The stages of alcoholism can be described in many ways and we’ll explore what to expect as social drinking becomes heavy drinking, as dependence slides into addiction.
In order to explore the stages of alcoholism, we first need to double down and establish what the non-clinical descriptor “alcoholism” actually means.
What is Alcohol Use Disorder?
While alcoholism is frequently used in conversation, the term isn’t used in a clinical setting.
Doctors, therapists, and researchers use the American Psychiatric Association’s DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders) as a diagnostic tool for identifying alcohol use disorder, the formal name for alcoholism.
According to the National Institute on Alcohol Abuse and Alcoholism, 7.2% of American adults had a diagnosable alcohol use disorder in 2012. This hefty percentage equates to a full 17 million adults struggling with a serious alcohol problem. More than half of these problem drinkers, 11.2 million, were male.
While everyone has different experiences with alcohol abuse, DSM-5 outlines 11 factors doctors can use to diagnose AUD and to grade its severity.
This fifth edition of the Diagnostic and Statistical Manual of Mental Disorders includes some notable changes. In DSM-IV, alcohol abuse and alcohol dependence were classified separately. DSM-5 sees them integrated into a single disorder, alcohol use disorder.
To assess AUD, variations on the following 11 questions are posed with regard to the individual’s drinking habits over the previous year:
- Do you regularly drink more than you intended to?
- Have you tried and failed to cut down or quit drinking?
- Are you spending large chunks of time drinking or recovering from drinking?
- Do you experience cravings for alcohol?
- Does drinking along with the after-effects negatively impact your family or work life?
- Do you continue to drink despite experiencing these problems?
- Are you starting to neglect activities you previously enjoyed?
- Have you found yourself engaging in risky behavior?
- Do you keep on drinking even after feeling anxious or depressed?
- Has your tolerance built so you need to drink more than you used to?
- Have you suffered from withdrawal symptoms when you stop drinking alcohol?
AUD is diagnosed as mild, moderate or severe depending on the number of symptoms:
- Mild: 2 to 3 symptoms
- Moderate: 4 to 5 symptoms
- Severe: 6 or more symptoms
These factors, as you can see, deal with both psychological and physical components of alcohol use disorder. While physical dependence is a key component of addiction, the two are not synonymous as outlined by the National Institute on Drug Abuse.
So, using the above framework, it’s simple to establish whether someone has alcohol use disorder.
How about the various stages of alcoholism, though?
Well, here it’s not quite as clear cut as those 11 questions of DSM-5, but we’ll dive down into the various distinct phases of the debilitating alcohol use disorder.
Alcoholism Broken Down
While there’s no uniform set of stages for alcoholism, most classifications are based on the four phases of alcoholism first defined in the 1950s by E Morton Jellinek.
Jellinek was a scientific researcher who studied alcoholism extensively. He subscribed to the view that alcoholism was due to a biological rather than moral failing.
The stages of alcoholism were defined by Jellinek as follows including an additional fifth phase:
- Pre-alcoholic: If you start drinking to feel better about yourself or you drink to dull pain and eliminate anxiety, you could find this escalating. These are red flags and you should think seriously about your drinking habits while the problem is easy to fix.
- Early alcoholic: This stage of AUD is characterized by blackouts. It’s also typical to lie about drinking excessively and to spend disproportionate amounts of time thinking about drinking.
- Middle Alcoholic: By this stage of alcoholism, you’ll no longer be able to keep things secret from your loved ones. Signs of your struggle will be obvious. From physical clues like a bloated stomach, dull skin and weight gain to irritability and problems at work, your friends and family will know you’re dependent on alcohol.
- Late Alcoholic: At the late alcoholic stage, your life revolves entirely around drinking in spite of the ruinous consequences across the board. Fortunately, it’s not a hopeless cause if you commit to recovery…
- Recovery: If you manage to stop drinking after a medical detox and then progress through residential rehab or outpatient therapy, you can achieve a life of ongoing sobriety
With that overview in place, we’ll look at these 5 stages in a little more detail.
1) Pre-Alcoholic
This preliminary phase of alcoholism is characterized by a lack of evidence that drinking is problematic. If someone in your family is pre-alcoholic, there’s every chance you’ll have no idea at this stage.
Drinking is primarily social at the beginning of this phase. As things progress, though, drinking is also often used as a means of relieving stress.
The core physiological aspect of the pre-alcoholic stage is the development of tolerance. More alcohol is needed to achieve the same effect.
Maybe you’re aware that you drink on a regular basis and you’re wondering whether you could be pre-alcoholic.
Ask yourself if you ever drink to make yourself feel better or to cope with pain.
Do you limit yourself to drinking when others around you are drinking in social situations or have you started to drink alone?
This is a difficult phase to accurately diagnose. If you suspect you or one of your loved ones might be pre-alcoholic, make an appointment with your doctor. If you do have a problem, the longer you leave it, the more difficult it will be to unravel.
