The 4 Stages of Alcohol Addiction

Last Updated: April 10, 2020

Authored by Nena Messina, Ph.D.

Alcohol abuse can bring along devastating side effects. Pinpointing one’s addiction to a certain stage of alcoholism is the first step forward in treating hazardous dependence. Roughly speaking, the abuse develops through four stages of alcoholism, with each stage being treatable. It’s important to remember it is never too late to get help; achieving sobriety accounts for improved wellbeing and a much healthier lifestyle.

What do Different Alcoholism Stages Have in Common?

Also called alcohol use disorder, alcoholism is a severe addiction that takes a firm grip on one in every twelve Americans, fuelled by a substance which is the third leading cause of death in the country. Most people can handle occasional consumption with ease. Others, with certain risk factors, aren’t so lucky and fall into one of the four stages of alcohol abuse. And while individuals who experience alcohol use disorder are never the same, the side effects of their excessive drinking across stages of alcoholism will be alike.

Identifying Alcoholism Stages

When diagnosing an alcohol use disorder, a clinician may seek guidance in the Diagnostic and Statistical Manual of Mental Disorder-5 (DSM-5). This diagnostic tool allows professionals in the field to identify the stage of alcoholism their patients are facing. DSM-5 contains a list of 11 symptoms which will determine the severity grade of one’s condition.

An alcoholic can be in an early, middle, late, or end-stage of alcohol abuse. Simply put, if one has experienced two or more symptoms from the list in the past year, they may qualify for an alcohol use disorder.

Consequences of Alcoholism

Liver damage, cancer, depression. These are only a few of the debilitating conditions an alcoholic may develop, sometimes with fatal consequences. Hence it is so crucial to determine whether a person suffers from alcohol use disorder as early as possible, as it will be easier to prevent psychological and physical damage occurring in the first place. Unless steps to stop drinking are taken, and intervention into one’s habits takes place, these four stages of alcoholism can progress into unfavorable health conditions and chronic illnesses, likes of which include:

  • Anemia
  • Cardiovascular diseases
  • Liver Cirrhosis
  • Cancer
  • Depression
  • Nerve damage
  • Gout
  • Pancreatitis

How to Detect an Alcohol Problem?

The number of drinks a person has per week is what ultimately makes him or her susceptible to an alcohol use disorder. Due to physiological differences between genders, one’s sex will affect the risk criteria. Men are at risk if they consume more than 14 drinks per week while women are at risk if their weekly intake surpasses seven units per week. Interestingly, men suffer from alcohol use disorder nearly twice as much as their opposite gender. In the 17 million estimated sufferers, only 5.7 million are women. Whatever gender, identifying an addiction can be achieved by asking the following questions:

  • Do I feel a strong urge for alcohol regularly?
  • Am I able to stop drinking once I’ve started?
  • Do I experience any of the withdrawal symptoms, such as sweating or nausea, when I’ve had not had a drink for 24 hours?
  • Have I built up the tolerance to alcohol and feel the need to drink larger amounts to overcome it?

What are the Four Stages of Alcoholism?

People who start to feel socially and physically affected by alcohol consumption habits might discover they are in one of the four stages of alcoholism. So what are the stages of alcoholism? The stages differ in their severity and bring along gradually worsened physical, psychological, and withdrawal symptoms. The four stages of alcoholism are:

  • The early stage
  • The middle stage
  • The late stage
  • The end stage

The Early Stage

The first stage of alcohol addiction is also called the initial stage. This stage is particularly challenging to recognize as impairments and lifestyle dysfunctions haven’t necessarily started appearing yet. Higher tolerance to alcohol and a change of social aspects are the first clues. If other people have started noticing changes in a person’s drinking habits wherein he or she drink to, for example, deal with other problems, they may be in the first stage of alcoholism.

Concerning DSM-5, alcohol abusers in their early stages display one or two of the 11 symptoms in the set. People in the early stages of alcoholism frequently include high school or college students who have been introduced to the different types of alcohol through binge-drinking and partying. Such individuals are often at higher risk of expanding their addiction to other stages.

