What does the Progression of Alcoholism Look Like in the Average Alcoholic?
By the age of 15, 33 percent of teenagers in the United States have had at least their first drink. By the age of 18, this number jumps to about 60 percent.
7.7 million youths ages 12 to 20 reported drinking at least one drink in 2015.
Alcohol is prevalent and pervasive in American culture. Draft beer advertisements adorn every commercial break during an NFL game. Hard liquor companies are permitted to take out entire billboards of space to advertise their liquid courage.
Alcohol seems to be mixed into nearly every activity possible today. Yoga and wine, marathons and beer, TV shows and shots. Everywhere we look, alcohol is available.
So it shouldn’t be a surprise that America’s young people begin drinking at such an early age. The real question, though, is how alcoholism develops once these young people have become adults.
Is alcoholism active from the moment of the first drink or is it more of a problem that develops over time? Can we pinpoint a specific moment that someone becomes an alcoholic or are they always an alcoholic who just hasn’t drank heavily enough yet?
Where does alcoholism start? What even determines whether or not someone is an alcoholic? These are all questions to consider when outlining the stages of alcoholism like this post aims to do.
What Makes Someone an Alcoholic?
The definition of an alcoholic is a vague one. Alcoholism is not a term you will find used in the medical field; it’s a term used in everyday language to describe someone who drinks to excess.
In medical terms, alcoholism is referred to as alcohol use disorder (AUD). The presence of an AUD is determined by a set of 11 criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).
In order to be diagnosed with an AUD, in the past year you must have either:
- Drank a larger amount or for longer than you originally intended.
- Wanted to cut down or quit drinking but found yourself unable to.
- Spent an excessive amount of time drinking or being sick as a result of drinking.
- Experienced a craving for alcohol when not drinking, or wanted a drink so badly you couldn’t think of anything else.
- The time spent drinking or being sick from drinking often interfered with your ability to take care of your home or family, or caused problems at work or school.
- Continued to drink despite the consequences you experience, such as trouble with family or friends.
- Cut back on or stopped participating in activities that you once enjoyed as a direct result of drinking.
- Found yourself in dangerous situations multiple times as a direct result of drinking, such as driving, swimming, occupying dangerous areas, or having unsafe sex.
- Continued to drink despite the negative feelings it created, such as depression or anxiety, or the worsening of another health problem, or a blackout.
- Developed a tolerance to alcohol, or the need to drink a larger amount in order to achieve the desired effect.
- When you weren’t drinking, you experienced withdrawal symptoms such as difficulties sleeping, body tremors, nausea, sweating, or seizures.
There are three different levels of severity for alcohol use disorders, determined by the number of criteria you experience:
- Mild: 2 to 3 symptoms
- Moderate: 4 to 5 symptoms
- Severe: 6 or more symptoms
It’s easy to go through the list, answer yes or no to each, and determine which category your alcohol use places you in.
What are the Different Stages of Alcoholism?
Now that you know what makes someone an alcoholic, what are the steps that lead up to someone drinking alcohol so heavily?
Depending on who you ask, alcoholism usually does not develop overnight. Occasionally you will hear from people who “drank alcoholically from the very beginning.” Some never “learned” to drink in a social manner.
More often than not it begins with casual drinking during early or late teenage years and tends to progress over time. Depending on whether or not you put a stop to your drinking at a certain point,
It’s difficult to pinpoint an exact moment when someone crosses over into the point of alcoholism. If you’re honest with yourself, though, you will know when your drinking has passed beyond the limits of “normal” drinking.
The National Institute of Alcoholism and Alcohol Abuse outlines a few different levels of drinking:
- Moderate (“Normal”) Drinking: 1 drink per day for women and 2 drinks per day for men.
- Binge Drinking: Any drinking that brings your blood alcohol concentration up to 0.08, which usually means 4 drinks for women and 5 drinks for men over the course of about 2 hours.
- Heavy Alcohol Use: Having binge drinking episodes on 5 or more days in the past month.
Once someone starts drinking, the progression of alcoholism can usually be broken into four stages: The Adaptive Stage, The Dependence Stage, The Progression Stage, and The Conclusion Stage.
What do each of those mean?
Stage 1: The Adaptive Stage
The adaptive stage usually begins when a drinker uses drinking as a means to cope with or escape from reality. Alcohol becomes a way to blur the sharp outlines of life and take the edge off after a long day.
Many people will have a drink in the evenings after work. This is the time when your drinking either remains at the moderate level or progresses into the next stage.
