Complaints & connections · borters.ch
Not weakness of will but a disease of the reward system — and help works at any stage.
Also known as: alcohol dependence · alcoholism · problematic alcohol use
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
The shift from habit to dependence is gradual, with no clear line. Signs: a strong craving, difficulty stopping once started, rising tolerance, withdrawal signs such as trembling, sweating and restlessness in the morning, and continuing despite visible harm. Alcohol affects practically every organ — liver, pancreas, heart, nerves, blood formation — and raises the risk of several cancers. One point is often overlooked: sudden withdrawal can be life-threatening with marked dependence and needs medical supervision. But the most important sentence is another: it is worth it at any stage — the liver recovers remarkably well, and seeking help is not a matter of willpower but an effective step.
The key lever for raised GGT — values often fall within weeks.
Fatty liver is the commonest cause of raised ALT; weight loss normalises it.
Drive fatty liver; fewer soft drinks/sweets lowers values.
The liver has so much reserve that nothing shows for a long time. Stopping changes the course at every stage — even late on.
Three drugs have been studied and work in different ways: naltrexone damps the reward of drinking and also suits people who want to cut down rather than stop; acamprosate lowers craving during abstinence; disulfiram makes drinking physically unpleasant and works only under supervision. None of them makes the decision. Withdrawal itself is the most dangerous phase — it belongs under supervision, because seizures and delirium occur in the first three days.
In Switzerland, low risk counts as at most two standard drinks a day for men and one for women, with two alcohol-free days a week; a standard drink holds about ten to twelve grams of pure alcohol. The body clears about 0.1 to 0.15 per mille an hour — regardless of coffee, movement or food. Withdrawal signs begin six to twenty-four hours after the last drink, seizures after six to forty-eight, delirium after forty-eight to seventy-two hours.
It takes more for the same effect, and one tolerates a striking amount without anyone noticing. This tolerance is one of the earliest signs.
Restlessness, shaking hands, sweating, nausea and palpitations after a night without — and the disappearance of these signs after the first drink. That is withdrawal and the clearest pointer to a physical dependence.
The firm plan to drink nothing today, or only two, repeatedly does not work out. It is not the amount that is the sign but the loss of control — and that is the point that causes shame and is therefore kept quiet.
Supplies in the house, appointments arranged around the drinking times, occasions without alcohol avoided, ever more time for getting it and recovering. Other things step back, even those that mattered.
Poor sleep in the second half of the night, heartburn and morning nausea, high blood pressure, night sweats, reddened cheeks and nose, bruises. Normal liver values rule nothing out.
The single most important nutrient in this context. The store lasts a few weeks, and a lack can damage the brain for good — which is why it is corrected before everything else in withdrawal, and always before a glucose infusion.
Alcohol disturbs uptake and storage at the same time. A lack shows as red cells that are too large in the blood count and as a tiredness that gets put down to the drinking.
Both are lost through urine and vomiting and are often low in withdrawal. Replacing them lowers trembling, a racing heart and the tendency to seizures.
Runs short with chronic alcohol use and with a one-sided diet. Tingling in hands and feet therefore belongs investigated and not accepted as a matter of course.
The most important point on this page. Alcohol blocks uptake and storage; a deficiency can cause lasting memory damage within days. In withdrawal thiamine is therefore given before any glucose infusion, not after.
Folate, B6 and B12 are regularly missing too with heavy drinking. A complex covers them — but it does not replace a separate, high enough dose of thiamine.
Excreted more through the kidney and often missing in withdrawal. A deficiency lowers the seizure threshold — which is why it is measured and corrected during withdrawal.
Studied for addictions, with small and inconsistent results — 1200–2400 mg a day. Alcohol withdrawal without support is the one case where stopping alone can be dangerous.
In pregnancy clearly established against neural-tube defects, otherwise mainly with deficiency. Can mask a B12 deficiency — watch both.
Clearly worthwhile and well supported when deficient — vegan, older adults, certain drugs. No energy boost without a deficiency.
Alcohol suppresses this hormone — hence the frequent trips to the toilet and the dry mouth the next morning. A large part of the hangover is simply a lack of fluid.
Regular heavy drinking lowers the testosterone value and leaves the liver holding more oestrogen. In men that leads to breast enlargement and loss of body hair — visible signs of an internal reckoning.
With heavy drinking a picture arises that resembles Cushing’s syndrome — round face, belly fat, thin skin, high blood pressure. It recedes after weeks of abstinence, and that is how it is recognised.
Alcohol blocks the uptake of vitamin B1. A deficiency can, when sugar is given, trigger severe brain damage — so B1 is always given before glucose in withdrawal. That is not a diet question but a sequence.
All three are often low after longer use. Correcting them in the first weeks of abstinence eases sleep and mood; measure where possible.
In relapse prevention studies mindfulness-based support performs about as well as other approaches. It replaces neither withdrawal treatment nor support, it comes in addition.
Movement lowers craving in studies and improves sleep and mood in the abstinence phase — the two most common reasons for relapse in the first months.