The 5 Stages of Alcoholism

Early signs of alcoholism, or alcohol use disorder (AUD), include increased tolerance and dependence on alcohol. In the later stages of alcohol use, addiction takes hold, affecting daily life and health. 

Warning signs of the condition include denial, blackouts, neglecting responsibilities, and withdrawal symptoms when alcohol intake is stopped or reduced.

What Is Alcoholism? 

The National Institute on Alcohol Abuse and Alcoholism defines AUD this way: “Alcohol use disorder (AUD) is a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.”[14]

Doctors use the Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition (DSM-5) to diagnose AUD. People with AUD have two or more of the following symptoms occurring at any time in the prior 12 months:[15]

• You drink more alcohol or over a longer period than intended.
• You have tried to cut back or control drinking but can’t.
• You spend a lot of time getting, using, or recovering from alcohol.
• Continued drinking results in the failure to fulfill major obligations at school, home, or work.
• You continue drinking despite persistent social or personal problems caused by alcohol.
• You reduce participation in social, occupational, or recreational activities due to drinking.
• You are drinking often in physically hazardous situations.
• You continue drinking despite the knowledge that it causes physical or psychological problems.
• You have a tolerance to alcohol.
• You experience withdrawal when you try to quit drinking.

According to the 2022 National Survey on Drug Use and Health, 10.5% of people 12 and older had an AUD. The rates can vary by race. Among white people, 10.9% had AUD, and just 5.6% of Asian people had AUD.[19]

Treatment for AUD includes medication, therapy, and lifestyle changes.

Breaking Down the 5 Stages of Alcoholism 

The five stages of alcoholism outline the typical phases individuals go through during alcoholism and recovery. This is a system based on the Jellinek Curve, which is a graphical representation of the progression of alcoholism based on the research of E. M. Jellinek, who is often called the father of the disease model of alcoholism.[2]

The Jellinek Curve, which was revised as the Glatt Chart in 1958 with the help of  additional research, looks a little like a bowl. It’s meant to be a visual representation of a person’s journey from sobriety to alcoholism. On the far left of the chart, the person is only drinking occasionally. At the bottom, the person is drinking in vicious circles. On the far right, the person is moving toward a happier, sober life.[10]

These stages show how one goes from the beginning stages through to sustained recovery. It offers insight into drinking behavior as well as the intervention and treatment strategies that can help.

These are the stages of alcoholism:[2]

Stage 1: Pre-Alcoholic 

The pre-alcoholic stage marks the early period during which a person starts to engage in drinking. During this stage, alcohol consumption is typically moderate and infrequent, often in social or celebratory settings. 

Individuals in early stage addiction do not usually exhibit overt signs or experience serious negative repercussions related to their drinking. Many people stay in this stage their whole lives and never progress, but most of those who eventually develop an alcohol use disorder begin here.

The World Health Organization says no level of alcohol consumption is safe for health.[16] While you may not exhibit signs of AUD at this stage, your drinking habits could put you at risk for health effects if you keep consuming alcohol.

To determine whether or not you may be in the first stage of this model, answer the following questions. If you answer “yes” to most of them, you may be in this stage along with most people who drink on occasion. 

If you’re not certain how much you drink, consider using an app on your phone like Reframe. Use this app to count how many drinks you have and identify what tends to make you drink more.

Social Drinking

Do you tend to only drink in social situations like family gatherings or parties where it’s appropriate to have a drink or two?

Controlled Consumption

Are you able to stop after having a single drink or don’t mind spacing out a couple of drinks over many hours?

Occasional Indulgence

Do you tend to only drink occasionally without much thought to when you may drink again?

No Cravings or Withdrawal Symptoms

Do you have no withdrawal symptoms or cravings when without alcohol?

No Impact on Daily Life

Does your alcohol use not interfere with your responsibilities, work, or relationships?

Moderation Awareness

Are you conscious of not exceeding your drinking limits and maintaining moderation most of the time?

Limited Negative Consequences

Have there been no major negative repercussions on your health, work, or personal life due to alcohol?

Stage 2: Early Alcoholic

The Centers for Disease Control and Prevention (CDC) defines moderate drinking as one drink or less per day for women or two drinks or less per day for men. The CDC says drinking above this level can increase the risk of short-term harm, such as injuries.[17]

If you’re struggling with drinking, consider limiting how much alcohol you keep at home. It’s harder to drink when there are no beverages available. If you always drink with friends, consider meeting for coffee instead.

Answering “yes” to most of the following questions may indicate that you are in the early alcoholic stage:[3]

Increased Frequency of Drinking

Have you noticed a rise in how often you consume alcohol compared to how you used to drink?

Tolerance Development

Are you finding that you need more alcohol to achieve the desired effect than you did initially?

