Alcohol dependence can have serious consequences causing problems to the body such as liver disease or problems with daily functioning in the case of severe alcoholism. The American Academy of Family Physicians recognizes that later stage alcoholism is recognizable to physicians due to the presentation of serious medical symptoms 1. However, early stage alcoholism is marked by subtle clinical findings. Although there is some debate about the number of stages of alcoholism, the condition can be summarized by three major stages and accompanying symptoms 2.
Early alcoholism is often indistinguishable to the drinker or others. This stage signifies the drinker using alcohol on a regular basis and building a tolerance to the substance. Tolerance is marked by drinking more while still functioning in normal daily activities. At this point performance on the job, at home and sociability is minimally changed. The website HealthGuidance.org indicates that during early alcoholism a foundation is set for the alcoholic to develop dependence on the substance to relieve stress and alter mood 3. The early stage of alcoholism also leads to the body showing early signs of withdrawal, such as minor impairments in thinking, when blood alcohol level decreases.
- Early alcoholism is often indistinguishable to the drinker or others.
- The website HealthGuidance.org indicates that during early alcoholism a foundation is set for the alcoholic to develop dependence on the substance to relieve stress and alter mood 3.
Four Stages of Alcoholism
The desire to drink more alcohol to achieve intoxication grows during this stage. The body becomes more dependent on the substance yet the mind does not necessarily acknowledge this fact. Denial of having a potential alcohol problem often accompanies this stage. The Cleveland Clinic Foundation notes that an attempt to control drinking occurs with using promises such as not drinking before a certain time as a means to justify use 3. However, the growing dependence upon alcohol leads to breaking the promises and drinking more than planned. Stability at work and home can remain but typically as alcoholism progresses this wanes. There is no specific time limit from this stage to the next but in some cases the onset of blackouts, functioning but not knowing what happened, means serious progression of the condition.
- The desire to drink more alcohol to achieve intoxication grows during this stage.
- The Cleveland Clinic Foundation notes that an attempt to control drinking occurs with using promises such as not drinking before a certain time as a means to justify use 3.
Chronic loss of control signifies the late stage of alcoholism. This includes obsessions with drinking, avoidance of normal activities and spending copious amounts of time engaged in alcohol related behavior. Job and home life suffer during and this period, which often peaks with growing financial obligations being ignored. Some individuals in this stage still appear to function. However, the progression of alcohol use at this time often makes hiding the condition difficult. The Los Angeles Times online notes that frequent blackouts occur in addition to severe withdrawal symptoms such as tremors and hallucinations during end stage alcoholism. Physical indicators during end stage alcoholism include malnutrition, fatigue and emotional instability. The American Academy of Family Physicians recognizes that many office visits occur due to the physiological symptom of pain from possible liver damage during this stage.
- Chronic loss of control signifies the late stage of alcoholism.
- The Los Angeles Times online notes that frequent blackouts occur in addition to severe withdrawal symptoms such as tremors and hallucinations during end stage alcoholism.
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- American Academy of Family Physicians: Alcohol Related Problems: Recognition and Intervention
- Alcoholism and Drug Addiction Help: Alcoholism Stages
- Cleveland Clinic Foundation: Alcoholism
- Health Guidance: Alcoholism Stages 3 Stages of Alcoholism You Should Know
- Rehm J. The risks associated with alcohol use and alcoholism. Alcohol Res Health. 2011;34(2):135–143.
- National Institute on Alcohol Abuse and Alcoholism. Alcohol Facts and Statistics. Updated February 2020.
- Singal AK, Bataller R, Ahn J, Kamath PS, Shah VH. ACG clinical guideline: Alcoholic liver disease. Am J Gastroenterol. 2018;113(2):175-194. doi:10.1038/ajg.2017.469
- Centers for Disease Control and Prevention. Chronic Liver Disease and Cirrhosis. Updated May 2013.
- Zahr NM, Pfefferbaum A. Alcohol's effects on the brain: Neuroimaging results in humans and animal models. Alcohol Res. 2017;38(2):183–206.
Aubri John has been a contributing researcher and writer to online physical and mental health oriented journals since 2005. John publishes online health and fitness articles that coincide with her licensed clinical skills in addictions, psychology and medical care. She has a master's degree in clinical social work and a Ph.D. in health psychology.