The Progression of Alcoholism
Although many adults are capable of drinking in moderation, alcohol’s highly addictive properties frequently lead to excessive consumption and quickly spiral-out-of-control. The evidence of alcohol’s neurotoxicity and accompanying socioeconomic burden are overwhelming in magnitude, and continue to worsen with each passing year. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) more than 17 million people suffer from an alcohol abuse disorder (AUD), with men twice as likely to abuse alcohol when compared to women. The prevalence of adolescent AUDs is also alarming. Currently, an estimated 850,000 physically and psychologically vulnerable adolescents between the ages of 12 and 17 suffer from alcoholism, and experts project a future increase.
CHARACTERISTICS OF ALCOHOL USE DISORDER
There are numerous factors that can be used to diagnose AUDs. The following list provides a general diagnostic guideline:
- Continuing consumption in spite of the deleterious effects upon relationships
- Interference with family, work, or school responsibilities
- Dangerous impulsivity or engaging in risky behaviors such as driving while intoxicated, having unprotected sex, provoking conflicts, or displaying other forms of criminal or delinquent behavior
- Requiring greater quantities of alcohol—and more frequent binge drinking sessions—in order to achieve the desired effect
- Self-imposed isolation and social withdrawal
- Worsening anxiety, depression, or other debilitating mental health symptoms
Physical dependence is exhibited when the body begins to develop tolerance to alcohol—a process that is long-term for many users, but almost immediate for some depending upon genetic factors and/or a documented family history of alcohol abuse. Once tolerance is developed, withdrawal symptoms begin to occur whenever there is a lapse, or total cessation, in use. These symptoms occur as a result of neurochemical and behavioral changes that naturally accompany regular intoxication. For example, alcohol’s artificial manipulation of the neurotransmitters GABA and dopamine, although euphoria-inducing, is short-lived and followed by a chemical crash. Experts blame this crash on the gradual depletion of vital nutrients and body-wide chemical dysregulation triggered by excessive consumption. Depending upon which of the three stages an alcoholic is suffering from, withdrawal symptoms may include anxiety, tremors, nausea, sleeplessness, vomiting, cardiac distress, and confusion.
EARLY STAGE ABUSE
It is impossible to predict whether occasional social drinking will lead to the development of an AUD. In the early stages, alcoholism is characterized by experimentation with the different types of alcoholic beverages, which is most commonly seen in young, college-age adults. Frequently, binge drinking will ensue during parties—a pattern of immoderate consumption defined as five or more alcoholic beverages for men in a two hour period, and four for women. Although some binge drinkers never progress beyond the experimental phase, many go on to drink more regularly and excessively due to genetic predisposition or their immediate social environment. Consequently, they become more dependent on the euphoric feeling that accompanies drinking and thus their drinking increases in its severity and frequency.
Women, in particular, who drink more than three drinks per day, or seven drinks weekly, are at greater risk of developing long-term alcoholism. Using the same clinical criterion, men are considered to be at risk if they imbibe four drinks per day, or more than 14 per week. Regardless of its causes, the experimental stage ends when excessive alcohol consumption becomes a regular habit.
This second, more problematic stage, occurs when one experiences a loss of control over their drinking and begins to experience the destructive effects of their alcohol consumption with increasing frequency. In people suffering from escalating abuse, emotional and psychological attachments trigger and fuel their alcohol addiction—yielding consequences of mounting severity. As a result of this downward spiral, erratic behavior increases, and relationships, friendships, and other significant connections become strained or broken. The heightened cravings and withdrawal symptoms associated with this stage make it much more difficult to stop, and people are routinely held hostage to the madness of the disease against their better judgment.
In this stage, the individual progresses into full-blown addiction. They become ensnared in a web of physical craving that is difficult—if not impossible—to overcome, and their mental preoccupation with drinking becomes pathological. This stage is destructive in every aspect of the alcoholic’s life and almost impossible to successfully treat without professional intervention.
Approximately twenty percent of full-blown alcoholics are considered “high-functioning alcoholics,” meaning they are able to show up to work every day and meet their financial and professional obligations—but with continued heavy drinking. In many ways, the term ‘high- functioning alcoholic’ is a misnomer, as it is only a matter of time before the bottom falls out and they suffer the severe consequences of their addiction.
