Stages of Alcoholism: Early Stage, Middle Stage, Late Stage, Diagnosis, Treatment

Alcohol use disorder (AUD) progresses through several stages, each with distinct characteristics and challenges. Understanding these stages aids in recognizing the development of the disorder and seeking timely intervention.

The early Stage is the initial phase involving increased alcohol consumption both in frequency and quantity. Individuals start using alcohol as a coping mechanism for stress or emotional distress. According to the 2023 National Survey on Drug Use and Health (NSDUH), in the United States, 62.5% of people aged 12 and older reported drinking alcohol in the past year, indicating widespread exposure to potential early-stage behaviors. Tolerance begins to develop, requiring more alcohol to achieve the desired effects. 

The middle Stage is as AUD advances, the individual experiences a loss of control over drinking, leading to negative consequences in personal and professional life. Physical dependence becomes more evident, with withdrawal symptoms such as shaking, sweating, and anxiety manifesting when not drinking. Despite these adverse effects, the person continues to consume alcohol. 

Late Stage is a severe phase, in which the individual’s life revolves around alcohol. Chronic health issues, including liver disease and cognitive impairments, develop. The risk of life-threatening conditions increases, and the person neglects responsibilities, relationships, and self-care. ​According to the Centers for Disease Control and Prevention, alcohol-related liver disease accounted for 30,910 deaths in the U.S., highlighting the critical risks at this stage.

Diagnosis of Alcohol Use Disorder includes Healthcare professionals diagnosing AUD based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This includes assessing patterns of alcohol use leading to significant impairment or distress, with evaluations of factors such as unsuccessful attempts to cut down, cravings, and continued use despite problems.

Treatment for Alcohol Use Disorder is effective when combining behavioral therapies and medications. Behavioral treatments aim to change drinking behavior through counseling, while medications like naltrexone, acamprosate, and disulfiram help manage withdrawal symptoms and reduce cravings. Mutual support groups, such as Alcoholics Anonymous, provide peer support. In severe cases, residential treatment programs offer comprehensive care. According to the 2023 National Survey on Drug Use and Health (NSDUH), less than 10% of individuals with past-year AUD receive any treatment, indicating a significant gap in care.

Early recognition and intervention are important in managing AUD, as timely treatment significantly improves outcomes and quality of life.

What Are the Different Stages of Alcoholism?​

The different stages of alcoholism include the pre-alcoholic, early, middle, and late stages. ​Alcoholism, clinically referred to as Alcohol Use Disorder (AUD), progresses through several stages, each characterized by escalating patterns of alcohol consumption and associated consequences. Recognizing these stages aid in early intervention and treatment. In the pre-alcoholic stage, individuals consume alcohol socially and begin using it to cope with stress, gradually developing tolerance that leads to increased consumption.

The early stage is marked by more frequent drinking, blackouts, and a growing preoccupation with alcohol, accompanied by difficulties in controlling intake and neglecting responsibilities. During the middle stage, physical dependence becomes evident, with withdrawal symptoms such as tremors, sweating, and anxiety manifesting when not drinking; relationships and work performance deteriorate.

In the late stage, alcohol consumption dominates the individual’s life, leading to chronic health issues like liver disease and cognitive impairments, along with significant declines in physical health, relationships, and overall quality of life. Recognizing these stages is important for early intervention and effective treatment to prevent the progression of AUD and mitigate its adverse effects.

The different stages of alcoholism  are as follows:

Stage #1: Early Stage

The early stage of Alcohol Use Disorder (AUD) is characterized by increased alcohol consumption and the emergence of problematic drinking behaviors. During this phase, individuals transition from social or occasional drinking to more frequent use, sometimes engaging in binge drinking defined as consuming five or more drinks for men, or four or more drinks for women, on a single occasion.

