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4 Stages of Alcoholism

What is Alcoholism (Alcohol Use Disorder)?

Alcohol use disorder (AUD) is a brain disorder that impairs someone’s ability to stop or control alcohol use.

The term AUD encompasses all alcohol-related conditions, including:

A person with AUD will drink alcohol despite knowing the occupational, health, and social consequences it causes.

Prolonged and heavy alcohol consumption permanently changes brain chemistry. This makes you more dependent on alcohol over time.

They will have to drink more alcohol to feel the same effects. This can lead to AUD and increases the risk for relapse.

Who's at Risk?

Those more at risk of developing alcoholism include:

  • People with a family history of alcohol use disorder (AUD)
  • People with a history of trauma, specifically childhood trauma
  • People with mental health disorders, such as attention deficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), or depression 
  • People who started drinking before the age of 15 

What are the 4 Stages of Alcoholism?

Alcohol use disorder (AUD) develops gradually. The symptoms can range from mild to severe, depending on the “stage” of alcoholism. 

It is important to be aware of the signs that develop during each stage to ensure your loved one seeks treatment for their addiction early on. The earlier they seek treatment, the better chance they have of successful recovery. 

Although, there are different types of alcoholics, alcoholic personalities, and tolerances. The health effects are the same, especially long-term.

The four main stages of alcoholism include:

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1. The Pre-Alcoholic Stage

The primary symptom of stage one is the development of alcohol tolerance.

This stage of alcoholism is difficult to notice, even for the person misusing alcohol.

During the pre-alcoholic stage, a person will begin drinking in social settings. As they continue to drink, they may also start using alcohol for stress relief.

In other words, they use alcohol to self-medicate but can still limit consumption without drinking too much. 

They may also drink to cope with sadness, loneliness, stress at work, or relationship issues, among others. Rather than dealing with the actual problem, pre-alcoholics will drink alcohol to dull emotional pain. 

The pre-alcoholic stage is not obvious to others. However, alcohol tolerance is gradually developing.

The individual can stay in this stage for many years but will eventually start showing more disordered behaviors.

2. Early-Stage Alcoholism

The primary symptom of stage two is increasing alcohol tolerance. 

During the early stage of alcoholism, the individual is becoming more clearly dependent on alcohol.

They tend to think a lot about drinking and often bring up alcohol during conversations.

Rather than just drinking in social settings, they may drink by themselves or have trouble deciding not to drink.

Unlike pre-alcoholics, early-stage alcoholics have trouble limiting alcohol consumption. 

Binge drinking and blackouts are also common during this phase.

An early-stage alcoholic typically begins to hide their drinking behaviors. This may mean skipping events that do not provide alcohol or sneaking in their own alcoholic beverages.

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3. Middle-Stage Alcoholism

The primary symptoms of stage three include high tolerance to alcohol, physical symptoms, and more obvious drinking behaviors.  

The middle stage of alcoholism is when drinking begins to interfere with everyday life. At this point, an individual has developed an alcohol use disorder (AUD).

They may start drinking at work, are frequently hungover, and make alcohol the priority over all other responsibilities.

These people need to drink more and more alcohol to achieve the same effects and often pass out from drinking too much. Irritability and other mental health conditions can arise when the person is not drinking.  

Physical symptoms also develop during this stage. They are typically obvious to others around them, including coworkers, family members, and friends.

The most common signs include:

  • Weight gain or weight loss
  • Stomach bloating
  • Sluggishness
  • Shaking
  • Sweating
  • Skin changes
  • Facial redness/puffiness 

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4. End-Stage Alcoholism 

The primary symptoms of stage four include all-consuming alcohol use, health problems, and dangerous withdrawal symptoms.

End-stage alcoholism, also known as late-stage alcoholism, is the most severe. Late-stage alcoholics drink all day and are unable to keep steady jobs.

They often lose relationships with friends and family due to excessive drinking, lying, and sometimes violent behaviors.

Paranoia, depression, and loneliness are also common, leading the individual into a very dark place. 

These people have also been drinking heavily for many years and typically experience serious health problems. Drunk driving, memory loss, and frequent trips to the hospital often occur during end-stage alcoholism. 

Without treatment, late-stage alcoholism can lead to the following medical problems:

  • Tuberculosis
  • Chronic bronchitis
  • Liver disease and failure
  • Brain damage
  • Chronic pancreatitis
  • Other chronic conditions
the health effects of alcohol

An end-stage alcoholic will experience life-threatening withdrawal symptoms whenever they stop drinking alcohol.

This is why it is never recommended to detox without medical professionals' supervision at an addiction treatment center.

Common withdrawal symptoms associated with end-stage alcoholism include delirium tremens (DTs), vomiting, nausea, sweating, shaking, and seizures.

