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Stages of Alcoholism | Signs & Symptoms You Need to Look For

Alcohol use disorder (AUD), or alcoholism, poses significant dangers, including life-altering medical problems, mental health complications, and accidents. If left untreated, alcoholism can be fatal.[2] 

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Alcoholism progresses through several stages, which are as follows:

  • Pre-alcoholic stage
  • Early-stage alcoholism
  • Middle-stage alcoholism
  • Late-stage alcoholism

Each stage signifies a worsening of the disorder and increasingly more severe signs and symptoms.[1]

Warning signs of alcoholism include an increasing use of alcohol to the detriment of every aspect of life and an inability to stop drinking.[3] Early detection and treatment of AUD can save lives. 

What Is Alcohol Use Disorder?

Alcohol use disorder occurs when someone compulsively drinks to excess and develops a physical and psychological dependence on the substance. They are usually unable to stop drinking for any significant length of time despite negative effects in almost every part of their lives.[3] 

The negative side effects of an untreated AUD include the following:[4]

  • Damage to the liver, pancreas, and heart
  • An increased risk of cancers
  • Impaired judgment that can lead to accidents, risky behaviors, and legal issues
  • Strained or broken relationships
  • Job loss and financial struggle
  • New or worsened mental health issues like depression or anxiety
  • Alcohol poisoning or overdose

What Are the Stages of Alcoholism?

Alcoholism progresses through several distinct stages, each representing a significant shift in the person’s relationship with alcohol. While individual experiences will vary when it comes to the exact signs and the length of time spent in each stage, this framework provides a general understanding of the development of alcohol use disorders and the effects on the individual in crisis and their family.

1. Pre-Alcoholic Stage of Alcoholism

The pre-alcoholic stage marks the initial phase in the development of AUD. Early on, people may engage in occasional or experimental drinking without any symptoms of addiction or dependency. 

Though they may have a few issues due to binge drinking, such as showing up late to work, dealing with hangovers, or making choices under the influence that harm relationships, a person in this stage does not yet have a significant problem. They are not experiencing life-threatening or life-altering consequences. 

People who are in the pre-alcoholic stage may exhibit some or all of the following:[5]

Social Drinking

Though many people have a drink on social occasions, someone in the pre-alcoholic stage may drink to excess during social situations, celebratory events, or to manage uncomfortable feelings associated with a singular event like job loss or divorce. 

Managed Consumption

People at this stage typically maintain the ability to regulate and limit their drinking, usually drinking in moderation or slightly more. They may be able to hide it or justify it if they have a few too many.

Limited Negative Consequences

Alcohol use has not led to severe detrimental impacts on physical or mental health, relationships, work performance or other aspects of life. Some of the more extreme drinking episodes may cause minimal disruptions, such as an argument with a spouse or being late to work.

Curiosity & Experimentation

Individuals in the pre-alcoholic stage might be curious about alcohol’s effects. They may start drinking different types of alcohol, drinking in situations when they might not have in the past, or drinking slightly more than usual.

Developing Tolerance

Although tolerance to alcohol may not be significant at this stage, some individuals may notice that they require slightly higher amounts of alcohol to achieve the desired effects over time, especially after drinking for multiple days in a row.

2. Early Stage of Alcoholism

In the early stage of alcoholism, people move beyond experimental or occasional excessive drinking. Their use of alcohol becomes more problematic and more noticeable to the people around them.

Some common signs that someone is in the early stages of developing an alcohol use disorder include the following:[3]

Increased Frequency & Quantity of Drinking

People may start consuming alcohol more often and in larger quantities. It becomes a regular occurrence, which extends beyond social gatherings or special occasions and becomes a regular habit.

Increased Tolerance

In the pre-alcoholic stage, a single drink may have brought the desired effect of relaxation and pleasure, but in the early stages of the development of alcohol use disorder, the body adjusts to that amount. Multiple drinks are then needed to achieve the same effects.

Loss of Control

People in this stage struggle to control their alcohol intake and their behavior under the influence. They may have intended to have just one, cut back, or even quit drinking, but they find it increasingly difficult to do so. Instead, they drink more and more.