Individual Behavior:

• Increased Tolerance: Needing more alcohol to achieve the same effects.​
• Drinking to Relieve Stress: Using alcohol as a coping mechanism for stress or emotional issues.​ For instance, a study published by The Independent found that nearly 60% of adults reported drinking alcohol to manage everyday stressors.
• Preoccupation with Alcohol: Spending considerable time thinking about, obtaining, or consuming alcohol.​
• Concealing Drinking Habits: Hiding alcohol consumption from others.

Symptoms:

• Blackouts: Experiencing memory lapses during drinking episodes.​
• Mood Swings: Notable changes in mood or behavior.​ A study published by the JAMA Network has shown that alcohol use is associated with mood instability and poorer work functioning, particularly in individuals with bipolar disorder.
• Neglecting Responsibilities: Failing to fulfill obligations at work, school, or home.​
• Physical Signs: Bloodshot eyes, sleep disturbances, and unexplained weight changes.

Impact on Life:

In this stage, alcohol consumption begins to interfere with daily life. Individuals find themselves drinking more than intended, attempting unsuccessfully to cut down, or spending significant time recovering from the effects of alcohol. These behaviors strain relationships, hinder work or academic performance, and lead to risky situations. ​According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), 14.5 million individuals aged 12 and older in the United States had Alcohol Use Disorder (AUD) in 2019. This condition contributes to significant mortality, with 95,000 deaths annually attributed to alcohol-related causes. ​According to the Centers for Disease Control and Prevention, in 2020, alcohol-impaired driving was responsible for 11,654 fatalities, accounting for 30% of all traffic-related deaths in the United States. 

A study published in the Journal of Studies on Alcohol and Drugs found that individuals exhibiting early-stage AUD behaviors, such as frequent binge drinking, are at a heightened risk of developing more severe alcohol dependence later in life. ​

Recognizing these signs and behaviors is important for early intervention, which prevents the progression of AUD and mitigates its adverse effects.

Stage #2: Middle Stage

The middle stage of Alcohol Use Disorder (AUD) represents a progression where alcohol consumption becomes more frequent and begins to significantly impact various aspects of an individual’s life. During this phase, individuals experience an increased tolerance to alcohol, requiring larger quantities to achieve the desired effects. This escalation leads to physical dependence, where the body exhibits withdrawal symptoms such as tremors, sweating, and nausea when alcohol consumption is reduced or stopped.

Behaviorally, individuals start neglecting personal and professional responsibilities, exhibit mood swings and engage in risky activities, including drinking and driving. They also attempt to hide their drinking habits from others, leading to strained relationships with family, friends, and colleagues. Recognizing these signs is important, as an intervention during the middle stage to prevent further deterioration associated with late-stage alcoholism.​

Symptoms of the Middle Stage:

• Increased Tolerance: Needing more alcohol to achieve the same effects.​
• Withdrawal Symptoms: Experiencing physical symptoms like shaking, sweating, and nausea when not drinking. A study “Incidence of Hospitalizations Involving Alcohol Withdrawal Syndrome in a Primary Care Population” by Tessa L. Steel, et al. 2024, involving over 500,000 adult primary care patients found that Alcohol Withdrawal Syndrome (AWS) was prevalent during hospitalizations, especially among men aged 30 to 49 years.
• Neglect of Responsibilities: Failing to fulfill obligations at work, school, or home.​
• Mood Swings: Notable changes in mood or behavior, including irritability and depression.​
• Risky Behaviors: Engaging in activities such as drinking and driving.​ ​According to the Centers for Disease Control and Prevention, in 2020, 1.2% of adults reported driving after having too much to drink in the past 30 days, resulting in an estimated 127 million episodes of alcohol-impaired driving among U.S. adults.
• Secrecy: Hiding alcohol consumption from others.​

The impact of alcoholism during this stage is profound. Individuals face deteriorating health, damaged relationships, and declining performance in professional or academic settings. According to the 2023 National Survey on Drug Use and Health (NSDUH), in 2023, of the 96,610 liver disease deaths among individuals aged 12 and older, 44.5% (43,004 deaths) involved alcohol. The strain on personal relationships leads to social isolation and the neglect of responsibilities results in job loss or academic failure.

