to achieve an effective effect. Accordingly, people with high tolerance levels have to drink more to get drunk, as they have gotten used to the alcohol through regular drinking. This excessive tolerance limit can also be a sign of alcohol addiction, as it reflects a practiced drinking behavior.

Withdrawal symptoms in alcohol addicts

When people with an alcohol addiction do not have access to their addictive substance for a period of time, withdrawal symptoms appear. These can be physical, but also psychological. The body longs for its drug so that the respective receptors can be occupied and happiness hormones can be released. The psychological dependence can also refer to thoughts about the drug - you drink because you think that you will feel better afterwards - but also to your own body. Withdrawal symptoms are very stressful for the body and are also accompanied by physically experienced pain. Of course, nobody wants to experience this pain, so the addiction to the cure - alcohol - grows.

The first symptoms of withdrawal appear through physical reactions such as sweating, tremors, sleep disorders and pain. Psychological reactions to withdrawal can be expressed through aggressive behavior, irritability, fear or a depressed mood. In addition, so-called delirium can occur with alcohol-related withdrawal symptoms. This is a state of mental confusion that is accompanied by impaired perception and hallucinations.


Drugs and psychotropic substances have a direct influence on neuronal messenger substances and their transmitters. In this way, you can specifically influence their release and inhibition. Drugs are also highly addictive, which in the event of withdrawal can lead to serious physical and psychological withdrawal symptoms. These withdrawal symptoms often lead to depression, as the body and the psyche long for the supposedly missing substance.

Neglect of other interests

Due to the high relevance of alcohol and all the time that is used for drinking and the ensuing intoxication, other interests, tasks and fellow human beings are neglected for addicts.

Persistent alcohol consumption despite harmful consequences

Addicts are often aware of their harmful addiction. Still, they can't stop pursuing their addiction. They continue to consume, although negative physical, psychological and often also social consequences have already occurred.


Causes and Risk Factors of Alcoholism

In Germany, the consumption of alcohol is part of the culture and sometimes part of everyday life and is viewed as completely normal. This is why most people drink alcohol regularly without being dependent on it.

As with other addictions, the development of alcohol addiction can often not be traced back to a single cause. Several influencing factors come together, which are composed of genetic predisposition, but also psychosocial factors.

Genetic causes

Scientific studies have shown that alcoholism appears to be at least partially hereditary in the form of a susceptibility. In family and twin research, results have shown that children are up to 30% more likely to develop alcohol addiction if both parents are alcoholic. Identical twins are also very likely, if one of them is already addicted to alcohol, that the other will develop alcohol addiction as well.


The family has always been a formative circle for one's own behavior. Accordingly, it makes sense to take a look at the consumption behavior of alcohol in one's own family. When children learn that their parents use alcohol to deal with problems, for example, or as a regular drink with food, they develop a potentially disturbed relationship with it. If the parents also pass on a very liberal relationship to alcohol to their children, the children will also grow up with loose contact with alcohol and will tend to consume more at an earlier age.

social environment

The social environment has a direct influence on our behavior and habits. Especially during puberty, the first behavioral habits are established in one's own circle of friends, which can then continue through life. Peer pressure plays an important role in this. After all, every adolescent wants to be and belong to the group. Drinking alcohol and being “hard-drinking” shows coolness and strength. Often times, young adolescents also brag about how much they drank and how drunk they were at the last meeting. The developed tolerance helps not to get drunk so quickly, but the amount that is consumed increases, which ultimately means that steadfast drinkers are more likely to develop alcohol addiction than adolescents who tolerate little alcohol and therefore only slightly Consume quantities.

Free from inhibitions

Alcohol lowers inhibitions and causes anxiety to be reduced in the short term. Insecure or introverted people welcome this effect as it makes them more social. However, if these people are currently in difficult phases of life, the targeted use of alcohol in order to experience these positive effects can lead to a problematic relationship to alcohol.

Attempts can also be made to briefly forget traumatic experiences caused by the consumption of alcohol.

