Vivian Marlowe
Alcoholism is a chronic relapsing disorder characterised by compulsive alcohol drinking, a loss of control over intake, and negative emotions when alcohol is not available. Alcohol addiction can be broken down into three stages: the denial phase, the dependency phase, and the deterioration phase. Each stage presents its own challenges and can provide insight into how to deal with the problem. The first stage, the denial phase, is often when nobody knows how much an individual is drinking, and their thoughts become obsessive about drinking. The second stage, the dependency phase, is when a drinker depends on alcohol to feel normal and may experience withdrawal symptoms or negative feelings when they are not drinking. The third stage, the deterioration phase, is when an individual experiences physical and emotional deterioration, as well as increased tolerance to alcohol.
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What You'll Learn
- Denial: Characterised by obsessive thoughts about drinking, and secrecy about alcohol consumption
- Dependency: Alcohol is used as a coping mechanism for stress and negative emotions
- Deterioration: The body requires alcohol to feel normal, and withdrawal symptoms occur without it
- Negative emotional state: The basal ganglia and extended amygdala are affected, causing dysphoria, anxiety, and more
- Loss of control: Alcohol addiction is now a controlling force, with physical and mental health impacted
Denial: Characterised by obsessive thoughts about drinking, and secrecy about alcohol consumption
Alcoholism is a chronic relapsing disorder characterised by compulsive alcohol drinking, the loss of control over intake, and the emergence of a negative emotional state when alcohol is no longer available. Alcohol use disorder (AUD) is a condition characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. AUD can be mild, moderate, or severe, with alcoholism representing the moderate to severe end of the spectrum.
The first stage of alcoholism is denial, characterised by obsessive thoughts about drinking and secrecy about alcohol consumption. During this stage, individuals may not appear to have a drinking problem and may not perceive their alcohol use as harmful. They may drink socially or use social gatherings as an excuse to drink. They may also start consuming alcohol to cope with negative consequences caused by drinking, such as hangovers. This stage is also referred to as the pre-alcoholic or early stage of alcoholism.
During the denial stage, individuals may experience increased tolerance to alcohol, which can lead to drinking more regularly as a coping mechanism for anxiety, stress, or other emotions. They may become preoccupied with alcohol and how to get more of it, and their thoughts and behaviours may become focused on obtaining and consuming alcohol, even at the expense of important responsibilities. This preoccupation with alcohol can drive the transition from controlled, occasional use to chronic misuse, which can be challenging to control.
The denial stage of alcoholism is marked by secrecy and a lack of awareness of the problem. Individuals may hide how much they are drinking or how their thoughts are becoming obsessive about drinking. This secrecy can contribute to the progression of alcoholism as it can be difficult for others to recognise the problem and provide help. It is important to note that not everyone struggling with alcohol misuse will fit neatly into these stages, but they can provide a helpful guide for assessment and intervention.
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Dependency: Alcohol is used as a coping mechanism for stress and negative emotions
Alcoholism is a chronic relapsing disorder characterised by compulsive alcohol drinking, a loss of control over intake, and the emergence of a negative emotional state when alcohol is no longer available. Alcohol use disorder (AUD) is a condition characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.
Alcoholism can be broken down into three stages: the denial phase, the dependency phase, and the deterioration phase. The second stage, dependency, is when alcohol is used as a coping mechanism for stress and negative emotions. At this stage, the drinker depends on alcohol to feel normal and may experience alcohol withdrawal symptoms or negative feelings when they are not drinking. This dependency may have underlying emotional and mental motivations. The drinker may experience a reward deficit, which makes it difficult for them to experience the pleasures of everyday living. Conversely, they may experience a stress surfeit, which contributes to anxiety, irritability, and unease. At this stage, the person no longer drinks alcohol for the pleasurable effects, but rather to escape the negative feelings caused by chronic alcohol misuse and withdrawal.
Alcoholism is a spectrum disorder and can be mild, moderate, or severe. It is important to remember that not every person struggling with alcohol misuse will fit into these exact stages, but they can be a helpful guide to assess where they are now to potentially prevent future problems. Alcoholism is a treatable disease, and any program should be catered to an individual’s unique needs.
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Deterioration: The body requires alcohol to feel normal, and withdrawal symptoms occur without it
Alcoholism is a complex and progressive condition that can vary from person to person. The deterioration stage, the second phase of alcoholism, is marked by a person's increasing dependence on alcohol. At this stage, the individual's body has become accustomed to the presence of alcohol and now requires it to function normally. This is a critical period, as the person is at risk of experiencing withdrawal symptoms if they do not consume alcohol.