Research “Association Between Workplace Absenteeism and Alcohol Use Disorder From the National Survey on Drug Use and Health” by Ian C. Parsley, et al. 2022, indicates that individuals with severe AUD miss an average of 2.69 workdays within 30 days, compared to 1.08 workdays among those without AUD. Additionally, engaging in risky behaviors increases the likelihood of legal issues and accidents. Addressing AUD at this stage through professional treatment and support is necessary to mitigate these adverse effects and promote recovery.

Stage #3: Late Stage

The late stage of Alcohol Use Disorder (AUD), referred to as end-stage alcoholism, is characterized by severe physical and psychological deterioration due to chronic and excessive alcohol consumption. At this point, individuals engage in continuous or near-continuous drinking to avoid withdrawal symptoms, indicating a profound dependence on alcohol.

Behaviorally, there is a complete loss of control over drinking habits, leading to neglect of personal hygiene, poor nutritional intake, and social isolation. Individuals also experience severe withdrawal symptoms, including tremors, hallucinations, and seizures, when not consuming alcohol. The impact on one’s life during this stage is profound, encompassing critical health complications such as liver cirrhosis, pancreatitis, heart disease, and neurological impairments like alcoholic dementia.

Socially, relationships are irreparably damaged, and occupational or academic functioning is nonexistent. Without intervention, end-stage alcoholism is fatal. Seeking comprehensive medical treatment and support is necessary to address the extensive damage caused by prolonged alcohol abuse and to facilitate any possibility of recovery.

Symptoms of Late-Stage Alcoholism:

• Severe Physical Health Issues: Development of chronic conditions such as liver cirrhosis, pancreatitis, and cardiovascular diseases. ​According to a study published by the University of Michigan Health, 10% to 20% of heavy drinkers develop cirrhosis, after 10 or more years of drinking. 
• Neurological Impairments: Cognitive deficits, including memory loss, confusion, and alcoholic dementia. A study “Alcohol and Dementia, What is the Link? A Systematic Review” by Caspar Wiegmann, et al. 2020, has shown that high-level alcohol consumption (>14 units per week) is linked to a higher incidence of dementia.
• Persistent Withdrawal Symptoms: Experiencing severe withdrawal effects like tremors, seizures, and hallucinations when not drinking.
• Neglect of Personal Care: Disregarding personal hygiene and nutritional needs. 
• Social Isolation: Withdrawing from family, friends, and social activities to focus solely on drinking. ​
• Loss of Employment or Academic Standing: Inability to maintain job responsibilities or academic commitments due to alcohol dependence.​

Addressing AUD at this critical stage requires immediate medical intervention, including detoxification and comprehensive rehab programs, to manage withdrawal symptoms and begin the recovery process. Without such intervention, the prognosis is poor, underscoring the importance of seeking help as early as possible.

What are the Health Complications in the Late Stage of Alcoholism?

The health complications in the late stage of alcoholism are liver cirrhosis, pancreatitis, cardiovascular diseases, neurological impairment, increased cancer risk, and gastrointestinal issues. They affect nearly every organ system and lead to significant morbidity and mortality. Chronic excessive alcohol consumption results in life-threatening conditions such as liver cirrhosis, pancreatitis, cardiovascular diseases, neurological impairments, and an increased risk of various cancers. These complications not only diminish the quality of life but also substantially shorten life expectancy.

