Alcoholism

The alcoholic, if he does not receive effective treatment, will progress through three stages of increasing deterioration. Alcoholism is difficult to diagnose in the early or adaptive stage. The alcoholic may drink heavily and remain functional. He does not experience any withdrawal symptoms other than the standard hangover following excessive drinking. The cells of the body adapt to large quantities of alcohol and still function. The alcohol provides a ready source of energy for cell functions and the cells become adept at using it. Even at this stage, however, alcohol intake will exact a penalty. The alcohol begins to attack cell structures, eroding cell membranes, altering cellular chemical balances, and otherwise upsetting a finely tuned system.

In this early stage of the condition the alcoholic can show a tremendous tolerance for alcoholic beverages. He might consume quantities that render normal adults hopelessly inebriated, yet not lose his ability to function. Only when his blood alcohol level begins to lessen does the alcoholic show symptoms of impairment. Thus, even though he does not exhibit signs of delirium tremens, the alcoholic in the early stage will know that he feels better when he drinks, functions more efficiently, and thinks more clearly. He will increase the frequency and amount of his drinking and will cross over into the middle stage of alcoholism.

No definite signpost marks the border between the early stage and middle stage of alcoholism, and the change may take years. Eventually, however, the alcoholic drinks to effect a cure, not to attain euphoria or efficiency in functioning. Deterioration of the cells of the body's organs and systems by steady infusion of alcohol begins to exert itself. The alcoholic experiences withdrawal symptoms that bring on physical and psychological pain that persists until it is eased by taking in more alcohol. These withdrawal symptoms soon worsen and require increased amounts of alcohol to erase them. The alcoholic will experience severe headaches, trembling, chills, and nausea when his blood alcohol level begins to ebb.

Full-blown DTs will eventually follow as the alcoholic continues to drink and his cellular metabolism becomes more and more dependent upon alcohol. He may have hallucinations, may become frightened and shrink into a corner, or may become dangerous as he lashes out to protect himself from an imaginary attack. He may manipulate his hands as if playing a game of cards or throwing dice or whittling. These symptoms are not benign, but signify a deep-seated stress on the body, especially the nervous system, and require immediate medical attention. The trauma of DTs may bring about a heart attack, stroke, or respiratory failure. Up to 25% of alcoholics experiencing DTs may die if not treated. At this stage, the alcoholic's body will no longer tolerate a state of low blood alcohol. His withdrawal symptoms become painful, and he can no longer limit his consumption to socially acceptable times; he must have a drink when he arises in the morning, and will probably drink on the job to alleviate his withdrawal symptoms.

But as the alcoholic's drinking increases, so does the cellular demand for alcohol, to the extent that he can no longer forestall his painful symptoms without being constantly in a state of drunkenness. This is the final, deteriorative stage of alcoholism. At this stage the alcoholic's tolerance to alcohol lessens because of widespread organ damage, especially in the liver and nervous system. A minority, probably about 10%, die as a result of late-stage organ damage such as cirrhosis. The liver simply cannot perform its functions, and the blood has a steadily increasing level of toxins. Perhaps a third of those in the late stages of alcoholism die from accidents such as falling down stairs or drowning, or by committing suicide. The physiological damage is widespread: the heart, pancreas, digestive system, and respiratory system all have characteristic changes in the late-stage alcoholic. The liver, however, suffers the most extensive damage.