Understanding the Stages of Alcoholism

Alcohol is one of the most used and misused substances in the world. It is a central nervous system (CNS) depressant, which slows down brain activity and induces drowsiness and relaxation. While drinking is common, it is not social drinking or moderate, controlled drinking that is a reason for concern. It is when drinking becomes frequent and uncontrolled, leading to dependence and alcohol use disorder, that is when it becomes dangerous.

The National Institute of Alcohol Abuse and Alcoholism says that nearly 28.9 million Americans aged 12 or older suffer from alcohol use disorder every year. Now, this does not develop overnight. There are stages of alcoholism that eventually lead to alcohol dependence and alcohol use disorder. In this blog, we shall seek to understand the same, as understanding the different stages of alcoholism can lead one to seek help before it turns into dependence or a substance use disorder.

What Is Alcoholism?

Before we get into the stages of alcoholism, let us first seek to understand what alcoholism is. Alcoholism was first identified as a disease nearly 70 years ago in 1956 by the American Medical Association or the AMA. It refers to a chronic condition characterized by uncontrolled drinking.

• For males, heavy drinking is defined as 5 or more drinks within 2 hours or 15 or more drinks in a week.
• For females, heavy drinking is defined as 4 or more drinks within 2 hours or 8 or more drinks in a week.

Alcoholism is also characterized by a dependence on alcohol, which can be physical and psychological. What this means is that when a person engages in repeated and heavy drinking, the body gets used to alcohol content after a while. If this is cut off or stopped, then the body cannot function normally and experiences withdrawal symptoms. Alcohol withdrawal symptoms are intensely unpleasant and can lead to life-threatening conditions like delirium tremens if not addressed immediately.

What Are The Stages Of Alcoholism?

Now, to the stages of alcoholism. Alcoholism stages or levels of alcoholism are five in total. Also known as the Jellinek Curve for the psychiatrist who proposed it, E. Morton Jellinek, they describe the typical stages of alcoholism and recovery. Understanding them helps in knowing that alcoholism progresses as a condition and can lead to dependence if the vicious circle is not broken. However, at the same time, the stages of alcoholism also indicate that there is a silver lining in the form of recovery.

1. Stage 1 – This is known as the pre-alcoholic stage. It is when alcoholism is not yet a problem but can become one depending on the reasons why a person consumes alcohol. For instance, is the person consuming alcohol to unwind, fall asleep, or to let go of any social inhibitions? If the answer is yes, then alcohol consumption can progress to the next stage. 
   Spotting the pre-alcoholic stage is quite difficult. It does not overtly look anything different from social drinking. However, the devil is in the details. Does a person have a drink in hand in any social situations? Do they drink to deal with the challenges of a long, arduous day or a week? Do they drink to sleep well? These are some indications of the pre-alcoholic stage.
   
   
2. Stage 2 – This is known as the early alcoholic stage. Some signs of the early alcoholic stage are preoccupation with drinking, excessive drinking, lying about excessive drinking, and drinking to the point where one experiences a blackout.
   Early-stage alcoholism is easier to spot than pre-alcoholic stage. In this stage, the condition has progressed far beyond what seemingly looks like social drinking. Binge drinking (5 or more drinks for males and 4 or more drinks for females within 2 hours) is common in this stage and even blackouts are experienced. In the early alcoholic stage, binge drinking episodes do not happen every day, but they can happen regularly.
   Early alcoholic stage is a reason for concern. Even if alcoholism does not progress beyond this stage, regular binge drinking can lead to many health complications. Hence, it must be addressed as early as possible.
   
   
3. Stage 3 – This is known as the middle alcoholic stage. In this stage, struggles with alcohol become evident. Physical signs of alcohol abuse, like slow gait, sluggishness, weight gain/loss, and bloated stomach are visible. Moreover, irritability, frustration, and forgetfulness are some psychological signs that also begin to show.
   Middle-stage alcoholism is where alcoholism progressively gets worse. While health complications might not have gone too far, treatment and even rehabilitation at this stage can prove to be more beneficial than the fourth stage.
   
   
4. Stage 4 – This is known as the late alcoholic stage. In this stage, alcohol takes the center stage in life. Everything revolves around it. Alcoholism threatens relationships, career, and even livelihood. There are times when efforts are made to curb drinking, however, this leads to intense withdrawal symptoms like tremors, paranoia, and even psychosis.
   End-stage alcoholism is the most severe stage of alcoholism. Treatment needs to be provided as soon as possible. Otherwise, alcoholism can turn deadly as it can give rise to health complications like cancer and cirrhosis.
   
   
5. Stage 5 – This is the recovery stage. In this stage, the treatment involves medically-supervised detoxification or detox, treatment, maintenance, and transcendence. It is when a person is able to actively disengage from alcoholism and find new purpose in their life, a life characterized by sobriety and health.
   Lasting recovery and sobriety become possible with treatment and rehabilitation. These involve detox, psychotherapeutic interventions, 12-step recovery programs, and ongoing care.

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Early Signs of Alcoholism

Alcoholism is a condition that progressively gets worse. Therefore, spotting early signs of alcoholism can be useful in getting the help needed. Early treatment is greatly beneficial, and there is no such thing as enough alcoholism to get treatment.