Preoccupation With Drinking

Do you spend a lot of time thinking about alcohol or planning opportunities to drink?

Rationalization & Excuses of Alcohol Use

Are you making excuses for your drinking, attributing it to stress, celebrations, or other reasons?

Defensive Behavior Regarding Alcohol Use

Do you become defensive or irritated when others question your drinking habits?

Occasional Memory Blackouts While Drinking 

Have you experienced brief periods where you can’t recall events or conversations while drinking?

Neglecting Responsibilities

Are you starting to neglect your responsibilities at work, home, or school due to drinking?

Interference With Relationships

Is alcohol use causing strain or conflicts in your relationships?

Concealing Drinking Habits

Have you started to hide the extent of your drinking from friends or family?

Stage 3: Middle Alcoholic

The middle alcoholic stage marks an intensification in alcohol dependence and its negative impacts on life. At this stage, consequences from substance abuse become increasingly severe, impacting physical health as well as mental health.

People in this stage might engage in binge drinking. The CDC defines this approach as women drinking more than four alcoholic beverages on one occasion and men drinking more than five such beverages.[18] The short-term risks of this approach include injuries, violence, unprotected sex, and alcohol poisoning.

If you’re in this stage of alcoholism, consider seeking help. Reach out to a treatment professional. Find an Alcoholics Anonymous meeting near you. Connect with other people who struggle with alcoholism and find out how they cope.

Answering “yes” to most or all of the following questions may indicate that your alcohol use falls into this stage:[3]

Loss of Control

Have you experienced instances where you intended to have just one or two drinks but ended up consuming much more?

Increased Tolerance

Is it taking larger amounts of alcohol to achieve the desired effect compared to before?

Regular Binge Drinking

Are you frequently engaging in episodes of excessive drinking, known as binge drinking?

Physical & Psychological Withdrawal Symptoms

Do you experience physical symptoms like shaking, sweating, or anxiety when not drinking, leading to the need for a drink to relieve these symptoms?

Job & Financial Issues

Is your alcohol use affecting your job performance, leading to warnings, reprimands, or even job loss? Are you facing financial difficulties due to overspending on alcohol?

Strained Relationships

Are your relationships with family, friends, or colleagues deteriorating due to your drinking habits? Is alcohol causing arguments or distance between you and your loved ones?

Legal Problems

Have you encountered legal issues, such as DUI arrests or public intoxication, due to alcohol use?

Health Complications

Are you experiencing health problems, such as liver damage, gastrointestinal issues, heart problems, or memory lapses, due to excessive drinking?

Hiding Alcohol Consumption

Are you concealing the extent of your drinking, drinking alone, or hiding alcohol in different places?

Stage 4: Late Alcoholic

The late stage of alcoholism represents a severe and advanced form of alcohol use disorder. At this stage, individuals experience significant physical, mental, and social deterioration due to their prolonged and intense use of alcohol, with an obvious impact on family relationships and work life.

The National Institute on Alcohol Abuse and Alcoholism says long-term drinking (which is common in this late stage of alcoholism) is associated with several health problems, including the following:[19]

• Changes in mood and behavior
• Heart disease
• Liver disease
• Pancreas inflammation
• Cancer of the head, neck, esophagus, liver, breast, and colon
• Weakened immune system

Alcohol withdrawal symptoms can be life-threatening, and it’s not safe to quit drinking without the help of a doctor. If you’re in the late stages of alcoholism, you must enroll in a treatment program to get the help you need to quit for good.[13]

If you answer “yes” to most of the following questions, you may be in the late alcoholic stage:[3,4]

Obsessive Drinking

Do you feel a strong urge to drink and find it challenging (or even impossible) to control or stop your drinking?

Physical Dependency

Do you experience severe withdrawal symptoms when not drinking, such as tremors, hallucinations, or seizures?

Liver Cirrhosis & Damage

Have medical professionals diagnosed you with cirrhosis or other severe liver conditions related to alcohol abuse?

Loss of Employment

Have you lost your job or faced ongoing unemployment due to your drinking habits?

Neglect of Personal Hygiene

Are you disregarding personal grooming, hygiene, or proper nutrition due to alcohol consumption?

Alcohol-Related Psychosis

Are you experiencing hallucinations, delusions, or paranoia due to alcohol-induced psychosis?

Isolation & Alienation

Are you socially isolated, often signified by deteriorated relationships and strained interactions with loved ones?

Frequent Blackouts

Do you regularly experience memory lapses or blackouts after drinking episodes?

Persistent Fatigue & Health Issues

Are you facing extreme fatigue, weakness, frequent illnesses, or chronic health problems related to alcohol abuse?

Malnutrition & Weight Loss

Have you lost a significant amount of weight or experienced malnutrition due to a poor diet and excessive alcohol intake?

