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The stages in alcohol dependence
The pre-alcoholic symptomatic stage
These drinkers would start their drinking in conventional social situations but would soon experience the rewarding relief from tension. They felt that their tensions were either greater than others or they had not learned to handle them effectively. They would initially seek to relieve the tension only occasionally but gradually their tolerance for tension decreases to such an extent that they resort to alcohol almost daily. This transition from occasional to frequent drinking may take several months or as long as two years.
The dangers of alcohol dependence
The prodromal phase
The second phase is indicated by a sudden onset of blackouts yet the drinker might show few, if any, signs of intoxication and might be able to carry on a reasonable conversation or perform elaborate activities but with no memory of the events the next day.
Average drinkers experience these amnesic episodes when they drink excessively during a state of emotional or physical exhaustion during rare occasions. This amnesia without loss of consciousness and sometimes without the intake of extremely large amounts of alcohol is an indication of a susceptibility to alcohol.
Typical behavior amongst these drinkers:
· Surreptitious drinking as the drinker would seek occasions for having a few drinks for fear of being misjudged.
· Preoccupation with alcohol which often takes the form of worrying about whether there would be enough to drink at a future social gathering. The drinker will probably have several drinks ahead of time in anticipation of a possible shortage.
· Avid drinking as the first one or two drinks are gulped down.
· Guilt feelings about this drinking behavior and recognizing that it is unusual.
· Avoidance of references to alcohol in conversation.
The Crucial Phase
The third phase is characterized by the loss of control over drinking as any consumption of alcohol would seem to trigger a chain reaction that continues until the drinker was either intoxicated or too sick to drink anymore.
Although they would lose the ability to regulate their drinking once they begin, they could still control whether they would drink on any given occasion. This takes place during periods of abstinence or following recovery from severe intoxication.
Their drinking behavior would then be rationalized, producing the familiar alcoholic alibis. They would either convince themselves that they had not really lost control on a particular occasion or that they had good reason to be intoxicated. This is the result of increased social pressures as their behavior becomes more conspicuous.
There will usually be a marked lowering of self-esteem and some drinkers will compensate with extravagant expenditures and other grandiose behaviours as well as by projecting the blame for their difficulties onto others. They would remain remorseful, however, leading to further tension and added reason for drinking.
These drinkers may even blame the type of beverage they were drinking and will attempt to control the problem by changing their patterns. But the drinking would usually begin in the afternoon and they will be intoxicated in the evening. This would cause loss of work yet they will struggle to maintain their employment and social standing while slowly withdrawing from their environment. This increased isolation will lead to increase alcohol abuse and the drinker’s behavior will solely centre on alcohol. Focus will now change to how their activities might interfere with their drinking rather than the other way around.
Now these drinkers may begin to take steps to protect their supply by laying in a large stock of alcoholic beverages which would be hidden in the most unlikely of places. Proper nutrition will also be neglected which would aggravate the effects of the drinking leading to hospitalization. It may also lead to a marked decreased in sexual drive which may affect hostility towards their spouses resulting in “alcoholic jealousy syndrome” in which they blame their loss sexual drive on the mate’s alleged extramarital affairs.
The Chronic Phase
These drinkers may find themselves intoxicated during the day on a weekday and might continue in this state for several days until they are entirely intoxicated. These drawn out drinking bouts are associated with marked impairment of thinking and with ethical deterioration. For example, they would no longer be selective about their drinking companions and if their normal sources of liquor were not available, they would drink almost anything even hair tonic or rubbing alcohol. During this period alcoholic psychoses may occur.
Loss of tolerance for alcohol will increase probably due to liver damage. Half of the usual amount would be sufficient to induce the drunken stupor. However, indefinable fears and tremours would become persistent and become pronounced when alcohol is not present in the drinker’s alcohol.
Rationalizations would fail as they are mercilessly tested against reality and vague religious desires may begin to develop.