Health complications in the late stage of alcoholism include:

• Liver Cirrhosis: Irreversible scarring of the liver tissue impairs liver function, leading to liver failure. ​​According to the Centers for Disease Control and Prevention, in 2020, chronic liver disease and cirrhosis resulted in 54,803 deaths in the United States, highlighting the severe impact of alcohol-related liver damage.
• Pancreatitis: Inflammation of the pancreas causes severe abdominal pain and digestive issues.
• Cardiovascular Diseases: Increased risk of high blood pressure, heart disease, and stroke. A genetic study “Association of Habitual Alcohol Intake With Risk of Cardiovascular Disease” by Kiran J. Biddinger, et al. 2022, showed that a one standard deviation increase in genetically predicted alcohol consumption correlates with a 30% higher risk of hypertension and a 40% higher risk of coronary artery disease.
• Wernicke-Korsakoff Syndrome (WKS): This neurological disorder results from a severe deficiency of thiamine (vitamin B1), due to chronic alcohol consumption. WKS comprises two stages: Wernicke’s encephalopathy and Korsakoff’s psychosis. Without prompt treatment, Wernicke’s encephalopathy progressed to Korsakoff’s psychosis, leading to persistent memory problems and cognitive deficits. A study “The Wernicke–Korsakoff Syndrome: A Neuropsychiatric Disorder Caused by a Dysfunction of Energy Metabolism” by Pierre J. Magistretti, 2004 indicates that WKS affects 2% to 12% of individuals with alcohol use disorder, highlighting the importance of early intervention and thiamine supplementation.
• Increased Cancer Risk: Higher likelihood of developing cancers such as liver, breast, throat, and esophageal cancer.
• Gastrointestinal Issues: Development of gastritis, stomach ulcers, and gastrointestinal bleeding. ​Alcohol irritates the stomach lining, causing inflammation (gastritis), and increases the risk of developing stomach ulcers and gastrointestinal bleeding. Additionally, heavy drinking is associated with a 43% increased likelihood of major gastrointestinal bleeding, reported by the 2023 National Survey on Drug Use and Health (NSDUH),.

Addressing these health complications requires comprehensive medical intervention and lifestyle changes to halt disease progression and improve overall health outcomes.

What are the Risk Factors of Alcohol Addiction?

The risk factors of alcohol addiction include steady drinking over time, early initiation of alcohol use, undergoing bariatric surgery, a history of trauma, and various social and psychological influences. Regular, excessive alcohol consumption leads to tolerance and physical dependence, significantly increasing the likelihood of addiction. Individuals who begin drinking at an early age are particularly susceptible; early exposure disrupts brain development and establishes patterns that heighten the risk of future alcohol use disorders.

Research indicates that undergoing bariatric surgery, such as gastric bypass, elevates the risk of developing alcohol use disorder due to changes in alcohol metabolism and increased sensitivity to its effects. For instance, a systematic review and meta-analysis “Alcohol use disorders before and after bariatric surgery” by Hamza Azam, et al. 2014, observed an increased rate of AUD in the postoperative period following bariatric surgery, suggesting a significant association between the surgical procedure and subsequent alcohol-related issues.

Furthermore, a history of emotional or physical trauma is strongly associated with alcohol misuse, as individuals use alcohol as a coping mechanism for distressing experiences. Additional factors, including genetic predisposition, mental health disorders like depression and anxiety, and social environments where heavy drinking is normalized, also contribute to the risk of alcohol addiction.

How is Alcohol Addiction Diagnosed?

Alcohol addiction is diagnosed based on specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Healthcare professionals assess individuals by evaluating the presence of certain behaviors and symptoms related to alcohol consumption over the past 12 months. The DSM-5 specifies 11 criteria for diagnosing AUD. For instance, a systematic review assessed the effectiveness of various screening tools for AUD according to DSM-5 criteria, highlighting the importance of precise diagnostic measures. 

The severity of the disorder is determined by the number of criteria met:

• Mild: Presence of 2-3 symptoms.​
• Moderate: Presence of 4-5 symptoms​.
• Severe: Presence of 6 or more symptoms​.

