Silence Hurts
Alcohol Abuse and Violence Against Women
Supplements
Signs and Symptoms Related to Stages of Drinking
Early Onset
History
- Significant alcohol-related problems for many years; often has a family history of alcohol problems
- Generally began drinking sometime between the early teens and late 20s
- Began drinking for relief (from stress, pain, etc.), with gradual increasing tolerance
- Often dies by middle age; survivors bring their problems with them into late life
- May have numerous short-lived periods of sobriety
Medical Problems
- Alcohol-related health problems are usually advanced:
- Liver problems
- High blood pressure
- Gastrointestinal problems
- Increasingly severe withdrawal symptoms
- Possible alcohol-related dementia
- May have been hospitalized for alcohol-related problems, which may not have been identified as alcohol related
- In some cases, alcohol problems may have been recognized long ago by health and social service providers, but they have given up on the person
Social problems
- History of marital and family problems:
- May have divorced as a result of drinking
- May have had multiple marriages
- Adult children may have given up on the parent; the children also may have alcohol problems
- Alienated from family, often for prolonged periods
- Social network may be limited to friends who drink
- May be living in isolation as a solitary drinker
- May be homeless or living in a single-room occupancy hotel
- History of occupational, financial, and legal problems
Psychological Problems
- Significantly higher level of depression and incidence of psychological problems
- Is most likely to increase drinking in response to stress
- Has more social upheaval
- May have antisocial personality traits in 10 to 15 percent of cases
- May lack emotional development and exhibit personality characteristics similar to those of much younger adults
Prognosis
- Potential for benefits of treatment should not be discounted; early-onset drinkers do about as well in treatment as late-onset drinkers
- Treatment for this group of drinkers may be more complex because:
- Denial is long-term, well practiced, and ingrained
- Alcohol has been associated with every aspect of adult living; the person does not know how not to drink
- Person has no frame of reference for sober adult living skills
- Support system, which is important during treatment and aftercare, is usually absent
- Alcohol-related health problems are usually advanced
- Some adults may have a long history of sustained functionality despite consistent, heavy alcohol use. This heavy use can be particularly problematic given the physical and metabolic changes that occur with aging.
Late Onset
History
- Less likely to have a family history of alcoholism
- Onset begins around age 50-60 years, often in response to losses, stresses, or difficult life events (e.g., retirement, declining health, death of family and friends)
- Loneliness, isolation, bereavement, and depression tend to precede the development of a drinking problem
- Initially drinking is perceived to ease the pain and anxiety of life change or to "take the edge off" of difficult feelings
- Alcohol/drug problem is more difficult to detect because of a lack of drinking/drug history and related health problems
- Often considered a moderate to heavy social drinker earlier in life
Medical Problems
- Because contact with health care professionals has been routine, clinicians are more likely to overlook signs of an alcohol problem and to prescribe medication that will help the person weather a difficult time
- No previous long-term alcohol-related medical problems
Social Problems
- More likely to conceal the truth about the amount of alcohol consumed
- If family live at a distance, they may not be aware that drinking is a problem until a crisis arises
- The precipitating event often is identified as the problem, so the need to stop the abusive drinking is overlooked
- Frequently, family members are reluctant to consider drinking a problem because it was not a problem in the past
Psychological Problems
- Feelings of shame and guilt may fuel the desire to keep the drinking hidden
Prognosis
- Prognosis is more promising for this group
- Often, the drinker has a lifetime of relatively good coping skills to draw on and is more likely to have a history of dealing with problems in a healthy way prior to the onset of the alcohol problem
- Long-term denial behavior is absent
- Is not as impaired physically, cognitively, or emotionally as early-onset drinkers
- Family/support system is generally intact; family members, once they realize there is an alcohol problem, will generally provide support during treatment and aftercare
- There is evidence that, in some cases, the drinking problem will resolve spontaneously without professional assistance.
Intermittent
History
- May have a history of episodes of heavy drinking, including binge or weekend drinking, alternately, Some may drink daily for years at a time and abstain for years at a time.
- Began drinking between the ages of 20 and 30
- Has had episodes of alcoholic drinking followed by periods of abstinence, which may have lasted from weeks to years
- Stress and loss brought on by the aging process will often trigger relapses
Medical Problems
- Often has some physical deterioration
- Medical problems are in proportion to the number and duration of alcoholic episodes and the length of periods of abstinence
- May not have severe medical consequences from the drinking, but hangover symptoms have intensified
Social Problems
- May have experienced occupational, legal, and financial consequences from the drinking
- Family relationships are usually strained
- Family tends to focus on triggering event and waits for the episode to pass
- Person and family may have sought help during times of drinking but lacked follow-through, falling back on the knowledge that the episodes don't last
Psychological Problems
- Has long-term, well-practiced denial system
- Episodic psychiatric disorder (e.g., bipolar affective disorder) may be related to intermittent alcohol abuse pattern
Prognosis
- Prognosis is better than for early onset but not as good as for late onset
- Although long-term denial exists, the person may be able to gain insight into the relationship between periods of heavy drinking and negative consequences
- May have some family and social support
- If previous periods of extended abstinence were initiated by alcoholism treatment or AA involvement, the prognosis for positive response to new treatment plan may be excellent
Focal Problem
- Focal problem drinkers have a specific health, legal, or social problem related to alcohol use (such as driving while intoxicated)
- Focal alcohol problems become very important with increasing age
Medical Problems
- Examples of health problems are hypertension and diabetes mellitus, which are made more difficult to manage by excessive alcohol use that increases blood pressure, interferes with glucose metabolism, and alters the effects of prescribed medications
Social Problems
- Irritability or coarse humor may be exaggerated by alcohol use and may cause social friction
- Arrests for driving while intoxicated represent a common legal problem
Psychological Problems
- Some individuals with focal problems may be drinking regularly, on a heavy basis and thus have at least mild alcohol dependence
- Some may qualify for a diagnosis of alcohol abuse
- Still others, however, manifest problems of such specificity that they do not meet all the DSM-IV criteria for an alcohol use disorder
Prognosis
- Prognosis is good if focal problems are addressed in a timely manner
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Last Updated: 6/14/04
SAMHSA is an Agency of the U.S. Department of Health & Human Services
