Course of alcohol abuse

The traditional view, which may well apply to some of the most severely affected, is of a relentlessly progressive disorder. Alcohol problems commonly begin when social drinking becomes heavier for psychological reasons, such as living in a hard-drinking environment, or stressful work or family circumstances. This stage of psychological dependence is followed in some cases by development of physical dependence, manifested by loss of control over the amount consumed, and withdrawal symptoms (tremor, sweating, anxiety, and craving) if alcohol is unavailable for a few hours. Intake increases further to combat withdrawal symptoms. Alcohol tolerance increases initially, decreasing again when the condition becomes advanced. Drinking gains priority over other activities, and the various physical, psychiatric, and social problems ensue.

Other patterns include repeated relapses and remissions according to current circumstances and/or changes in mood. As with other kinds of substance misuse (see Chapter 12), some people drink heavily in early adulthood but 'grow out' of their habit later on. Many drinkers deny their problem, concealing the extent of their drinking and hiding bottles at home or at work. Heavy smoking, dependence on other drugs, and heavy gambling may be associated.

Vagrant (skid row) alcoholics are those without families, homes, or jobs, often handicapped by low intelligence or chronic mental illness, who live rough in city centres drinking cheap forms of alcohol.

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