Stages of Alcoholism

What Is Alcoholism?

Alcoholism is a chronic, often progressive disease involving excessive consumption of alcohol to the extent that it causes physical, mental, and social harm to an individual.

Alcoholism is often associated with the following signs of problem drinking:

• Loss of control over drinking
• Tolerance (need for more alcohol to feel the same effect)
• Craving for alcohol
• Physical withdrawal symptoms (e.g., shaking, sweating) when you don’t drink
• Harmful behavior caused by your drinking
• Continued use of alcohol despite negative consequences
• Missing work or other obligations because of drinking

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), approximately 14.5 million adults in the US suffered from Alcohol Use Disorder (AUD) in 2019.

Over time, alcohol use disorder (AUD) can cause serious mental and physical problems:

• Brain damage
• High blood pressure
• Heart disease
• Kidney disease
• Liver damage or disease (i.e., cirrhosis of the liver)
• Anxiety disorders
• Depression

Alcoholism not only affects the individual suffering from it, but it also affects their families, friends, and communities.

However, with proper treatment and support, most people with alcoholism can recover and lead healthy, productive lives.

What Are the Different Stages of Alcoholism?

Alcoholism is a disease that can take over a person’s life and leave them feeling hopeless.

It starts innocently enough, with an occasional drink—but before you know it, drinking becomes a habit that’s hard to control. As time goes on, alcoholism progresses, affecting your health and well-being.

There are four distinct stages of alcoholism, each with unique characteristics:

1. Early-stage alcoholism: Occasional binge drinking and an increasing tolerance for alcohol.
2. Middle-stage alcoholism: Development of physical and psychological dependence on alcohol, increased frequency of drinking, and signs of alcohol withdrawal.
3. Late-stage alcoholism: An individual qualifies for the severe form of alcohol use disorder (AUD) as per DSM-5 criteria
4. End-stage alcoholism: Final stage of alcoholism; can include severe health problems, disability, and a reduced life expectancy.

Early-Stage Alcoholism

This stage of alcoholism starts when people experience an increasing tolerance to alcohol and raise their alcohol intake with greater frequency and quantity.

Typically, people in the first stage of alcoholism do not notice the harmful effects of alcohol because they’re not experiencing withdrawal symptoms. They may use alcohol to relieve stress but also enjoy being high or drunk.

The severity of early-stage alcoholism varies widely among individuals but generally increases over time. It doesn’t start causing harm until it results in frequent intoxication or withdrawal symptoms.

Signs and Symptoms of Early-Stage Alcoholism

Early-stage alcoholism can be difficult to diagnose because it does not always include all the classic symptoms of addiction. However, some warning signs may indicate an alcohol problem at this stage, including:

• Binge drinking: Consuming five or more alcoholic drinks (men) or four or more drinks (women) on one occasion at least once per week
• Tolerance for alcohol: The individual may require more alcohol to achieve the desired effects.
• Drinking to deal with negative feelings or stress
• Trying unsuccessfully to cut down on alcohol intake
• Regularly drinking until intoxicated (at least once a week)
• Experiencing blackouts
• Being unable to control the amount of alcohol consumed in a single sitting
• Preoccupation with alcohol: The person may begin to spend a lot of time preoccupied with drinking and recovering from hangovers

Treatment for Early-Stage Alcoholism

The most effective treatment during the early stages of alcoholism includes therapy and support groups.

The first step in treating early-stage alcoholism is recognizing the problem. You should seek help from a professional counselor or therapist if you feel like you can’t handle this on your own.

Middle-Stage Alcoholism

Alcohol abusers often fail to realize the dangers of their drinking habits until they’ve moved into the middle stage of alcoholism.

While in this phase, an individual may still be able to function at work and home, but friends or family may begin to notice changes in their behavior.

The person’s use becomes more frequent and risky, and they may begin to experience negative consequences such as health problems and job losses.

The body also begins showing physical symptoms from alcohol withdrawal at this stage. However, if the alcoholic seeks help early enough, they may be able to avoid serious issues later.

Signs and Symptoms of Middle-Stage Alcoholism

Middle-stage alcoholics might deny their drinking problem or try to hide their alcohol use from others.

However, there are some common signs of middle-stage alcoholism to look out for, including:

• Difficulty controlling drinking: They may find it hard to stop drinking once they start and may drink more frequently and in larger amounts.
• Neglecting responsibilities: They may continue to neglect their responsibilities at work, home, and school.
• Physical dependence: The individual will need to consume large quantities of alcohol to feel normal.
• Withdrawal symptoms: The person may experience negative physical and psychological symptoms when they stop drinking, such as:
  • Alcohol cravings
  • Anxiety
  • Agitation
  • Sweating and clammy skin
  • Rapid heartbeat
  • Nausea
  • Vomiting
  • Reduced appetite

Treatment for Middle-Stage Alcoholism

Medical detoxification and outpatient rehabilitation or intensive outpatient programs may be necessary to help the individual overcome their physical alcohol dependence.