DSM-5 Criteria for Alcohol Use Disorder:

1. Alcohol is consumed in larger amounts or over a longer period than intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
3. A great deal of time is spent in activities necessary to obtain, use, or recover from the effects of alcohol.
4. Craving, or a strong desire or urge to use alcohol.
5. Recurrent alcohol use failing to fulfill major role obligations at work, school, or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
8. Recurrent alcohol use in situations in which it is physically hazardous.
9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
10. Tolerance is defined as a need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
11. Withdrawal, as manifested by alcohol (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.

Accurate diagnosis is important for developing an effective treatment plan. Healthcare providers use interviews, questionnaires, and medical examinations to assess these criteria and determine the appropriate level of intervention.

What Are the Treatments for Alcohol Addiction?

The treatments for alcohol addiction are detoxification, Partial Hospitalization Programs (PHP), Intensive Outpatient Programs (IOP), various therapies, and support groups. Detoxification is the initial phase, involving medically supervised withdrawal to manage symptoms safely. PHPs offer structured, intensive treatment during the day, allowing individuals to return home in the evenings, serving as a bridge between inpatient and outpatient care. IOPs provide rigorous therapy sessions multiple times a week, focusing on relapse prevention and coping strategies while enabling participants to maintain daily responsibilities.

Therapies such as cognitive-behavioral therapy (CBT), motivational interviewing, and family therapy address underlying psychological factors contributing to addiction. Support groups like Alcoholics Anonymous (AA) offer peer support and a sense of community, which are vital for sustained recovery. Combining these treatments, tailored to individual needs, enhances the effectiveness of alcohol addiction treatment efforts. 

The treatments for alcohol addiction are given below:

• Detoxification: This initial phase involves medically supervised withdrawal from alcohol, ensuring safety and managing withdrawal symptoms. It includes continuous medical monitoring and utilizing medications to alleviate discomfort. A study “Patient and Program Factors that Bridge the Detoxification-Treatment Gap: A Structured Evidence Review” by Christine Timko, et al. 2015, Studies indicate that completion rates for detoxification programs vary widely, ranging from 45% to 95%, influenced by factors such as program structure and patient commitment. Detoxification helps individuals safely eliminate alcohol from their system, preparing them for further treatment. ​
• Partial Hospitalization Programs (PHP): PHPs provide intensive, structured treatment during the day, allowing individuals to return home in the evenings. These programs include multiple hours of therapy per week, such as individual counseling, group therapy, and educational sessions. According to a study by the National Institute on Drug Abuse (NIDA) 2022, individuals in PHPs have a 54% higher treatment retention rate compared to those in standard outpatient programs. PHPs offer a high level of care while enabling participants to maintain connections with their home environment.
• Intensive Outpatient Programs (IOP): IOPs offer a comprehensive treatment approach for individuals who do not require detoxification or 24-hour supervision. These programs involve multiple therapy sessions per week, focusing on relapse prevention, coping strategies, and group counseling. IOPs allow participants to continue with their daily responsibilities while receiving structured support. 
• Behavioral Therapies: Approaches such as Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) address the psychological aspects of addiction. These therapies help individuals identify and modify negative thought patterns, develop coping strategies, and manage triggers that lead to alcohol use. Meta-analyses “Efficacy of Cognitive Behavioral Therapy for Alcohol and Other Drug Use Disorders: Is a One-Size-Fits-All Approach Appropriate?” by Molly Magill, et al. 2023, reveal that CBT is more effective than no treatment or minimal interventions, with effect sizes in the small-to-moderate range, highlighting its role in promoting behavioral change. Behavioral therapies are integral in promoting long-term behavioral change.
• Support Groups: Groups like Alcoholics Anonymous (AA) and other peer support networks provide a community of individuals who share similar experiences. These groups offer emotional support, shared coping strategies, and a sense of accountability. A study “Alcoholics Anonymous Effectiveness: Faith Meets Science” by Lee Ann Kaskutas, 2009, has shown that about 50% of individuals who consistently attend AA meetings maintain abstinence for one year, demonstrating the potential of peer-led support in long-term recovery. ​Participation in support groups significantly enhance the recovery journey by fostering a sense of belonging and mutual encouragement.

