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Stages of Alcoholism and When Does It Become a Problem

December 29, 2023
21 min read
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Reframe Content Team
A team of researchers and psychologists who specialize in behavioral health and neuroscience. This group collaborates to produce insightful and evidence-based content.
December 29, 2023
21 min read
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Certified recovery coach specialized in helping everyone redefine their relationship with alcohol. His approach in coaching focuses on habit formation and addressing the stress in our lives.
December 29, 2023
21 min read
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Recognized by Fortune and Fast Company as a top innovator shaping the future of health and known for his pivotal role in helping individuals change their relationship with alcohol.
December 29, 2023
21 min read
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Reframe Content Team
December 29, 2023
21 min read

It starts small and sneaks up on you slowly. First, you find yourself going out most weekends, casually asking the host of a party you’re planning to go to if there’s going to be wine there. Maybe you start stopping by your neighborhood bar for trivia night every Thursday — even on weeks when it’s canceled. Before you know it, a glass — or two, or four, or a bottle — of cabernet is a nightly thing. Eventually, you might be asking yourself that dreaded question: Am I an alcoholic? 

Why is alcohol so addictive? And when does drinking truly become a problem? Simply put, alcohol use disorder (AUD) develops when you can't stop or control your drinking, even if it's causing trouble in your life. While it can range from mild to severe, the good news is that recovery is totally possible at any stage. This isn't the easiest of topics, but understanding it is a huge step towards making healthier choices — so let’s take a closer look and break it down!

Part 1: History of AUD

Understanding AUD isn’t just about the present — it’s also fascinating to look back at its history. How has our understanding of AUD evolved over time? Let’s take a brief journey through time.

Ancient Times and Early Civilizations

  • Early use. Alcohol has been around for millennia. Ancient civilizations like the Egyptians and Greeks used it for both enjoyment and ritual purposes.
  • First red flags. Even back then, some recognized the potential for abuse. Aristotle, for instance, warned against the excessive use of wine.

The Middle Ages to the 18th Century

  • A staple in daily life. In the Middle Ages, alcohol was a common part of daily life, often safer to drink than water. However, this didn’t mean everyone got a free pass when it came to booze — drunkenness was usually frowned upon.
  • Distillation and stronger spirits. The development of distillation in the 12th century led to stronger forms of alcohol. This period saw an increase in alcohol abuse, leading to a wider recognition of its health impacts.

19th Century: The Temperance Movement

  • Rising concerns. The 1800s saw a growing concern over alcohol abuse. The Temperance Movement, aimed at reducing alcohol consumption, gained momentum in Europe and America.
  • Early treatment attempts. This period also saw the opening of the first inebriate asylums and the use of early treatment methods, although they were rudimentary by today’s standards.

20th Century: Medical Understanding and Modern Treatment

  • AUD as a medical condition. It was only in the 20th century that AUD began to be understood as a medical condition. The American Medical Association declared alcoholism an illness in 1956.
  • Alcoholics Anonymous (AA). Founded in 1935, AA introduced the concept of peer support in recovery — a significant shift in treatment approach.

21st Century: Advances in Treatment and Awareness

  • Modern treatments. Today, we have many treatments for AUD, ranging from medication-assisted therapies to comprehensive rehabilitation programs.
  • Increased awareness. There's a greater understanding of the complexity of AUD, with all of its psychological, social, and genetic factors — which we will now explore in more detail.

Part 2: Why Do People Become Alcoholics

As we know today, a lot of the “why” behind AUD (a preferred term over alcoholism these days) has to do with our brains, which — amazing and complex as they are — are prone to being hijacked by certain processes.

Alcohol disrupts the delicate balance of our brain chemicals, and regular heavy drinking changes our neural pathways, leading to dependence. It's a mix of genetics, mental health, and our environment.

