Stages of Alcoholism: Early, Middle, and End Stages 

Alcoholism is a progressive disease with serious physical, emotional, and social consequences. It is characterized by an increased tolerance to alcohol, cravings for more alcohol, and withdrawal symptoms when the individual stops drinking.1

In 2012, approximately 17 million adults over the age of 18 and older, or 7.2% of American adults, had a diagnosable alcohol use disorder, according to the National Institute on Alcohol Abuse and Alcoholism. Almost twice as many adults have alcohol use disorder as women; of the estimated 17 million affected, 11.2 million are men, and 5.7 million are women.2

To better understand alcoholism, it is important to understand the stages of alcohol use disorder. These stages include early-stage alcoholism, middle-stage alcoholism, and end-stage alcoholism.3

Each of these three stages of alcoholism has unique characteristics, which will be explored in this article in order to gain a deeper understanding of the effects of chronic alcohol abuse on an individual’s life. By recognizing the signs and symptoms associated with each stage, individuals can seek help before their condition worsens or becomes irreversible.1

What are the Stages of Alcoholism? 

Elvin Morton Jellinek was an early researcher in alcohol addiction and developed a model to categorize different stages of alcoholism. According to his paper, The Disease Concept of Alcoholism, alcohol use is a relapsing chronic disease that requires medical attention.2 

According to his model, alcohol dependency can be divided into stages, each with its own physical, mental, and social characteristics. These stages do not apply to everyone but can be useful when assessing where a person is at in terms of alcohol misuse in order to prevent future issues.2

According to Jellinek, the 3 stages of alcoholism are:3

• Early stage.
• Middle stage of alcoholism.
• End-stage.

Recognizing the stages of alcoholism is an important step in helping someone who is struggling with alcohol addiction. If you or someone you know is showing signs of an alcohol problem, seek help immediately. With the right treatment and support, it is possible to fully recover from alcoholism.1

Stage 1: Early Stage of Alcoholism 

During the first stages of alcoholism, the individual begins to experiment with drinking and desires to drink more often than they used to. They may also begin to engage in risky behaviors while under the influence of alcohol, such as driving or engaging in unprotected sex. As their tolerance increases, they may need to drink more in order to achieve the desired effects, and this can lead to frequent blackouts or memory loss.3

Students and young adults, such as college students, are often the ones experimenting with alcohol in the first stages of alcoholism. Drinking is often a social event among this age group, and binge drinking is a way to party together. However, the risk of developing alcohol use disorder remains even if they don’t drink regularly. 4

A binge drinker reaches a blood alcohol content of 0.08 or higher within two hours of binge drinking, according to the National Institute on Alcohol Abuse and Alcoholism. In 2 hours, women typically need four drinks, while men require five drinks, depending on their body weight. Binge drinkers will, however, experience higher levels of blood alcohol concentration and a host of debilitating physical and mental effects if they exceed the four or five-drink mark.4

Signs and Symptoms of Early-Stage Alcoholism

The first stages of alcoholism can be difficult to recognize because the individual may not yet have developed the obvious physical and behavioral signs associated with the final stages of alcoholism. However, there are some signs and symptoms that may indicate an individual is in the early stages of alcohol use disorder.3

Some common signs and symptoms of the first stages of alcoholism include:3

• Increased tolerance to alcohol: An individual in the early stages of alcoholism may require more alcohol to achieve the same effects as before. This is because the body adapts to the presence of alcohol and becomes less sensitive to its effects.
• Difficulty controlling alcohol use: Individuals in the first stages of alcoholism may find it difficult to control their alcohol intake, especially in social circumstances.
• Negative consequences: An individual who is becoming dependent on alcohol may start experiencing negative consequences as a result of their drinking. For example, they may be more prone to drunk driving, unprotected sex, and other forms of inappropriate or dangerous behavior.

