It Still Outranks Them All (Part II)
By Fr Bogdan Djurdjulov
Phases, Signs and Symptoms
When thinking of alcoholism and other chemical dependencies, it is helpful to think of them as a progressive condition having at least three or four phases or stages; early, middle and late, for example.
E. M. Jellinek (The Disease Concept of Alcoholism), was an early pioneer in the study of alcoholism. He cites these progressive stages:
2. Early or prodromol
3. Crucial or middle
4. Chronic or late stage
Vern Johnson (I’ll Quit Tomorrow), also considered a pioneer in the field, speaks of the following phases:
1. Learning phase
2. Seeking the mood swing
3. Harmful dependency
4. Impaired judgment phase
Robert and Mary McAuliffe in their book, The Essentials of Chemical Dependency, cite five progressive stages:
2. Initial stage
3. Chronic stage
4. Acute stage
5. Terminal stage
Although the McAuliffe diagnostic inventory is very lengthy, it is nevertheless worth looking at because of the detailed exploration into the various aspects of the impact of the disease on the person.
It goes without saying that there are a lot of different ways of looking at the signs and symptoms of alcoholism/chemical dependency. Despite this fact, it is readily agreed that alcoholism is a disease which has its own symptoms that are describable just as those for chicken pox and the mumps. Each of the phases or stages of this disease is characterized by a series of signs and symptoms which tend to occur more or less predictably. Each stage varies in length and varies from individual to individual. The symptoms often associated with alcoholism do not need to appear in every alcoholic and not in any specific order. For an accurate determination for alcoholism/chemical dependency, a complete history is necessary, including past and present condition, (physical, emotional and spiritual), family and concerned person information, identified problems, behavioral history etc. Making a correct diagnosis is vital, as chemical dependency is ultimately fatal if left untreated and undisturbed.
PLEASE NOTE: The intention of this discussion is not to enable the reader to be able to make a definitive determination of alcoholism/chemical dependency, but rather to be able to recognize more clearly signs often associated with this disease so that the proper help and intervention can be sought from professionals in the drug and alcohol field.
At the onset, keep in mind that no symptom can be considered outside of its context. No behavior should be looked at without looking at the bigger picture. Looking at this disease from a “systems” perspective is encouraged. Look at what’s happening not just with the person identified, but also with the people close to or around him or her. Look at different situations such as job, family, church or social functions. How is the person’s life and those around him being affected by the use of alcohol and other mood-altering drugs? A key here is “harmful” dependence on any mood-altering drug, characterized by repeated use despite negative and harmful consequences to self and others.
Symptoms Related to Alcoholism/Chemical Dependency
Rather than just list the signs/symptoms often associated with alcoholism alone, I thought it would be helpful to incorporate them with “questions to ask” under each listed symptom while also expanding the line of thinking to include drugs other than alcohol alone. The symptoms are based on E. M. Jellinek’s work, The Disease Concept of Alcoholism and Vern Johnson’s book, I’ll Quit Tomorrow. Many, but not all of the symptoms will be listed and not in any particular order. Please keep in mind that the symptoms listed below are related to alcohol and other mood-altering drugs. Some of the symptoms can be associated with other diseases as well. Make no assumptions about what is causing a person to behave the way he or she does.
- Sneaking or Secretive Use of a Chemical
- When making a drink, have you ever made yours extra strong?
- Have you ever had liquor in your coffee, soda or juice in order not to be noticed drinking?
- Have you ever had a drink before going to a party?
- Have you ever drunk other’s unfinished drinks?
- Have you ever had a “quick” one on the side without others knowing?
- Have you ever drunk or used drugs in your garage, bathroom, basement or car so no one would see you use?
- Have you ever offered to bartend in order to drink more without being noticed?
- Have you ever used someone else’s prescription in order to conceal your own use?
Preoccupation with Chemical Use
- Do you ever find yourself thinking about drinking or drugging?
- Do you choose social gatherings that serve drinks over those that don’t?
- Have you ever called acquaintances to find drugs or booze?
- Have you ever thought of ways to create occasions where your drinking would be deemed acceptable?
- Have you ever counted the hours, even minutes until your next drink or hit?
- Have you ever thought of more ways to make money to get drugs?
- Have you ever found yourself buying dope, cocaine, etc. on your lunch hour?
Rapid or Hurried Ingestions of Chemicals
- Have you ever gulped two drinks in an attempt to “catch up” with the rest of the group?
