MODULE II: Awareness

Stages of Alcoholism1

 

Competency 1 - Be aware of the:
Generally accepted definition of alcohol and other drug dependence
Societal stigma attached to alcohol and other drug dependence

Competency 2 - Be knowledgeable about the:
Signs of alcohol and other drug dependence
Characteristics of withdrawal
Effects on the individual and the family (household)
Characteristics of the stages of recovery

Competency 3 - Be aware that possible indicators of the disease may include, among others:
Marital conflict, Family violence (physical, emotional and verbal), Suicide, Hospitalization, or Encounters with the criminal justice system

Competency 4 - Understand that addiction erodes and blocks religious and spiritual development; and be able to effectively communicate the importance of spirituality and the practice of religion in recovery, using the scripture/sacred writings, traditions and rituals of the faith community

In refining further what symptoms one looks for to detect alcoholism, the stages of addiction can be presented in paradigmatic fashion. It is important always to remember that these are not rigidly determined in sequential fashion, since there is a tremendous amount of fluidity in the way in which the illness progresses in a person.

mod2_clip2 Clip from Recovering Nation

Stage 1 – Early Signs (signs that may be evident)

  • The person drinks to reduce tension, anxiety or avoid conflict.

  • Consumption begins to increase to get the desired effect.

  • Turning to alcohol or any other mood altering substance becomes the first thought of the person when experiencing stress.

Professionals in the field then speak about crossing the invisible line from frequent or even abusive drinking to addictive drinking. It is virtually impossible to pinpoint this transition, but exactitude diagnostically is less important than the realization that the person is no longer controlling the alcohol; rather the alcohol is controlling the person. See Module II Handout 3 for Signs of Alcohol and Drug Dependence.

Stage 2 – Clear Signs (warning signs)

  • Blackouts that refer to the person's inability to recall what occurred when drinking. It is a kind of amnesia that is frightening. Example: a person could not recall receiving a phone call or the substance of the conversation, but the next morning realized that a friend had called because the cell phone indicated that a conversation had taken place.

  • Gulping/sneaking drinks that result in rapid ingestion in order to get the desired effect more quickly. Being aware that this kind of drinking is "different" from what others do, the person hides the drinking or volunteers to serve at the bar at a party.

  • Chronic hangovers involve the after-effects of a drinking episode. The body begins to crave the alcohol and the craving is ameliorated by taking another drink, to elevate the blood alcohol count and preclude the experience of withdrawal.

  • Preoccupation with drinking not only means that the person is drinking more and more, but that her/his time, energy and attention are focused on getting the next drink.

  • Avoiding references to drinking in conversation with others. There is the intuitive awareness that the drinking is out of control and there is great discomfort and defensiveness if someone challenges the person about the drinking episodes and behavior.

Stage 3 – Critical Stage (warning signs)

  • Loss of control means that the user cannot predict what will happen once the first drink is consumed. Alcoholics Anonymous has a slogan that speaks to this situation, "One drink is too many and a thousand is not enough!" The complete loss of any control is really the hallmark of addiction.

  • Alibi system is frequently used to justify the using because the drinking is out of control. The addict becomes defensive if s/he believes that others are concerned. Herculean efforts are expended in order to convince others as well as her/himself that alcohol is not the problem. The alibis used are as varied as there are people. The drinking may be blamed on a bad relationship, difficulties at work, one's geographic location or even the weather.

  • Changing the pattern is another symptom of the critical stage. An example would be changing the time of drinking, using another form of alcohol, making promises to the self or others that are broken because they can't be kept.

  • Rejection by significant others who are frustrated with the situation and find the alcoholic intolerable and obnoxious, particularly when using. Sometimes the alcoholic will reject significant others first in order not to experience the rejection. It is a "I will beat them to the punch" mentality.

  • Loss of friends and a circumscribed social life-the behavior of the addict is unacceptable and often incomprehensible to friends who exclude the alcoholic from social gatherings. Once again, if the addict senses this is coming, s/he may reject the friends using the same rationale as with significant others.

  • Loss of job comes as a result of erratic, incompetent, slovenly work; frequent accidents, unexplained absences and tardiness and perhaps conflict with co-workers. Though most heavy alcoholics are employed, they have high rates of turn-over and are a hazard to themselves and others. The alcoholic sensing that termination is imminent may quit rather than suffer the shame of being fired.

  • Antisocial behavior is exhibited as the alcoholic may become destructively violent, hypercritical of others, paranoid, or explosive as well as abusive of others at work and in the household. Acting out in inappropriate ways sexually and relationally are often experienced.

  • Geographical escapism features the addict leaving a particular community and moving on to another, attempting to flee from the problems created by the alcohol. Of course, the illness accompanies the alcoholic and the family, and the cycle begins all over again.

  • Medical help may not be sought, but often is necessitated because of the total breakdown of the person emotionally and physically. Addicts often end up in emergency rooms of hospitals because they have overdosed on alcohol or some other drug, have had an accident, or have had a reaction as a result of drug interaction, or are badly beaten up because of bad deals made or bad debts incurred.

Stage 4 – Chronic Stage

In this final stage of alcoholism, the alcoholic cannot NOT drink. S/he is no longer capable of predicting what will happen after the first drink. The addict is compelled to drink and that compulsion is outside of her/his volitional control. Possible symptoms include:

  • Benders or uncontrolled binge drinking often for days at a time. There ensues complete disregard for everyone and everything in the addict's life. Inattention to dress, hygiene, relationships and other things that matter in life becomes the norm. The alcoholic drinks to escape the problems created by drinking!

  • Tremors or the shakes occur if the blood alcohol level drops beyond a certain point. Without alcohol, the alcoholic goes into withdrawal which results in:
    • increased shakes, sweating, elevated blood pressure

    • possible delirium tremens that result in paranoia, rapid heartbeat and a compromised immune system

    • hallucinations, (visual and tactile)

    • Alcoholic convulsions that appear like a grand mal epileptic seizure; the tongue may be swallowed during such a seizure and death may result.

  • Protecting the supply at all costs. The alcoholic will do or sell anything in order to secure funds to support the habit. This is where alcoholics often encounter the criminal justice system if not prior to this time. Bottles of alcohol will be hidden in a variety of locations to insure that a supply is always available. Some people after getting into recovery will discover bottles that they had hidden from themselves because they could not remember where the stash was hidden!

  • Unreasonable resentments follow with unprovoked hostility towards other people. There may be unpredictable outbursts, violence or complete and total isolation from other human beings.

  • Nameless fears and anxieties increase and intensify; there may be a sense of impending doom and destruction.

  • Collapse of all systems, even the alibi system. Suicide is not an uncommon phenomenon at this point, if not earlier in the progression of the illness. A total sense of helplessness and hopelessness engulfs the person.

1. These stages of addiction are revised and reworked symptoms as described by E.A. Jellenik in his book, The Disease of Alcoholism. New Haven: College and Universitiy Press, 1972. (fifth printing).

 

Module Home • Introduction • General Awareness Information • Salient Features Concerning Alcoholism • Stages of Alcoholism
Physiological Impact of Alcoholism • Other Options to Exercise in Conjunction with this Module