The Natural History of Alcoholism

The course of alcoholism is highly predictable, but never smooth.

By PT Staff, published on September 1, 1993 - last reviewed on January 23, 2015

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.

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

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

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.