What Are the Stages of Alcoholism?
What does an early stage of alcoholism look like? Occasional binge drinking characterizes people in this group.
What does chronic alcoholism look like? A person with chronic alcoholism typically drinks every day and has likely done so for years. Serious consequences due to alcohol begin to appear here, including job losses and family conflicts.
What does end-stage alcoholism look like? Someone with end-stage alcoholism is consumed by drinking. Withdrawal symptoms and years of habit make it incredibly difficult to stop. Professional help is usually required.
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The term “alcoholism”is commonly used in American society, but it is a nonclinical descriptor.
Unlike laypersons, researchers, doctors, therapists, and a host of other professionals require a consensus on what constitutes the different levels of alcohol use. The Diagnostic and Statistical Manual of Mental Disorder-5 (DSM-5), a publication of the American Psychiatric Association, provides professionals in the mental health field with an indispensable diagnostic tool that helps them to identify the various mental health disorders, including alcohol use disorder.
What Is Alcohol Use Disorder?
According to the National Institute on Alcohol Abuse and Alcoholism, in 2012, an estimated 7.2 percent of American adults aged 18 and older, approximately 17 million people, had a diagnosable alcohol use disorder. Men have alcohol use disorder almost twice as much as women; of the estimated 17 million affected adults, 11.2 million were men and 5.7 million were women. Adolescents are not immune. In 2012, an estimated 855,000 young people between 12-17 years of age had this disorder.
No two individuals who experience alcohol abuse are the same; however, DSM-5 provides clinicians with a set of 11 factors that can guide them in the diagnosis of an alcohol use disorder and its severity grade. In short, if a person has experienced at least two of the 11 factors (or symptoms) in the past year then the person is considered to have an alcohol use disorder. The existence of two or three symptoms equals a diagnosis of mild alcohol use disorder, while four to five symptoms is considered moderate, and six or more is considered severe.
To provide insight into the alcohol use diagnostics process, consider the following sample of four possible symptoms:
- An interference with work, school, family, and/or other responsibilities as a result of alcohol consumption
- Continuing to consume alcohol despite the negative impact it is having on one’s relationships
- Engaging in risky behavior after drinking, such as fighting, driving, swimming, having unprotected sex, or operating machinery
- Over time, requiring more alcohol to achieve the desired intoxicating effects
There are two main hallmarks of physical dependence. First, the body will build a tolerance, which is a natural process. As tolerance builds, a person who consumes alcohol will require a higher volume in order to experience the familiar effects. Second, the body will go through withdrawal if intake of the familiar drug ceases or if there is a significant reduction in the usual amount. When a chronic alcohol abuser stops drinking the signs of withdrawal will set in. These alcoholics may continue to drink in order to avoid feeling such symptoms.
Individuals with an alcohol use disorder (alcoholism) will likely experience the symptoms of physical dependence as well as psychological effects.
Withdrawal symptoms include: anxiety, confusion, tremors, racing heart, nausea, vomiting, and/or sleeplessness.
The psychological component of addiction does not refer to the effects alcohol has on one’s mental state, such as disordered thinking. Rather, it refers to how the person’s thoughts and actions become geared toward obtaining alcohol and consuming it, even to the exclusion of important responsibilities.
Early Alcohol Abuse
In terms of the DSM-5, new alcohol users could roughly equate to displaying 0-2 of the 11 symptoms discussed. The difficulty is that one never knows if social or occasional drinking will lead to the development of alcohol use disorder. In the early phases of alcohol abuse, a person will usually get an introduction to different types of alcohol and experiment with alcohol in various forms.
Most often, these experimental individuals are either high school students or young adults, such as college students. Drinking is usually a social event among this younger set, and they collectively binge drink as a way of partying. They may not be regular drinkers, but binge drinking alone still puts them at risk of developing alcohol use disorder. According to the National Institute on Alcohol Abuse and Alcoholism, binge drinking occurs when, within two hours, a person reaches a blood alcohol content of -0.08 or greater. For women, depending on body weight, this usually requires four drinks, and in men, it requires five drinks. However, many binge drinkers will exceed the four or five drink mark and experience higher levels of BAC as well as a host of debilitating physical and mental side effects.