Alcohol as a drug of happiness

Alcohol directly affects the brain and causes happiness hormones to be released. In contrast to foods like chocolate, the dopamine receptors in the brain react much more intensely to alcohol. Here, however, the effect of tolerance also sets in, as the receptors get used to the impulses and therefore become less sensitive. So you need more frequent and more intense impulses so that the receptors can continue to release dopamine - which has a direct influence on consumer behavior.


Recognize alcoholism and the different types of alcohol addiction

Just as each of us is unique, the reasons behind alcohol addiction are also diverse. Nonetheless, certain drinking habits can be summarized in the five most common categories.

Drinking level

Level drinkers or level drinkers consume small amounts of alcohol continuously throughout the day in order to maintain a constant alcohol level. This is how they prevent withdrawal symptoms from occurring. Level drinkers do not need a large amount of alcohol at once, but rather split it up over the course of the day.

Binge drinking

In contrast to level drinkers, heavy drinkers drink large amounts of alcohol at once. They cannot curb their drinking habits and drink until they become too alcoholic. By consuming large amounts of alcohol, the body gets used to it and develops a tolerance over time. Therefore, heavy drinkers have to drink larger and larger quantities in order to be able to feel their intended high in the first place.

Conflict drinking

Conflict drinkers consume excessive amounts of alcohol in very specific situations: conflict situations. They use alcohol as a coping aid or means of escape when problems arise because they cannot or do not want to deal with the respective problem directly.

Functional drinking

Functional drinkers are very skilled at hiding their alcohol addiction from those around them. They manage to carry out a regular daily routine and job, although they may have been consuming alcohol regularly for years.

Episodic drinking

While level and high drinkers continuously consume alcohol in large quantities, the episodic drinker only drinks excessively at times. Otherwise he can stay abstinent for several days or weeks without experiencing restrictive withdrawal symptoms. This episodic drinking behavior is also called dipsomania.


Consequences of alcoholism

The consumption of alcohol causes great damage to our body in the short and long term. In addition to the acute effects, long-term consumption leads to numerous, in the worst case fatal, secondary diseases. In Germany, around 74,000 people die every year from hazardous alcohol consumption.

Medical consequences

One of the things that is responsible for breaking down alcohol in our body is the liver. Sometimes it is also the first organ to be damaged by high alcohol consumption. If the liver is unable to cope with the processing, the liver can become fatty or hardened, which in the end stage can lead to liver cirrhosis (shrunken liver) or liver cancer.

Even short-term alcohol consumption has a direct impact on our brain. Numerous neurotransmitters are disrupted in their work and suppressed in the long term. One consequence of alcohol consumption is therefore damage to memory and the ability to concentrate. Studies have shown that prolonged, excessive alcohol consumption has a degenerative effect on various areas of the brain, so that intellectual impairment can occur.

Many cancers, such as cancer of the liver, oral cavity and throat, rectum, esophagus, and female mammary gland, are the result of excessive alcohol abuse.

Alcohol has an effect on our heart and blood pressure during consumption. Accordingly, high blood pressure can be diagnosed in the long term and heart muscle diseases can develop.

A 0.3 liter glass of beer also has about 130 calories. It is therefore a logical consequence that excessive consumption also leads to the typical beer belly and obesity.

Change of your own being

Alcohol is a drug that has different effects on our psyche in different concentrations. Even small amounts of alcohol cause your own inhibition threshold to drop, the willingness to take risks increases and euphoric feelings can spread. Alcohol has the property of intensifying one's own experienced emotions - if one is happy while consuming alcohol, one becomes euphoric through consumption. However, if you are sad, then consuming it can make you feel even more depressed. Since alcohol has an impact on the brain, continuous consumption also has negative consequences for our personality. Unreliability, constant restlessness and irritability, fears, depression or even thoughts of suicide can occur more frequently.

Effects on the social environment and the family

A cozy evening with friends or family, during which there is a little more drink, is certainly not a cause for concern. After all, in German culture, alcohol is part of evening planning and in terms of socializing. However, if consumption changes from social gathering to personal drinking alone, this will usually become noticeable in one's own social environment after a short period of time. People with an alcohol addiction are often individualists. This means that they are socially isolated, as alcohol plays a more important role for those affected than maintaining friendships and family.


