Stages of Alcoholism

       The stages of alcoholism is a sneaky disease that tricks you into thinking you’re in control while slowly tightening its grip on your life. What starts as harmless experimentation can evolve into dependence, which can quickly cause alcohol cravings that turn into abuse. There isn’t an aspect of the alcoholic’s world left untouched by it; relationships crumble or health suffers greatly (key word: greatly), dangerous choices are made without any seeming consideration for consequences. Recognizing these stages can help prevent you or someone you love from slipping farther down this hole of addiction and seek appropriate help.

Stage 1: Binge Drinking

stages of alcoholism

        The first stage of alcoholism is typically binge drinking. Which is practically a rite of passage for many young adults who are new to alcohol and likely to experiment. Social situations, such as college parties or happy hours with coworkers, increase the pressure to drink, and boundaries are tested by drinking large amounts in a single sitting. The National Institute on Alcohol Abuse and Alcoholism defines binge drinking as more than five drinks in two hours for men, and four for women. The average binge drinker consumes an average of eight alcoholic drinks per binge. Even though binge drinkers are rarely considered alcoholics, the habit is still problematic. According to the American Medical Association, binge drinking is more likely than other types to cause an accident on the road. Regular binge drinking can lead to cycles of debilitating blackouts and memory loss, not to mention a serious toll on your liver.

Stage 2: Drinking to Deal with Feelings

stages of alcoholism

         If you find yourself looking forward to a stiff drink after a long day, you might be at risk of falling into the second stage of alcoholism. Drinking as a response to stress or strong emotions is a red flag behavior. When you drink in a stressed state, the alcohol triggers your dopamine receptors more powerfully than when you’re relaxed. As a result, you’ll naturally want to drink more as a way to seek those feel-good hormones. Not only can this be hard to stop, but it can also lead to negative consequences like job loss, financial problems, and relationship troubles. If you find yourself struggling with this behavior, it’s important to seek help from a professional before it’s too late.

Stage 3: Problematic Drinking

stages of alcoholism

         Problem drinking doesn’t just impact the drinker, it also takes a toll on those around them. At this stage in alcoholism, the drinker begins to move alcohol to the forefront of their life, often at the expense of work, relationships, and social activities. Consequences begin to build as a result of drinking, including financial problems, legal troubles, and relationship issues. The addict may try to hide their drinking from others or downplay the severity of their problem, but eventually the truth will come out. As the consequences of alcoholism mount, so does the pressure on the addict to get help. If they don’t seek treatment at this stage, they may continue to spiral downward, leading to more serious health problems, job loss, and homelessness. Thankfully, there is help available for those who are willing to seek it. With treatment, alcoholism can learn to manage their disease and live a healthy and fulfilling life.

Stage 4: Deterioration

As the disease progresses, drinking becomes more frequent. People suffering from this stage are often unable to hold down a job. Their behavior is erratic, and their waking hours are filled with thoughts of alcohol if not actually drinking, may have jaundice skin or eyes from liver damage. The alcoholic no longer holds any control over their drinking. They must drink to function or he will become sick and may experience severe withdrawals if stopped abruptly. Symptoms of alcohol withdrawal may include nausea, tremors, extreme irritability, and even hallucinations. If you or someone you know is struggling with alcoholism, it is important to seek professional help as soon as possible. Alcoholism is a serious disease that can be difficult to overcome without treatment.

Medication Options for Alcohol Abuse

  • Naltrexone: Naltrexone can reduce cravings up to 80% and can be an effective treatment for alcohol abuse when used in combination with other therapies.        Naltrexone is a medication that has been used to treat alcohol abuse and alcohol use disorder for many years. It is a part of the opioid receptor antagonist family, and it helps to block the effects of opioids in the brain. This can be helpful for people who are struggling with alcohol addiction, as it can help to reduce cravings for alcohol.
  • Antabuse: Another medication which is not as widely used due to side effects when consumed with alcohol is called antabuse. It is a pill taken once daily like naltrexone and it creates an aversion to alcohol so that when people have even the slightest sip they will have intense GI symptoms (leave to the imagination), increased heart rate, palpitations, sweating, and will experience feelings of malaise.
  • Topamax:Topamax is another option for alcohol treatment. It is an anti-seizure medication that has been shown to be effective in treating alcohol use disorder, although not FDA approved and not fully understood.  Topiramate is thought to have its effect on alcohol cravings and alcohol use by interacting with GABA and potentially decreasing the release of dopamine, which is involved in the pleasure caused by alcohol consumption.
  • Campral: Campral is also an option for alcohol abuse however it requires a multi-dose daily (3) administration to be effective which can be difficult for compliance

Abstinence or Harm Reduction Practice

         Alcoholics Anonymous is a popular modality which includes groups many find helpful in conjunction with medication or therapy. AA meetings take place all over the world and are free to attend. The 12 step program followed by AA is based on abstinence from alcohol, and members support each other through their recovery journey. If you would like to find an AA group near you, please visit this link. 

       If AA or an abstinence program is not for you there are other options available to reduce harmful drinking. Hazardous drinking reduction has experienced its share of controversy, especially from leaders in the abstinence community who believe that true alcoholics must abstain from alcohol completely. Harmful drinking reduction program ideologies require accountability and deep reflection to truly identify how drinking impacts your life and how reduced drinking can improve areas such as relationships, legal problems, motivation, physical health, your career, and others. Including medication to decrease cravings, having a support network, and working with a counselor or coach can be beneficial in your recovery process if you are not ready to fully quit. 

Alcohol Abuse as a Secondary Symptom

        Lastly alcohol use disorder may also be a symptom of an underlying anxiety, depression, or even a reaction to trauma. In these cases dual diagnosis treatment may be necessary to help address both the alcohol abuse as well as the anxiety, depression, ptsd, or another condition. Untreated or poorly managed ADHD can also commonly lead to alcohol abuse due to poor impulse control and dysregulation of certain neurotransmitters. 

       Two common therapies which can be used to treat alcoholism are cognitive behavioral therapy (CBT), and exposure therapy. CBT is a type of therapy that helps people to learn how to change their thoughts and behaviors. Exposure therapy is a type of therapy that helps people to face their fears in order to overcome them for example if you are struggling with unresolved trauma. 

       Hazard reduction programs or abstinence programs such as Alcoholics Anonymous can be helpful for people in recovery. If you would like to learn more about any of these options, please speak to your doctor or therapist. They will be able to advise you on the best course of treatment for your individual needs.

Want to learn more? Read on here to learn why alcohol causes cravings and the effect on the brain.

Medication Management & Counseling