Memory Lapses & Risky Behavior

Blackouts or memory gaps become common during drinking episodes in this stage. Engaging in impulsive and risky behaviors, such as drunk driving or unsafe sexual activities, may occur during this stage as well.

Emotional Instability

Alcohol’s impact on the brain can lead to mood swings, increased irritability, and changes in behavior that become noticeable to friends, family, and coworkers. Individuals may be easily agitated or confrontational, particularly when their drinking habits are challenged.

Strained Relationships

Problematic drinking starts to strain relationships with loved ones in this stage. Social activities that do not involve alcohol may be avoided. They may spend more time with people who drink and less time with others.

3. Middle Stage of Alcoholism

The middle stage of alcohol use disorder development is defined by considerably increased use of alcohol despite the negative consequences that are starting to add up to big life changes. During this stage, people who are struggling will usually face significant challenges and experience profound disruptions in their lives. 

Some signs that someone has moved into the middle stage of alcoholism include the following:[6,7]

Continued Tolerance Development

Even more alcohol is needed in this stage for the person to reach a state of inebriation — so much so that friends and family may comment on the quantity that the person drinks in a given drinking session.

Heightened Alcohol Dependency

Tolerance is not only a physical issue at this point; it becomes a psychological issue as well. The person will often experience intense cravings and struggle to control or reduce their alcohol intake even when they know that they will harm their relationships at work or at home if they drink.

Withdrawal Symptoms

Physical dependence becomes a problem during this stage. People are often drinking so much and so frequently that they experience physical withdrawal symptoms when they reduce their drinking.

Impaired Physical & Mental Health

Prolonged and excessive alcohol consumption takes a toll on physical and mental well-being. People who drink a lot may begin to experience liver damage, gastrointestinal issues, cardiovascular problems, neurological impairments, and heightened vulnerability to infections. Mental health conditions, such as depression, anxiety, and cognitive difficulties, may worsen as well. 

Neglected Responsibilities 

Alcohol becomes the central focus of the person’s life in this stage, leading to the neglect of obligations, which causes strain in relationships. Work, education, and personal commitments suffer as alcohol takes precedence. Interpersonal relationships may become strained or severed due to erratic behavior, emotional instability, and neglect.

Social Isolation

People who are in this stage will often withdraw from activities that don’t involve alcohol, even important events like a child’s performance or a required work event. They will often spend increasing amounts of time alone or in the company of others who also frequently drink.

Financial & Legal Repercussions

The middle alcoholic stage brings about financial difficulties as a significant portion of resources are spent on alcohol. Legal troubles may arise and be costly as well as people are charged with DUI, public intoxication, or other alcohol-related offenses.

4. Late-Stage Alcoholism

The late stage of an alcohol use disorder is the most advanced phase, marked by increased physical dependency, medical and mental health problems, and significant decline across various aspects of life. People struggling with this stage often face numerous obstacles and experience severe consequences that are not only life-altering but life-threatening as well.

Some of the signs of late-stage alcoholism include the following:[8,9]

Severe Alcohol Dependency

People in the late stage of alcoholism are heavily reliant on the substance both physically and psychologically. They experience intense cravings for more alcohol and have great difficulty controlling or stopping their drinking behavior.

Increased Tolerance & Consumption

People in this stage drink more than ever, often starting very early in the morning, sneaking drinks throughout the day, and continuing to drink late into the night. The constantly high levels of alcohol in the system may mean that the person sometimes appears to be sober and functional even when they are not because they are so used to living under the influence.

Severe Withdrawal Symptoms

If the person is without alcohol for a period of time or genuinely tries to stop drinking, they will usually experience severe withdrawal symptoms in this stage. These may include intense shaking, hallucinations, seizures, delirium tremens (DTs), and potentially life-threatening medical complications.

Severe Physical Health Issues

Prolonged and excessive alcohol abuse can result in serious physical health problems, including advanced liver disease (cirrhosis), pancreatitis, cardiovascular problems, gastrointestinal bleeding, and a compromised immune system that increases susceptibility to infections. 

Loss of Relationships

Individuals in the late stages of alcoholism often find themselves isolated due to the strain caused by their addiction, losing connection with family members and loved ones. They often maintain only dysfunctional relationships with codependent people in their lives or with other people who are living with addiction.

