Alcohol Abuse Courses

There is no one course for alcohol dependence. Some people begin drinking early in life; others begin later. Some abuse alcohol for a short period of time; others are dependent for life.

When a person begins to rely on alcohol to enhance all social interactions, he or she is at risk for dependence. Alcoholics believe that alcohol is necessary to get through everyday activities, alleviate stress, and cope with problems. The alcoholic denies the overpowering role alcohol plays. He or she may drink in secret to avoid confrontations with family or friends, and then feel guilty afterwards; drink more to alleviate the emotional stress, feel guilty; drink again; and so on, thereby creating a cycle of abuse.

Others use alcohol in isolation to ease the pain of loneliness and alienation. Depression may also be a factor, and alcohol use may serve as a form of self-medication. Alcohol produces sedative effects that relieve anxiety. However, these initial effects subside and more severe depressive symptoms follow. The alcoholic may drink to relieve these symptoms. Once again, alcohol creates a cycle of abuse.

Those who are dependent on alcohol show a variety of patterns of drinking, including:

  • Binge drinking: heavy drinking which lasts for days, weeks, or months followed by long periods of sobriety
  • Daily drinking: moderate to heavy drinking each day which may or may not occur at specific times of the day
  • Weekend drinking: heavy drinking to the point of intoxication, but only on weekends

Over the course of months of drinking, the central nervous system adapts to the alcohol and tolerance develops. The drinker requires increased amounts of alcohol to achieve the desired effect. Despite experiencing adverse effects, the person continues to drink and will likely increase the amount and frequency.

Over time, withdrawal symptoms, a sign of physical dependence, may develop. Symptoms include high blood pressure and accelerated pulse rate, and tremors which occur when not using alcohol.

Alcohol dependence has a variable course. Sometimes a crisis such as having a car accident while drunk will cause alcoholics to stop drinking for a short period of time (i.e., go into remission). After a while, they may relapse, or begin drinking again. Once the alcoholic begins drinking again, the amount and frequency likely escalate.

Two courses of alcohol dependence have been clinically defined:

  • Young males who typically begin drinking in the teens or early 20s, with abuse developing rapidly. Young men with a significant family history of alcoholism may become dependent within 1 or 2 years. Dependence often lasts through the 30s, and sometimes into the 50s and 60s. Of the two courses, this has the worse prognosis.
  • People of both genders who experience a late onset of abuse. There may or may not be a family history of alcoholism, and the progress from abuse to dependence is slower, taking from 5 to 15 years. The prognosis for recovery is better for this group.

Publication Review By: Debra Emmite, M.D., Stanley J. Swierzewski, III, M.D.

Published: 02 Apr 2001

Last Modified: 28 Aug 2015