Substance Abuse: CNS Depressants - Alcohol

Signs and Symptoms of Alcoholism

Better known than the causes of alcoholism are the signs and symptoms, often described in a series of developmental phases or stages. E.M. Jellinek first established the following four-phase description based on his analysis of recovering alcoholics: (1) the so-called pre-alcoholic phase; (2) the prodromal or early warning phase; (3) the crucial phase; and (4) the chronic phase. This initial description was later refined and expanded by other alcoholism and drug dependence specialists, including Great Britain's Max M. Glatt, who depicted the development of and recovery from alcoholism in chart form.

The general phases of alcoholism are identified and explained as follows:

Phase 1--during this initial contact-with-alcohol phase, the evolving alcoholic drinks first for social reasons, but eventually changes the motivations for consumption to include those of anticipated stress reduction and relief from psychological tension or pain. Soon the developing alcoholic seeks out drinking occasions, begins to increase consumption (dose), becomes defensive about his or her intake, and typically associates with new drinking partners who accept the heavier drinking behavior and more frequent intoxication. It is during this phase that alcohol and drinking become significant parts of daily living. In essence, the all-consuming "love affair" between the drinker and the drink begins to grow and flourish.

Phase 2--In this phase, the alcoholic tends to drink in secret in order to hide the consumption level, and develops several of the early warning signals, such as, feelings of guilt about drinking; lying about drinking behavior when confronted by others; an extremely pleasant response to alcohol; drinking before joining others in drinking situations; drinking due to worry, tiredness, or depression; the need for increased intake to produce desired effects (tolerance); and the experience of alcohol-induced amnesia, the blackout or memory blank-out. Soon there is no social motivation for drinking. What began as a trend earlier is now the exclusive motivation for intake of alcohol--the expectation of euphoric relief.

Eventually, the alcoholic is preoccupied with procuring a source of alcohol and begins to drink alone, inventing occasions for imbibing if none exists. Intake increases rapidly as guzzling becomes the norm. Sometimes the drinker is unable to abstain. More often, the alcohol abuser cannot control drinking once it has begun, evidence of the so-called "loss of control" phenomenon--inability to determine with any consistency duration of drinking or the amount consumed.

A psychological dependency is now established, and if denied a regular dose, the alcoholic will experience the withdrawal syndrome--restlessness, tremulousness or involuntary shaking of the body, insomnia, feelings of depression and anxiety, loss of appetite, mental confusion, hallucinations and seizures, typically occurring within 6-48 hours after the last drink. The term DT's describes the intensification and most severe form of the withdrawal symptoms, which usually follow heavy drinking that has lasted over an extended time period. Characterized by vivid and terrifying hallucinations, complete disorientation and confusion, severe agitation with almost continuous motor activity, this medical emergency usually develops between 48 and 96 hours after the last drink. Fortunately, only a small minority of individuals undergoing withdrawal experience DT's.

Phase 3--Now there is an intensification of all forms of alcohol abuse experienced earlier--more solitary drinking, avoidance of family and friends, and an increase in memory blackouts and passouts. When sober, the alcoholic may regret what was said or done while drinking. To prove that he or she still has everything under control, the drinker will often attempt to restrict personal consumption by going "on the wagon" (an abrupt cessation of drinking). Usually, such action is only temporary, excessive intake is resumed, and morning drinking becomes the norm in an attempt to stabilize one's rather chaotic life. Sometimes a form of reverse tolerance develops as a result of liver damage. In such an instance, the alcoholic appears to be easily intoxicated on a small dose that would rarely affect behavior earlier in the disease. A series of physical, mental, and social changes now occurs in the alcohol-dependent individual. These may include nervous and gastrointestinal disorders, cirrhosis of the liver, malnutrition, the overuse of defense mechanisms to justify drinking, and a general deterioration in interpersonal relationships. Chain-drinking and extended "benders" are characteristic of this phase of the illness. Hospitalization for alcoholism or an alcohol-related problem is frequently required during this phase.

Phase 4-- Progression to this stage usually develops after a number of years of excessive intake. Drinking bouts often last for several days at a time. When the alcoholic gets the "shakes" in the morning upon wakening, more alcohol is consumed to quiet the "nervous" condition. The person is drunk on important occasions and has increasing numbers of blackouts and passouts. Completely oriented around alcohol, the alcohol abuser displays a complete, ethical breakdown, unreasonable fears, increased reverse tolerance, and loss of motor coordination. Now, the "love-affair" between the drinker and the alcoholic beverage is complete and that relationship takes priority over all the other people and all other life activities. At this point, alcoholics drink to live and live to drink. The medical complications may be so severe that either institutionalization or death occurs unless there is some type of intervention.

Not every alcoholic experiences all of the foregoing signs and symptoms. Moreover, the order in which the abnormal behaviors occur displays great variation. It should also be noted that while alcoholism is a devastating disablement, it tends to display a somewhat inconsistent symptomology; that is, the alcoholic does not always behave the same way with regard to alcohol. Especially in phase two or three, the alcoholic may enter a stage of remission--a temporary, periodic absence of symptoms--during which time he or she does not get drunk after starting to drink. This phenomenon should not be viewed as a complete cure, because another characteristic of alcoholism is the tendency to have a relapse, a return to problem-causing alcohol use again. Consequently, the prevention of relapse is an important part of the alcoholic's recovery.

Continue to Withdrawal Stages