Each of these treatments plays a vital role in addressing the multifaceted nature of alcohol addiction, and a combination tailored to the individual’s needs yields the most effective results.

What Medications Are Used to Treat Alcohol Addiction?

The medications used to treat alcohol addiction include naltrexone, acamprosate, and disulfiram. These medications serve different purposes in supporting recovery from alcohol use disorder.

The medications used to treat alcohol addiction are as follows:

• Naltrexone: An opioid receptor antagonist that diminishes the pleasurable effects of alcohol, thereby reducing cravings and the likelihood of relapse. A study “Targeted Oral Naltrexone for Mild to Moderate Alcohol Use Disorder Among Sexual and Gender Minority Men” by Glenn-Milo Santos, et al. 2022, indicates that naltrexone significantly decreases binge-drinking days and overall alcohol consumption.
• Acamprosate: This medication helps restore the balance of neurotransmitters disrupted by chronic alcohol use, aiding in the maintenance of abstinence. Research “Effectiveness of Acamprosate in the Treatment of Alcohol Dependence” by WILLIAM E. CAYLEY, et al. 2011, has shown that acamprosate reduces the risk of returning to any drinking by 14% compared to placebo, with a number needed to treat (NNT) of 9 to prevent one additional patient from relapsing.
• Disulfiram: Acts as a deterrent by causing unpleasant physical reactions—such as nausea and flushing—when alcohol is consumed, discouraging drinking. Meta-analyses “Disulfiram in the management of alcohol dependence: A comprehensive clinical review” by Gurvinder Kalra, et al. 2014, suggest that supervised disulfiram therapy is more effective than unsupervised use, showing a significant success rate compared to controls.

The effectiveness of these medications varies based on individual circumstances, and they are most beneficial when combined with counseling and support programs.

Can Treatment Cure Alcohol Addiction?

No, alcohol addiction cannot be permanently cured as it is considered a chronic condition. However, with appropriate treatment, including medications, counseling, and support groups, individuals effectively manage and control their addiction. Ongoing support and lifestyle adjustments are necessary to maintain long-term recovery and prevent relapse.

How Much Alcohol Leads to Addiction?

14 drinks per week for men and seven drinks per week for women leads to addiction. The American Medical Association (AMA) aligns with the U.S. Dietary Guidelines, recommending that men limit alcohol consumption to two drinks or less per day and women to one drink or less per day. Exceeding these amounts increases the risk of developing alcohol use disorder (AUD) and other health issues.

Specifically, heavy drinking is defined as consuming more than four drinks on any day or more than 14 drinks per week for men, and more than three drinks on any day or more than seven drinks per week for women. Consistently drinking at or above these levels is associated with a higher likelihood of developing alcohol addiction. Any level of alcohol consumption carries some health risks, and the safest option is to abstain from drinking altogether. ​   

How to Prevent Alcohol Addiction?

Preventing alcohol addiction involves adopting mindful habits and proactive strategies to manage alcohol consumption responsibly. Setting personal limits on drinking and adhering to them helps maintain control. Being aware of situations or emotions that trigger the urge to drink, such as stress or social pressures, allows individuals to develop healthier coping mechanisms. Incorporating alcohol-free days into your routine provides the body with regular breaks from alcohol, promoting better health.

Engaging in alternative recreational activities, like sports or hobbies, reduces reliance on alcohol for entertainment. Building a supportive network of friends and family who respect and encourage your choices fosters an environment conducive to responsible drinking. Seeking professional guidance when struggling to control alcohol intake is a proactive step toward prevention. By implementing these strategies, individuals reduce the risk of developing alcohol dependence and promote overall well-being.