The Natural History of Alcoholism

Disease Progression

Alcoholism is a lot like true love: Its course never runs smooth. It's a very rocky downhill slide. What's most surprising is that from the beginning of alcohol dependence to the onset of potentially lethal problems, the pace is pretty swift.

In a pioneering study, a team of San Diego psychiatrists has documented that, contrary to conventional wisdom, the course of alcoholism is highly predictable. Clearcut medical and life problems mark every tumble of the way.

Marc Schuckit, M.D., and his colleagues VA Medical Center of San Diego scrutinized and interviewed 636 alcohol-dependent men admitted for inpatient treatment. They ranged in age from early twenties to late forties. From the findings, they created a new working model of the disease that looks like this:

Late 20s: The gin and tonics start sliding down a little too swiftly. Severe alcohol problems develop. There are binges, morning drinking. Job problems related to alcohol set in swiftly.

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Early to mid-30s: Problems with alcohol skyrocket. Objective signs of interference with functioning in many life areas. Blackouts, morning shakes, car accidents, drinking instead of eating, and signs of alcohol withdrawal. First arrests for drunk driving and public intoxication.

Age 34: By this time most alcoholics perceive they are losing control of their drinking. They can see the social damage increase in the form of lost jobs and ruined relationships. They get fired. They get divorced.

Age 35: Medical problems related to alcohol use begin to appear. Deterioration in body systems sets in. Some vomit blood, some hallucinate. Severe withdrawal reactions like convulsions develop.

Late 30s to early 40s: Serious longterm medical consequences of alcohol abuse occur. At this stage many are hospitalized, some with hepatitis or pancreatitis.

The patients studied were all male and mostly whites, the researchers report in the American Journal of Psychiatry (Vol. 150, No. 5). But Schuckit points to evidence that the disease takes the identical course in females. Even when alcohol dependence starts later, progression of problems is similar.

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