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What is Alcoholism (Alcohol Use Disorder)?

Alcohol use disorder (AUD) is a diagnosable medical condition (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, and alcohol dependence.

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, making someone more dependent on alcohol over time.

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



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. 

In the beginning stages, the alcohol problem is typically not apparent to the individual or their peers. However, as they continue to drink heavily, the symptoms of alcoholism will start to interfere with everyday life.

They will eventually hit a point of chronic alcohol use or crippling alcoholism. This is when the person is unable to function correctly due to compulsive alcohol consumption. 

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. 

The four 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. This is because alcohol mimics the effects of glutamate and GABA, which are two essential chemicals that the brain produces naturally.

Glutamate makes you more active, while GABA causes relaxation. The more alcohol you drink, the less your body relies on your brain to make these chemicals. It begins to depend on the ethanol in alcohol to release these chemicals into the body, leading to alcohol dependency.

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. 

Pre-alcoholics are people who drink to reduce unwanted mental health symptoms, such as those associated with anxiety and depression.

These people 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.

For example, they may begin drinking larger amounts of alcohol. This is a sign that they have reached the next phase of alcoholism.  

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: 

  • Binge drinking is a harmful drinking pattern that makes someone’s blood alcohol concentration (BAC) level rise to 0.08 percent or higher. Men reach this BAC after consuming about five drinks within two hours. Women reach this BAC after consuming about four drinks within two hours.
  • A blackout is almost always connected to binge drinking. It usually occurs at a BAC of 0.16 percent or higher.

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. These people might also think they “can’t have fun” if there is no alcohol involved. 

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. Most people who join Twelve Step programs have reached middle stage alcoholism.

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 

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:

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


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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. 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 for Alcohol Use Disorder (AUD)

Evidence-based addiction treatment can help anyone overcome alcoholism (if they want help). A combination of behavioral therapies, support groups, medical detox, and/or medication-assisted treatment may be used to help people with an AUD maintain abstinence. Inpatient rehab is the most effective treatment option for middle and end-stage alcoholism. 


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“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.

“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

“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.

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.

“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.

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(1):39-46. Japanese. PMID: 23659004.


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