The Disease Concept of Alcoholism
Denial is the biggest symptom of this illness, and not just for the alcoholic.
Many years ago, I looked at alcoholism with a judgmental and moralistic eye, believing it only happened to "other" people.
Then it hit close to home, with someone in my family.
I will never forget the resources that helped me to understand this problem from a much different perspective.
Eventually, I was able to view alcoholism with compassion and discernment.
In the '60s, '70s and '80s, alcoholism treatment was in its heyday. In 1956, the American Medical Association (AMA) stated alcoholism was a disease, as it met the five criteria needed in order to be considered a disease: pattern of symptoms, chronicity, progression, subject to relapse, and treatability.
One could learn about the disease concept through community lectures, articles in the paper, alcoholism hotlines and, of course, Alcoholics Anonymous (AA) meetings.
I learned that alcoholism is an illness that crosses all social classes. Anyone could get it, regardless of age, sex, education, class, ethnicity or religion. Those with a family history of drinking are at a higher risk, even if they once swore they would never drink like their mother or father.
I also learned that alcoholism is a chronic, progressive disease that manifests itself with symptoms that affect one physically, mentally, emotionally, spiritually and socially.
Denial is its number one symptom, and the alcoholic is usually the last one to believe he or she has it. Alcoholism has a ripple effect and affects at least four to five other people, including family, friends, co-workers, neighbors, etc.
There are four stages of alcoholism. Most people in the first or pre-alcoholic stage are usually amazed how much they can drink. In fact, many may joke about their "hollow leg" or being able to drink their friends "under the table."
Other symptoms of this first phase include: drinking to provide relief from stress and mental fatigue, or to relax; seeking more opportunities when drinking will occur; and a gradual development of increase in tolerance (use of more and more alcohol to get the same desired effects).
In the second and early stage of the illness, the person may have alcohol-induced blackouts. These are amnesia-like periods that occur while drinking, when the person seems to be functioning normally but will later have no recall of some or all of what he or she said or did.
The individual may not remember getting home or having said something hurtful or outlandish to another person.
Other symptoms include: sneaking extra drinks before or during events; gulping the first drink or two; and feelings of guilt.
The third or middle stage of alcoholism is a crucial phase, for loss of control sets in. This is the inability to drink according to intention. Once the first drink is taken, the individual can no longer predict what will happen, even though the intention may have been to only have a few drinks.
Other symptoms include: drinking bolstered with excuses; grandiose and aggressive behavior; persistent remorse; increase in amount and frequency of drinking; failure of repeated attempts to control drinking; failed promises and resolutions to self and others; loss of interests; avoidance of family and friends; trouble with money and work; unreasonable resentments; problems with the law; neglect of food and loss of willpower; tremors and early morning drinks; decrease in alcohol tolerance (needing less alcohol to feel the effect); and the beginning of physical deterioration.
The fourth, final and late state of alcoholism is chronic.
Up until this point, the individual may have been successful in maintaining a job, but now drinking occurs earlier in the day and can go on all day. Symptoms in this stage include: onset of lengthy intoxications; moral deterioration; impaired thinking; indefinable fears; obsession with drinking; and vague spiritual desires.
A person may not develop all of these symptoms or in this particular order, but there is a continual loss of control.
This disease is often described as cunning, baffling and powerful.
The alcoholic is often just as puzzled as those around him or her, because no matter how he or she attempts to modify drinking, nothing seems to work. The individual just can't seem to get a "grip" on the problem.
Denial is the biggest symptom of this illness, and not just for the alcoholic. Those around the alcoholic are also often in denial, believing the person just needs to stop drinking or cut down. It is only after treatment that this confusing problem begins to make sense.
The alcoholic learns that he or she has a chemical reaction to alcohol and that it is the first drink that causes the trouble. That is, it's the first drink that sets the obsession to drink in motion.
Alcoholism does not have to continue through all four phases, but if help isn't sought, the fourth stage can end in death, insanity or incarceration.
From recovery stories, we know that loving interventions planned by concerned others, with the aid of trained professionals, can help alcoholics avoid the pain and misery of all these stages.
Alcoholism is treatable, but successful recovery from alcoholism requires active participation of the individual.
It is critical that the alcoholic accepts the illness and be willing to manage his or her recovery process, much like anyone with any other chronic illness has to do.
Education is essential. Recovering alcoholics must be well informed about their illness and the need for good self-care. To avoid relapse, the individual needs to learn skills in treatment to maintain and enhance his or her ability to continue in recovery.
The recovering alcoholic needs emotional support from family, friends and the community to make the necessary changes to live within the limitations imposed by the illness.
Family involvement and support are imperative for two reasons. Statistics show that if the family is involved in the alcoholic's treatment and their own recovery process, the rate of successful recovery is 70%.
If the employer or employee assistance program is involved, success rates climb to 80%. Secondly, and most importantly, the family needs an opportunity to understand and talk about the impact this illness has had on them.
It is important to remember that alcoholism affects an individual five-fold: physically, mentally, emotionally, socially and spiritually.
Recovery needs to take place in all these major life arenas as well. Finding new ways to handle life situations without the use of alcohol is the challenge and the blessing.
Sheila Leskinen, M.S., S.C.A.C., L.M.F.T., is a marriage and family therapist with a specialty in addictions. She has a private practice in Anchorage.
Source: The Disease Concept of Alcoholism
NOTE by AddictionInfo editor: Classifying alcohol and drug problems as a medical "disease" is being disputed by many experts - see these articles, among many others on this site:
Why hasn't alcohol rehab worked for Lindsay Lohan and 93% of the problem drinkers in the US?
Addiction as a Disease: Birth of a Concept