- Have you ever ordered two drinks at the same time?
- Do you ever drink straight from the bottle?
- Have you ever gulped your drink because the first one wasn’t working fast enough?
- Have you ever noticed that your glass is usually empty before the others around you?
- Have you ever used two different drugs together to get your “high” faster?
- Is your first drink ordered usually a double?
Temporary Loss of Memory (Blackout-no loss of consciousness)
- Have you ever had family or friends say “Don’t you remember what happened… or what you said?” and have absolutely no recollection of what they were talking about?
- Has your mind ever gone blank and you’ve wondered what you’ve done?
- Have you ever experienced not remembering where you put things and what you said?
- Have you ever not remembered how or when the party ended or how you even got home?
- Have you ever made a phone call in the middle of the night for example and not remembered this the next day?
- Have you ever experienced a car accident or any significant incident that you can’t remember?
- Have you ever not remembered what or how much you drank or drugged the night before?
Increase of Tolerance
- Are you getting “high” on the same amount, or does it take more to get you there?
- Are you looking for more occasions to drink more often?
- Has anyone ever accused you of having a “hollow leg”?
- Are you often the last one to leave the party and close the bar?
- Does it take 2 or 3 joints instead of 1 joint on the lunch hour to keep you high during the afternoon?
- Is your prescription running out faster than what was prescribed by the doctor because of doubling/tripling doses?
Avoiding Reference to Your Personal Chemical Use
- Have you ever changed (or wanted to change) the topic of conversation when drinking or drugs was being discussed?
- Have you ever used breath spray, gum or candy to cover up the odor?
- Have you ever come home late in order to avoid confrontation?
- Have you ever turned the table and put it back on the other person saying, “You should talk ...you drink/drug with me?”
- Have you ever tried to change the subject when your drinking or drug use was mentioned?
More Frequent Memory Loss
- Have you ever forgotten where the bottle or your drugs were hidden?
- Have you ever forgotten where you left the car?
- Have you experienced shorter periods of time between blackouts?
- Have you lost track of how much money you were spending on drugs and can’t remember where you charged or wrote checks?
Loss of Control This is a hallmark symptom of Chemical Dependency. It is an inability to consistently choose between using and not using. At least two types exist. 1) Inability to stop using once started and 2) Inability to refrain from starting to use. It doesn’t mean that every time an alcoholic takes a drink, he won’t be able to stop before getting drunk. It’s unpredictable, it could be 1, 2 or 20 drinks.
- Have you ever gone into a bar when you really didn’t intend to?
- Have you ever missed scheduled appointments or meetings?
- Have you ever done all the drugs you bought for the weekend in one day?
- Did you ever tell yourself that you would quit at 9:00 PM and not quite until 1:00, 2:00 or 3:00 A.M.?
- Have you ever experienced the inability to reliably predict how much you will drink or use or what will happen when you do?
- Have you ever stopped for a couple and missed dinner or closed the bar or restaurant instead?
- Have you ever made promises that you would quit, but ended up going back to drinking/using again in a few days or so?
Alibis and Excuse Making
- Have you ever said, “If you had a job (family, etc.) like mine… you would drink too?”
- Did you ever say you had to work late, but really stopped off for some drinks?
- Did you ever say that alcohol/drugs make you more alert and that’s why you use them?
- Have you ever said: “I work hard and deserve my fun… it relaxes me… I deserve it?”
- Have you ever said: “If people would get off my back, I wouldn’t drink/use so much?”
- Have you ever claimed you were just going to the grocery store to pick up a few things, but really stopped off for a few rounds?
Reproof by Others
- Has anyone, family, friends, co-workers, etc… . ever expressed any concern over your drug or alcohol use?
- Have you ever heard anyone make comments to you like… “You’re no fun to be with when you have a few too many… or… You’re different when you drink?”
- Have you ever been warned at work that unless your job performance improves, you will be fired (due to drinking or drug use)?
- Have your kids ever said that they don’t like it when you drink?
Aggressive Behavior (verbal or physical)
- Have you ever been physically abusive?
- Have you picked arguments for no apparent reason?
- Have you ever thrown things, broken things or put your fist through something?
- Have you ever become very quiet, pouty and aloof with your family and friends?
- Have you experienced yourself feeling more angry lately?
- Do you find yourself being irritated with things that never seemed to bother you before?
- Have you ever quit for Lent, Christmas or other holidays?
- Have you ever gone on the “wagon,” made a New Year’s resolution or taken the “pledge” not to drink anymore?
