Alcohol is one of the most common psychoactive substances in the United States, and its acceptance in the country’s culture has made it one of the most popular recreational substances.

Alcoholism is a disease that affects millions of people across the country. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) estimates that roughly 16 million people in the U.S. have an alcohol use disorder. More than 15 million adults and more than 620,000 adolescents had an alcohol use disorder in 2015.

Alcohol use disorder is defined as a chronic relapsing brain disease where people experience a compulsion to use alcohol, lose control over their alcohol intake, and experience negative emotions when they don’t consume it.

Alcohol use problems can come on suddenly. While many of your friends continue to drink without developing a problem that you can see, you may start to develop an alcohol use disorder that starts to take over your life. Unfortunately, you may not realize that your alcoholism is a problem until it starts to cause consequences in your life.

Addiction is a progressive disease, which means that it can get worse over time if it’s left unaddressed. However, treating alcoholism can help you address or avoid some of the most severe consequences of the disease. But what is the typical progression of alcoholism? Learn more about alcoholism and why it can get worse.

What Are the Signs of Alcoholism?

The line between drinking a little too much and an alcohol use disorder is extremely thin. But learning the signs of alcoholism may allow you to spot a substance use disorder in yourself or a loved one. The signs can be difficult to notice during the early stages of alcoholism, especially in another person. However, through the typical progression of alcoholism, it will be harder to hide.

There are several common signs of alcoholism that you may notice as you examine your drinking habits. Some behavioral signs may even be noticed in loved ones.

To consider whether you have an alcohol use disorder, NIAAA provides a list of questions about drinking to ask yourself.

  • Have you had times where you drank more than you meant to?
  • Have you tried to cut back on drinking in the past but were unable to do so?
  • Do you experience cravings for alcohol?
  • Do you continue to drink despite facing negative impacts on your relationships with family and friends?
  • Do you drink instead of participating in activities that were once enjoyable to you?
  • Have you experienced any trouble at work or school due to your drinking?
  • Do you continue to drink even in the face of depression and anxiety caused by drinking?
  • Do you experience blackouts due to drinking?
  • Do you put yourself in dangerous situations, such as driving under the influence, operating heavy machinery, or engaging in unsafe sex when drinking?
  • Do you find yourself drinking higher volumes of alcohol than you used to in order to achieve the same effects?
  • Do you experience withdrawal symptoms, such as nausea, shakiness, sleep problems, anxiety, and depression when you attempt to reduce your alcohol intake

You do not need to answer “yes” to all of the above questions to meet diagnostic criteria for an alcohol use disorder. Answering affirmatively to just two questions can qualify as a mild alcohol use disorder. The more questions you answer “yes” to, the more severe your alcohol use disorder is likely to be.

The Main Stages of Alcoholism

There are five main stages of alcoholism that range from occasional overdrinking to full-blown alcoholism. Understanding each stage can help you assess your situation and level of risks for experiencing dangerous unintended consequences. If you are considering quitting drinking, knowing which stage of alcoholism you are in can also help guide you toward appropriate treatment, as needs will vary by stage.

  • Stage 1: In the first stage of alcoholism, people exhibit occasional instances of abuse and binge drinking. People in this stage are often testing their limits with drinking and may overdrink from time to time. Young adults, particularly students in high school and college, are likely to occasionally abuse alcohol and experiment with the substance. People in this stage of drinking typically can quit drinking by simply deciding to do so.
  • Stage 2: The second stage of alcoholism concerns the frequency of your drinking. Increased drinking that goes beyond drinking occasionally at parties indicates that your drinking habits have progressed. You may now find yourself drinking more regularly, such as every weekend or even throughout the week. What was once a social activity at parties is now a regular habit that is used to put yourself in a good emotional state.Becoming a regular drinker like this puts you at risk for developing a dependency on alcohol, followed by alcoholism. Formal treatment for an alcohol use disorder is not likely to be necessary at this stage, though a firm commitment to reduce your drinking will be.
  • Stage 3: The third stage of alcoholism, problem drinking, develops out of a consistent and regular pattern of abusing alcohol. Problem drinkers are still not necessarily alcoholics, and many people in this stage are still able to quit drinking on their own. People struggling with problem drinking are probably facing negative consequences as a result of their drinking habits. They may encounter problems with their relationships, problems at work or school, and mental and physical health consequences.Problem drinking is also a risky stage to be in as it puts you at high risk of becoming dependent on alcohol. Because dependence has not necessarily developed, as many as 70 percent of problem drinkers can quit drinking without seeking medical attention, counseling, or participating in support groups.
  • Stage 4: The fourth stage of alcoholism is alcohol dependence. Following a sustained pattern of problem drinking, your body is likely to develop a tolerance to alcohol, meaning you must consume it in greater quantities to achieve the same desired effects as before. Additionally, you have lost control over how much alcohol you consume and continue to drink despite the negative consequences you experience.By this stage, dependence on alcohol indicates a need for formal treatment. It can be physically dangerous to detox on your own or quit cold turkey. Medically assisted detox can ensure your safety as your body adjusts to alcohol gradually leaving your system.
  • Stage 5: The fifth and final stage of alcoholism is addiction. By the time of addiction, you have developed both a physical and psychological dependence on alcohol. You crave alcohol at all times and often can’t function until you have some. Severe and dangerous withdrawal symptoms, such as nausea, vomiting, and seizures, are likely to take place if you try to reduce your alcohol intake.By the time you have developed an alcohol addiction, you must seek medical attention to detox safely and get you on the right path to recovery. In addition to medical attention to monitor your withdrawal symptoms, you will need to participate in personal therapy to address the psychological impacts of addiction. Through therapy, you will learn vital coping skills for helping you maintain a life free from alcohol use following treatment.