  • Dopamine and the feel-good factor. Our brains release dopamine, a chemical that motivates us to seek out and repeat enjoyable activities, including drinking. However, alcohol: gives the brain a dopamine overload. Over time, the brain starts thinking, “Hey, I need alcohol to release dopamine!” and that’s where the addiction cycle — and dependency — begins.
  • The reward system. Alcohol affects the brain's reward circuits within our limbic system which are designed to remember activities that make us feel good, encouraging us to do them again. It's a survival mechanism but, with alcohol, it gets hijacked.
  • Altered brain structure. Heavy drinking can actually change the structure of our brains, particularly in areas responsible for judgment, decision making, learning, memory, and behavior control, leading to cravings and making alcohol harder to resist.

Genetic and Environmental Factors

  • Genetics play a role. Our genes can influence our risk of developing AUD. Some people have genetic factors that affect how alcohol impacts their brain, making them more susceptible to dependency.
  • Environment matters, too. Our surroundings, life experiences, and our social circle can influence our drinking habits and the potential development of AUD.

Mental Health and AUD: A Two-Way Street 

There's also a close relationship between AUD and mental health issues like anxiety and depression. Sometimes, people use alcohol to cope with these conditions, but alcohol can also exacerbate or trigger mental health problems on its own.

Part 3: The Journey Through Alcoholism Stages

1. Early Stage: The Sneaky Beginnings

Recognizing the early stage of alcohol use disorder (AUD) can be tricky, but it's super important. Let’s break down what this early stage really looks like.

Subtle Shifts

It usually starts small — maybe drinking a bit more or more often than we used to. The reasons for our drinking might also start to change.

  • Increased frequency and quantity. What used to be a weekend thing might now edge into the weekdays as well. And the number of drinks? That can start to creep up as well.
  • Drinking for different reasons. Initially, we might have a drink socially, but now, there might be a shift. Maybe we find ourselves reaching for a drink after a stressful day or to ease some anxiety.
  • Change in social settings. We might start preferring events or places where alcohol is available. Sometimes, there’s a gradual shift from enjoying the social aspect to focusing more on the drinking itself.
  • Feedback from friends or family. Loved ones might start noticing changes, even if they mention them casually. Comments like “You’re having another one?” can be early indicators.

Physical and Emotional Changes

  • Needing more to feel the same effects. This is a big one. As the body gets used to alcohol, it needs more to feel the same buzz or relaxation. This increase in tolerance is a clear biological sign of the body adapting to more regular alcohol use.
  • Mood swings and irritability. Fluctuations in mood, especially irritability or frustration, can become more common. These can be subtle at first, but they're a significant sign that alcohol is starting to affect our emotions.
  • Denial or minimization. It’s common to think “I can stop anytime” or “It’s not a big deal.” These thoughts are part of the early stage, as it's hard to see the gradual increase in drinking as a problem.

Catching these early signs can be crucial. They might seem small on their own, but together, they can signal the start of a deeper issue with booze. Stay tuned as we explore the next stages!

2. Middle Stage: Increased Reliance on Alcohol

The middle stage of AUD is often a wake-up call. It’s when the effects of alcohol use become more tangible in everyday life — we might start dropping the ball at work and in our personal life, and booze becomes more of a need. We might even start drinking alone or keeping our drinking a secret.

At this point, the signs become more apparent. Recognizing them is key to understanding where we are on the spectrum.

  • Regular cravings. Unlike the early stage when drinking might have been more spontaneous, now there's a noticeable pattern — cravings for alcohol are a regular, if not daily, thing.
  • Drinking becomes a priority. We might find ourselves planning our day around drinking or looking forward to it as the highlight of our day. Booze becomes a staple for celebrations, and alcohol-free fun sounds like an oxymoron. 

Physical and Mental Health Symptoms

  • Increased tolerance. Just as in the early stage, our tolerance continues to increase in a way that’s more pronounced. We need even more alcohol to feel the effects.
  • Early withdrawal symptoms. When we’re not drinking, we might start getting mild withdrawal symptoms, such as irritability, anxiety, or shakiness.
  • Noticeable health changes. We might start noticing physical symptoms, such as sleep disturbances, digestive problems, or unexplained aches and pains. There could also be shifts in appetite or weight.
  • Mental fog and memory issues. Difficulty concentrating, mental fog, or occasional memory lapses become more common.

