What are the Stages of Alcoholism?

What’s the difference between early and late-stage alcoholism? Learn what it is— and, why it’s never a good idea to wait to get help for a drinking problem.

Addiction, like most diseases, progresses in stages. However, the initial diagnosis is unlikely to come, as a cancer diagnosis would, with a label of “Stage 1” or “Stage 4” or anything in between. Often, it’s difficult to categorize the stages of addiction. A quick online search can turn up a variety of articles that speak of the “four stages of alcoholism” or the “seven stages of alcoholism,” or any other number with arbitrarily selected “stages.”

If there is an “official” list of the most commonly recognized stages of alcoholism, it’s probably the one first popularized in 1960 by biostatistician E. M. Jellinek, in The Disease Concept of Alcoholism. The four “stages of alcoholism” it recognizes are symptomatic, prodromal, crucial and chronic. Or, as more commonly known, “pre,” “early,” “middle” and “late.” Symptoms can overlap between stages, but each stage represents a stronger level of alcohol dependence.

THE PRE-ALCOHOLISM STAGE 

Drinkers in the “pre-alcoholic” stage have not developed physical tolerance or emotional dependence, but their perception of drinking dangers is skewed. Instead of regarding beer or wine as simply part of a food menu, they have started to see it primarily as a stress or pain reliever.

In some cases, it’s possible to be “pre-alcoholic” long before the first drink, due to “alcoholism genes” or years of seeing parents drink to escape stress. Anyone whose close relatives have alcoholism should think long and hard before starting even “social” drinking—“it won’t happen to me” is among the most famous of last words.

Symptoms of pre-alcoholism:

• Looking forward to the day one is old enough to drink legally
• Having a drink at the same time every day, and eagerly looking forward to it
• “Needing a drink” to cope with stress
• Unwillingness to take a turn as “designated driver”
• Drinking while alone

THE EARLY STAGE OF ALCOHOLISM

Drinkers in the “early” stage of alcoholism show no obvious symptoms at first glance and remain fully functional in most of life. A close look at their drinking habits, however, hints at trouble developing. They drink more than they used to, and physical consequences may start to manifest. Others—perhaps without knowing exactly why—may suspect the drinker is “changing.”

At this point, the drinker may not be strictly “addicted,” but he or she is in the early stages of dependence—unable to really picture coping without alcohol. Functional, social and often medical problems begin to develop, though most of these are still relatively easy to hide and deny.

Symptoms of early-stage alcoholism:

• Automatically choosing “a drink” as the first line of stress relief
• Increased tolerance: feeling the need to drink more per sitting or per day
• Feeling irritable and stressed with increasing frequency
• Finding it harder to keep up former levels of work and social effectiveness
• Difficulty sticking to predetermined drinking limits
• Periodic or frequent “binges”
• Guilt feelings over having gotten “buzzed” or drunk
• Occasional memory blackouts after drinking
• Others suggesting “maybe you’ve had enough” on a regular basis

THE MIDDLE STAGE OF ALCOHOLISM

Drinkers in the “middle” stage of alcoholism begin to experience hard-to-ignore physical effects, including cravings, blackouts and withdrawal symptoms. They become defensive as others start hinting that a problem is building up. Interest in non-drinking activities and personal care diminishes.

The middle-stage drinker is the classic “high-functioning” alcoholic—the person who, despite problems now obvious to anyone in close association, can still protest he or she is “okay” because “I have a steady job” or “I haven’t been arrested.”

Symptoms of middle-stage alcoholism:

• Drinking earlier in the day
• Feeling increasingly guilty about “binges” or drunken behavior
• Attempting to hide one’s drinking from intimates
• Making unkeepable promises (to oneself or others) to limit (but not stop) drinking
• Resentment over being questioned about drinking habits
• Rationalizing or blaming—regularly trying to convince others and oneself “it’s not really my fault”
• Obvious deterioration in job performance, social behavior and self-care
• Letting others cover for mistakes and poor performance
• Loss of interest in former (non-drinking) favorite activities
• Spending money on drink when it was budgeted for other things
• Frequent headaches, nausea, muscle tremors, unexplained sweating or loss of appetite
• Frequent anxiety, depression or mood swings
• Insomnia, chronic drowsiness or fatigue

THE LATE STAGE OF ALCOHOLISM

Drinkers in the “late” stage of alcoholism are barely if at all functional, suffer major health damage, and keep drink as their top priority in life. Alcohol is their “quick fix” for every pain. They take it for granted others will “enable” their habit by ignoring their behavior, cleaning up their messes, lying for them or taking over as primary financial provider. They may have given up all hope of getting their old life back or of things ever getting better.

Late-stage alcoholics often have no reason left for drinking besides “kill the pain”—any thought of enjoying it for flavor or pleasurable sensations is long forgotten. This is the stage when many literally “drink themselves to death.”

Symptoms of late-stage alcoholism:

• A sense of having totally lost control over one’s drinking—and not caring much anymore
• Being unable to get through even one day without multiple drinks
• Thoughts of “the next drink” becoming obsessive
• Intense physical cravings for alcohol
• Withdrawal from everyone except “drinking buddies”
• Job loss or repeated warnings about reduced performance
• Clashes with the law over rowdy public behavior or driving under the influence
• Prolonged loss of memory or coordination

TIME FOR RECOVERY

It’s important to realize that an alcoholic doesn’t have to “hit bottom” before being “ready for” treatment: effective treatment is possible at any if the four stages of alcoholism. If you recognize yourself or a loved one in any of the above descriptions, don’t try to analyze “which stage” or rationalize you don’t have all the symptoms: look for help before things get worse. You can find freedom from alcoholism and live a fulfilling life!

S0urces:

AddictionCampuses.com. “The 4 Stages of Alcoholism for the Functioning Alcoholic.” April 15, 2015. Accessed October 24, 2017. 

American Addiction Centers. “Stages of Alcoholism: Early, Chronic & End Stage.” Accessed October 24, 2017.  

Brande, Lauren. “Alcoholism and Recovery Stages.” Recovery.org, updated April 25, 2017. Accessed October 24, 2017.

Caron Treatment Centers. “Seven Stages of Alcoholism: A Diagnostic Tool to Assess Alcohol Abuse and Addiction.” Accessed October 24, 2017.

Cherney, Kristeen. “Stages of Alcoholism.” Healthline.com, November 8, 2016. Accessed October 24, 2017.

ProjectKnow. “Early, Mid, and Late Stages of Alcoholism.” Accessed October 24, 2017.