They may also benefit from behavioral therapy, such as cognitive behavioral therapy (CBT) and motivational interviewing (MI), to help them change their attitudes and behaviors related to alcohol use.

Furthermore, support groups like Alcoholics Anonymous (AA) can provide a supportive community for individuals in early recovery.

Late-Stage Alcoholism

Late-stage alcoholism occurs when the body has become so dependent on alcohol that it cannot function without it. It can result in significant physical and mental health problems, plus social and occupational impairment.

This stage also qualifies as a severe form of alcohol use disorder (AUD) according to the DSM-5 criteria.

Signs and Symptoms of Late-Stage Alcoholism

Severe AUD diagnosis is based on at least 6 of these 11 criteria being met in a 12-month period:

• Alcohol cravings
• Tolerance (needing more alcohol to feel intoxicated)
• Continued drinking despite alcohol-related health problems
• Alcohol withdrawal symptoms
• Lack of control over drinking
• Preoccupation with drinking or recovering from drinking (e.g., hangovers)
• Continued use despite damaged relationships because of alcohol
• Disruptions in family life or school/work performance
• Getting into risky situations (drinking while driving, unsafe sex) due to excessive drinking
• An inability to cut back on alcohol use
• Giving up on previously enjoyed activities because of prioritizing drinking

Treatment for Late-Stage Alcoholism

Late-stage alcoholism requires a more intensive and comprehensive treatment approach than middle-stage alcoholism. Treatment may include medical detoxification and inpatient rehabilitation, where the individual can receive 24/7 support and care.

Common medications that help reduce cravings and prevent relapse include:

• Disulfiram (Antabuse®)
• Naltrexone (Vivitrol®)
• Acamprosate (Campral®)

Different forms of psychotherapy, such as CBT, MI, dialectical behavioral therapy (DBT), and interpersonal therapy, can also be effective in helping the individual get to the root cause of their addiction.

Finally, support groups, such as AA, can support the individual and give them a sense of accountability.

End-Stage Alcoholism

End-stage alcoholism is the final stage of alcohol addiction and is associated with life-threatening health problems and often isolation.

After a long period of continuous heavy drinking, alcohol has contributed to the damage and deterioration of vital organs such as the liver, heart, kidneys, pancreas, and brain. Mental problems such as dementia or delirium tremens (DTs) occur, and they face an increased risk of developing cancer.

Financial distress from job losses and loneliness due to damaged relationships are also prevalent in this phase.

Signs and Symptoms of End-Stage Alcoholism

Some signs and symptoms common to end-stage alcoholism include:

1. Life-threatening health problems: The individual may experience serious health problems, such as liver failure, brain damage, and heart disease, which may threaten their life.
2. Increased alcohol consumption: The person may continue to drink heavily despite their life-threatening health problems.
3. Physical changes: Extreme weight loss, weaker bones and muscles, and bloodshot eyes are some of the evident physical changes in this stage.
4. Difficulty quitting: The person may have difficulty quitting or reducing their alcohol consumption, even if they want to.
5. A decline in personal hygiene: They may neglect their hygiene and overall appearance.
6. Severe withdrawal symptoms: When not drinking, they may experience severe withdrawal symptoms such as tremors or seizures.
7. Isolation: Due to the damaging effects alcohol has had on an individual’s relationships and the shame associated with addiction.

Treatment for End-Stage Alcoholism

Treatment options for end-stage alcoholism may include hospice care, palliative care, or hospitalization to manage complications. However, recovery is possible at any stage of alcoholism.

• Medical care: Treatment for end-stage alcoholism may first require hospitalization and intensive medical care to manage the individual’s symptoms and prevent further decline.
• Medical detoxification: The doctor will advise when to begin medical detoxification for alcohol withdrawal. Like middle-stage alcoholism, they may prescribe medications (naltrexone, acamprosate, and disulfiram) to help manage the withdrawal symptoms and reduce cravings.
• Rehabilitation: After a safe detox, further treatment in an inpatient rehabilitation center will be the next step, where the individual will also have behavioral therapy sessions.
• Psychotherapy: Cognitive Behavioral Therapy (CBT), dialectical behavioral therapy (DBT), interpersonal therapy, and motivational interviewing (MI) can help manage the psychological and emotional aspects of addiction. Family therapy can also be beneficial in addressing the impact of the individual’s drinking on their loved ones.

Get Help for Alcoholism at Any Stage

Alcoholism is a dangerous and life-altering disease that can seriously affect your health and well-being. However, it is never too late to seek help and turn things around.

No matter what stage of addiction you or a loved one may be in, addiction treatment is available to help you overcome alcoholism.

Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-HELP (4357) or use their Substance Abuse Treatment Facility Locator at FindTreatment.gov to find treatment options in your area.