During the adaptive stage, alcoholics begin to escape from feelings of frustration or fear. Alcohol becomes more of a coping mechanism rather than just a relaxing drink at the end of the day. The drink is not quite enjoyable so much as it is a habit.
Tolerance also begins to develop during the adaptive stage. As you drink each evening, the drinks begin to provide less and less of the effect you are looking for. When you use them to relieve feelings, you eventually need to drink more to achieve the desired effect.
Stage 2: The Dependence Stage
Once you begin to develop a tolerance to alcohol, you start to enter the dependence stage. Now that your body has a tolerance it expects the alcohol at a certain time. You likely start drinking earlier in the day to compensate for the frustration that settles in during the afternoon.
Oftentimes you begin to plan your day around when you’ll be able to have a drink. Maybe it’s a a drink or two with your lunch in the middle of the day or it’s a couple of beers with your coworkers after work. Perhaps you stop in at the bar on the way home if you can’t wait.
The dependence stage is when you might start to realize there is something abnormal about your drinking. Family, friends, and coworkers may begin to notice how often you focus on drinking.
However, it is still easy to find excuses for a drink. Enough drinking takes place throughout the day in regular society to make it somewhat acceptable at this point. It’s more than average drinking but and you’re developing a dependence, but it’s simple to find ways to explain why you’re doing it.
“If you had the stresses I did you would drink, too.”
“Oh, it’s just a couple drinks with the coworkers.”
“Everyone has a beer at lunch when we go out. There’s nothing wrong with it.”
Sure, there’s nothing wrong with it at this stage. The consequences of your drinking are still minimal. Hangovers are common, blackouts begin to happen, and perhaps the morning shakes even start. Nausea is often a constant companion.
It’s still manageable, though. But if you continue to progress, things will really begin to go wrong.
Stage 3: The Progression Stage
The progression stage is where the loss of control really begins to take hold. During the dependence stage you still planned your day around the drink. Now you simply take it with you wherever you go.
The morning drink is a daily ritual. You most likely bring alcohol with you in a water bottle or keep some handy in your desk at work. You drink throughout the day and keep a steady supply going.
Your drinking has now isolated you from friends and family. The hobbies you once enjoyed are long gone, a thing of the past. Drinking is your constant companion, the thing that keeps you going. You rely upon your drinks to function.
Personal hygiene begins to slide to the back burner and eating properly is a thing of the past. The fact that you have a problem is undeniable at this point; there is no dodging the question. You might try to quit and find yourself unable to.
You might even think this is the final stage of alcoholism but there is still another level to drop down to.
Stage 4: The Conclusion Stage
Loss of control is obvious. You no longer take care of yourself and your responsibilities have long been neglected. You are likely behind on bills and have built up credit card debt to support your drinking.
Your friends are gone and your family likely is as well. You’ve most likely tried to quit multiple times by this point and found it seemingly impossible. You have become a slave to the bottle. Your alcoholism is undeniable at this point.
Physical symptoms are excruciating. You are unable to hold food down, the tremors begin mere hours after your last drink, hallucinations have likely started, and seizures might have even set in.
Delirium tremens are a possibility at this point as well. Oftentimes, without medical attention, this stage of alcoholism can be incredibly dangerous. The best course of action at this point is to seek alcoholism treatment to help pull you out from the hole you’ve dug yourself into.
How Do You Find Help at the Conclusion Stage?
The stages paint a bleak picture of alcoholism but alcoholism is a bleak disease. There is nothing noble about an alcoholic death; it is slow, painful, and pitiful. However, even if you’re in the fourth stage of alcoholism, there is still hope for you.
Addiction and alcoholism treatment have helped countless alcoholics who once thought they were hopeless as well. You don’t have to recover alone, though. Working towards recovery alongside people with the same goals as you makes achieving it that much more possible.
There are multiple options for addiction and alcoholism treatment. The option you select can depend on a number of factors, including at which stage you chose to put the bottle down.
Detox is the best option to begin with for those who made it all the way to the conclusion stage. During detox, you will detox from alcohol under the care of doctors and nurses who provide round-the-clock care to ensure you are as safe as possible.
During detox, the staff helps manage and keep withdrawals at bay through the use of medication. When you are in the fourth stage of alcoholism, this will make the detox period as manageable as possible.
After detox there are a number of other treatment options available to you. There is no single right or wrong way to get sober, just the way that works for you and keeps you away from the bottle.
Again, even if you reach the fourth stage of alcoholism, there is still hope for you. Find out more about the choices you have and take action today to make a change in your life. No one is beyond help. You deserve a chance at sobriety no matter how far down you have dug.