Thu. Jan 20th, 2022

Process and Progression of Alcoholism

Alcoholism: The Process and Progression of the Most Common Addiction

Alcoholism: The Disease Model

Alcoholism was declared a disease by the American Medical Association in 1956.  Some groups of people agreed to this decision whilst others expressed doubt; alcohol consumption has been an acceptable, and sometimes necessary, sociocultural practice for almost 2000 years.  Until alcoholism was officially declared a disease, people who suffered from addiction to alcohol were critically and negatively judged, viewed as weak willed, and/or simply bad.  Remnants of these perspectives persist in the current stigma of those with alcoholism and substance addiction.  The truth is that public opinion can take a long time to change and advocating for that change through education and raising awareness significantly helps in shifting perspectives from stigma to acceptance, empathy, and understanding.

The Disease Model

Alcoholism is considered a disease because it meets the three criteria of the disease model: it has a cause, it has an obvious set of symptoms and it causes physical changes during the course of its progression.  Some people have a genetic predisposition to alcoholism.  Additionally, similar to many other diseases, it is potentially fatal if not treated.  A common comparison to illustrate the disease model further is the comparison of alcoholism and diabetes.  In the case of diabetes, when glucose accumulates in excessive amounts, it results in severe metabolic dysregulation and negatively effects cognition.  Similarly, excessive alcohol consumption causes severe metabolic dysregulation and cognitive dysfunction.  Behavioral patterns, genetic predispositions and environmental factors often combine to create chronic alcohol use, tolerance, dependency, and addiction.   Although chronic, alcoholism is a treatable disease through proper medical, individual, and group support.


Following the disease model and progression, the introduction of the causative factor, alcohol, is the first step of progression.  The environment, which includes the possible reasons that cause a person to start drinking alcohol (peer influence, celebration, tradition, or experimentation and risk-taking) is referred to as the susceptible environment.  Genetic factors influence the person’s physical and psychological reactions to the alcohol consumption.  In some cases where there is a long family history of substance abuse, individuals report abusing the substance immediately after the first use.  Not all people, however, continue drinking or using illicit substances after experimentation or first-time use.  For those individuals, there is no progression to tolerance or dependency.

 Signs and Symptoms of Alcoholism

When physical and psychological changes become significant, behaviors and behavioral patterns begin to change.  The signs and symptoms of alcohol dependency include:

  • Symptoms of chronic depression
  • Mood Swings including increased irritation or agitation, and reduced ability to cope with daily stress
  • Preoccupation with drinking; creating a lifestyle around drinking behaviors and patterns
  • Denial of addiction
  • In severe dependency, physical symptoms of withdrawal accompany changes in mental status between intoxication and withdrawal.

These symptoms start as mild complaints but increase in severity over time.  As alcohol dependency progresses to alcoholism, individuals become increasingly motivated to drink, often at the expense of financial, social, and interpersonal problems and loss.

What is Alcoholic Psychosis?

Alcohol is a neurotoxin; chronic consumption of neurotoxins can produce effects that mimic organic psychosis and psychotic disorders.  Alcoholic psychosis is one of the many psychological complications produced by the chronic, heavy drinking.  Heavy drinking is defined by the Substance Abuse and Mental Health Services Administration (SAMHSA) as the consumption of 5 or more drinks, in one day, on five or more days per week.  Continued alcohol consumption can lead to secondary psychosis that is characterized by hallucination, delirium and delusions; masking the link with reality.  Alcoholic psychosis can pose a life-threatening situation if not treated properly.

How Alcoholic Psychosis Occurs in the Brain

Alcoholic psychosis can be seen in states of acute intoxication and alcoholic withdrawal. Heavy alcoholic consumption for a prolonged period is the main culprit behind alcoholic psychosis.  As alcohol enters the brain, it alters proteins involved in the regulation of neurotransmitters and their pathways.  Among these different brain pathways, the paths of dopamine and serotonin make up the dopaminergic system, the system most affected by alcohol.   The overstimulation of the dopaminergic system causes rapid-firing of the brain’s neurons, causing a flood of stimulation.  Similar to the brain functioning of those with schizophrenia or suffering a psychotic episode, the flood of stimulation causes the person to hear, see, or sometimes smell, things around them that are not present; this is called a hallucination.