Alcoholism Therapy

Alcohol withdrawal (detoxification)

Alcohol is poison to the body. That is why the first thing to do with therapeutic treatment is to rid the body of this poison. This is done through alcohol withdrawal. Since the organism has got used to the continuous consumption of alcohol over a longer period of time, withdrawal is a difficult challenge for it and is accompanied by severe withdrawal symptoms. These withdrawal symptoms range from mood swings and irritability, tremors, dizziness, vomiting, to seizures with fainting or delirium. The latter in particular can be life-threatening, so alcohol withdrawal should always take place under medical supervision. There is the possibility to choose between an outpatient withdrawal and an inpatient withdrawal.

Outpatient withdrawal

If those affected do not want to or cannot be treated as an inpatient, outpatient withdrawal is planned for around 2 weeks, depending on the severity. Daily visits to the doctor's office are necessary for the first week, where tests are carried out and medication is given to relieve the symptoms of withdrawal. In the second week, visits to the doctor are carried out every other day and the need for further treatment is determined. During an outpatient withdrawal, those affected who are employees receive a certificate of incapacity for work for the period.

Inpatient withdrawal

Inpatient withdrawal is suitable for people who suffer from severe alcohol dependency, who do not trust themselves or are afraid of outpatient withdrawal. That is why inpatient withdrawal takes place either in a hospital, a specialized clinic or a psychiatric clinic that carries out qualified detoxification. In addition to physical detoxification, psychological discussions, further information and participation in self-help groups are also offered during inpatient withdrawal.


In the psychotherapeutic treatment of alcohol addiction, the majority nowadays choose the psychoanalytic, depth psychological and behavioral approach. Since 2011, it is no longer compulsory that those affected have to be abstinent at the beginning of their therapy in order to start it. However, it has been shown that there is abstinence after the first 10 treatment sessions.

A driving element of psychotherapeutic treatment is to promote the motivation to change drinking behavior. Crises that arise in which patients are torn back and forth by the urge to consume must be avoided through therapy. That is why the motivational conversation according to William R. Miller and Stephen Rollnick is increasingly used in therapy against alcoholism. In order to minimize the likelihood of a relapse, the background of the drinking behavior of the person affected is addressed in the therapy.At the same time, coping strategies are developed that can be applied to risky situations so that those affected learn to deal better with these dangerous situations.

Avoidance strategies are often used so that those affected, for example, should no longer go to certain places where they had previously consumed. Finally, therapy methods are developed that are intended to support those affected in the event of an actual relapse so that they do not fall back into old behavior patterns. Since alcoholism also occurs in combination with or as a result of other mental disorders such as depression or anxiety disorders, these are also treated in the therapy.

A popular theoretical model of willingness to change that describes the process and willingness to change one's own drinking behavior well is that of Prochaska & DiClemente (1983). The two researchers describe 5 different stages that an affected person goes through:

  • Stage of lack of intentions At this stage, the person concerned does not yet see any need for action. So he has no intention of changing anything in his behavior.
  • The person concerned realizes and becomes aware that their drinking behavior is problematic. At this stage he starts thinking about a possible change.
  • This stage is characterized by the fact that a clear desire to change one's own drinking behavior has been and still exists.
  • Stage of action At this stage, drinking behavior has been changed. Those affected remained abstinent for a period of up to 6 months.
  • The last stage describes a state of abstinence for more than 6 months. Here it is important to maintain the behavior and not to relapse.

Support groups

Self-help groups such as Alcoholics Anonymous can support those affected in maintaining their therapeutic success and abstinence in the long term and in their own everyday lives. Participation in such groups is therefore recommended at the end of the psychotherapeutic treatment. In these self-help groups, those affected can talk to like-minded people about their personal situations, difficulties and how they deal with them. Relatives of people with alcohol addiction also find opportunities to exchange ideas with other affected persons in similar self-help groups.