Behavioral Changes

  • Neglecting responsibilities. This might be one of the more evident changes — maybe our work performance slips, or we’re not as engaged in family or social responsibilities as we used to be.
  • Withdrawal from social activities. Pulling away from social gatherings that don’t involve booze or losing interest in hobbies that used to be enjoyable is often a red flag.
  • Secretive behavior about drinking. We might start hiding how much we’re drinking, feel guilty about it, or lie about our alcohol consumption to friends and family.
  • Defensive responses to concerns. When others express worry about our drinking, we might react defensively or downplay their concerns.

3. Advanced Stage: Deepening Dependency on Alcohol

This stage is the toughest, but understanding it is crucial for taking the right steps toward recovery. Alcohol often becomes the central part of our life. It's not just about craving it anymore — it's about needing it to function. Controlling our drinking becomes increasingly difficult, if not impossible. We might find ourselves drinking more than we intended, and for longer periods. Sooner or later, our life might start crashing down around us, carrying us to the dreaded “rock bottom” people in recovery circles sometimes talk about. 

More Severe Health Impacts

Our day revolves around drinking, and not drinking can actually make us feel physically sick. This takes a serious toll on our health — both mentally and physically.

  • Intense withdrawal. Withdrawal symptoms might now include tremors, hallucinations, and seizures. This is why medical supervision is critical during detoxification.
  • Physical health concerns. The toll on our body becomes more apparent. This can include liver damage, heart problems, or digestive issues. Our immune system might also take a hit, making us more susceptible to illnesses.
  • Mental health struggles. Mental health can seriously be affected. We might experience bouts of depression, anxiety, or other mental health issues.

Impact on Personal and Professional Life

Life gets rocky, as our relationships, job, and health take a serious hit. We might even run into legal problems or put ourselves in serious danger.

  • Strained relationships. Personal relationships might suffer significantly, leading to conflicts with family, friends, or partners.
  • Professional consequences. Work performance often declines, which can lead to job loss or strained professional relationships.
  • Increased risk-taking. There’s often a rise in risky behaviors, like drinking and driving, or putting ourselves in dangerous situations while under the influence.
  • Legal issues. Legal problems can crop up at this stage, whether due to DUIs, public intoxication, or other alcohol-related offenses.

The advanced stage of AUD is serious, but it’s not the end of the road. With the right support and treatment, recovery is absolutely possible! It’s about taking that brave step to seek help and starting the journey towards a healthier, alcohol-free life.

Part 4: Treatment and Support for Each Stage: A Map to Recovery

1. In the Early Stage: Getting a Grip

  • Track your triggers. Keep a note of what makes you want to drink. The goal isn’t to judge — think of yourself as a scientist gathering information about your drinking habits.
  • Make small changes. Set some goals for cutting back. Maybe you’ll skip that second drink or avoid situations where you're tempted to overdo it.
  • Switch it up. Replace drinking with something healthier, like a new hobby or exercise.
  • Stress less. Try some chill-out techniques — meditation, yoga, or just deep breathing.
  • Finding your tribe. Support groups rock! There's strength in numbers and shared experiences. Groups like the Reframe community can feel like finding your long-lost family. They get it, because they're there too.
  • Chatting with a pro. Sometimes, talking to a therapist who knows their stuff about addiction can give you some seriously good tips and tricks. In other cases, a healthcare provider can offer the best advice.

2. In the Middle Stage: Stepping It Up

  • Outpatient programs. Think of these as workshops where you get to learn, share, and still sleep in your own bed.
  • Medication options. Some meds can help take the edge off those cravings or make withdrawal less difficult.
  • Regular heart-to-hearts. Keep those therapy sessions going. It's like having a coach in your corner, helping you figure out the mental game.
  • Bringing in the fam. Sometimes, bringing your family into the loop can help. They’re part of your world, and they can be part of your support system too.

