From Early Warning Signs to Severe Dependence: Understanding the Stages of Alcoholism

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What you will learn

• Stages of alcoholism could define how drinking becomes progressively worse for an individual. However, alcohol use disorder is identified by its own criteria of symptoms and degree of seriousness, not by distinct stages of development.
• From the initial increase in the amount of alcohol consumed to increased tolerance, loss of control, and eventually physical dependence and serious health issues.
• Not everyone will move through each stage of alcoholism at the same speed nor in the same order. Severity levels of alcohol use disorders range from mild to moderate to severe, and not all individuals will have the exact same level of severity.
• Genetics can influence vulnerability to alcohol use disorder, but a family history does not guarantee that an individual will develop the problem.
• Health risks in late-stage alcoholism can include liver disease, impaired thinking or cognitive abilities, cardiovascular illnesses, and the possibility of dangerous withdrawal symptoms when trying to stop drinking.

While alcohol problems may not develop immediately, some individuals find that drinking habits become more problematic as their tolerance for alcohol develops, the importance of alcohol in their daily lives increases, and as physical or psychological complications develop.

The stages of alcoholism are one way to describe this progression. However, they should not be mistaken for a formal diagnostic system. Today, healthcare professionals diagnose alcohol use disorder, also known as AUD, using criteria from the Diagnostic and Statistical Manual of Mental Disorders. AUD is classified as mild, moderate, or severe according to the number of symptoms a person experiences. [1]

Understanding how problematic drinking can progress may allow individuals and their families to acknowledge troublesome changes in their drinking sooner and seek help more promptly.

Understanding the Development of Alcohol Dependency

While most people understand that the progression of an alcoholic’s dependency is different for each individual, a common conceptualization of the development of an alcoholic’s dependency includes an early or pre-alcoholic phase followed by increasingly problematic phases of use, dependency, and severe alcohol use disorder.

Phase One (Early Phase): Drinking Becomes Increasingly Important

Even during an early or pre-alcoholic phase, an individual’s drinking often resembles social drinking. During this time, an individual may consume alcohol primarily at social events (e.g., parties, meals with friends), holidays, and other celebrations. However, there comes a time when drinking begins to serve a purpose beyond just socializing. At this juncture, an individual may use alcohol to deal with emotional distress (e.g., sadness or depression), loneliness, and/or lack of sleep. In addition to serving as a coping mechanism, individuals also tend to develop a growing tolerance for alcohol. Specifically, individuals may require increasingly large amounts of alcohol to feel effects that were previously achieved after consuming less alcohol.

During this phase, friends and family members may not perceive any detrimental effects from an individual’s drinking. However, friends and family members may observe signs that suggest an individual is struggling with increasing levels of problematic drinking. These warning signs may include:

• Consuming more than they intend to consume
• Relying on alcohol to cope with feelings and emotions
• Feeling urges or cravings for alcohol
• Developing physical dependence on alcohol
• Engaging in unhealthy or unusual behavior related to alcohol use
• Missing responsibilities or work obligations related to drinking

Phase Two (Middle Phase): Drinking Contributes to Obvious Problems

In the middle phase of alcoholism, an individual’s ability to conceal his or her drinking is reduced. An individual’s drinking may take up more time and attention, and an individual may experience more frequent consequences as a result of their drinking. Examples of potential middle-phase consequences may include:

• Increased frequency or intensity of drinking
• Binge drinking episodes
• Blackout episodes or memory lapses
• Intense cravings for alcohol
• Tolerance increases
• Failure to decrease or limit drinking
• Irritability or anger when unable to obtain alcohol
• Neglecting important tasks or responsibilities to spend time drinking
• Continuing to drink despite relationship or marital problems

Again, please note that these consequences do not represent “stages.” Clinically speaking, AUD is diagnosed when an individual exhibits at least two of the established diagnostic criteria outlined in the Diagnostic and Statistical Manual (DSM) within a twelve-month time frame. Meeting six or more of these criteria is classified as severe AUD. [2]

Thus, even though an individual’s drinking becomes more compulsive and therefore more difficult to cease without assistance, an individual can still access support to aid in the cessation of their drinking.

Phase Three (Late Phase): Physical Dependence Develops

After extended periods of heavy drinking, an individual’s body adjusts to the consistent presence of alcohol. Therefore, when an individual attempts to discontinue or significantly diminish their consumption of alcohol, withdrawal symptoms may develop. Withdrawal symptoms may include:

• Trembling or shaking hands
• Sweating or perspiration
• Insomnia or sleep disturbances
• Anxiety or tension
• Nausea
• Rapid heartbeat or increased pulse rate
• Anger or hostility
• Restlessness or agitation

Severe cases of withdrawal may produce seizures or delirium tremens, potentially resulting in death, making withdrawal potentially life-threatening for some people. [3] Because this situation poses a potential threat to some individuals’ safety, it is recommended that those with significant dependence on alcohol do not attempt to stop drinking at home without proper supervision.

