There are, and have been, many theories about alcoholism and addiction. The most prevailing theory, and now most commonly accepted, is called the Disease Model.
Basic beliefs are that alcoholism and addiction are a disease with recognizable symptoms, causes, and methods of treatment. In addition, there are several stages of the disease which are often described as early, middle, late, treatment and relapse.
While it is not essential to fully define these stages, it is useful to understand them in terms of how the disease presents itself.
This describes the signs and symptoms of each stage as well as exploring treatment options.
The early or adaptive stage of alcoholism and addiction is marked by increasing tolerance to alcohol and physical adaptations in the body which are largely unseen.
This increased tolerance is marked by the alcoholic’s or addict’s ability to consume greater quantities of alcohol or drugs while appearing to suffer few effects and continuing to function. This tolerance is not created simply because the alcoholic or addict drinks or uses too much but rather because the alcoholic or addict is able to drink great quantities because of physical changes going on inside his or her body.
The early stage is difficult to detect. By appearances, an individual may be able to drink or use a great deal without becoming intoxicated, having hangovers, or suffering other apparent ill-effects from alcohol or drugs. An early stage alcoholic or addict is often indistinguishable from a non-alcoholic or addict who happens to be a fairly heavy drinker or drug user.
In the workplace, there is likely to be little or no obvious impact on the alcoholic’s or addict’s performance or conduct at work. At this stage, the alcoholic or drug addict is not likely to see any problem with his or her drinking or drug use and would scoff at any attempts to indicate that he or she might have a problem. The alcoholic or addict is simply not aware of what is going on in his or her body.
There is no clear line between the early and middle stages of alcoholism and addiction, but there are several characteristics that mark a new stage of the disease.
Many of the pleasures and benefits that the alcoholic or addict obtained from drinking or using drugs during the early stage are now being replaced by the destructive facets of alcohol or drug abuse. The drinking or drug use that was done for the purpose of getting high is now being replaced by drinking or drug using to combat the pain and misery caused by prior drinking or drug use.
One basic characteristic of the middle stage is physical dependence. In the early stage, the alcoholic’s or addict’s tolerance to greater amounts of alcohol or drugs is increasing. Along with this, however, the body becomes used to these amounts of alcohol and drugs and now suffers from withdrawal when the alcohol or drug is not present.
Another basic characteristic of the middle stage is craving. Alcoholics and addicts develop a very powerful urge to drink or use drugs which they are eventually unable to control. As the alcoholic’s or addict’s tolerance increases along with the physical dependence, the alcoholic or addict loses his or her ability to control drinking or drug use and craves alcohol or drugs.
The third characteristic of the middle stage is loss of control. The alcoholic or addict simply loses his or her ability to limit his or her drinking or drug use to socially acceptable times, patterns, and places. This loss of control is due to a decrease in the alcoholic’s or addict’s tolerance and an increase in the withdrawal symptoms. The alcoholic or addict cannot handle as much alcohol or drugs as they once could without getting intoxicated, yet needs increasing amounts to avoid withdrawal.
Another feature of middle stage alcoholics or addicts is blackouts. Contrary to what you might assume, the alcoholic or addict does not actually pass out during these episodes. Instead, the alcoholic or addict continues to function but is unable to remember what he or she has done or has been. Basically, the alcoholic or addict simply can’t remember these episodes because the brain has either stored these memories improperly or has not stored them at all. Blackouts may also occur in early stage alcoholics and addicts.
Impairment becomes evident in the workplace during the middle stage. The alcoholic or addict battles with loss of control, withdrawal symptoms, and cravings. This will become apparent at work in terms of any or all of the following: increased and unpredictable absences, poorly performed work assignments, behavior problems with co-workers, inability to concentrate, accidents, increased use of sick leave, and possible deterioration in overall appearance and demeanor. This is the point where the alcoholic or addicted employee may be facing disciplinary action.
The late, or deteriorative stage, is best identified as the point at which the damage to the body from the toxic effects of alcohol or drugs is evident, and the alcoholic or addict is suffering from a host of ailments.
