Knowing how to help an alcoholic, is the first step. When a person is struggling with alcohol addiction, they may hide how much they drink, lie to themselves or others about their consumption, or deny they have a problem. This can make it difficult for them to get help or for loved ones to talk with them about seeking treatment.
To better understand this complex disorder and how to get help, the following discusses the theoretical stages of addiction development, the risk factors to be aware of, how alcoholism is diagnosed, and what effective alcoholism treatment looks like. Although alcoholism, or an alcohol use disorder (AUD), is a chronic disease, it is treatable and can be managed effectively.
4 Stages of Alcoholism Development
In 1960, biostatistician and alcohol abuse researcher Elvin Morton Jellinek (E. M. Jellinek) gained widespread attention when he published The Disease Concept of Alcoholism, offering a new way to look at alcohol addiction.1
Jellinek viewed alcoholism as a chronic relapsing condition that needed to be treated by health professionals and developed a theory on the progression of alcoholism through various stages. His model, now widely accepted, detailed his theoretical stages of alcohol addiction, each characterized by different changes in mental, physical, and social functioning.1
Although not every person struggling with alcohol abuse goes through these stages, they can be a helpful checklist to assess alcohol consumption and prevent forthcoming problems.1 Based on Jellinek’s theory, the four stages of alcohol addiction are:
- Pre-Alcoholic: The first involves general experimentation with alcohol and is when alcohol tolerance develops as the person begins drinking more regularly as a coping mechanism for anxiety, stress, or other emotions.2,3
- Early Stage: Jellinek considers this the transitional stage where the development of a cyclical pattern of alcohol abuse starts. Drinking becomes more regular and individuals begin using social gatherings as an excuse to drink. They may also start consuming alcohol to cope with the negative consequences caused by drinking such as hangovers.3 At this stage, blackouts may also occur.2
- Middle Stage: This is the most crucial stage in Jellinek’s theory, and when a person begins to drink frequently and consistently, maybe even starting off their morning with a drink.3 They may struggle with worsening relationships with friends and family or experience changes to their behavior that impacts them negatively.2 They often feel health impacts such as hangovers or feeling sick more often when not drinking.
- Late Stage: This final phase leads to a complete loss of control over alcohol consumption—the individual must drink.3 At this point, the individual’s body begins to require the presence of alcohol to feel normal. When the individual does not consume alcohol regularly, they may experience withdrawal symptoms and intense cravings.
Risk Factors for Alcohol Dependence
A combination of genetics, family history, environment, and mental health issues may contribute to whether a person develops an alcohol use disorder. Yet, how these conditions influence an individual’s risk is not fully understood. Some have all of these risk factors but never develop AUD, while others may not have apparent risk factors, but still struggle with alcohol abuse.
Some factors that are believed to contribute to the risk of developing an alcohol use disorder or alcohol dependence include:
- Environment: Children who are raised by parents who regularly drink alcohol may be more likely to engage in this behavior themselves than children who are raised in alcohol-free homes. Other environmental influences can include the behaviors of peers, siblings, and other family members.4 Individuals who were abused, neglected, or exposed to recurring incidents of domestic violence are at a higher risk of developing alcohol-related problems in the future. 14
- Genetics: The influence of genetics remains unclear, but researchers have noted that factors including a higher tolerance for alcohol, a craving for alcohol, and a predilection for becoming addicted to alcohol can be passed from parents to children. Scientists estimate that genes account for between 40-60% of a person's risk of addiction in conjunction with environmental factors.4
- Gender- and Ethnicity-Related Physiological Differences: Along with genetics, there are other biological factors that can affect a person's risk of addiction.4 Studies of the effects of alcohol on members of various ethnic groups have discovered that some may be predisposed to drink less due to enzymatic differences in the body’s ability to metabolize and eliminate alcohol. For example, many Asian subpopulations experience flushing of the skin, headaches, nausea and other uncomfortable symptoms when consuming alcohol.5 When it comes to gender, women tend to be more vulnerable to the adverse consequences of alcohol use than men.6
- Mental Health: Individuals with underlying mental health issues (e.g., depression, anxiety) who use alcohol to self-medicate are at a greater risk of developing an AUD than those without pre-existing conditions.4 An estimated 43.4 million adults ages 18 and older experienced some form of mental illness in 2015.7 Of those, 8.1 million also had a substance use disorder (SUD).7 While both disorders commonly occur together, it is not always clear if one is necessarily the antecedent of the other or if other similar factors contribute to developing them independently.
