The Four Stages of Alcoholism
The current, most commonly accepted model of alcoholism is the disease model. And nearly every serious disease develops in stages.
There is no set time table for the escalation of alcoholism. And there is no way to tell how serious or life-threatening the disease may become until it has reached that point.
The four stages of alcoholism can be categorized as Pre-Alcoholism, Early Alcoholism, Middle Alcoholism, and Late Alcoholism. They may be known by other names or features, but typically the signs and symptoms are the same.
Pre-alcoholism can begin with one drink, but at some point, it escalates to levels of abuse. Abuse includes binge drinking, and/or drinking when it’s not appropriate (i.e. to ease tension before a final exam).
In addition, the drinker may partake simply because of peer pressure. This stage often happens with young people in high school or college.
Some level of tolerance may develop, but typically speaking, day to day life is unaffected (except for possibly the occasional hangover). Some persons at this stage are able to stop and never progress.
Perhaps this stage could be better thought of as not among the actual stages of alcoholism, but rather simply problematic, worrisome alcohol abuse.
Stage 1 – Early Alcoholism
Early Alcoholism is often characterized by a general feeling that the person is no longer in control of their drinking. Black outs may occur, and drinkers may escalate in terms of alcohol content (i.e. from beer to liquor). Other signs include day drinking and increased tolerance.
At this point, the drinker is often drinking to become intoxicated. This may seem obvious, but consider that if every drinker stuck to the “1 to 2 drinks per day” guidelines, no one would really become intoxicated.
During early alcoholism, the drinker may also begin to have cravings for alcohol at times when it is not present. When it is present, it may be difficult to NOT take a drink, despite efforts to say no.
Stage 2: Middle Alcoholism
One of the major characteristics of middle alcoholism is drinking as a coping mechanism. The drinker is probably drinking every day, or almost every day. And ironically, they are probably drinking to mask feelings associated with their addiction.
During this stage, dependency also begins to develop. That is, the brain and body is becoming dependent upon the substance in order to function “normally.”
Typically speaking, the drinker is becoming more isolated, and consequences of drinking are beginning to significantly affect daily life. For example, friends and family of the drinker are becoming concerned, and the drinker’s behavior and habits are started to become alarming and/or embarrassing. Also, work or school performance are likely affected.
The drinker may have also managed to incur legal problems, such as a DUI, but not always.
Emotions for the drinker have probably become difficult to manage. At this stage, depression, guilt, and anxiety are probably feelings the drinker is becoming well-acquainted with. And he or she is probably beginning to experience some physical and mental symptoms of withdrawal.
Stage 3: Late Alcoholism
In late alcoholism, the drinker is completely dependent on alcohol, and may suffer severe withdrawal symptoms if they attempt to stop. Tolerance may be very high, and drinking during most of the waking hours is possible.
Despite the many negative consequences that have occurred, including health issues, the late stage alcoholic continues to drink. In fact, brain chemistry has been altered to the point that alcohol is the only thing that can make them feel okay – at least temporarily.
The drinker may have also sustained irreversible damage to their liver, heart, and other vital organs. Signs of mental incapacity in addition to intoxication may also be evident.
Keep in mind that almost no one is a “gutter alcoholic” – most drinkers, even heavy drinkers, fall on a continuum, and this is an extreme example. Moreover, the alcoholic can appear much more function to others, despite the dysfunction of their disease.
Is There Hope?
Of course there is. The disease can be treated at any of the stages of alcoholism. The frequency, duration, and level of use over a prolonged time factor in to length of recovery time and the intensity of treatment.