- Have you ever quit in order to prove to yourself or someone else that you could do it, but go right back to it after it’s over?
- Have you ever quit in order to avoid the consequences of losing a job, divorce, or a DWI? (driving while intoxicated)?
- Have you quit using during the week, promising that you would use only on the weekends?
Excessiveness or Extravagance
- Have you ever made wild purchases while drinking?
- Have you ever purchased expensive things for your family to make up after drinking episodes?
- Have you found yourself spending more and more of your free time in drinking or getting high?
- Have you become an expert in all things, giving all sorts of advise to barroom or party guests?
- Did you ever buy drinks for everyone in the “house”?
- When drinking, do you tip extravagantly?
Persistent Gilt or Remorse
- Have you ever thought to yourself “Why can’t people understand me?”
- Have you ever wished you could be like “social drinkers”?
- Have you ever wished you could be like other people?
- Do you constantly feel like you’re falling short?
- Do you find yourself always apologizing, yet still continue to do the same thing?
- Have you been experiencing continual guilt regarding your lies, broken promises and overall behavior?
Change or Modification in Chemical Use Pattern
- Have you ever switched drinks or mixes in an attempt to keep from getting sick or drunk?
- Have you switched from vodka to gin to wine to beer to select beer to near beer in an attempt to keep from getting drunk?
- Have you ever tried changing the place where you drink or drug?
- Have you tried not drinking/using with certain friends or family members thinking maybe you wouldn’t get as drunk or high?
- Have you ever switched the time of day you use or the day of the week?
- Have you ever switched from daily use of alcohol to daily use of another drug like valium?
Loss of Friendship
- Have you ever left your spouse or roommate and lived alone?
- Have you ever withdrawn and isolated yourself from your family?
- Have you ever told off your boss and quit before getting fired?
- Have you found yourself avoiding non-using or drinking friends and relatives?
- Have you experienced people avoiding you when you’ve been drinking or using?
Loss of Job, Position or Clients
- Have you ever done your work poorly enough to be fired or suspended from your job?
- Have you ever let your work at home go and leave projects unfinished or keep putting them off?
- Have you been overlooked for promotion or asked to step down to a lower level position?
- Have you lost your position, standing or respect within your family, social circles or community?
- Have you ever resigned or been asked to step down from any clubs or organizations?
- Have you ever abandoned social and sports events?
- Have you ever been so ashamed of your drinking behavior that you’ve avoided going back to be with certain friends or social circles?
Change in Habits of Family and Other Significant Persons
- Have your children stopped bringing their friends home?
- Has your family started going places and doing things without you?
- Has anyone ever walked on tiptoes to avoid getting you angry or upset?
- Have your family and friends ever lied to you?
- Has your family ever refused invitations because of your drinking?
- Has your spouse ever increased his/her drinking/drugging eating or smoking?
- Have friends or relatives ever tolerated your drinking or drug use just to avoid arguments?
- Has your family ever attended Alanon or Alateen meetings.
- Have you ever thought “Why me Lord… what have I done to deserve this?”
- Have you ever thought that all your problems were your spouse’s, kid’s or employer’s fault?
- Have you ever envied others because they had more than you?
- Have you ever resented anyone for criticizing your work performance?
- Have you ever thought that people expect too much of you, that your spouse doesn’t understand you, that people just don’t take you seriously enough?
- Have you held grudges and used them to justify your feelings today?
- Have you ever resented people who represent authority?
Geographical, Social or Psychological Escape
- Have you ever switched bars or using places?
- Have you changed living quarters frequently?
- Have you ever thought it would be better if you were dead?
- Have you ever thought about moving as a way to make things better and get a “new start”?
- Have you changed friends, thinking that it would be better if you didn’t hang around with so and so?
- Have you ever just threatened to pack-up and leave home?
- Do you experience frequent thoughts that begin with the words, “If only… “?
Protecting or Guarding your Supply of Alcohol or Drugs
- Have you ever held money back from your household needs for drugs/alcohol?
- Have you ever kept a supply hidden for your own use?
- Have you ever stored up enough “extra” alcohol/drugs for your use on weekends or holidays?
- Have you ever hid any alcohol/drugs in the garage, basement, secret places even if you lived alone?
- Have you ever quit sharing your drugs if you were low?
- Have you ever not served a drink to someone for fear that you would not have enough for yourself?
Morning Use of Chemicals (Depends on work shift also)
- Have you ever shot up before going to work?
