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Articles & Presentations
The Disease of Alcoholism
In General - The Three Stages of Alcoholism
(Early, Middle and Late)
There are many attitudes in our society about alcoholism which have proven to be ineffective when applied to the treatment of this illness. They generally assume that alcohol has the same effect on everyone who uses it, leading most people to erroneously believe that alcoholism is caused by the excessive use of alcohol by people lacking sufficient personal willpower or moral convictions to control their drinking.
Our society has a universal preoccupation with the amount and frequency of drinking however, there is no one "alcoholic profile". There are daily drinkers, periodic drinkers and binge drinkers. It is neither how much nor how often one drinks that determines alcoholism - rather, it is the abnormal physiological effect which alcohol has on the drinker which is indicative of the disease.
Nor is alcoholism a secondary symptom arising out of mental illness as many psychiatrists still believe. The prolonged use of large amounts of alcohol on the brain may create psychological problems which generally disappear when the alcoholic stops drinking. Alcoholics suffer from mental illness in the same proportion as the rest of our society; however, any psychotherapy which does not stress abstinence from alcohol and all mood altering drugs (prescription or illicit) will fail.
Several studies have proven that alcoholism runs in families. Alcoholics appear to be genetically susceptible to this disease as a result of a liver enzyme malfunction creating a buildup of acetaldehyde throughout the body. Acetaldehyde interacts with the brain's neurotransmitters to create isoquinolines which act on the opiate receptors of the brain.
The early stage of alcoholism is characterized by cellular adaptations in the liver and central nervous system, increased tolerance to alcohol, and improved performance when drinking. These reactions are hidden but over a period of months or years the cells will have been so altered by alcohol that the alcoholic's behavior and thought processes will be affected.
The middle stage of alcoholism is characterized by physical dependence, craving, and loss of control. As the body adapts to accommodate alcohol (in response to the malfunctioning metabolic pathways of the liver and brain), tolerance increases. Cellular adaptation allows the alcoholic to drink more without becoming drunk (increased tolerance). The increased presence of alcohol causes further adaptations and eventually the cells are no longer able to function normally without the presence of alcohol (withdrawal). The physiological disruption in the body and brain triggers both a physical and psychological overwhelming need for alcohol. Alcohol becomes the only release from this intense physical and mental pain. As the disease progresses, the alcoholic is no longer able to restrict his or her drinking to socially and culturally accepted times and places. This gradual loss of control is the result of a decrease in tolerance and an increase in withdrawal symptoms. At some point, the episodes of uncontrolled drinking become more frequent and severe.
Late stage alcoholism is when the symptoms associated with adaptation to alcohol are gradually overcome by symptoms that reflect increasing toxicity and damage to the body organs and systems. The alcoholic's mental and physical health are seriously deteriorated and he or she spends most of his or her time drinking to avoid the agony of withdrawals. Continued drinking, however, is eventually fatal.
How Denial and Enabling Prevent the Alcoholic From Facing Reality
The first drink an alcoholic ever takes sets in motion a complex bioneurological reaction that results in a chemical effect on the opiate receptors of the brain. How they feel and how they perform are improved after a few drinks a reaction contrary to the nonalcoholic. This sets in motion an unshakable belief that alcohol solves their problems. The alcoholic clings to this way of thinking long after it becomes obvious to others that alcohol is interfering with their health, personal relationships, and career. This is called denial. Denial allows the alcoholic to continue drinking by blaming their problems on others, rationalizing or justifying their inappropriate behavior, and minimizing their responsibility.
Enabling is the system of support provided to an alcoholic by his or her friends, family members, colleagues and coworkers that keep the alcoholic from facing the consequences of their drinking. Misplaced loyalty, friendship or concern leads the enabler to protect the alcoholic by covering up mistakes, making excuses, doing their work, and accommodating them at every turn. Eventually the enabler grows weary of the situation. Their concern turns to despair, frustration and anger when the alcoholic breaks promises to change and quit drinking.
Intervention can put an end to both the enabling and the denial.