Alcoholism Progression

One of the most insidious things about the disease of alcoholism–and it is a disease, despite the best efforts of thundering moralists to deny the science and the plain medical and biochemical facts–is that it plays on your character defects (which all people have) and, worse, it progresses slowly. Biochemically, it’s known to generally progress faster in women, for a variety of reasons that are understood (women are generally smaller, with consequent lower blood volume on average, and may also be able to conceal drinking better if they’re stay-at-home moms) and some of which undoubtedly are not currently understood. But in any case, in most alcoholics the progression is slow; while a certain minority subset (with a strong genetic component most likely to effect males) progress at a frighteningly fast pace, most people will progress very slowly, moving from social drinkers who are basically functional members of society to having occasional overindulgence problems to drinking regularly to an unhealthy degree to finally reaching a pathological, out-of-control state.

What’s also well-documented about the disease, even symptomatic, is that the alcoholic will occasionally undergo “dry spells” where they “prove” to themselves and others that they’ve got the problem “under control” by just not drinking, or by moderating their intake. I myself had such a dry spell 3-4 years ago, where I went about 100 days without drinking, trying a few meetings and then giving up on them because I hated them–the ones I went to were mostly pity-parties, which is one of the negative things you see at some AA meetings. I also did a lot of reading on alternative approaches, and tried some of them with mixed levels of success. Those things I don’t regret, but what I do regret is that I did go back to drinking, with firm intention never to get out of control again.

But, as is yet another symptom of the disease, I soon was back pretty much where I’d left off. What is quite typical of the progression, which generally takes 3-10 years in women and 5-15 years in men (or so I was told in the hospital last fall), is that you go through periods where you don’t drink at all, or where you convince yourself that you’re moderating successfully. You have instances where you do indeed don’t-drink, or succeed in your goal to drink less. But you don’t notice that the times you fail are increasingly more frequent than the times you succeed. You see the success (“See! last night I said I’d have only two, and I had only two!”) but the failures are just things you kick yourself for in the morning, with much self-abuse, and then move on.

In my own case, I’m fairly well convinced I had no real “problem” per se until approximately 1999. I drank regularly, but only occasionally to the point where it made me irrational or affected my job or family life in a significant way. I had a lot of fun, and in fact a lot of people in my life said they preferred my company when I had a few in me, as I was a lot more jolly and funny and outgoing than my normally fairly quiet and reserved demeanor. Around 1999, after the failure of my business and I got into repossessing cars, I started working midnights and drinking more heavily, and was a hell of a lot grumpier. I got a better job I liked better, training computer classes, and accomplished a lot, but didn’t love that job either (although in retrospect I wish I’d never left it, I did well there and was mostly well-liked). But by 2001, everything collapsed, none of it due to drinking. Financially and otherwise, disaster was more or less complete, and right around the time of the September 11 2001 attacks, too. I got a terrible job that was the only thing available then in Michigan’s economy for someone with my skillset, a crappy tech support job for a crappy company that treated its employees like dirt, making approximately a third of what I’d once made. Working the midnight shift was the only way to make the job bearable and pay enough, and but I also made the near-fatal mistake of deciding to get a college degree. The only thing that saved my sanity in those years, where I was so often isolated from my family, was blogging, and blogging also brought in money as a second job that was often helpful. But I was alone a lot, I was tired constantly (working midnights and going to school will do that to you) and so my family relationships suffered. Alcohol was the only thing that seemed to help.

Then around 2003 or so I had stomach surgery that is now known to tend to aggravate alcoholism in some people. I can see why. It caused alcohol to hit my system much faster than in normal people. Yet at the same time, strangely, my capacity went up. You can see why that was a disaster. From 2003 to about 2005, my progression went from slow to extremely rapid, aggravated both by physical factors and severe isolation and career/school stresses. It also made me a bear to live with, and my then-wife struggled to deal with it, usually valiantly. I quit for a while on my own, but the obsession wouldn’t leave, the factors making me miserable didn’t change, and so I went back, and took up almost exactly where I left off.

