Alcoholism: The Truth
Alcoholism can be a devastating illness, having a profound impact not just on the alcoholic, but also on their friends and family. Partly because of the effects of alcoholism, and alcohol’s easy availability, alcoholism carries a high personal and social cost.
What causes alcoholism?
The old model of addiction, in which use of a drug led to tolerance, which in turn led to dependency and addiction, has now been abandoned1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625995/. Part of that was because it could not adequately explain why some people became addicts and others didn’t, especially with legally and easily available drugs like alcohol. This, however, has made identifying the causes even more difficult.
Much current thinking lies with neuroscience, and suggests that alcoholism, like any addiction, is a result of the way our brains are wired. As a depressant, alcohol affects the way our brain deals with neurotransmitters, like dopamine. To compensate, more of these neurotransmitters are produced, and, eventually, the body becomes reliant on the presence of alcohol to operate normally.
Instead of identifying specific causes, the focus is on the risk factors that appear to be shared by those who are more susceptible to forming addictions.
Family history is as a big risk factor, with family members of those with alcoholism being more likely to become alcoholics themselves. This may point to a genetic factor, although it is also possible that social and environmental factors will play a part, such as an upbringing in which excessive alcohol consumption was normalized.
Other substance abuse is also a risk factor. Those that have an unhealthy relationship with other drugs are at a higher risk of forming addictions. Again, this might be a consequence of a predisposition to addiction but might also be because of the social cues.
Another major risk factor is poor mental health. Those with mental health disorders are more likely to form addictions, including alcoholism. This might be because of an attempt to self-medicate, for example drinking because of a depression. Other mental health factors, such as exposure to trauma or stress, whether in a single incident or an ongoing exposure, can also increase the risk of alcoholism.
Other factors that have been identified as increasing risk include peer pressure and social environment, which can both result in increased consumption. The age at which drinking starts also has an effect, with risk increasing the younger the drinker starts. And gender also plays a role, with men more likely to become alcoholics, although it’s unclear if this is a consequence of social or physiological differences.
Becoming an alcoholic
An alcoholic is, broadly, defined as anyone with a dependence on alcohol, however that dependence manifests, whether it’s a constant need to drink, or regularly drinking heavily. Alcoholism is generally broken down into early-, middle- and end-stages.
Early-stage alcoholism can be hard to recognize. However, it marks the transition into alcoholism. Even though the drinker may only be drinking socially, it is the drink, not the social aspect, that is important to them. Drinking has become a habit, they may be drinking alone, responding to stress, or to be able to relax.
Biological changes will be taking place, both in how the body is metabolizing alcohol and how the brain adapts to it. They will still be high functioning, so it’s possible no-one will have noticed a developing problem, but dependency will be developing.
Middle-stage alcoholics are addicted to alcohol. Their body will have formed a dependency, so attempts to stop drinking will be accompanied by cravings and withdrawal symptoms. At this stage, they may still have dry periods when they do not drink, but they will have less control over alcohol. They may be unable to stop drinking when they start, drinking more and for longer than planned when they do drink. They will frequently experience blackouts, periods when they are unable to remember what happened as a result of excessive consumption, and they will frequently lie about their habits if challenged. It is likely that, by this stage, their alcoholism will have had negative effects on their life, creating personal and professional difficulties as well as affecting their physical appearance.
End-stage alcoholism, as the name suggests, marks the end of their alcoholism, either by addressing their addiction or death. The stage is marked by dependency and deterioration. It is likely the alcoholic’s life will revolve around alcohol, often with significant impacts on their lives. The addiction will be so severe that withdrawal is impossible without professional help, and the damage caused by alcohol will have caused profound, and in some cases irreversible, physical harm.
What is alcoholism?
Like any illness, alcoholism needs to be formally diagnosed, but, for many, alcoholism is easy to recognize: a dependency on alcohol that has a significant negative effect on the addict’s life.
Of course, alcohol can have a negative impact without addiction, from a hangover or an unhealthy relationship with alcohol. A medical professional would look at the longer term, expecting to see relevant symptoms over a 12-month period, such as experiencing loss of control, either while drinking or trying to control drinking, cravings or withdrawal symptoms, negative impacts on other parts of life, and continuing to abuse alcohol despite this.