How to Identify Which Stage of Alcoholism You Are In

is alcoholism a disease or choice

The best way to identify which stage of alcoholism you are in is by evaluating how much you are drinking, how often, and what kind of consequences you face when you stop or cut back on drinking.

Binge drinking is defined by consuming more than five alcoholic drinks for men, and four alcohol drinks for women in about two hours, according to the U.S. Centers for Disease Control and Prevention (CDC). Although people who binge drink are abusing alcohol, most of them do not have alcohol dependence.

If you have noticed an increase in your drinking patterns, such as drinking more often or consuming higher quantities of alcohol than you used to, it is essential to evaluate your behaviors related to drinking and options for cutting back. Decreasing your alcohol intake before your drinking progresses to the next stage of alcoholism will greatly reduce your risks of developing dependence and addiction to alcohol.

Does Alcoholism Get Worse With Age?

Alcoholism is a progressive disease that can get worse with time. If left unaddressed, addiction can worsen gradually, taking over multiple aspects of your life. Plus, long-term alcohol use disorders can cause serious medical problems, such as liver disease, heart disease, and other chronic illnesses. However, the long-term consequences aren’t the only factors that make alcoholism worse with age.

Alcohol abuse is often associated with teens and young adults, but it’s the most common substance of abuse among older adults. In many cases, older adults increase their drinking as they age for various reasons. Often, it has to do with self-medications. They may drink at night to help them sleep, mask mental health issues, or alleviate chronic pain.

As you age, your body will take longer to process alcohol, and you may feel the influence of the substance more easily. It may also take longer for alcohol to wear off, causing symptoms to linger longer. In fact, prescription drugs that are similar to alcohol, like benzodiazepines and barbiturates, are often not recommended to people over age 65 because they have a higher likelihood of experiencing side effects. Older people who drink excessively may be more likely to experience negative side effects like memory issues, loss of balance, poor motor control, and other issues.

Because falls can be more dangerous and damaging among older people, drinking poses a greater risk. Since alcohol is more likely to cause motor control problems in seniors, the risk of accidents and injuries is significant.

Longer recovery times can also make driving more dangerous. When you drink at night, you may be more likely to feel some effects the next morning, like drowsiness or a slowed reaction time.

Finally, older people are also more likely to experience chronic health conditions that may be worsened by alcoholism. They may also be taking various prescription or over-the-counter medications that could clash with alcohol.

How Alcoholism Affects People Differently

No matter which stage of alcoholism you are in, consuming too much alcohol at any given time can be dangerous and even life-threatening. Not everyone will have the same experience with alcohol. However, there are many factors that affect how the body responds to it. Factors such as age, gender, physical health, body mass, metabolism, and drinking history all influence how alcohol affects you.

Some common effects of alcoholism include:

  • Increased risk of certain cancers
  • Liver damage
  • Brain damage
  • Harm to your unborn baby
  • Impaired cognition and motor skills
  • Anxiety and depression
  • Thoughts of suicide

The longer your history of excessive drinking is, the greater your chances of developing any of the above long-term problems. If you believe you are struggling with any of the stages of alcoholism, it is important to seek treatment as soon as possible. The more symptoms you exhibit, the more serious your problem is and the greater the urgency for seeking treatment.

Consulting with your doctor is a great place to start to gain an understanding of which phase of alcoholism you are in. Your doctor can also make referrals to appropriate treatment.

Treatment for Alcoholism

If you are struggling with an alcohol use disorder, the good news is there are many well-established and evidence-based treatment options available. According to NIAAA, fewer than 10 percent of people struggling with alcoholism seek proper treatment. Those who do receive treatment, however, benefit greatly.

If you recognize that you (or someone you know) is in any of the five stages of alcoholism, it is important to get help now so that your physical and mental health aren’t further harmed.

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