No matter what, the disease gets worse and worse, and no matter how much you convince yourself that you’re getting better, you’re not getting better at all. You convince yourself that the problems you’re having, most particularly in your personal life, are the fault of everything and everybody (including yourself) except for the one thing that’s really aggravating everything: the alcohol. No, not all your problems are caused by it, but as another friend in recovery wisely observed, “there is no problem in the world that can’t be made worse [for the alcoholic] by another drink.”

None of this applies to the person who occasionally drinks, or even occasionally ties one on after a period of stress. Heck, in some cases that may even be psychologically healthy–until it becomes a habit.

The truth of the matter is that if you think you have a problem, you probably do. On the other hand, there is spontaneous remission; something like 20% of people with severe alcohol problems just stop on their own and cease to have a problem.

About 80% don’t experience such remission. They continue to get slowly worse and worse. The result for them is usually the same: an increasing despair, despondency, and overwhelming depression, with irrational bouts of anger, frustration, and even paranoia, and usually an aching loneliness even when around loved ones. For those around them, it’s often just as bad or worse. But as I say, it’s insidious: it usually doesn’t get worse over a period of weeks, but more often in a period of many months and multiple years. With one step forward, two steps back, but those little steps forward helping you convince yourself, to rationalize and lie to yourself, that you’re getting better and that whatever problems you’re having have nothing to do with that bottle. The bottle becomes your only real friend, especially when your social life is already gone due to things beyond your control (although the bottle makes that social life worse too).

Every journey down this road is unique, yet has certain traits in common. And, no matter the exact course of your journey, the end points are the same for most: unless you’re one of the lucky minority who has a spontaneous remission, the end is insanity, prison, or death. Usually death, because the number of alcoholics who spend years in jail only to get out and take up right where they left off is huge. So they wind up drinking themselves to death, dying as a result of drinking, or, doing something while intoxicated that lands them in jail for life.

Although I am a regular 12 step program participant, and active in 12th-step work, I’m actually sympathetic to many criticisms of AA and its approach. I firmly believe there are other approaches besides 12 step programs that work, and may work better for some people. I’ve written about that in the past, and you can search this site for articles on them, or just search the internet yourself. I chose it because it was the right fit for me at this time, and because I’ve seen how, properly applied, it can be tremendously helpful for some individuals, even if it is a poor fit for others and is sometimes rammed down people’s throats in an inappropriate manner.

Anyway, it was a fascinating chart given to me by a doctor (himself an alcoholic) that finally made me truly believe this was a disease, that the science was rock solid, and that I had it; the way it described the progression was such a precise description of what the last 8 or so years had looked like in me, it was shocking, going from minor problem to full-blown out-of-control, with me quite rapidly (by late 2007) approaching the chronic, often terminal stages.

Unfortunately, I can’t find that chart online and don’t have a scanner. The only one I’ve managed to find so far is the better-known Jellinek chart, which is much less detailed, although it is generally accurate and also hopeful (PDF here). On the other hand, it’s way too limited, too lacking in details, and elides the fact that some people enter recovery much sooner than it would indicate.

The chart I was given was much better, at least for my logic-and-detail-obsessed way of thinking. I’m wondering, does anyone out there know the one I’m talking about? It had three rows, showing a progression timeline through four basic stages, with various symptoms of each of the stages (like “water wagon” and “self-loathing” and “firm commitment to stop” among them). Anyone seen it?

Anyway, not everyone who drinks a little too much has a problem. But if you think you have a problem, there’s a good chance you do. And if you drink a lot, and you have a lot of problems, you might want to consider the possibility that it’s the bottle that’s making the problems worse, not the worsening problems making you drink more. But you, and only you, can decide if you’re an alcoholic. Good luck and let me know if you’d like help if you think you are.