What are the Stages of Alcoholism?

Robert Gerchalk

Robert is our health care professional reviewer of this website. He worked for many years in mental health and substance abuse facilities in Florida, as well as in home health (medical and psychiatric), and took care of people with medical and addictions problems at The Johns Hopkins Hospital in Baltimore. He has a nursing and business/technology degrees from The Johns Hopkins University.

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How Many Stages Of Alcoholism Are There?

Because alcoholism is a gradual disease, drinking excessively can seem harmless. Unfortunately, alcoholism works in stages, with each stage getting progressively worse and more dangerous. At some point, the damage to a person’s health becomes irreversible. This article looks at the stages of alcoholism and the key characteristics of each stage.

Alcoholism and Its Symptoms

Alcoholism, or alcohol use disorder (AUD), is a disorder defined by the excessive drinking of alcohol. Although the symptoms can range from mild to severe, individuals are usually diagnosed with the disorder when they can no longer control their drinking. The symptoms of alcohol range from physical to social and psychological. Some symptoms include the following.

Loss of Control

Many people suffering from alcoholism are unable to quit drinking even when they try. They are also unable to control the amount they drink, leading them to drink to excess every time they start drinking. In addition, the withdrawal symptoms are often intense, which makes quitting harder. Withdrawal symptoms may include excessive sweating, depression, nausea, and hand tremors.

Intense Cravings

Alcoholics tend to have intense cravings for alcohol when they are not drinking. These cravings develop into preoccupation—obsessing about alcohol—and then anticipation.

Higher Tolerance

As the body starts to adapt to alcohol, individuals with AUD need more and more alcohol to feel the same effects. Essentially, it takes more alcohol for the person to become intoxicated. 

Brain Chemistry Alters

Drinking alcohol produces feelings of pleasure in the brain. Some people drink for the rewarding effects in the brain while some drink to relieve emotional discomfort.

Time Spent Drinking Increases

People with an alcohol addiction spend more of their time drinking alcohol. As soon as drinking becomes the main focus of their life, it’s a good indication the person has AUD.

Physical Changes

Alcoholics may also display physical symptoms, such as yellow eyes or jaundice. This is known as alcoholic hepatitis, and up to 35% of long-time heavy drinkers exhibit these symptoms.

The Stages of Alcoholism

Alcoholism typically falls into four stages, with each stage getting progressively worse.

Pre-Alcoholic

The pre-alcoholic stage is also known as the prodromal stage. This is the “premonitory symptom of disease” or the stage that gives warning signs if action is not taken. Not everyone in the pre-alcoholic stage will go on to develop an alcohol use disorder (AUD), but some certainly will. 

At this stage, people will start to develop a tolerance for alcohol. The body has started to adapt to alcohol in the bloodstream, and the person now needs more to feel the same level of intoxication.

People will also start to drink more, whether in quantity or frequency. This increase is typically gradual and is, therefore, easy to overlook.

A person in the pre-alcoholic stage may also deny having a problem with alcohol. Often, people attribute their drinking to socializing or taking the edge off a stressful day. However, gradually, they are starting to lose control over how much they drink and when they drink. They are also starting to think about drinking more and going to events and social outings only if there will be alcohol present. 

The pre-alcoholic stage is often not noticeable by many people, except those very close to the individual in question. However, these signs should be a warning that an individual’s drinking problem may become increasingly worse.

Early Alcoholic

At this stage, it’s often clear to others around the individual that the person is starting to develop an alcohol use disorder. If family and friends can recognize the signs, they can intervene and get treatment before the condition spirals out of control. Here are some key characteristics of the early alcoholic stage.

Like the pre-alcoholic stage, one of the most telling signs that people are developing an addiction to alcohol is that they no longer have control over their drinking. They often consume too much when they drink, and they are unable to stop when they want to. 

They also have more tolerance, and friends or family who drink with them socially may notice that they are consuming more and more alcohol. At this stage, alcohol is starting to become a major focus in their daily lives. 

In the early alcoholic stage, individuals may become moody and irritable when they don’t drink. As a result, they may drink more to even out their temperament. There may be physical changes, too, as they swing abruptly from hangovers to changes in their sleeping patterns. This could lead to weight gain or weight loss. 

At this stage, family and friends who try to intervene may be met with defensive behavior or denial. Individuals who are unwilling to admit they have a problem may attempt to overlook or minimize any negative consequences, such as problems at work, at school, or in their relationships. 

Middle Alcoholic

At this stage, it is clear that the individual is an alcoholic and needs help. It is obvious to friends, family, and everyone who interacts with the person. Worse, this is the stage where long-term health effects start to become an issue. Here are some key features of the middle alcoholic stage.

People who are in the middle alcoholic stage are aware that they are unable to quit. They drink to excess often, despite the negative consequences, and they are physically and psychologically dependent on alcohol. When they are not drinking, they start to experience withdrawal symptoms, such as hand tremors, sweating, and nausea. 

Their health problems are becoming an issue, and they may be experiencing cardiovascular issues, liver damage (the beginnings of cirrhosis), and gastrointestinal problems. They may also have a red face due to enlarged blood vessels. 

Family and friends may start to notice cognitive issues, too. Memory decline and problems with concentration start to become apparent at this stage.

Middle alcoholics may also start to suffer from job instability. This may be a result of missing too many days of work, habitually showing up late due to frequent hangovers, or even losing their jobs as a result of their addiction. This can cause financial issues, too. 