How do I behave as a relative of an alcohol addict?

Alcohol addiction affects not only the life of the person affected, but also the life of loved ones. Spouses or life partners and children especially suffer from it. Worries about well-being, feelings of helplessness and overwhelming, financial difficulties, violence, sexual abuse and loneliness are factors that relatives can suffer from.

A common feeling from loved ones is shame. Life partners in particular are ashamed of their partners' dependency, do not talk to anyone, try to keep up appearances and support their partner.

The constant stress also has health consequences for the relatives: sleep disorders, digestive disorders, depression or the development of their own alcohol addiction because they drink together with the person concerned so that he does not feel bad. Even if relatives find it difficult in such situations, it is important to protect yourself and your own integrity and to make yourself aware of your own interests again.

The same steps apply to relatives as to those affected:

In psychological research, it is assumed that relapses do not occur suddenly, but rather develop gradually over a steady period of time. In the event of a relapse into old drinking habits, internal and external factors such as social conditions, thoughts, feelings, conflicts, critical life situations, expectations, moods or places play an important role.

  1. Overcoming stealth
  2. Contact counseling institutions (in addition to specialist counseling centers for relatives and those affected, marriage and family counseling centers and general practitioners' practices are suitable as contact points)
  3. Self-help groups are also openly accessible to relatives
  4. The Federal Center for Health Education (BZgA) offers an initial personal consultation on the information telephone (Tel: 0221 892031 - Mon-Thu: 10:00 a.m. to 10:00 p.m. / Fri-Sun: 10:00 a.m. to 6:00 p.m.) Mediation of suitable local offers of help.


Relapse in alcoholism

A relapse into old drinking habits does not only occur in people who have successfully completed therapy. It is important to note that not every one-off or relatively low consumption of alcohol automatically represents a relapse to old behavioral habits. So you can differentiate between an actual relapse and a "slip". Even dry alcoholics can experience small slip-ups several times, but these do not necessarily lead to a complete relapse. In these cases, ongoing therapeutic support can make sense in order to return to complete abstinence.

Causes of relapse

In psychological research, it is assumed that relapses do not occur suddenly, but rather develop gradually over a steady period of time. In the event of a relapse into old drinking habits, internal and external factors such as social conditions, thoughts, feelings, conflicts, critical life situations, expectations, moods or places play an important role.

Slips during abstinence

The abstinence injury effect according to Marlatt & Gordon (1985) describes in two ways how an affected person can react after a slip.

On the one hand, the slip can lead to feelings of guilt and shame in the person concerned. This reduces one's self-esteem, which can lead to a negative downward spiral. The risk of a complete relapse increases when one's self-esteem is particularly low and the blame increases. On the other hand, those affected can also learn to process their slip constructively and learn from their mistakes.

“It was just a one-time incident now, it won't happen again in the future. I can learn something from this and do better in the future. "

It is important that the slip is processed in a reflected manner and that the person concerned actively deals with it. Otherwise, such a statement can be interpreted as a pretended excuse, with which the person concerned tries to mitigate his action. However, if the person concerned deals constructively with their slip, there is less chance of a complete relapse.


HelloBetter training: drink less

At HelloBetter, we offer specially developed training on addiction prevention and changing one's own drinking behavior. Our HelloBetter training "Drinking Less" has been confirmed in its effectiveness in 4 large-scale scientific studies. Participating people were able to demonstrate a sustained reduction in drinking behavior even after 6 months. In addition, the training also relieved symptoms of depression and anxiety.

The training is aimed at all people who consume alcohol to a risky extent, but who have not yet been diagnosed with addiction. In appealing texts, videos and audios, proven psychological techniques of cognitive behavioral therapy are conveyed, which serve to reflect previous drinking habits and to reduce consumption to a harmless level.

The training can be flexibly integrated into your own everyday life so that you can access it independently at any time. In addition, a trained psychologist will accompany you through the training - after each lesson you will receive written feedback on your exercises and your progress.