- Have you ever used on the way to work or during breaks?
- Have you ever taken a tranquilizer, joint or speed when just getting up?
- Have you ever drunk before noon or at the start of your work day, weekend or vacation?
- Have you ever started drinking before lunch?
- Have you ever experienced “hair of the dog”... taken a drink to calm the nerves?
- Have you ever mixed alcohol in your juice in the morning to avoid suspicion of your drinking?
More Frequent and Intense Use of at Least 18 Hours Long
- Have you ever been or are you a daily drinker/user?
- Have you ever drunk/used at night and started up in the morning before the drugs have left your system?
- Have you ever done drugs/alcohol sometime for days in a row?
- Have you experienced on and off drinking during the period of a day and then followed it by morning drinking?
- Has your “5:00 O’Clock Cocktail” been starting hours earlier?
- Have you ever gotten up in the middle of the night, had a pill or drink and then gone back to sleep?
- Have you ever had your weekend turn into a marathon of three or four days long?
Ethical and Moral Deterioration
- Have you found yourself going against your moral standards?
- Have you lied, stolen or cheated to cover up your habit?
- Have you found yourself in strange physical relationships?
- Have you violated a respectable code of sexual ethics?
- Have you ever taken money from your spouse or children to finance your drug/alcohol use?
- Have you ever said or done things drunk/high that you wouldn’t have sober/straight?
- Have you ever identified with the “Prodigal Son”?
Inappropriate, Erratic Thinking
- Have you ever found yourself second guessing yourself and even thinking that you’re crazy?
- Have you often asked yourself, “Why do I keep on using . . what am I trying to do to myself”?
- Have you found yourself saying one thing and doing another?
- Have you heard yourself saying things that are totally off the wall and inconsistent with what you consider to be normal for you?
Decrease of Tolerance
- Have you ever said to yourself, “For some reason I can’t handle it like I used to…, I must have been tired, that one really hit me…, that’s the last time I drink on an empty stomach”?
- Have you found that it is taking less to get you drunk or high lately?
- Have you been afraid of being alone lately?
- Have you ever experienced sleeplessness or restlessness?
- Have you ever been concerned that people are talking about you?
- Have you avoided meeting people, afraid of answering the phone or door?
- Have you been afraid of doing the things that usually gave you no problems, e.g., going to work, talking to strangers?
- Have you ever experienced the shakes, sweating or cramps when not using?
- Have you ever experienced not being able to stop shaking when shooting up?
- Have you ever had facial tics or lip twitching?
- Have you ever felt shaky inside, hyper, anxious or uptight?
- Have you ever had difficulty focusing your eyes?
- Have you ever had difficulty buttoning your shirt, tying your shoe laces or other tasks requiring hand/eye coordination?
- Have you ever misjudged walking up stairs?
- Have you ever tripped for no apparent reason?
- Have you ever experienced difficulty in doing daily routine tasks, like writing, shaving, putting on make-up, pouring liquids into a glass etc.?
- Have you experienced difficulty in doing detail work that once came easily?
Spiritual Weakening and Recognition of Spiritual Need
- Have you ever said, “God help me ..., I don’t know what to do anymore… “?
- Have you all of a sudden found yourself back in church?
- Have you ever called your pastor for help?
- Have you ever gone to an A.A. or N.A. meeting for help?
- Have you felt alone lately?
- Have you found yourself praying again?
- Have you ever called anyone for help?
As you can see, there are many symptoms that can appear related to alcoholism/chemical dependency. Remember that not all symptoms need to be present and that some of these symptoms can be associated with other diseases. It is important to get as much information as possible. The key issue is to look for harmful change in a person’s functioning related directly to drug and alcohol abuse.
At the end of this article I have added a comparison chart of the progression of this disease. I took the authors named at the beginning of this article (Jellinek, Johnson, and McAullife) and placed them side by side in order to view more easily how each researcher conceptualized the progress of the disease and where it begins. I hope you find it helpful.
Knowing what to look for is an important step in preparing to intervene. Often times this intervention takes place when the right person says the right thing at the right time. When is the “right time” and who is the “right person” is often difficult to determine, but there are specific actions that can be taken to provide help for the alcoholic and the family. Never give up hope. If one person in a troubled family or relationship begins making change and sees hope, others will be influenced by virtue of the fact that change in one inevitably causes change in another to occur. That’s how systems work.
Intervention is the topic of Part 3 of It Still Outranks Them All.