13. Various Stages of Alcoholism

Dr. James West is the author of The Betty Ford Center Book of Answers and writes a newspaper column, from which this is excerpted. You can mail questions to him at 39000 Bob Hope Drive, Rancho Mirage, California 92270.

"Alcoholism is a disease. It is inevitably progressive, and it is exquisitely predictable, based on these symptoms:

• Early Stage: Preoccupation with alcohol, sneaking drinks, gulping drinks, increasing tolerance to alcohol, guilty feelings about increased drinking, refusal to talk about one's drinking and the beginning of memory blanks are early symptoms of alcoholism. Because of increasing tolerance, the person may rarely appear to be drunk. This stage may continue for a prolonged period of time.
  
• Middle Stage: Identifiable symptoms of this stage are beginning loss of control (drinking more and for longer periods than intended), expressed feelings of remorse and repeated unsuccessful attempts to cut down or quit. Important social, occupational or recreational activities are given up or reduced due to drinking. Alcohol-centered behaviors, characterized by legal problems (DUIS), job loss, hospitalizations and family disruptions occur in a progressive pattern. Minor to major alcohol withdrawal syndromes are a part of this stage of the disease. Rationalization becomes the way of explaining all the consequences of drinking that accumulate during this stage. In spite of adverse consequences, drinking continues.
  
• Late Stage: The physical signs of alcoholism mark this stage. These include organic brain changes characterized by ethical deterioration and impaired judgment. There is loss of abstract thinking, memory and the ability to concentrate. Alcohol-related liver disease, heart disease and an increased incidence of mouth and esophageal cancers may have developed by this late stage. Severe forms of withdrawal (DTs) are frequent occurrences in the chronic alcoholic after long years of heavy consumption. In addition to this morbidity, the mortality rate is 5 percent of the U.S. population, exceeded only by heart disease, stroke and cancer.

"These symptoms occur on a continuum, some slower, some more rapidly, but inevitably in this sequence."