Understanding the Five 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 know 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 their chance of successful recovery.

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:

• Alcoholism
• Alcohol addiction
• Alcohol abuse
• Alcohol dependence

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

There are different types of alcoholics, alcoholic personalities, and tolerances, but the health effects are the same, especially long-term. Prolonged and heavy alcohol consumption permanently changes brain chemistry. This makes you more dependent on alcohol over time.

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What are the 5 Stages of Alcoholism?

The five main stages of alcoholism include:

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 may:

• Begin drinking in social settings
• Start using alcohol for stress relief
• Drink to cope with sadness, loneliness, stress at work, or relationship issues, to dull emotional pain

The individual can stay in this stage for many years but 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 becomes more dependent on alcohol. During stage two of alcoholism, they may:

• Think a lot about drinking and often bring up alcohol during conversations
• Drink by themselves or have trouble deciding not to drink
• Have trouble limiting alcohol consumption
• Binge drink and blackout
• Hide their drinking behaviors
• Skip events that do not provide alcohol or will sneak in their alcoholic beverages

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 interferes with everyday life.

At this point, an individual has developed an AUD. Middle-stage alcoholics may:

• Start drinking at work or other inappropriate functions
• Be frequently hungover
• Make alcohol the priority over all other responsibilities
• Need to drink more to achieve the same effects
• Pass out from excessive alcohol use
• Become irritated or mentally distressed when they’re not drinking

Physical symptoms also develop during this stage. They are typically obvious to others, 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 

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 may:

• Lose relationships with friends and family due to excessive drinking, lying, and sometimes violent behaviors
• Experience paranoia, depression, and loneliness
• Start experiencing serious health problems
• Drunk drive
• Experience memory loss
• Find themselves in the hospital often
• Feel serious withdrawal symptoms when not drinking

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

• Cirrhosis
• Alcoholic hepatitis
• Cancer
• Pneumonia
• Esophageal damage
• Emphysema
• Heart failure

• Tuberculosis
• Chronic bronchitis
• Liver disease and failure
• Brain damage
• Chronic pancreatitis
• Other chronic conditions

An end-stage alcoholic will experience life-threatening withdrawal symptoms when they stop drinking. This is why detoxing should be done with a medical professional's supervision at an addiction treatment center.

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

5. Recovery

If willing, a person with an AUD can get stabilized with recovery. This step aims to transition from drug use to detox to treatment. From there, you will work on maintenance (learning to live sober) and, finally, transcendence or full recovery.

Who's at Risk for Alcoholism?

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 

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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. 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. Got into situations that increased your chances of getting hurt due to alcohol consumption
8. Continued to drink despite the negative mental health effects
9. Noticed alcohol withdrawal symptoms, such as shaking, sweating, increased heart rate, restlessness, and/or seizures after stopping
10. Have continued to drink more and more alcohol to get the effect you want

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5 Treatment Options for Alcohol Abuse & Addiction

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

1. 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. 

These programs typically last 30, 60, or 90 days. Most will offer aftercare once you complete the inpatient portion of your treatment.

2. Partial Hospitalization Programs (PHPs)

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

• Medical care
• Behavioral therapy
• Support groups
• Other customized therapies

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

3. Outpatient Programs

Outpatient treatment is less intensive than inpatient treatment or partial hospitalization programs. They are best for people who have a high motivation to recover but cannot leave their responsibilities at home, work, or school.

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.

Outpatient programs are often part of aftercare programs once you complete an inpatient or PHP program.

4. Medication-Assisted Therapy (MAT)

Sometimes medications may be used in alcohol addiction treatment. These medicines can help reduce the negative side effects of detoxification and withdrawal. Others can help you reduce cravings and normalize body functions.

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

5. 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.