Some binge drinkers or party drinkers will not progress beyond the experimental phase to drink regularly. Those who do continue to drink heavily or regularly may do so because they are environmentally or genetically predisposed to do so. For instance, children of people with an alcohol use disorder are four times more likely to also experience this disorder. Further, research suggests that certain elements of a child’s home life can dispose them to alcohol abuse, such as seeing a parent abuse alcohol or other drugs, or being exposed to a parent’s depression or conflict/violence in the family. Additionally, some people have an existing mental health disorder, and they may graduate from social drinking to more frequent drinking because they perceive it relieves some of their psychiatric symptoms.
Environmental and genetic factors aside, the sheer number of drinks people consume in a given period of time can put them at risk for developing an alcohol use disorder. Women who have a daily intake of more than three drinks, or more than seven per week, are considered at risk. Men, due to their physiological differences from women, are considered to be at risk if they partake in more than four drinks a day or more than 14 per week.
However, if a person has an attachment to drinking, such as relying on it to “have a good time”then it will likely only be a matter of time before there are signs of physical dependence.If alcohol dependence sets in, it will likely be more difficult to stop drinking because of the presence of withdrawal symptoms and possibly cravings for alcohol.Most addiction professionals agree that an at-home detox or “going cold turkey”is never advisable. The best practice would be to talk with an addiction counselor or mental health professional about safe options to detox from alcohol. The need for a medically supervised detox depends, in part, on the length of time of alcohol abuse and usual volume of consumption. In some cases, alcohol withdrawal can present heightened risks and even lead to fatality. Individuals who are at risk for withdrawal effects require supervised medical detox. As a result, it is recommended that anyone seeking to detox from alcohol consult a medical professional first.
- Cardiovascular disease
- High blood pressure
- Nerve damage
- Infectious diseases
End-Stage Alcohol Abuse
In One Flew Over the Cuckoo’s Nest, celebrated author Ken Kesey insightfully communicated the extreme cost that drinking can have on a chronic user’s life when Chief Bromden described the last time he saw his father, “He was blind and diseased from drinking. And every time he put the bottle to his mouth, he didn’t suck out of it, it sucked out of him.”This quote artistically communicates a truth about alcohol abuse; in end-stage alcohol abuse, a person loses control over alcohol use and actually becomes controlled by it.
The end stage may be thought of as the most severe articulation of all the possible problems associated with alcohol use disorder. It is a circumstance of reversals; rather than living to drink, a person in the end stage likely drinks to live. At this point, individuals have lost the ability to stop themselves from drinking. After a long enough period of heavy chronic alcohol use, withdrawal symptoms may be so painful that the person is motivated to continually drink just to prevent them.
At this point, an individual may develop a serious disease, such as cirrhosis of the liver. Cirrhosis of the liver emerges from years of liver damage. As individuals continually consume alcohol, their liver produces scar tissue instead of new healthy tissue. Over time, the scar tissue in the liver prevents the necessary flow of blood. The presence of scar tissue also impairs the body’s ability to clean toxins from the blood, control infections, process nutrients, and absorb cholesterol and certain vitamins.In addition to chronic health diseases and conditions, persons in the end stage of alcohol abuse may be at a heightened risk of falls and other accidents due to balance and coordination problems. Most often, when death occurs after a fall, it is due to bleeding in the brain and not the fall itself.
A person in the end stage of alcohol abuse is also at risk for intentional self-harm. The loss of control over alcohol consumption can leave a person feeling powerless. Withdrawal, as stated, can be painful. The end stage alcohol abuse is in a true quagmire. Help is always available, as the depression associated with alcohol abuse can lead individuals to end their lives.
Getting HelpAlcohol abuse can have harrowing and hazardous side effects at every phase; however, each stage of alcohol abuse is treatable. Even if certain chronic conditions cannot be reversed, abstinence can help to better manage them. Achieving sobriety is always a win for a person’s health and wellbeing whether treatment occurs in the early, middle, or end stage. It’s never too late to get help and achieve recovery.
Alcohol abuse is never exclusively about alcohol. For this reason, a full spectrum of rehab services that starts with medical detox and continues to treat the psychological aspects of abuse is needed.