From recreational drinking to problem drinking to the late stages of alcohol addiction, the disease of alcoholism goes through several phases. For most alcoholics, drinking begins as a social activity. As the body develops a tolerance to alcohol, however, recreational consumption may turn into risky drinking, which can evolve into a physical and psychological dependence on the drug. At this point, your health is seriously compromised, and damage to your body, your relationships and your overall well-being may be profound.
You don’t have to be at the end stages of alcoholism to seek help with this devastating disease. If you binge drink at parties or your alcohol consumption has been increasing lately, you may already realize that you have a problem. No matter where you are on the spectrum of alcohol addiction, professional treatment is the way to get sober and achieve long-lasting abstinence.
Screening for Alcoholism
There are a number of popular screening tools available that can help you determine whether you have a problem with alcoholism. The CAGE Questionnaire for the Detection of Alcoholism, published by Dr. John A. Ewing in the Journal of the American Medical Association in 1984, is a basic yet effective tool for gauging the degrees of alcohol addiction. The test consists of four questions, which feature keywords that spell out the acronym CAGE:
- Have you ever felt that you should cut down on your alcohol consumption?
- Have you ever been annoyed when other people made critical remarks about your drinking?
- Does your drinking ever make you feel guilty?
- Do you need an alcoholic beverage, or eye opener, to deal with hangover symptoms or get yourself moving in the morning?
According to the National Institute on Alcohol Abuse and Alcoholism, you may be at risk for alcoholism if you answered “yes” to one of the questions in the CAGE questionnaire concerning your drinking habits in the past 12 months. Answering “yes” to two questions may indicate that you have a drinking problem, and three or four positive answers indicate that you may have reached the dependence stage of alcohol addiction.
Early Stages: The At-Risk Drinker
The at-risk drinker often doesn’t realize that he or she has a potential problem. Men who consume an average of two drinks a day every day, or who consume four or more drinks during any given episode, may be at the early stages of alcohol addiction. Women who drink an average of one alcoholic beverage per day, seven days a week, or who drink three or more beverages at each episode may be at risk.
According to Alcohol Research & Health, positive reinforcement caused by drinking motivates the at-risk drinker to continue. Positive reinforcement occurs when the drinker experiences feelings of pleasure, contentment or relaxation after consuming alcohol. These pleasant experiences can perpetuate the behavior even if you have a negative alcohol-related incident, such as a fight with a friend when you’re intoxicated. In the early stages, before chemical dependence begins, drinking is usually considered to be a rewarding experience, and the benefits seem to outweigh the risks.
In the at-risk stage, giving up alcohol doesn’t seem to be a problem. You may be able to go for days, weeks or even months without a drink.
Middle Stages: The Problem Drinker
At-risk drinking turns into problem drinking when your consumption of alcohol increases and your alcohol use begins to take a noticeable toll on your life. You may have problems at work, an arrest for drunk driving, conflicts in your marriage or difficulties with your finances. WebMD cautions that you may also have health problems at this stage, such as:
- Weight gain or bloating
- Broken blood vessels in your cheeks
- Abdominal pain
- Blackouts (temporary memory loss during a drinking episode)
- Sleep disturbances
If you try to cut back on your drinking in the problem stage, you may experience headaches, anxiety, an upset stomach, insomnia or tremors. These symptoms are signs that your body is in withdrawal. Withdrawal takes place when your system is becoming dependent on alcohol.
At the problem stage, drinking no longer seems quite so easy to control. You may have strong cravings when you’re not drinking and obsess over when and how you’ll get your next drink. Many problem drinkers can still function at a surprisingly high level and may appear to be very successful at work. But these drinkers are often walking a very fine line between alcohol abuse and full-blown addiction. Attempts to quit drinking may be temporarily successful, but unless the problem drinker goes through a comprehensive rehab program, the chances of a relapse are very high.
Late Stages: The Dependent Alcoholic
At the dependence stage, giving up drinking without medical help may not only be extremely difficult, it may endanger your life. Alcohol dependence is characterized by all of the symptoms of addiction, including chronic relapses, a high tolerance for alcohol, and compulsive use of the drug in spite of your understanding of the consequences.
In the later stages of alcoholism, damage to the body and mind are severe. American Family Physician lists some of the most common chronic health problems associated with chronic alcohol use:
- Liver disease (cirrhosis)
- High blood pressure
- Heart disease
- Stomach ulcers
- Neurological disorders, such as Wernicke’s syndrome, neuropathy and brain atrophy
- Cancer (especially of the head and neck, liver, stomach or pancreas)
Social and personal problems may include divorce, loss of child custody, unemployment, homelessness, arrest or imprisonment. But at this stage of the disease, the alcoholic relies so heavily on the drug that giving it up may be literally impossible without medical detox. At this stage, the side effects of withdrawal – delirium tremens, seizures, sudden hypertension, hyperthermia, etc. — are so severe that medical supervision is necessary during detox to prevent life-threatening complications.
Rehab and the Degrees of Alcoholism
When you enter rehab, one of the first steps in your intake evaluation will be assessing your degree of alcoholism. Your treatment team will need to know how long you’ve been drinking, how much you drink on a daily or weekly basis, and whether you’ve suffered any health complications as a result of your alcohol consumption. If you’ve been through detox before, whether alone or at a rehab facility, your provider will need to have this information too.
For drinkers in the early to middle stages of alcohol addiction, inpatient medical detox may not be necessary. Outpatient detoxification can be very effective for heavy drinkers who have no serious health complications and who are still able to manage their drinking to some degree, notes the Journal of Family Practice.
Alcoholics in the latter stages of the disease may need intensive inpatient care while they go through detox, especially if they’ve been through detox before without the proper treatment. Other factors that may contribute to the need for inpatient treatment include:
- Having a serious co-existing health problem, like heart disease or kidney failure
- Having a serious psychiatric disorder, like schizophrenia or major depression with suicidal ideation
- Having a history of severe complications during past detox attempts
- Being pregnant
The addiction specialists here at Axis are trained to identify the degrees of alcoholism and to help you get the level of treatment you need for your specific condition. No matter where you are in the evolution of the disease, our compassionate professionals are concerned about providing the best possible care.