10 Warning Signs of Alcoholism 

You may have an AUD if you’ve experienced two or more of the following in the past year:

  1. Often drank more or longer than intended.
  2. Spent a lot of time drinking or recovering from alcohol.
  3. Wanted to drink so badly that you couldn’t think of anything else.
  4. Noticed that drinking or being sick from alcohol interfered with daily life, work, family, and other responsibilities.
  5. Continued to drink despite knowing the negative consequences.
  6. Didn’t attend certain events (that used to give you pleasure) to drink instead.
  7. Have gotten into situations that increased your chances of getting hurt due to alcohol consumption.
  8. Continued to drink despite the negative mental health effects it causes.
  9. Noticed any alcohol withdrawal symptoms such as shaking, sweating, increased heart rate, restlessness, and/or seizures after stopping use. 
  10. Have continued to drink more and more alcohol to get the effect you want. 

Treatment Options for Alcohol Abuse & Addiction

There are many treatment options available for alcohol use disorder (AUD) and addiction, including:

Inpatient Programs

Inpatient treatment takes place at a licensed residential treatment center.

These programs provide 24/7 comprehensive, structured care. You'll live in safe, substance-free housing and have access to professional medical monitoring. 

The first step of an inpatient program is detoxification. Then behavioral therapy and other services are introduced. These programs typically last 30, 60, or 90 days, sometimes longer.

Most programs help set up your aftercare once you complete the inpatient portion of your treatment.

Partial Hospitalization Programs (PHPs)

Partial hospitalization programs (PHPs) provide similar services to inpatient programs.

Services include medical care, behavioral therapy, and support groups, along with other customized therapies. 

However, in a PHP program, you return home to sleep. Some services provide food and transportation, but services vary by program.

PHPs accept new patients as well as people who have completed an inpatient program and require additional intensive treatment.

Outpatient Programs

Outpatient treatment is less intensive than inpatient treatment or partial hospitalization programs.

These programs organize your treatment session based on your schedule. The goal of outpatient treatment is to provide therapy, education, and support in a flexible environment.

They are best for people who have a high motivation to recover and cannot leave their responsibilities at home, work, or school. Outpatient programs are often part of aftercare programs once you complete an inpatient or PHP program.

It is important for people undergoing treatment to have a stable and supportive home environment. If family members/roommates drink or use drugs in the home environment, it will be extremely difficult for the person to maintain abstinence when they return home after treatment. It is extremely difficult to undergo successful outpatient therapy if you are living in a home environment with ready access to drugs and alcohol.

Medication-Assisted Therapy (MAT)

Sometimes medications may be used in alcohol addiction treatment.

Some medicines can help reduce the negative side effects of detoxification and withdrawal.

Others can help you reduce cravings and normalize body functions. Disulfiram (Antabuse), acamprosate (Campral), and naltrexone are the most common medications used to treat AUD. 

When combined with other evidence-based therapies, such as cognitive behavioral therapy (CBT), MAT can help prevent relapse and increase your chance of recovery.

Support Groups

Support groups such as Alcoholics Anonymous (AA) and Self-Management And Recovery Training (SMART) are open to anyone with a substance use disorder.

They are peer-led organizations dedicated to helping each other remain sober.  Support groups can be the first step towards recovery or part of a long-term aftercare plan.

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Updated on April 5, 2022
7 sources cited
  1. “ALCOHOL'S DAMAGING EFFECTS ON THE BRAIN.” National Institute on Alcohol Abuse and Alcoholism, U.S. Department of Health and Human Services, pubs.niaaa.nih.gov/publications/aa63/aa63.htm.
  2. “Alcohol Use Disorder.” National Institute on Alcohol Abuse and Alcoholism, U.S. Department of Health and Human Services, 4 June 2020, www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders
  3. “Drinking Levels Defined.” National Institute on Alcohol Abuse and Alcoholism, U.S. Department of Health and Human Services, www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking.
  4. Harvard Health Publishing. “Alcohol Use Disorder (Alcoholism) - Harvard Health.” Harvard Health, Harvard Health, 24 Apr. 2019, www.health.harvard.edu/a_to_z/alcohol-use-disorder-alcoholism-a-to-z.
  5. “Understanding Alcohol Use Disorder.” National Institute on Alcohol Abuse and Alcoholism, U.S. Department of Health and Human Services, www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder.
  6. Yoshimura A, Maesato H, Hisatomi N, Higuchi S. Treatment processes of pre-alcoholism and alcohol dependence targeted towards drinking reduction. Nihon Arukoru Yakubutsu Igakkai Zasshi. 2013 Feb;48:39-46. Japanese. PMID: 23659004.
  7.  

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