An alcoholic or addict in the final stages may be destitute, extremely ill, mentally confused, and drinking or use drugs almost constantly. The alcoholic or addict in this stage is suffering from many physical and psychological problems due to the damage to vital organs. His or her immunity to infections is lowered, and the employee’s mental condition is very unstable. Some of the very serious medical conditions the alcoholic or addict faces at this point include heart failure, fatty liver, hepatitis, cirrhosis of the liver, malnutrition, pancreatitis, respiratory infections, and brain damage, some of which is reversible.
Why does an alcoholic or addict continue to drink or use drugs despite the known facts about the disease and the obvious adverse consequences of continued drinking and drug use? The answer to this question is quite simple. In the early stage, the alcoholic or addict does not consider him or herself sick because his or her tolerance is increasing. In the middle stage, the alcoholic or addict is unknowingly physically dependent on alcohol or drugs. He or she simply finds that continuing to use alcohol or drugs will prevent the problems of withdrawal. By the time an alcoholic or addict is in the late stage, he or she is often irrational, deluded, and unable to understand what has happened.
In addition to the effects of these changes, the alcoholic or addict is faced with one of the most powerful facets of addiction: denial. An alcoholic or drug addict will deny that he or she has a problem. This denial is a very strong force. If an alcoholic or drug addict did not deny the existence of a problem, he or she would most likely seek help when faced with the overwhelming problems caused by drinking or using drugs. While denial is not a diagnosable physical symptom or psychiatric disorder, it is an accurate description of the state of the alcoholic’s behavior and thinking and is very real.
An alcoholic or drug addict will rarely stop drinking or using drugs and remain sober without professional help. Also, he or she usually will not stop drinking or using drugs without some kind of outside pressure. This pressure may come from family, friends, clergy, other health care professionals, law enforcement or judicial authorities, or an employer. For example, a spouse may threaten divorce, or the alcoholic or drug addict may be arrested for driving under the influence.
There was at one time a widespread belief that alcoholics and addicts would not get help until they had “hit bottom.” This theory has generally been discredited as many early and middle stage alcoholics and drug addicts have quit drinking or using drugs when faced with consequences such as the loss of a job, a divorce, or a convincing warning from a physician regarding the potentially fatal consequences of continued drinking or drug use.
There are obvious advantages to getting the alcoholic or drug addict into treatment earlier rather than later. One advantage is that, the earlier treatment is begun, the probability of having less expensive treatment, such as outpatient care, is increased. There is also a greater likelihood of success in treatment with an individual who has not yet lost everything and still has a supportive environment to return to, including an intact family, good health, and a job. In addition, the employer has a stake in the early treatment of alcoholism and addiction, since the employee will have a greater chance of returning sooner to full functioning on the job if the disease is arrested at an earlier point. Early treatment is simply less disruptive and can help the alcoholic avoid further misconduct and poor performance. If an alcoholic or drug addict doesn’t get help until very late in the disease, there may have been irreparable harm done.
The alcoholic or drug addict does not initially have to want to get help to go into treatment. Many people go into treatment because of some kind of threat such as loss of a job, divorce or possible incarceration. However, even the individual that is forced will eventually have to personally accept the need for treatment for it to be effective. Employers are a very potent force in getting the alcoholic into treatment. The threat of the loss of a job is often the push the alcoholic needs to enter treatment.
There are various kinds of treatment and programs for alcoholism and addiction. Though some alcoholics and drug addicts do stop drinking on their own, this is rare. Most alcoholics and drug addicts require some type of professional treatment or help. Ongoing support facilitated by 12-step programs such as AA or NA are an essential to long-term recovery.
An important and frustrating facet of treating alcoholism and addiction is relapse or a return to drinking or using drugs and is common. An alcoholic or drug addict often relapses due to a variety of factors including:
Relapses are not always a return to constant drinking or drug use and may only be a onetime occurrence. However, relapses must be dealt with and seen as a sign to the alcoholic or drug addict that there are areas of his or her treatment and recovery that need work. Relapse prevention is an area in the treatment field that is receiving increased attention and research. A basic part of any effective treatment program will include relapse prevention activities.