During the deterioration stage, a person's drinking habits have progressed from social or binge drinking to a more frequent and problematic pattern. They may start drinking alone or in secret, and their spending on alcohol may increase, impacting other areas of their lives. This is a crucial time to seek help, as the situation can quickly escalate. The individual may begin to exhibit signs of alcohol tolerance and dependence, such as increased frequency and quantity of alcohol consumption. They may also experience blackouts, lying about their drinking, and thinking obsessively about alcohol.
The negative consequences of alcohol abuse become more apparent during this stage. Physically, the person may exhibit signs such as facial redness, weight changes, sluggishness, and stomach bloating. They may also experience digestive problems, disturbed sleep patterns, and increased anxiety and stress. Additionally, their professional and social lives may suffer, with underperformance at work, strained relationships, and risky behaviours such as drink driving.
The psychological component of addiction becomes more prominent during this stage. The person's thoughts and behaviours become increasingly focused on obtaining and consuming alcohol, even neglecting important responsibilities. They may start drinking to cope with negative consequences caused by drinking, such as hangovers, and using social gatherings as an excuse to drink. This preoccupation with alcohol can lead to a cycle of addiction, where the person seeks alcohol to relieve negative emotions and experiences withdrawal symptoms when abstaining.
Withdrawal symptoms can be both physical and emotional. Physical symptoms include sleep disturbances, pain, feelings of illness, headaches, nausea, and shaking. Emotionally, the person may experience dysphoria, irritability, anxiety, and emotional pain. These negative feelings are associated with changes in the brain's reward and stress systems, causing an overactive negative emotional state that drives further alcohol consumption. The severity of withdrawal symptoms can vary, with delirium tremens (DTs) being the most severe form, characterised by altered mental status and autonomic hyperactivity, which can be life-threatening.
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Negative emotional state: The basal ganglia and extended amygdala are affected, causing dysphoria, anxiety, and more
Alcohol addiction is a chronic relapsing disorder characterised by compulsive alcohol drinking, the loss of control over intake, and the emergence of a negative emotional state when alcohol is no longer available. This negative emotional state is driven by changes in the brain's reward and stress systems, specifically the basal ganglia and extended amygdala.
The basal ganglia are responsible for processing rewards and positive emotions. When alcohol consumption stops, there is a diminished activation in the reward systems of the basal ganglia, resulting in a reward deficit. This makes it difficult for individuals to experience pleasure and positive emotions, leading to an overall negative emotional state.
The extended amygdala, on the other hand, is closely linked to the processing of fear and anxiety. During withdrawal, there is an increased activation of the brain's stress systems in the extended amygdala, contributing to feelings of anxiety, irritability, and unease. This heightened stress response further exacerbates the negative emotional state experienced by individuals going through alcohol withdrawal.
The combination of a reward deficit from the basal ganglia and a stress surfeit from the extended amygdala creates a powerful negative emotional state that drives the compulsion to seek and consume alcohol. This state is characterised by dysphoria, anxiety, irritability, and emotional pain.
It is important to note that not everyone struggling with alcohol misuse will fit neatly into distinct stages. However, understanding the neurological changes that occur during alcohol withdrawal can help guide treatment plans and potentially prevent future problems.
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Loss of control: Alcohol addiction is now a controlling force, with physical and mental health impacted
Alcohol addiction is a chronic relapsing disorder characterised by compulsive alcohol drinking, a loss of control over intake, and a negative emotional state when alcohol is not available. Alcohol use disorder (AUD) is a condition characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.
The mid-stage of alcohol dependence is marked by a loss of control over cravings and drinking habits. At this stage, alcohol addiction is a controlling force, and physical and mental health is impacted. The prefrontal cortex, an area of the brain responsible for executive function, is compromised in people experiencing alcohol addiction. This affects their ability to organise thoughts and activities, prioritise tasks, manage time, and make decisions.
The negative emotional state associated with withdrawal is caused by profound changes in the brain's reward and stress systems. When a person who is addicted to alcohol stops drinking, they experience physical and emotional withdrawal symptoms, which are the opposite of the positive effects of alcohol. Physical symptoms can include sleep disturbances, pain, and feelings of illness, while emotional symptoms can include dysphoria, irritability, anxiety, and emotional pain.
The negative feelings associated with alcohol withdrawal come from a diminished activation in the reward systems of the basal ganglia, making it difficult for people to experience the pleasures of everyday life. There is also an increased activation of the brain's stress systems in the extended amygdala, which contributes to anxiety, irritability, and unease. At this stage, a person no longer drinks alcohol for the pleasurable effects but to escape the negative feelings caused by chronic alcohol misuse.
The end stage of alcoholism is described as total alcohol dependence, where a person may experience uncontrollable alcohol consumption. If treatment is not sought, health conditions like cardiovascular and liver diseases may be caused or exacerbated by alcohol use, and death from alcohol poisoning or long-term effects of alcohol use is imminent.
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