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The Four Stages Of Alcoholism

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Alcoholism, or alcohol use disorder, is a serious problem that affects over 17 million adults in the United States, as well as many teenagers. Most portrayals of alcoholism that people see or read about in the media are of people struggling with severe alcohol addiction, which can skew people's perceptions of what constitutes a problem. The reality of alcoholism is that it is often much more complex. Each case of severe alcohol use begins somewhere. Many of the initial signs of a drinking problem are not so obvious and can sometimes be easy to miss due to the prevalence of drinking among adults. To allow room for the complexity of alcohol use and addiction, alcoholism is commonly described as having four stages:
  • the early stage
  • the middle stage
  • the late stage
  • the end-stage
Each stage features signs and symptoms of mild to severe alcohol use and can help people determine when someone has developed a problem and how severe it is. Although it can be difficult to confront a drinking problem, it is never too early or too late to seek professional help. No matter how long you have been struggling, recovery from alcohol use is possible.

What Are The Stages Of Alcoholism?

Alcohol use is a problem that tends to grow worse over time. Alcohol use can have effects on a person’s physical health, mental health, and their ability to function without alcohol. [inline_cta_one] The Diagnostic Statistical Manual of Mental Disorders (DSM-V), which is used to diagnose alcohol use disorder, lists three subcategories for alcoholism: mild, moderate, and severe. There are also four stages to describe the severity of alcohol use, based on how long a person has been abusing alcohol and the extent of its impact. Each person’s struggle is different, and the road leading up to severe alcoholism does not look the same for everyone. However, each road does begin somewhere, starting with the early stage of alcohol use.

Early Stage: Increased Drinking

The earliest stage of alcoholism often begins with an increased pattern of drinking. This can mean drinking more frequently, as well as drinking larger quantities of alcohol. Binge-drinking, which involves having multiple drinks within a small window, is a common initial sign of a drinking problem. Binge-drinking is defined as:
  • for men: having five or more drinks within a two-hour period
  • for women: having four or more drinks within a two-hour period
This amount of alcohol is typically how much it takes for a person’s blood alcohol concentration (BAC) levels to reach 0.08 g/dL. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), in 2015 about 26.9 percent of adults in the United States reported binge-drinking in the last month. Binge-drinking is especially common among young adults, and some teenagers experimenting with alcohol. Not every person who binge-drinks will necessarily go on to develop a drinking problem, but it does increase the risk of a serious drinking problem. In addition to binge-drinking, there are other signs that can indicate someone is in the early stages of alcoholism, including:
  • drinking out of boredom
  • drinking to relieve stress, sadness, or anxiety
  • developing a higher tolerance for alcohol
  • frequently blacking out as a result of heavy drinking

Middle Stage: Cravings And Dependence

During the middle stage of alcoholism, a person’s drinking problem is likely to become more obvious – both to the person and those around them. Frequent drinking, especially in heavy amounts, can lead to a dependence on alcohol. This can cause people to crave alcohol throughout the day and spend much of their time thinking about drinking or acquiring alcohol. Dependence can also result in withdrawal symptoms. Initial alcohol withdrawal symptoms include:
  • anxiety
  • agitation
  • sweating
  • fast heartbeat
  • nausea and vomiting
  • alcohol cravings
  • pale and clammy skin
  • loss of appetite
Experiencing alcohol withdrawal symptoms can make it difficult for people to get through the day without having alcohol in their system. This can make it difficult for a person to perform well at work, attend school, or attend to other personal obligations. People will often sneak a drink if only to relieve withdrawal symptoms, in order to feel “normal.” They may also begin experiencing other negative effects as a result of their drinking, including effects on health, mood, and behavior.

Late Stage: Severe Alcohol Use And Addiction

By this point, both physical dependence and addiction are present. People in this stage of alcoholism are likely to meet the DSM-V criteria for severe alcohol use. The ‘severe’ classification of alcohol use disorder means experiencing at least six of the following symptoms in the past year:
  • drinking more, or for longer than intended
  • experiencing problems at work, school, or socially as a result of drinking
  • continuing to drink after experiencing negative effects on physical or mental health
  • cutting back on activities you used to enjoy in order to drink
  • continuing to drink after experiencing family, social, or relationship problems as a result of alcohol use
  • spending a lot of time drinking and experiencing aftereffects
  • feeling an urgent need to drink and being unable to think about anything else
  • engaging in risky activities while drunk, more than once (e.g. drinking and driving, having unsafe sex, operating heavy machinery)
  • having to drink more than you used to in order to experience the effects of alcohol (i.e. developing high tolerance)
  • being unable to cut down on or stop drinking
  • experiencing withdrawal symptoms after the effects of alcohol have worn off
Reaching the late-stage of alcohol use poses serious consequences to a person’s physical and mental wellbeing. Many people at this point become unable to maintain a job or function normally in their usual routine. They may experience depression or anxiety as a result of alcohol use, and may show less desire or motivation to tend to their hygiene or appearance.

End Stage: Loss Of Control

Reaching the ‘end’ stage of alcoholism can sound frightening, and it is. Most people with end-stage alcoholism feel a loss of control over their drinking and experience several alcohol-related medical problems. Heavy and long-term alcohol use can cause several medical problems throughout the body, including damage to several vital organs such as the heart, liver, kidneys, and the brain. People in the end-stage of alcoholism are at high risk for serious and even life-threatening health problems. This includes issues such as liver cirrhosis, more severe withdrawal, polysubstance use, and suicide. It can be difficult for people at this point to believe that they have a way out. They may believe there is no real chance for recovery, or that it would be too painful to attempt. The reality is that severe alcoholism is still treatable. Although some severe medical conditions can be permanent, seeking help can often reverse or at least prevent problems from becoming worse. No matter how long you have been struggling, it is never too late to seek help.

When Should You Be Concerned About Your Drinking?

Every case of alcoholism begins somewhere, and that includes some of the more subtle symptoms described in the early stages of problem drinking. Not all early symptoms of alcoholism are life-threatening but can still be a cause for concern. If you are experiencing signs and symptoms of early alcoholism yourself, it may be time to reassess your drinking habits. If you’re noticing signs in a loved one, it may be helpful to express your concern by calmly asking them about their drinking. People that are struggling with alcohol use are not always responsive to a loved one’s concerns. People may often become defensive about their drinking, deny having a problem, lash out, or withdraw from those questioning their alcohol use. In these cases, staging a group intervention may be a beneficial option.

Getting Help For Alcohol Use

No signs of alcohol use should be ignored. If you are concerned about you or a loved one’s drinking, professional alcohol treatment programs is a beneficial option to consider. The first step for many people is talking to a doctor or treatment specialist. This can help a person determine whether they need to enter a detox program. Based on the severity of a person’s alcohol use and other personal needs, outpatient or inpatient treatment may be recommended. The most effective treatment for overcoming alcoholism involves a combination of behavioral therapy, medications, and attending support groups. The best option in order to receive adequate support in early sobriety is to enter an inpatient or residential rehab program. This provides a safe and structured environment for people to address all medical, emotional, and psychological aspects of their drinking for lifelong recovery. If you are struggling with alcohol use, or are worried about someone else, contact us today. We’ll help you find treatment options that suit you or your loved one’s needs.