Decline in Overall Function

The late alcoholic stage is marked by a severe decline in overall functioning. People may struggle with fulfilling basic responsibilities, maintaining employment, and engaging in meaningful activities. Personal hygiene, nutrition, and self-care also deteriorate significantly.

Warning Signs of Alcoholism

Recognizing the warning signs of alcohol abuse can help you to realize the problem early on and get help before it evolves into a full-blown alcohol use disorder. While not everyone will display all these signs, most people will exhibit some combination of the following symptoms:[3,10]

  • Needing to drink more alcohol to get the same effect or feeling less intoxicated after drinking the usual amount
  • Difficulty setting limits on drinking, including drinking more than intended
  • Physical or emotional symptoms, like shaking, nausea, anxiety, or trouble sleeping when trying to cut back or stop drinking
  • Drinking alone or hiding drinking from others
  • Neglecting work, school, or family obligations in because of alcohol use
  • Conflicts or difficulties in personal relationships due to drinking, such as arguments about the drinking itself or trust issues
  • Spending more and more time drinking or recovering from its effects while neglecting other responsibilities.
  • Losing interest in hobbies or activities that were once enjoyable, as alcohol becomes the main focus
  • Continuing to drink despite experiencing negative effects on health, relationships, or legal problems
  • Spending a lot of time thinking about alcohol, planning to get more alcohol while stores are open, drinking, or recovering from the effects of drinking
  • Developing specific rituals or habits around drinking
  • Displaying mood swings, becoming more irritable, or acting secretive about drinking behaviors or choices made while under the influence
  • Engaging in dangerous behaviors like drunk driving or unsafe sexual activities
  • Showing physical signs of alcohol abuse, such as unexplained injuries, poor hygiene, or weight changes

Get Help for Alcohol Use Disorder

If you or someone you love is showing signs of a developing alcohol use disorder, or if a more pronounced AUD is already present, don’t wait to reach out for help. There are a number of resources available that can help you to safely stop drinking.

Do not attempt to stop drinking on your own. This can be dangerous, and relapse is likely. Instead, reach out for help today. 

Updated January 11, 2024
Resources
  1. Transitions through stages of alcohol use, use disorder and remission: Findings from Te Rau Hinengaro, The New Zealand Mental Health Survey. Rapsey CM, Wells JE, Bharat MC, Glantz M, Kessler RC, Scott KM. Alcohol and Alcoholism. 2018;54(1):87-96.
  2. Alcohol and mortality. Rehm J, Shield KD. Alcohol Research: Current Reviews. 2014;35(2):174-183.
  3. Understanding alcohol use disorder. National Institute on Alcohol Abuse and Alcoholism. Published 2020. Accessed December 16, 2023.
  4. Alcohol’s effects on the body. National Institute on Alcohol Abuse and Alcoholism (NIAAA). Published 2021. Accessed December 16, 2023.
  5. [Treatment processes of pre-alcoholism and alcohol dependence targeted towards drinking reduction]. Yoshimura A, Maesato H, Hisatomi N, Higuchi S. Nihon Arukoru Yakubutsu Igakkai Zasshi = Japanese Journal of Alcohol Studies & Drug Dependence. 2013;48(1):39-46. Accessed December 15, 2023.
  6. Clinical course of alcohol dependence. Mattoo SK, Basu D. Indian Journal of Psychiatry. 1997;39(4):294-299. Accessed December 16, 2023.
  7. Alcohol dependence and harmful alcohol use. National Collaborating Centre for Mental Health. Published 2011. Accessed December 16, 2023.
  8. Diagnosis and treatment of alcohol use disorder in patients with end-stage alcoholic liver disease. Caputo F, Domenicali M, Bernardi M. Hepatology. 2019;70(1):410-417.
  9. Correlates of mild, moderate, and severe Alcohol Use Disorder among adults with problem substance use: Validity implications for DSM‐5. Mannes ZL, Shmulewitz D, Livne O, Stohl M, Hasin DS. Alcoholism: Clinical and Experimental Research. 2021;45(10).
  10. Alcohol use disorder. Nehring SM, Freeman AM. StatPearls. Published 2020.
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