Major health conditions that are caused or exacerbated by heavy alcohol abuse in this stage include:
- Severe depression
- Cardiovascular disease
- Brain damage
- Wernicke’s encephalopathy
- Korsakoff syndrome
END STAGE ALCOHOLISM
In this final stage, alcoholism invariably causes serious health manifestations—especially liver damage. Cirrhosis of the liver is usually the result of decades of unrelenting alcohol abuse. As the alcoholic continues to drink, the liver is rendered unable to purify toxins from the body effectively, process the nutrients the body needs to efficiently function, or absorb cholesterol. As a result, it forms stubborn scar tissue instead of healthy new tissue, eventually breaking down completely. In many alcoholics, cirrhosis is considered irreversible and can only be medically managed, usually with poor results. In others, it proves fatal.
Other chronic conditions and diseases manifest or worsen as a result of severely impaired cognition. For example, end-stage alcoholics experience a greater fall risk due to coordination and balance issues. Many fatal falls have occurred due to brain bleeding, rather than the fall itself. Other cognitive issues including Wernicke-Korsakoff syndrome become equally—if not more—debilitating, and severely diminish the quality of a sufferer’s life. This mind-corroding neurological disorder that frequently begins in earlier stages is the scourge of many late-stage alcoholics’ existence, obscuring their memory, damaging entire brain regions, triggering neuronal death, and depleting their body of vast nutrient reserves. The absolute powerlessness, depression, and demoralization the end-stage alcoholic suffers also increases their risk of suicide and debilitating depression. Beneath the train-wreck of their mental, physical, and psychological function, they realize that quitting would require monumental effort, and many are gripped by a paralyzing fear and apathy as a result.
THE ABC’S OF PROFESSIONAL TREATMENT
The progression of alcoholism to the point of interference in healthy adult functioning requires professionally-guided treatment and a multifaceted, evidence-based approach. Administering at-home detox and self-guided treatment are extremely dangerous and irresponsible practices that frequently lead to long-lasting—and potentially irreversible—complications. Only trained medical professionals and licensed clinicians possess the education, hands-on training, and acquired skill set necessary to confront the chronic, relapsing disease of alcoholism. The following stages of treatment form the basis of professional intervention and lead to the most favorable long-term recovery outcomes:
- Detox—clients unanimously require a short-term stay (3-7 days on average) in a detox program where alcohol’s toxic effects are safely and effectively removed from their system under 24/7 care.
- Hospitalization—clients suffering from alcoholism may require short-term hospitalization so that a team of physicians and nurses can monitor vital signs, administer necessary IV fluids and special medications, or help them recover from the effects of acute alcohol poisoning.
- Inpatient Treatment—clients may elect to enroll in a residential treatment program featuring round-the-clock medical monitoring and intensive clinical supervision. This short-term option, which generally lasts between 30 and 90 days, is considered extremely effective.
- Outpatient Treatment—after successfully completing residential treatment, clients may choose to enroll in a non-residential program that offers greater flexibility based upon their personal and/or professional schedules. While generally cheaper and less intensive than inpatient treatment, outpatient facilities offer many of the same medical and clinical benefits. For many clients, outpatient programs are ideal for purposes of transitional care or maintenance therapy. They are also excellent when used to help manage the longer-term—and more subtle—psychological symptoms associated with post-acute withdrawal syndrome (PAWS).
- Medication-Assisted Treatment (MAT)—at all levels of treatment, clients may be prescribed a combination of evidence-based medications and appropriate psychotherapy aimed at identifying and resolving the underlying causes of alcoholism, as well as whatever co-occurring mental health disorders need to be addressed.
If you or someone you love are suffering from alcoholism or displaying warning signs, call a substance abuse professional today! Alcoholism is a serious, life-altering disease that requires aggressive intervention and ongoing medical and clinical management.
For more about alcoholism and recovery, check out these related articles:
- “7 Benefits of Inpatient Rehab”
- “What to Consider Before Deciding to Detox at Home”
- “Can Too Much Alcohol Cause Infertility?”
- “How Long Does Alcohol Stay in Your System?”
Alcohol and Alcoholism. Biochemical and Neurotransmitter Changes Implicated in Alcohol-Induced Brain Damage in Chronic or ‘Binge Drinking’ Alcohol Abuse. March, 2009.
Journal of the American Medical Association (JAMA). Binge Drinking Among US Adults. Jan, 2003.
Journal of Hepatology. Managing excessive alcohol consumption at a population level: The earlier the better. March, 2018.
APA News and Journals. Frequent Binge Drinking Among US Adolescents, 1991-2015. May, 2017.
American Journal of Preventative Medicine (AJPM). Economic Costs of Excessive Alcohol Consumption in the U.S., 2006. Nov, 2011.
International Scholarly Research Notices. The Association between Alcohol Dependence and Depression before and after Treatment for Alcohol Dependence. Nov, 2011