The Stages of Alcoholism

No one becomes addicted to alcohol overnight. You don’t catch alcoholism the way you do the common cold.

Alcohol use disorder -- the name experts give to problem drinking that becomes severe -- is a relatively new term that combines alcohol abuse and alcohol dependence, including a level that is sometimes called alcoholism. It is a chronic, relapsing brain disease that includes:

  • Compulsive use of alcohol
  • Loss of control when it relates to alcohol
  • A noticeable bad mood when not drinking

Alcohol dependence is progressive, too. What might seem harmless at first can get worse if it’s not treated. And the worst of alcohol use disorder (AUD) can be deadly.

Close to 88,000 people in the U.S. die from alcohol-related causes every year. Only smoking, poor diet, and lack of physical activity kill more. About 31% of all driving-related deaths are linked to alcohol.

AUD affects nearly 16 million Americans. It can range in seriousness from mild to moderate to severe.

Knowing what AUD looks like is the first step in combating it.

Diagnosis

Officially, AUD is diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM). The manual lists 11 questions used to uncover typical symptoms. If you or someone you know has two of the symptoms in a 12-month period, they’ll be diagnosed with AUD.

The severity of the AUD depends on how many of the symptoms they have. A hit on six or more questions can be considered a severe case of AUD.

A doctor will ask the questions, which all start with, “In the past year, have you ... ”

They will include:

  • Spent a lot of time drinking? Or spent time being sick or getting over other aftereffects?
  • Wanted a drink so badly you couldn’t think of anything else?
  • Continued to drink even though it was causing trouble with your family or friends?
  • Had to drink much more than you once did to get the effect you want, or found that your usual number of drinks had much less effect than before?
  • Found that drinking -- or being sick from drinking -- often interfered with life responsibilities?

The DSM is the latest attempt by doctors to understand and diagnose this disorder. It builds on evolving research on the dangers of alcohol.

Continued

The Stages of AUD

In the earliest stages of alcoholism and AUD, behavior can include:

  • Drinking more than planned
  • Continuing to drink despite concerns from others
  • Frequent attempts to cut down on or quit drinking

The disorder progresses as the drinker becomes more tolerant to alcohol and has to have more to get the desired effect. If a person becomes dependent on alcohol and a drink isn’t available, they can have symptoms of withdrawal that can include:

As the disease becomes more severe, blackouts and loss of control can happen. Personality changes begin to show. And the physical costs of excessive alcohol use become noticeable.

It can cause (or make worse) problems like:

E. Morton Jellinek, a pioneer in the study of alcohol abuse and dependence, suggested “progressive phases of alcoholism” in 1950, which led to the Jellinek curve, which is still widely used.

The curve, tweaked over time, begins with the start of problem drinking and advances through physical problems like neglecting food and blackouts, and mental problems like guilt, resentment, and a change in moral compass that often accompany AUD.

It bottoms out with obsessive drinking.

But the Jellinek curve doesn’t end at the bottom. It moves upward after that into the “rehabilitation” phase.

How to Get Help

Treatment can help most people who have AUD. First, reach out to your doctor. They can assess your needs and help you figure out where to get help, including:

  • Group therapy
  • Family counseling
  • Long-term rehab programs
  • Alcoholics Anonymous
  • Outpatient treatments

In addition, medications may be able to help ease or stop drinking and guard against relapses.

For those who need help right away, the Substance Abuse and Mental Health Services Administration hotline is a good place to start. It’s a 24-hour free, confidential resource. Experts will point you to people in your area who can help.

The number is 800-662-HELP (800-662-4357).

WebMD Medical Reference Reviewed by Smitha Bhandari, MD on February 13, 2019

Sources

SOURCES:

National Institute on Alcohol Abuse and Alcoholism: “Alcohol Use Disorder.”

CDC: “Alcohol and Public Health: Alcohol-Related Disease Impact (ARDI).”

National Institute on Alcohol Abuse and Alcoholism: “Alcohol Facts and Statistics.”

National Institute on Alcohol Abuse and Alcoholism: “NIAAA Strategic Plan, 2017-2021.”

Mayo Clinic: “Alcohol use disorder.”

Miller, P. The International Journal of Psychiatry in Medicine, April 22, 2013.

National Institute on Alcohol Abuse and Alcoholism: “Alcohol Use Disorder: A Comparison Between DSM-IV and DSM-5.”

Harvard Health Publishing, Harvard Medical School: “Alcohol abuse.”

Journal of Studies on Alcohol and Drugs: “Re-Introducing Bunky at 125: E. M. Jellinek’s Life and Contributions to Alcohol Studies.”

National Institute on Alcohol Abuse and Alcoholism: “What Types of Alcohol Treatment Are Available?”

National Institute on Alcohol Abuse and Alcoholism: “Frequently Asked Questions: Searching for Alcohol Treatment.”

Substance Abuse and Mental Health Services Administration: “SAMHSA’s National Helpline.”

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