The Middle Stage

The middle stage of alcoholism often comes with more visible physical and social effects. The intense craving for alcohol may be developed, and first withdrawal symptoms may occur. These include:

  • Loss of appetite
  • Nausea or vomiting
  • Rapid heartbeat
  • Blackouts
  • Profound sweating
  • Strong Headaches
  • Pale skin

People in this stage are likely to show more of the DSM-5 factors, ranging from three to five. In this stage, physical dependence may appear, including withdrawal symptoms and higher tolerance levels. As for the sociological characteristics, sufferers won’t admit their problem when in the middle stages of alcoholism. Denial is a common phenomenon and can be challenging to overcome. An alcohol problem arises if one has begun to hide the amount he or she drinks or is making excuses for their excessive drinking. Also, they may experience troubles at the workplace, school, or home or feel their relationships with other people are jeopardized. These are all warning signs of the middle stage of alcoholism.

Late Stages of Alcoholism – Late and End Stage

The presence of six or more symptoms from the DSM-5 list indicates the late stage of alcoholism may be existing. This stage is also called the severe alcohol abuse stage. The number of factors results in an overwhelming experience for a sufferer who is at this point, strongly advised to seek professional help.

Third Stage of Alcoholism and Functionality

While one might be able to hold a job at this stage of even function normally daily, the problem acts as a ticking bomb and will eventually take effect. The mental focus will be on the next drink, and their working life and health will eventually start to get affected by the habit. Medical conditions such as hepatitis, liver cirrhosis, or in the severe cases heart failure and brain damage are possible.

The End Stage

In the end stage, the abuser is consumed by drinking rather than consuming drinks. The quote from a celebrated author Ken Kesey sums it up brilliantly. He described his uncle as being: “Blind and diseased from drinking. And every time he put the bottle to his mouth, he didn’t suck out of it, it sucked out of him.” In this final stage, the sufferer loses control over his or her drinking habits but still has a chance to achieve recovery.

Dying from Alcoholism – Final Stages

Dying in the Final Stages of Alcoholism is possible. After being exposed to excessive drinking for long enough through this stage, the patient can experience life-wrecking side effects. This full-blown addiction will carry heavy withdrawal symptoms and an increased risk of developing life-threatening conditions. The withdrawal symptoms can be so painful that the person needs to drink simply to alleviate them. Life expectancy in this stage can be as short as six months.

What is the Treatment for Four Stages of Alcoholism?

Curing of alcohol use disorder is possible regardless of the stage the patient is in. The disease will more likely produce better results if tackled in its early stages. Carrying the label of being the most abused substance among the rehab attendees, alcohol has been studied vigorously. Hence there are plenty of readily available treatment options on the market. Of all the treated substances in rehab centers, alcohol accounts for more than half, with 52.87% identifying to belong in one of the stages. For more information on the correct treatment facility, call the helpline number.
Just like there are stages of the disorder itself, their stages of quitting drinking, too. The treatment will most likely include a rehabilitation process that should be tailored to one’s particular needs. Although no one center is the same, the key elements shared throughout the facilities will remain similar whatever the stage one is experiencing. Talking to an addiction counselor or a mental health professional will be the safest option to engage in stages of recovery from alcoholism. Depending on the volume of the alcohol consumed and the length of consumption time, a supervised detox might be required. It is essential that the detox process, which is a step in the recovery from alcoholism, is carried out by a professional rather than just ‘going cold turkey,’ as this could potentially worsen the patient’s situation. Once the journey to recovery has been completed, the patient may take over the role of a mentor for those who are taking steps to stop drinking. It will not necessarily be an easy journey, but it is one that is highly rewarding and well worth its efforts.

Page Sources

  1. Roehrs T, Roth T. Insomnia as a path to alcoholism: tolerance development and dose escalation. Sleep. 2018.
  2. Fryer SL, Jorgensen KW, Yetter EJ, Daurignac EC, Watson TD, Shanbhag H, Krystal JH, Mathalon DH. Differential brain response to alcohol cue distractors across stages of alcohol dependence. Biol Psychol. 2013 Feb;92(2):282-91.

Published on: March 9th, 2018

Updated on: April 10th, 2020

About Author

Nena Messina, Ph.D.

Nena Messina is a specialist in drug-related domestic violence. She devoted her life to the study of the connection between crime, mental health, and substance abuse. Apart from her work as management at addiction center, Nena regularly takes part in the educational program as a lecturer.


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  • Lianne Meuse
    I have a 34yr. old daughter who is an alcoholic. she has a 10 yr.old daughter, we {the family are very worried about her.} I know my family is really working hard to take care of the 10yr. old, I want to see my daughter get the help she needs.