How is Alcoholism Diagnosed?
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) characterizes alcohol use disorder as compulsive drinking in which the person can no longer control their intake and suffers from a poor emotional state when sober.8
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines 11 criteria to consider when diagnosing and treating people struggling with alcohol abuse.9 If a person who experiences any two criteria in the same 12-month period, they may be struggling with an alcohol use disorder.
What Does Effective Treatment Look Like?
Since the mid-1970s, research has pointed to a number of key principles that are necessary to form the basis of any effective alcoholism treatment program.10 Treatment may involve medications to ease withdrawal symptoms, therapy through a rehabilitation program to understand the addiction and change behaviors, and long-term aftercare programming such as peer support groups to help maintain sobriety and avoid relapse.10
It should also be noted that no single treatment is appropriate for everyone and plans must be reviewed and modified according to a patient’s changing needs. Effective treatment will also focus on more than just a person’s alcohol abuse and will seek to address other possible mental disorders.10 Research indicates that remaining in treatment for at least 90 days allows for better outcomes.12
How To Help An Alcoholic
If you suspect that you or someone you care about has an AUD, it may be time to seek professional help. Research has shown that rehabilitation treatment can be very effective in helping individuals maintain a life of sobriety.11 According to NIAAA, about a third of people who successfully complete a rehabilitation program show no further symptoms 1 year later and have fewer alcohol-related problems.11
Depending on the severity of the AUD, individuals can enter into a number of alcohol rehabilitation programs including inpatient and outpatient settings. Treatment typically involves a mix of private and group counseling sessions, behavioral therapies, medications, and support groups.
After a rehabilitation program has been successfully completed, aftercare is an important part of the recovery process. Aftercare efforts vary, but things like sober-living arrangements, continued sessions with a therapist, and ongoing participation in peer support groups, such as 12-Step meetings, help many individuals maintain a life of sobriety. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 84% of treatment facilities offer aftercare services.13 Those that don’t can work with you to devise a plan using other outlets prior to program completion.
Does Your Insurance Cover Rehab?
If you're ready to help your loved one get the treatment they need, you may want to start thinking about how you will cover the cost of rehab.
The cost of an treatment program for alcoholism can vary widely, depending on the type of program and your insurance coverage. Because treatment costs can differ, you want to make sure the program you enroll your loved one in will actually work. American Addiction Centers can improve treatment outcomes for those in recovery for alcohol use disorder. Find out if you or your loved one's insurance covers treatment at an American Addiction Centers facility by filling out the form below:
. Page, P. B. (1997). E. M. Jellinek and the evolution of alcohol studies: a critical essay. Addiction, 92(12). 1619-1637.
. McCrady, B. and Epstein, E (eds.). (1999). Addictions: A Comprehensive Guidebook.
. World Health Organization. (1951). Expert committee on mental health: Report on the first session of the alcoholism subcommittee. World Health Organization Technical Report Series, 42. 1-24.
. National Institute on Drug Abuse. (2018). Drug Misuse and Addiction.
. National Institute on Alcohol Abuse and Alcoholism. (2002). Alcohol and Minorities: An Update. Alcohol Alert, No. 55.
. National Institute on Alcohol Abuse and Alcoholism. (1999). Are Women More Vulnerable to Alcohol's Effects? Alcohol Alert, No. 46.
. National Institute on Alcohol Abuse and Alcoholism. (2017). Mental Health Effects. Health Consequences of Drug Misuse.
. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Alcohol Use Disorder.
. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing; 490-491.
. National Institute on Drug Abuse. (2019). Treatment Approaches for Drug Addiction.
. National Institute on Alcohol Abuse and Alcoholism. (2014). Treatment for Alcohol Problems: Finding and Getting Help.
. National Institute on Drug Abuse. (2018). Principles of Effective Treatment. Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).
. Substance Abuse and Mental Health Services Administration. (2014). The N-SSATS Report: Recovery Services Provided by Substance Abuse Treatment Facilities in the United States.
. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Alcohol Abuse as a Risk Factor for and Consequence of Child Abuse.