Ascendant New York offers medically supervised drug and alcohol detox at its Manhattan facility, with continuous monitoring from licensed healthcare professionals and individualized medication support when clinically appropriate. Medical detox can help manage withdrawal safely, but detox is generally the beginning of treatment rather than the entire recovery process.

What Is Considered Late Stage Alcoholism?

Terminology such as “late stage” or “final stage” of alcoholism refers to advanced, alcohol-dependent drinkers whose drinking has resulted in significant physical, psychological, or social consequences. The terms “end stage” and “last stage” of alcoholism do not specifically denote an independent diagnosis listed in the DSM. Instead, someone referred to as being in late-stage alcoholism would likely suffer from either severe AUD or substantial medical complications stemming from their drinking.

Someone may view their daily routine as revolving almost exclusively around their drinking habits. Additionally, they may be aware that their drinking is causing serious health problems yet continue to consume alcohol in hopes that their health will improve, or because they fear withdrawal symptoms if they stop. Their relationships and job responsibilities may be severely impacted by their drinking.

Additionally, individuals suffering from late-stage alcoholism may exhibit nutritional deficiencies and cognitive decline. They may also experience worsening mental health issues.

It is essential to remember that the notion of an “alcoholism final stage” should never lead an individual to believe that they cannot recover from severe AUD. Severe AUD can be successfully treated; however, addressing medical issues simultaneously may be necessary for complete recovery. Furthermore, treatment is available regardless of where you fall along the spectrum of your AUD.

When Will My Health Be Impacted by Heavy Drinking?

Regardless of whether you are perceived as being in “late-stage” alcoholism or not, you are at risk for developing health problems from excessive or chronic heavy drinking. The more you drink, the higher your risk for developing health problems.[4]

Acute and chronic heavy drinking can negatively impact virtually all systems of the body, including the brain (cognitive impairments), cardiovascular system (high blood pressure, irregular heart rhythms, stroke, cardiovascular disease), and gastrointestinal system (liver disease, digestive tract issues).

Heavy drinking is associated with more than 200 various diseases, injuries, and other health-related conditions. [5] Chronic heavy drinking can also contribute to brain damage through several mechanisms, including direct neurotoxic effects from ethanol on neurons, malnutrition caused by poor eating habits while drinking heavily, inflammation caused by chronic irritation and injury to tissues throughout the body, and complications arising from liver dysfunction.

One example of a severe neurological condition resulting from malnutrition and chronic heavy drinking is Wernicke-Korsakoff syndrome. This condition results in memory loss, impairment, and significant cognitive deficits.

There is no need to wait until your liver fails or other severe complications arise before seeking help.

Can Family History Increase My Vulnerability to Developing AUD?

Individuals researching the progression of stages of alcoholism may also want to know whether a family history puts them at a higher risk for developing AUD.

Genetic studies demonstrate that genetic factors play a meaningful role in determining an individual’s susceptibility to developing AUD. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that approximately 50% to 60% of the susceptibility to developing AUD can be attributed to genetic factors. Multiple genes appear to contribute a small amount toward an individual’s risk factor for developing AUD by influencing aspects such as metabolism of alcohol, reactions to stress or alcohol use, impulsive behavior, and addiction-related brain processes. [5]

Therefore, while a family history may increase an individual’s vulnerability toward developing AUD, it does not mean that they will develop AUD. Environmental factors and experiences also contribute greatly to an individual’s risk factor for developing AUD.

How Does Drinking Progression Impact Each Individual?

An individual’s transition from low-risk drinking to dependency on alcohol can be subtle. Initially, an individual may drink because it feels enjoyable or enables him or her to socialize with friends. Eventually, an individual’s primary reason for drinking may evolve into using alcohol as a method for alleviating stress or emotional discomfort. As tolerance increases, an individual will need to consume more alcohol than they had originally consumed to achieve the original positive effects.

Finally, as an individual continues down this path, they may experience increased craving or compulsiveness related to drinking. They may find themselves wanting or trying not to drink but ultimately continuing to engage in excessive drinking patterns. In severe AUD, alcohol may be used partly to avoid withdrawal symptoms rather than simply to become intoxicated.

Not all individuals will undergo this progression. NIAAA describes alcohol addiction using a repeating cycle that includes binge and intoxication, withdrawal and negative affect, and preoccupation and anticipation. Changes occurring in an individual’s brain as a result of increasingly severe AUD can perpetuate this cycle and make it more difficult for him or her to stop drinking. [6]

Identifying changes occurring prior to serious medical consequences developing presents an opportunity for earlier intervention.

Finding Recovery at Ascendant New York

You do not have to wait until alcohol use becomes severe before seeking help. At Ascendant New York, we provide alcohol addiction treatment in New York City for individuals struggling with alcohol use disorder (AUD), alcohol dependence, and related substance use concerns. Our approach combines individualized care, evidence-based therapies, and a full continuum of treatment based on each person’s medical needs, mental health history, withdrawal risk, and individual circumstances.

If alcohol use, cravings, withdrawal symptoms, or difficulty controlling your drinking have become concerning, you can speak with our team for a comprehensive evaluation to determine whether medical detox, residential treatment, intensive outpatient care, or another level of support may be appropriate.