Stage 5: Recovery

In the recovery stage of alcoholism, people who are in crisis recognize that they need help and work to stop drinking entirely as they rebuild their lives. This stage is often characterized by sobriety, self-awareness, and positive changes with the goal of long-term recovery.

If you answer “yes” to the majority of these questions, you are likely in this stage:[3]

Commitment to Sobriety

Are you dedicated to remaining sober by staying away from people and environments that tempt you to drink?

Participation in Support Groups

Are you attending support groups like Alcoholics Anonymous (AA) or other recovery-based meetings regularly?

Individual or Group Therapy

Are you actively working with a therapist, either in solo sessions or as a part of a group to work through the issues that may trigger a relapse?

Healthy Coping Mechanisms

Have you worked on learning healthier ways to cope with stress, anxiety, or the types of problems that previously led to drinking?

Lifestyle Changes

Are you making positive changes in your lifestyle, such as adopting a healthier diet, engaging in regular exercise, and focusing on self-care?

Rebuilding Relationships

Are you actively working on repairing and rebuilding relationships with family and friends?

Employment or Education Stability

Are you maintaining stable employment or pursuing education goals as part of reintegrating into society?

Mental Health Management

Are you addressing any co-occurring mental health issues through therapy or medication as needed?

Relapse Prevention Strategies

Have you developed a plan to prevent relapse, including steps to take if you feel at risk of returning to alcohol misuse?

Warning Signs of Alcoholism

These warning signs of alcoholism signify a need to seek professional help:[5-7]

• Inability to drink in moderation
• Increased tolerance to alcohol (need to drink more to experience the same effects previously felt with less alcohol)
• Persistent focus on drinking, including planning when you can next drink
• Withdrawal symptoms when without alcohol
• Drinking to cope with uncomfortable emotions, such as anxiety, sadness, fear, or discomfort
• Neglecting responsibilities at work, school, or home
• Beginning to drink alone or hide your drinking from loved ones
• Continued to drink despite negative consequences related to drinking
• Failed attempts to quit drinking
• Legal issues, such as DUI arrests or public intoxication
• Beginning to drink early in the day, such as needing a drink to get the day going
• Defensiveness when loved ones attempt to talk to you about your drinking
• Unexplained injuries or accidents due to alcohol use
• Memory blackouts after drinking
• Health issues related to alcohol use
• Drinking in risky situations, such as before driving 

How to Seek Professional Help

While at least 38 million adults in the United States drink too much, only one adult in six talks to a medical professional about it.[11] By admitting that you have a problem, you could change your life for the better.

A typical conversation might work like this:

1. Your doctor asks about your drinking.
2. You answer, and your doctor tells you what’s good and not good about your habits.
3. If you want to quit, your doctor helps to draw up a plan, which likely includes treatment in a specialized facility.

Doctors and other health professionals are encouraged to talk to their patients about drinking at every appointment.[11] You’re not required to wait for your doctor to bring it up. You can make an appointment to talk specifically about alcohol and your need to quit. Your doctor can help you find a treatment program that’s right for you.

How Is Alcoholism Treated?

Researchers say about one-third of people who are treated for alcohol problems have no further symptoms 12 months later.[12] By enrolling in a qualified treatment program, you can get the help you need to quit drinking for good.

Quitting alcohol abruptly can be life-threatening. Always ask for help before you stop drinking for good. Medications can save your life.

Detox starts the process, and it’s critical. When long-term drinkers quit abruptly, they can develop life-threatening symptoms like hallucinations and seizures. Benzodiazepine medications and medical supervision can keep these problems under control. The dose is slowly tapered, allowing people to get sober at a safe pace.[13]

Detox alone isn’t a treatment for alcoholism. When this program is complete, people need a rehabilitation program. Some are offered on an inpatient basis (allowing you to move out of your home to get care), and others are available for outpatient treatment.

A typical treatment program involves the following three elements:[12]

• Medications: The U.S. Food and Drug Administration has approved three medications to help people stay sober once detox is through.
• Counseling: Behavioral treatments can help you understand why you started drinking and what you might need to change to stay sober.
• Support groups: Working with peers can help you develop a deeper understanding of alcoholism and give you a community to lean on during tough times.

At the end of treatment, an aftercare program begins. You may use options like counseling, support group meetings, and medication management to stay on track.

How to Avoid the Development of Alcoholism

If you or someone you know displays any of the signs above, you can get help before alcoholism develops or progresses. Don’t attempt to stop drinking on your own suddenly if you’ve been drinking heavily for a period of time.[8,9] You need professional management and supervision to safely stop drinking. In a comprehensive treatment program for alcoholism, you’ll gain coping skills to effectively stop drinking, be prescribed medications to manage AUD if needed, and build a healthier life in recovery.