April 2, 2023

What Are The Stages of Alcoholism?

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Alcoholism is a non-clinical term used to describe alcohol use disorder, a chronic and relapsing brain condition.

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AUD (alcohol use disorder) is a progressive condition that is characterized by the uncontrollable consumption of alcohol regardless of negative outcomes. DSM-5-TR is the revised fifth edition of Diagnostic and Statistical Manual of Mental Disorder, an American Psychiatric Association publication. DSM is the leading diagnostic tool used by mental health professionals to identify addictions including alcohol use disorder.

Alcohol use disorder is diagnosed as mild, moderate, or severe according to the number of symptoms that present. Alcoholism, by contrast, is typically discussed in terms of stages, from pre-alcoholism through to end-stage alcoholism. This guide outlines what to expect from each stage of this progressive brain disease.

What Is Alcoholism?

The most current data from SAMHSA (Substance Abuse and Mental Health Services Administration show that rates of alcoholism continue to rise in the United States.

  • 29.5 million U.S. adults met the DSM-5 criteria for AUD in 2021.
  • Among these, 22.2 million satisfied the criteria for alcoholism only, while 7.3 million had addictions to alcohol and drugs.
  • Just 2.5 million U.S. adults engaged with professional treatment for alcohol addiction in the same year.

Alcoholism unfolds on a spectrum, and all cases of alcohol use disorder are unique. From a diagnostic standpoint:

  • Mild alcohol use disorder: 2 to 3 diagnostic criteria
  • Moderate alcohol use disorder: 4 to 5 diagnostic criteria
  • Severe alcohol use disorder: 6 or more diagnostic criteria

These are the criteria for alcohol use disorder outlined in DSM-5-TR:

  1. Drinking more alcohol than planned or drinking for longer than intended.
  2. Making repeated failed attempts to moderate or discontinue use of alcohol.
  3. Spending lots of time drinking and recovering from the after effects.
  4. Experiencing intense cravings for alcohol.
  5. Withdrawal symptoms manifesting as the effects of alcohol wear off.
  6. Tolerance forming so you require more alcohol to achieve the same effects.
  7. Neglecting professional and personal obligations due to alcohol abuse.
  8. Ongoing alcohol use even though it is causing problems in your personal relationships.
  9. Spending less time doing things you once enjoyed in favor of alcohol use.
  10. Drinking alcohol in dangerous situations.
  11. Continuing to drink alcohol even though it is causing or inflaming a health condition, whether physical or mental.

The Different Stages of Alcoholism

Scientist Morton Jellinek studied a group of Alcoholics Anonymous members and subsequently published a paper on the progressive nature of the condition. Jellinek hypothesized that problematic drinking follows a standard trajectory through distinct stages of decline. Jellinek outlined these stages of alcoholism as follows:

  • Pre-alcoholism
  • Early stage alcoholism
  • Middle stage alcoholism
  • End stage alcoholism

Jellinek’s research in this area led to the formation of the Jellinek Curve, a tool that illustrates the symptoms that present as someone progresses through the various stages of alcoholism.

What to Expect from the 5 Different Stages of Alcoholism

 

  1. Pre-alcoholism
  2. Early-stage alcoholism
  3. Middle-stage alcoholism
  4. End-stage alcoholism
  5. Recovery from alcoholism

 

1) Pre-Alcoholism

In the pre-alcoholic stage, it is possible that none of the above symptoms of alcohol use disorder will present.

Answer the following questions honestly:

  1. Do you ever drink to dull pain?
  2. Have you ever consumed alcohol to feel better about yourself?
  3. Have you used alcohol as a coping mechanism to stop worrying?
  4. Do you find that tolerance has formed so you need more alcohol to achieve the initial effects?
  5. Do you drink to self-medicate the symptoms of anxiety or depression?

If you respond positively to the first four questions, your drinking habits may be problematic and could escalate without intervention.

Self-medicating symptoms of mental health disorders provides nothing but fleeting relief. The underlying problem is not addressed, and you introduce the added complication of alcohol use disorder developing.

Many people who exhibit drinking patterns categorized as pre-alcoholic never develop alcohol use disorder and drink within guidelines for moderate drinking – social drinking.

More damaging are those experimenting with alcohol who engage in episodes of binge drinking. Binge drinking is one of the most damaging forms of alcohol consumption. CDC (Centers for Disease Control and Prevention) defines binge drinking as:

  • Men drinking more than five alcoholic drinks within two hours.
  • Women drinking more than four alcoholic drinks within two hours.

Regular episodes of binge drinking increase the risk of alcohol overdose (alcohol poisoning) and heighten the chances of alcohol use disorder developing and progressing.

 

2) Early-Stage Alcoholism

The early stage of alcoholism may involve presenting just two of the above symptoms from DSM. These are the most common signs of problematic alcohol abuse in the early phase:

  • Lying about drinking.
  • Drinking excessively.
  • Binge drinking.
  • Thinking about drinking obsessively.
  • Blacking out after drinking too much.