2) Early Alcoholic
Once you’ve experienced a blackout induced by drinking, you’re already in the early alcoholism phase.
Drinking is becoming more problematic and, at the same time, too alluring to resist. You keep on sucking back those beers despite the consequences.
During the early alcoholism phase, it’s typical to start lying to your loved ones to cover up your drinking. You might start drinking alcohol more stealthily by spiking your coffee or your soda with spirits.
Tolerance continues to build and you start spending inordinate amounts of time drinking or recovering from the hangovers.
This stage of alcoholism is commonly described as the adaptive stage. This phase sees the beginning of a struggle with addiction developing.
Alcohol is by now no longer purely social. A daily habit often used as a coping mechanism, much of the joy of drinking has vanished. Alcohol serves almost like a maintenance medication by this stage.
Even though the problem with alcoholism is already in full swing, you might not exhibit many outward signs of struggling. Inside it’s a different story, though. The liver is battered by too many toxins and it adapts in order to process alcohol more quickly. Brain chemistry is also altered over time. Because alcohol is a sedative, your brain encourages increased activity of excitatory neurotransmitters to compensate by accelerating brain activity.
3) Middle Alcoholic
By the middle stage of alcoholism, you’ll find it tough to disguise the problem from friends and family.
Your behavior is likely to betray you in a number of ways…
- You start missing work and performing poorly at work
- You drink at inappropriate times
- You might become more irritable and argumentative
Your body also starts showing signs of alcohol abuse by this stage. Your face is liable to redden, your stomach might become bloated and you’ll be prone to either weight gain or weight loss.
As your drinking gets increasingly problematic, you may try and fail to stop drinking. You might even attend a support group like Alcoholics Anonymous at this stage.
Unless you manage to successful quit drinking, you’ll become more dependent on alcohol.
It’s commonplace to experience strong cravings in the absence of alcohol. Withdrawal symptoms can also kick in anywhere from 6 to 24 hours after your last drink. You might feel restless or nauseous. You could vomit and you’re likely to experience tremors or headaches. Insomnia can strike, too.
By this mid-stage, enjoyment has been removed from the equation almost completely. Your body has by now simply adapted to cope with the deluge of alcohol.
Almost all control over drinking is gone during this phase. You could start drinking early in the morning with the remainder of the day planned around drinking.
4) Late Alcoholic
The ravages of extended alcohol abuse are plain to see by this latter stage.
Drinking is now the main event with everything else being forced to revolve around alcohol. If job loss has not already happened, it’s likely to occur any time. Maintaining a regular schedule is not sustainable during the late alcoholic phase.
Serious health problems start developing from cirrhosis of the liver to dementia. Paranoia is also a regular presence at this stage of drinking.
Other diseases and conditions that can occur as a result of alcohol use disorder include:
- Anemia
- Cancer
- Cardiovascular disease
- Cirrhosis
- Dementia
- Depression
- Gout
- High blood pressure
- Infectious Diseases
- Pancreatitis
Attempts to stop can be accompanied by tremors and hallucinations. It’s unwise to attempt stopping without outside assistance if you’re a late-stage alcoholic.
Fortunately, things are not hopeless even at this advanced and chronic stage of alcohol use disorder.
5) Recovery
Just as alcoholism can be cleaved into discrete phases, so it’s possible to classify the process of recovery.
The model of change, developed by Carlo DiClemente and James Prochaska, says recovery has 6 stages:
- Pre-contemplation: You become aware of the many ways in which drinking is negatively impacting your life. While you won’t take direct action, you’re becoming aware of the fact you have an alcohol problem.
- Contemplation: You might want to get help but you don’t fully commit.
- Preparation: You’ll start to formulate a more concrete timeline for recovery. Although you might still be drinking, you’ll also be actively making plans to stop.
- Action: You follow through on your plans for recovery and undergo detox before beginning to engage in individual or group therapy.
- Maintenance: You’ll now be a recovering alcoholic continuing to apply what you learned in rehab to stay sober. You need to learn how to avoid and cope with triggers and also how to enjoy yourself without alcohol.
- Termination: It’s this final stage of the model that’s vigorously debated. According to this model, the sixth stage is when you consider you have conquered your addiction. The modern interpretation of alcoholism as a disease with no cure requiring lifelong medication would eliminate this stage.
What To Do Next
If you’re concerned about the amount you are drinking, feel free to call us here at Landmark Recovery.
You should have a clear idea from the above stages of alcoholism where you might be placed on that scale. Whether you need medical detox and residential treatment or whether you might benefit more from an intensive outpatient program, call us at 888-448-0302 and we’ll help get you back on track.
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We're here 24/7 to help you get the care you need to live life on your terms, without drugs or alcohol. Talk to our recovery specialists today and learn about our integrated treatment programs.
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