3. In the Advanced Stage: Pulling Out All the Stops

  • Detox with the docs. If withdrawal is rough, doing it under medical supervision can make it safer and less scary. Consider going to a detox facility or, perhaps, residential or inpatient treatment. Think of it as a time-out for your health — it's all about getting better.
  • Planning for the long haul. After rehab, it's all about staying on track. This means ongoing support, maybe some therapy, and strategies to keep you steady.
  • Whole-person wellness. Mix in some yoga, meditation, or whatever makes you feel centered and whole. Treating your body right is key!

What's Next?

As we can see, each stage of AUD has its own challenges and solutions. Find the right fit for you, and remember that reaching out for help is always a smart move.

Tackling AUD is a big deal. We're all in this together, and we're rooting for you every step of the way! Let's take this journey to recovery one day at a time.

Summary FAQs

1. What exactly is alcohol use disorder (AUD)?

Alcohol use disorder, or AUD, is a medical condition where a person has an impaired ability to stop or control alcohol use, despite the negative impact on their life. It can range from mild to severe and affects each individual differently.

2. How can I recognize the early stage of AUD?

In the early stage, you might notice an increased frequency and quantity of drinking, a growing tolerance to alcohol, and subtle changes in behavior, like drinking for stress relief. Loved ones may start commenting on your drinking habits, which is often a sign.

3. What are the signs of the middle stage of AUD?

The middle stage is marked by a noticeable dependence on alcohol. This includes regular cravings, prioritizing drinking over other activities, and experiencing physical and mental health changes like sleep issues and mood swings. There might also be a neglect of responsibilities and withdrawal from social activities.

4. What happens in the advanced stage of AUD?

In the advanced stage, alcohol becomes central to your life. There’s a loss of control over drinking, severe health impacts, strained relationships, and increased risky behaviors. Withdrawal symptoms also become more intense and can include tremors and hallucinations.

5. Can AUD be treated in its early stages?

Absolutely! Early-stage AUD can often be managed with education, behavioral strategies, support groups, and therapy. Recognizing and addressing it early can prevent more severe complications.

6. What treatment options are available for the middle and advanced stages of AUD?

For the middle stage, options include intensive outpatient programs, medication-assisted treatment, continuous therapy, and family involvement. In the advanced stage, treatments include inpatient rehab, medically supervised detox, long-term aftercare planning, and holistic therapies.

7. How has our understanding of AUD changed over time?

The understanding of AUD has evolved significantly. It was once seen as a moral failing but is now recognized as a medical condition. This shift has led to more compassionate, effective treatments and a deeper understanding of the psychological, social, and genetic factors involved.

Ready To Change Your Relationship With Alcohol? Reframe Can Help!

Although it isn’t a treatment for alcohol use disorder (AUD), the Reframe app can help you cut back on drinking gradually, with the science-backed knowledge to empower you 100% of the way. Our proven program has helped millions of people around the world drink less and live more. And we want to help you get there, too!

The Reframe app equips you with the knowledge and skills you need to not only survive drinking less, but to thrive while you navigate the journey. Our daily research-backed readings teach you the neuroscience of alcohol, and our in-app Toolkit provides the resources and activities you need to navigate each challenge.

You’ll meet millions of fellow Reframers in our 24/7 Forum chat and daily Zoom check-in meetings. Receive encouragement from people worldwide who know exactly what you’re going through! You’ll also have the opportunity to connect with our licensed Reframe coaches for more personalized guidance.

Plus, we’re always introducing new features to optimize your in-app experience. We recently launched our in-app chatbot, Melody, powered by the world’s most powerful AI technology. Melody is here to help as you adjust to a life with less (or no) alcohol. 

And that’s not all! Every month, we launch fun challenges, like Dry/Damp January, Mental Health May, and Outdoorsy June. You won’t want to miss out on the chance to participate alongside fellow Reframers (or solo if that’s more your thing!).

The Reframe app is free for 7 days, so you don’t have anything to lose by trying it. Are you ready to feel empowered and discover life beyond alcohol? Then download our app today!

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