Addiction of any kind follows a downward trajectory and alcohol addiction (alcoholism) is no exception. But what are the signs and symptoms of alcohol addiction? What may begin as social, casual drinking can over time become more and more frequent. Usually, before the drinker themselves is even aware, it has become a daily requirement. Below we will look at a generalized road map of the journey into alcoholism, and some noticeable things to look for in worsening alcoholism.
Symptoms of Alcohol Addiction
Drinking usually begins as a social activity. This can be the case for years, or even decades. Everyone is different in their propensity and susceptibility for alcoholism, but most alcoholics begin drinking in this manner. Over time, someone may find themselves needing less of an “excuse” to drink, and that they begin drinking more through the week. If this trend continues, they find themselves drinking every day, and waking up hungover every morning. Next, they may find that on days they have an extremely bad hangover, they need a drink in the morning; a so-called “eye opener” drink to get going for the day. The next steps usually involve drinking at work or other activities throughout the day. This can progress to the point where someone loses friends, jobs, are cut off from family, and become isolated as drinking becomes a primary fixation and dominates their life.
Some outward symptoms of alcohol addiction include:
- Going to the bar daily
- Isolation from family and friends
- Unexplained absences from school, work, or social gatherings
- Increased depression and/or anxiety
Signs of Alcohol Addiction
Alcohol addiction affects all aspects of an alcoholics life, even though they commonly think it does not. Some signs of alcohol addiction include:
- Frequent Blackouts: Someone cannot recall conversations, events, or being certain places.
- Tremors or Shakes: Some of the first signs of alcohol addiction are mild shakes or tremors. This begins as withdrawal begins ~8 hours after the last drink, and frequently begins in the afternoon or late evening.
- Cannot Control the Amount They Drink: Someone may say “Ok, I’ll have one” and proceeds to drink heavily. This often happens repeatedly.
- Being Drunk at Inappropriate Times: Such as at work, while watching their kids, driving, or at social or family events.
- Increased Avoidance of Social Life: Someone who is drinking heavily will usually begin to withdraw from their normal social circles or habits.
- Increasing Absences from Work: A developing alcoholic is likely to call out from work (or no-call, no-show) either due to being too hungover, or too drunk to go in.
- Legal Issues: Such as DUI, public intoxication, and unfortunately violent crimes such as domestic abuse or fighting.
Signs of Worsening Alcohol Use
As mentioned addiction always follows a downward slope, the only variable is how fast things go downhill. Some worsening signs of alcohol addiction, indicative of the later stages of alcoholism may include:
- Anger or Indignance Regarding Alcohol Use: An alcoholic will frequently get angry, defensive, or try to excuse their drinking. This can manifest as an alcoholic avoiding or pushing away people who try to talk to them about their drinking.
- Rapidly Declining Health: Alcohol is toxic to humans, and heavy drinking will quickly produce negative consequences. Frequent vomiting, gagging, stomach ulcers, digestion issues, impaired coordination, and general poor health due to gastrointestinal disturbance frequently accompany heavy alcohol use.
- Binge Drinking: Some alcoholics binge drink as a matter of course, but others may have to work up to that. This is typically a multi day, or sometime multi week drinking spree.
- Getting Fired: This is common in worsening alcoholism, as work performance declines as drinking becomes more and more of a priority. With drinking becoming the paramount concern, things which used to matter lose their importance.
- Open Hostility Towards Friends or Family: This is unfortunately very common as friends and family are typically close enough to see that things are getting bad. When they try to help, an alcoholic will isolate from them to continue drinking “in peace”.
- Financial Difficulties: Coupled with lack of work or reduced work, the increasing amount of money an alcoholic spends on alcohol commonly results in extreme financial difficulties.
Why Is Alcohol So Addictive?
Alcohol produces a cascade of effects in the body and brain. These effects require the body to adapt in order to continue functioning in the presence of alcohol through a process called downregulation (or upregulation in the case of glutamate). This will also produce tolerance, which means that it takes more alcohol to produce the same effects. Once this adaptation and tolerance begins to develop, a drinker will feel more and more uncomfortable without alcohol. This usually increases the amount and frequency of drinking, leading to even stronger tolerance and adaptation. In this manner, alcohol use can snowball out of control.
Due to changes in GABA and glutamate neurotransmitter pathways in the brain, heavy drinkers will begin feeling more anxious and depressed the longer they go without a drink. Anxiety can increase to the point of producing panic attacks, and depression will make it difficult to even get out of bed without the promise of a drink. Not only are there mental repercussions when an alcoholic stops drinking, there are physical consequences as well. Tremors will begin when a heavy drinker goes several hours without a drink. This can worsen to the point of seizures depending on how long and how much someone has been drinking.
Aside from tremors, the effects of alcohol withdrawal are extreme, dangerous, and horrible. Aside from panic, tremors, and depression there are a host of other issues which can sometimes be fatal. A newly abstinent alcoholic can expect sweats and fever, hallucinations, delirium, and heart issues such as wild blood pressure fluctuations and a very rapid heart rate. The discomfort during alcohol withdrawal is often severe enough to push someone back towards the bottle, even if they really don’t want to drink. The only way many alcoholics know to make this stop is to drink more. Alcoholics either may not know that they are making the whole cycle start over, or they are past the point of caring.
The Progression of Alcohol Addiction
While drinking could begin as a social activity or celebratory ritual, over time it often becomes a daily requirement for living. The subtlety of this progression often goes unnoticed by the drinker themselves and is sometimes only apparent to friends and family who may not see them everyday. The neurological changes often take quite some time to escalate to the point of causing behavioral issues or other problems in an alcoholics life. Some people are more prone to these changes, meaning they happen sooner or more quickly. The reason for this is unknown but almost every alcoholic has the same destination, the only difference is how fast they get there.
Genetics are known to play a factor, although the exact mechanisms are unclear. Regardless of genetic factors, heavy drinking is known to cause neurological changes in every animal that has been studied (including humans). The neurotransmitters GABA, glutamate, norepinephrine, dopamine, and serotonin are most heavily affected and changes in the limbic system of the brain are known to be a direct result of prolonged alcohol use. The limbic system is often called the “reward center” of the brain and is responsible for feelings of pleasure and motivation, as well as making strong connections between these feelings and the memories of the events which produced them. Alcohol seems to hijack this system and kick it into overdrive, making extremely strong connections between the feelings of reward and pleasure to the memory of drinking alcohol. This has the result of making it much more likely that when someone wants to feel good, they will think of taking a drink or two, or three. These limbic changes coupled with tolerance and downregulation mean that the more someone drinks, the more they feel that they “need” to drink. This process will build upon itself, becoming more destructive over time, often to the point where people will literally drink themselves to death.