In addition, there may be problems in their relationships as they continue to prioritize drinking over their marriage, children, or partners. 

Some middle alcoholics may experience occasional accidents, such as driving while drunk, falling while drunk, or accidentally injuring themselves while cooking.

Late Alcoholic

People who are in the late alcoholic stage have been drinking for years. Not only do they have increased tolerance, but they are suffering from long-term health problems as a result of their AUD. Here are some key characteristics of the late alcoholic stage.

Years of abusing alcohol can severely damage the body. Late alcoholics may be suffering from advanced liver failure (cirrhosis). They may also be experiencing cardiovascular problems, pancreatitis, and vitamin deficiencies. Middle alcoholics may have mild pancreatitis. However, with time, this can graduate to chronic pancreatitis or acute pancreatitis.

Late alcoholics may experience severe depression when they don’t drink alongside intense withdrawal symptoms. At this stage, their physical and psychological dependence on alcohol is all-consuming, and the best treatment for them is rehab.

Some late alcoholics are no longer able to hold a job, which can lead them to financial ruin and eventually homelessness. Others may suffer severe cognitive decline, resulting in alcohol-related psychosis.

Finally, there may be increased incidents of medical emergencies, such as blacking out on the street, alcohol poisoning, or more. Eventually, there may be premature death due to drunk driving or organ failure.

What Are the Long-Term Health Problems Associated With Alcoholism?

The damaging effects alcohol has on the body are often rather severe. The changes are gradual, and they may even go unnoticed for years. However, by the time people start to notice them, some of the damage is irreversible. 

Liver Disease

Fatty liver disease occurs when there is excess fat in the liver. Fortunately, the condition is reversible if the person abstains from drinking for months or years. 

As alcoholism progresses to later stages, however, alcoholic hepatitis may develop. This is an inflammation of the liver, and some symptoms include yellowing eyes, muscle pain, and dark urine. The later stages of hepatitis may cause swelling in the ankles and legs. 

Finally, alcoholics may develop cirrhosis, which is when the liver tissue starts to scar. This condition is irreversible, and it may result in death due to liver failure. 

Cardiovascular Problems

Another issue alcoholics face is high blood pressure (hypertension). When you drink frequently and heavily, your blood vessels narrow. This means your heart must work harder in order to push blood through your veins. This strain on the heart not only leads to high blood pressure, but it can also lead to a heart attack. 

Alcohol-induced cardiomyopathy is yet another serious cardiovascular problem caused by heavy drinking over a long period. Alcohol damages and weakens the heart muscle over time. There are usually no symptoms. Instead, the person may simply suffer from heart failure. 

Gastrointestinal Problems

As discussed, pancreatitis—inflammation of the pancreas—occurs after years of heavy drinking. Individuals may suffer from acute or chronic pancreatitis. 

There may also be instances of gastrointestinal bleeding. The acid from alcohol can eventually tear away at the tissues in the stomach and esophagus, causing internal bleeding. 

Alcohol-Induced Dementia

Long-term alcohol abuse affects the brain as well. Also known as Wernicke-Korsakoff syndrome, some heavy drinkers will go on to develop dementia as a result of long-term heavy drinking.

Sexual Dysfunction

Excessive alcohol use over many years can cause infertility in women and erectile dysfunction in men. Both are reversible, however, if the person abstains from alcohol or quits altogether.

What Treatment Is Available for Alcoholism?

Treating people with AUD can be complex as other disorders may be evident. The treatment plan will also depend on the severity of the alcoholism and if there are other health issues present, such as seizures. However, some therapies have been shown to be effective.

Therapy

Behavioral therapy or talk therapy can be effective in finding the root cause of the person’s addiction problems. Some therapies include cognitive behavioral therapy (CBT) and motivational enhancement therapy (MET). In both types of therapy, the goal is to give clients the skills to prevent relapses and manage their triggers. 

Medication-Assisted Treatment (MAT)

Behavioral therapy is often used in conjunction with medication-assisted treatment. Medication can help those with AUD effectively manage their withdrawal symptoms. 

Inpatient Rehab

For severe cases of alcoholism, clients are encouraged to seek inpatient rehab. This is where clients live in a structured environment with 24/7 support and care. After going through detox, these programs provide individual and group therapy.

Outpatient Rehab

Outpatient treatment is similar to inpatient programs, but clients get to live at home instead. There is still a structured environment, however, and outpatient programs offer medication-assisted treatment, individual therapy, and group therapy.

Support Groups

Individual therapy isn’t for everyone. However, support groups, such as Alcoholics Anonymous (AA), can provide alcoholics with a sense of community. Although AA isn’t therapy, individuals can find sponsors to help guide them through sobriety.

Dual-Diagnosis Treatment

Some people suffering from AUD also have other mental health disorders. Healthcare professionals typically develop customized treatment plans for their clients to manage both symptoms. This is known as dual-diagnosis treatment.

Holistic Treatments

Some people with AUD may prefer more holistic treatments to manage their addiction, such as yoga and meditation. These are not stand-alone treatments but are often used in conjunction with behavioral therapy.

Free Alcoholism Hotline

Alcohol Awareness is a free 24/7 alcohol abuse hotline. When you call, you will be connected to a healthcare professional who specializes in alcoholism, addiction, and mental health disorders. We can help answer your questions about alcohol addiction or help find an Alcoholics Anonymous group near you. Our goal is to raise awareness for alcoholism. If you or a loved one has an alcohol use disorder, don’t hesitate to call us. We can help.

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