 

One of the central components of any pattern of problematic drinking is the associated loss of control over alcohol intake. Loss of control and inability to moderate use are diagnostic criteria for alcoholism.

If your pattern of alcohol consumption has entered the early stages of alcoholism, you may experience as many as three or four symptoms of alcohol use disorder. You may or may not have developed physical dependence in the early stages of alcohol addiction.

Those who develop an emotional attachment to drinking alcohol are more likely to progress from early to middle-stage alcoholism.

If you become physically dependent on alcohol, intensely uncomfortable withdrawal symptoms will present in its absence. Detoxing from alcohol can be dangerous and potentially life-threatening, so all those at this stage of alcoholism would benefit from a supervised medical detox.

3) Middle-Stage Alcoholism

The middle stage of alcoholism correlates to severe alcohol abuse. By this point, the signs of your struggle with alcohol abuse will be evident to loved ones. Common adverse outcomes associated with this level of alcohol abuse include:

  • Weight loss or weight gain
  • Facial redness
  • Stomach bloating
  • Irritability
  • Sluggishness
  • Neglected responsibilities
  • Conflict in personal relationships
  • Financial problems
  • Issues at work related to alcohol abuse

Those in the middle stage of alcoholism would typically be diagnosed with severe alcohol use disorder, characterized by the presentation of at least six of the symptoms outlined above.

That said, it is estimated that one in five of those who abuse alcohol are high-functioning alcoholics. Even when drinking heavily and satisfying the criteria for severe alcohol use disorder, some people may still outwardly perform as normal. This does not apply in end-stage alcoholism.

Middle-stage alcoholism may trigger any of the following health complications:

  • Cirrhosis
  • Dementia
  • Anemia
  • Cardiovascular disease
  • Cancer
  • High blood pressure
  • Depression
  • Nerve damage
  • Gout
  • Pancreatitis
  • Seizures
  • Infectious diseases

4) End-Stage Alcoholism

End-stage alcoholism can be life-threatening without intervention and ongoing treatment. By this point, drinking is central to life, at the expense of health, relationships, and livelihood.

Attempting to stop drinking without medical supervision could lead to life-threatening seizures. This can occur during delirium tremens, the most severe form of alcohol withdrawal that impacts up to 5% of those withdrawing from alcohol.

An end-stage alcoholic will exercise no control over their drinking. Some people will continue to drink simply to avoid the manifestation of withdrawal symptoms. Others drink to live rather than living to drink. All joy has been sucked from alcohol consumption.

Serious health complications may occur during end-stage alcoholism, including cirrhosis of the liver and wet brain (Wernicke-Korsakoff syndrome).

There is also the risk of intentional self-harm among end-stage alcoholics.

That said, evidence-based treatment can almost always help someone from end-stage alcoholism into ongoing recovery.

5) Recovery from alcoholism at Gratitude Lodge in Southern California

Alcoholism is a progressive brain condition that typically worsens if untreated. Regardless of the stage of alcoholism, we can help you address the physical and psychological aspects of addiction at Gratitude Lodge in Southern California.

We have inclusive, pet-friendly treatment centers located in Long Beach and Newport Beach. All Gratitude Lodge facilities offer supervised medical detox programs. This enables you to access medications to streamline alcohol withdrawal and to mitigate cravings during detox. You will also have continuous emotional and clinical care available, minimizing the chance of complications during detoxification.

After a week or so, you will be ready to transition into one of the following treatment programs for alcoholism:

  • 30-day inpatient rehab
  • Intensive outpatient program
  • Dual diagnosis treatment program (for co-occurring disorders)

All Gratitude Lodges offer individualized care that draws from a variety of holistic and science-backed therapies, including:

  • MAT (medication-assisted treatment)
  • Psychotherapy (CBT and DBT)
  • Group therapy
  • Individual counseling
  • Family therapy
  • Holistic therapies

We’re here to help you from detox to discharge and beyond, so you will leave Gratitude Lodge equipped with relapse prevention strategies, healthy coping techniques, and a comprehensive aftercare plan that may involve ongoing therapy in an outpatient setting.To start living alcohol free regardless of the severity of your alcohol use disorder, call 888-861-1658 today for immediate assistance.

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Joe Gilmore

Joseph Gilmore

Joseph Gilmore has been working in the addiction industry for half a decade and has been writing about addiction and substance abuse treatment during that time. He has experience working for facilities all across the country. Connect with Joe on LinkedIn.
Jenni Bussi

Jenni Russe MS, LPCC

Jenni Busse MS, LPSS is the Clinical Director at Gratitude Lodge. Jenni oversees the clinical program and the clinical team at Gratitude Lodge as a whole. Jenni has worked in treatment for almost 14 years. Her background as a licensed therapist and her passion for helping others intersected with addiction recovery when she started working primarily in detox residential treatment.

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