The dangers of alcohol are such that it is sensible to seek professional support at the slightest concern of a problem. The earlier addiction and abuse can be identified, the easier and more effective treatment can be.
What does alcoholic death look like?
Alcoholism death is unpleasant and often gruesome. An end-stage alcoholic is likely to have caused significant damage to their body. And while their alcoholism will be the ultimate cause of death, it is usually the complications arising from multiple conditions that are the direct cause.
There are a number of conditions and diseases linked with alcoholism. Alcoholics frequently suffer from malnutrition, a consequence of self-neglect and meeting their calorific needs from alcohol, which contains virtually no nutrients. Alcohol also weakens their immune systems, leaving them unable to fight off infections. Liver disease, a direct effect of the stress the liver experiences, is very common, but illnesses linked to all parts of the digestive tract are more common in alcoholics. The CDC lists several conditions to which alcoholics are at greater risk, including alcoholic hepatitis, cancer, chronic bronchitis, cirrhosis, emphysema, heart failure, pneumonia, and tuberculosis.
The neurological problems associated with alcoholism are also incredibly distressing, especially for those that may still care for the alcoholic. Alcohol dementia is common in end-stage alcoholism. Actually alcohol-related brain damage, not dementia, it creates problems with cognitive function, leaving alcoholics unable to plan and stay focused. They will also have difficulties controlling their emotions, becoming irritable, and unable to understand how others may be feeling.
Wet brain, caused by a deficiency in thiamine (vitamin B1) is another, irreversible condition usually found in end-stage alcoholics. Alcoholism affects both the body’s ability to produce thiamine and the brain’s ability to produce it. Wet brain is actually a combination of two conditions, Wernicke’s encephalopathy and Korsakoff’s psychosis, and is medically known as Wernicke-Korsakoff’s Syndrome. The symptoms include confusion, loss of co-ordination, changes to vision and motor problems such as abnormal movement or weakness. It also has a cognitive impact, hindering the creation of long-term memory, and causing hallucinations. Someone with wet brain will even make up, and believe, stories to explain gaps in their memories. Wet brain is also the cause of ‘dry drunk syndrome’, when they can appear to be drunk, even though they have not been drinking.
Although recovery is unlikely, if identified and treated early enough, the condition can be managed, allowing a largely normal life.
Getting help for alcoholism
Just like any addiction, the first step in getting help is acknowledging the problem, and seeking support with a formal diagnosis.
Treatment will always start with detox, which can be a difficult process that should always be done under medical supervision: alcohol withdrawal can be fatal. For most addicts an inpatient stay will be required, allowing them to have constant support on hand in an environment which is clean, avoiding the risk of relapse.
The detox process typically starts when a loved one, or the person who needs to come in, calls. We talk to them, get some basic information, then complete an over-the-phone assessment for about 20 or 30 minutes. We ask them a series of questions: their basic history, medical history, and their substance use,” says Philippa Gold, Clinical Director at Physis Recovery
As a general rule, if you notice signs of substance or alcohol abuse as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), you may want to consider getting an evaluation for detox. Some signs of substance abuse include:
- cravings to use substances
- inability to cut down or stop substance use
- taking more substances than you plan to
- using substances for longer than intended
- continuing to use substances even when it puts you in danger or otherwise negatively affects your life
Treatment may also involve medication, there are several drugs which can help with addiction. And, because there are often co-occurring mental health problems, such as depression, it’s important to receive treatment from a facility that can help to manage these.
Therapy is also likely to be a key element of treatment, both in groups and individually, allowing the addict to understand what was behind their addiction, as well and how they will cope once the main part of their treatment is over. Relapse is an ever-present risk for alcoholics: alcohol is not just readily available, but may also be part of their usual work or social lives.
Twelve-step programs like Alcoholics Anonymous are also useful, and these are likely to be part of treatment and life afterwards. Helping the alcoholic come to terms with their disease and be part of a supportive group.
Alcoholism is a devastating illness. But it is possible to treat, even at the latest stages. However, treatment has the best chance of success, and the lowest risk of long-term complications, if started as soon as possible, so the damage caused is as little as possible.
Growing up around alcoholism
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