Some early signs of alcoholism are as follows:

• Drinking more than planned.
• Wanting to be where the drinks are.
• Drinking at odd times, like after waking up, or even at work.
• Hiding alcohol and lying about alcohol use.
• Changes in relationships, like avoiding contact.
• Increased lethargy.
• Increased problems in academics or professional life.

Physical And Mental Effects Of Chronic Alcoholism

Chronic alcoholism is a dangerous thing. Alcohol takes precedence over everything else in life, leading to a number of unwanted physical and mental effects:

• Decreased self-care
• Anxiety
• Depressed mood
• Sleep difficulties, characterized by sleeplessness and even wakefulness
• Rapid weight gain or loss
• Slow gait and sluggishness
• Lethargy
• Shaky hands
• Puffy face
• Red, glazed eyes
• Severe bouts of sweating and vomiting

In the long-term, alcoholism can give rise to:

• Weakened immune system
• Cirrhosis of the liver, characterized by scarring of the liver
• Pancreatitis or inflammation of the blood vessels in the pancreas
• Cancer
• Cardiovascular conditions, which can lead to heart attacks and strokes
• Brain damage, which can lead to motor imbalance, blurred vision, slurred speech, slow reaction times, and memory difficulties.

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What Are The 5 A's Of Alcoholism?

The 5 A’s of alcoholism are the 5 major steps of intervention. They can relate to alcohol use but can also relate to other substances like tobacco use and so on. The 5 A’s of alcoholism are as follows:

1. Ask – By asking, one can identify the alcohol use status of each client during their visits.
2. Advise – In a strong yet personalized manner, the clients can be advised to quit alcohol.
3. Assess – This involves assessing whether the client is ready to quit alcohol this time. For every visit during treatment, this can vary.
4. Assist – Once the client has made the commitment to quit alcohol, assist them in quitting alcohol. This can be done with rehabilitation and treatment.
5. Arrange – This involves arranging follow-up contacts either in person or even via phone, and is best served if scheduled in the first week after the quit date.

For any successful intervention, the 5 A’s help in identifying the willingness to quit and in designing the personalized treatment plans that will assist clients in their journey toward recovery and sobriety.

Alcohol Dependence and Withdrawal

Alcohol dependence and withdrawal are interconnected conditions, and both are dangerous. With chronic, uncontrolled alcoholism, what happens is that the body becomes accustomed to a certain level of alcohol. Now, alcohol is a CNS depressant. It slows down the activity of the central nervous system, and the body seeks to keep its effects at bay and continue functioning. However, if alcohol intake is cut off, even for a short period of time (6 – 12 hours), the CNS cannot accommodate this, leading to over activity and withdrawal symptoms.

Alcohol withdrawal symptoms are as follows:

• Anxiety
• Irritability
• Restlessness
• Wakefulness
• Tiredness
• Low mood
• Sweating
• Headache
• Abdominal pain
• High blood pressure
• Increased heart rate
• Tremors
• Hallucinations
• Seizures
• Hyperthermia or increased body temperature
• Delirium tremens, a condition characterized by delirium, psychosis, sweating, seizures, rapid heartbeat, and hyperthermia.

Treatment Options for Alcoholism at Every Stage

Treatment options for alcoholism are many and the good thing is that treatment is available at all stages of alcoholism. One does not have to reach a certain stage or be alcoholic enough to reach out for help in the case of alcoholism.

1. In the pre-alcoholic stage, a drinking problem is difficult to identify. Usually, alcohol is consumed as a way to cope with stress, anxiety, and other negative emotions. In this stage, lifestyle changes, counseling, and support groups like Alcoholics Anonymous can be beneficial.
   
   
2. In the early alcoholic stage, alcoholism begins to become evident. So, psychotherapeutic interventions like motivational interviewing, cognitive behavioral therapy, and contingency management can help. At the same time, medications like acamprosate and naltrexone can help in reducing cravings and preventing heavy drinking. Support groups like Alcoholics Anonymous can be beneficial.
   
   
3. In the middle alcoholic stage, alcoholism well and truly becomes a struggle. At this stage, support groups like Alcoholics Anonymous tend to be very beneficial. Medically-supervised detox is needed to minimize and manage withdrawal symptoms. Psychotherapeutic interventions like motivational interviewing, cognitive behavioral therapy, and contingency management as well as medications like disulfiram help in recovery and lasting sobriety.
   
   
4. In the late alcoholic stage, alcohol use takes over everything else in life. Inpatient rehabilitation is required for severe alcohol dependence and medically-supervised detox is also needed to minimize and manage withdrawal symptoms. At the same time, ongoing intensive psychotherapy and aftercare are also needed for preventing relapse and lasting recovery.

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Why Early Intervention is Key?

Early intervention is the key to treating alcoholism. The stages of alcoholism, as we learned before, are actually a vicious circle. If not broken, they progressively become worse until the person becomes a shell of what they used to be before. Alcohol consumption takes precedence over everything in life, including family, friends, academics, and so on.

Early intervention nips alcoholism in its bud. It improves the outcomes by preventing severe physical and mental effects of alcoholism and also relapse. Moreover, early intervention enables the person to maintain healthy relationships, career stability, and overall well-being.