Signs and symptoms of alcoholic psychosis can be confused with the psychosis caused by other illicit drugs, such as cocaine and amphetamine.  The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines a careful criterion to distinguish alcohol psychosis from other types of psychoses, including schizophrenia and illicit substance-induced psychotic episodes.  Psychosis should be suspected when symptom severity exceeds those anticipated during acute alcoholic intoxication. Clinical assessment is necessary to make a distinction between substance-induced brain disorders and mental illness.  Alcohol psychosis has a high degree of disorientation, misjudgment and depression problems, similar to symptoms seen in those with schizophrenia.  Contrary to schizophrenia, however, the alcohol induced symptoms cease after a few weeks of abstinence.

The first and most important treatment for alcohol-induced psychosis is the cessation of alcohol; however, for chronic, heavy drinkers, withdrawal may require medical intervention.  Alcoholic psychosis symptoms are usually self-limiting; the symptoms of psychosis should end after the effects of alcohol have dissipated. No drug is usually required for the treatment of alcohol-induced symptoms.  Only in extreme cases, individuals may require the support of anti-psychotic drugs.

Withdrawal-associated alcoholic psychosis is a consequence of alcohol withdrawal; it is relatively more difficult to treat than alcohol-induced psychosis.  Chronic thiamine deficiency is a causal factor that can influence the development of alcohol psychosis during withdrawal.  Typically, chronic heavy drinkers do not have balanced and healthy diets, which over time, leads to nutritional deficits.  Treatment involves nutritional replenishment, including folic acid and thiamine supplements.  Benzodiazepines are may also be used, with caution, to ease withdrawal symptoms.  For severe psychosis, antipsychotics like haloperidol may also be administered.  Proper dietary care, cautious use of medications and moral support are the keys to helping individuals through an alcoholic psychosis.

End Stage Alcoholism

Without medical and psychiatric intervention, ongoing support, and dedication to sobriety maintenance, those with alcoholism face the final stages of alcoholism?  The final stages involve the deleterious effects on the liver, pancreas, kidneys, and the brain; these effects can all lead to organ failure. In extreme cases, the cirrhosis of the liver may occur, bringing along with it a new set of potentially fatal effects.

Alcoholism’s effect on the brain is chemical, but as most people know, these chemical changes are demonstrated in behavioral change.  Severe alcoholism is linked to depression, antisocial tendencies, loss of motivation and enjoyment in activities that had once brought the person natural gratification and pleasure.  Throughout the life of an alcoholic who does not overcome their addiction, relationships deteriorate, employment and financial security becomes impossible and eventual homelessness and even incarceration are true potential outcomes.  Lifelong alcoholism’s detrimental effects on one’s personality and relationships is not only painful for the addict but for all those close to him or her; without a supportive network, the addict’s final stages are often faced alone.

The disease model for alcoholism has led to significant breakthroughs in understanding the progression of alcoholism; treatment interventions can be started in the early stages of its development, thereby minimizing the potential of the person suffering the painful and lonely end stages of alcoholism.  With the help of peer support, those suffering from alcohol dependency can learn to manage their lives, stop drinking, and lead healthy, happy, sober lives.  The greatest achievement of the disease model for alcoholism is that it has shed light on the disease of addictions in general.  More resources and research has been stimulated by this model, leading to not only a greater understanding of addiction among medical professionals, but significantly more compassion and empathy by people in the general population, and those with family members or friends dealing with alcoholism.  No longer viewed as simply a weakness of personality or willpower, more people are motivated to intervene and participate in the recovery process of alcoholics and addicts.





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