It is important to note that the signs and symptoms of early-stage alcoholism may not be easily observable and can be easily overlooked, but it is important to be aware of them as they can lead to more severe forms of alcohol dependence and related problems if left untreated.3

Stage 2: Middle Stage of Alcoholism

The middle stage of alcoholism, referred to as the “crucial stage” or the “chronic stage” by Jellinek, is a period of time during which the individual’s alcohol use becomes increasingly problematic. During this stage, the individual may begin to experience significant negative consequences as a result of their drinking, such as problems at work or school, financial difficulties, and strained relationships.3

During the middle stage of alcoholism, the individual begins to develop a regular drinking pattern and is often unable to control his or her drinking. Drinking becomes a regular part of the individual’s life, and they often feel compelled to drink even when it is not in their best interest. Additionally, they may start to experience withdrawal symptoms when they try to stop drinking or cut down on their consumption.3

At the same time, the individual will often struggle with guilt, shame, and a sense of powerlessness over their drinking. They may try to hide their alcohol use from others and deny that they have a problem, making it difficult for family members and friends to intervene and help them get the treatment they need.3

Signs and Symptoms of Middle Stage Alcoholism

In the middle stages of alcohol use disorder, the individual will continue drinking despite these negative consequences, and the physical symptoms of alcohol addiction become more pronounced. This might include:3

• Increased tolerance to the effects of alcohol.
• Withdrawal symptoms, such as tremors or agitation when sober.
• Increased alcohol consumption.
• Physical and mental health deterioration. 

The individual may also experience a change in attitude towards alcohol, where they no longer see it as a problem and may even feel that they need to drink in order to function normally.3

Stage 3: End Stage of Alcoholism

During the final stages of alcoholism, the disease has progressed significantly. They are at risk for a wide range of health complications, including liver disease and heart failure. This stage can also lead to suicidal thoughts and an increased risk of death due to alcohol-related accidents or illnesses.3

The physical craving for alcohol causes an individual to feel inconsolable until the substance is consumed again. During the final stages of alcoholism, individuals may also start experimenting with other illegal drugs or abusing prescription drugs. Alcohol addiction is characterized by compulsive behaviors, and people drink wherever and whenever they want.5

Signs and Symptoms of End-Stage Alcoholism

The end stages of alcoholism, also known as the “chronic” stages, are characterized by addiction and severe physical, psychological, and social consequences of excessive alcohol use. The individual’s primary focus becomes obtaining and consuming alcohol, and the ability to function in daily life is severely impaired.3

Here are some signs and symptoms of the final stages of alcoholism:5,6

Physical:

• Severe liver damage, including cirrhosis and hepatitis.
• High blood pressure and an increased risk of heart disease and stroke.
• Increased risk of cancer, particularly of the liver, esophagus, and throat.
• Malnutrition and vitamin deficiencies.
• Pancreatitis and other digestive problems.
• Sexual dysfunction and fertility problems.
• Neurological disorders, including memory loss and tremors.
• Increased risk of accidents and injuries.

Psychological:

• Depression and anxiety
• Insomnia
• Irritability and mood swings
• Paranoia and hallucinations
• Progression of pre-existing mental health conditions and dual diagnosis.
• Severe emotional turmoil and potentially suicidal thoughts

Social:

• Job loss or financial problems.
• The strain on personal relationships, including those with family and friends.
• Legal problems, including arrests for public drunkenness or driving under the influence.
• Social isolation.
• Homelessness.

It is important to note that alcoholism is a progressive disease, and it can be fatal if left untreated. Individuals who have reached the late stages of alcoholism are in urgent need of professional help, including medical and psychological treatment, as well as support from family and friends.3

How does Alcohol Use Disorder Progress Through Different Stages? 

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) and other experts in the field describe alcohol use disorder (AUD) as a chronic relapsing brain disease that progresses through three stages: early, middle and late stages of alcoholism. Each stage is characterized by specific symptoms and consequences, and the severity of the disorder increases as the disease progresses.4

At the early stage, individuals may not yet have developed a dependence on alcohol, but they may be experiencing negative consequences as a result of their drinking. They may start drinking to cope with stress or emotions or to fit in with social groups. They may experience occasional blackouts and have difficulty remembering what they did while they were drinking. This stage is also defined by patterns of risky drinking behaviors, such as drinking and driving or combining alcohol with other substances.5

As alcoholism progresses to the middle stage, individuals may develop a physical dependence on alcohol. They may experience withdrawal symptoms, such as tremors and sweating when they stop drinking. They may also start to build up a tolerance to alcohol so that they need to drink more to achieve the same effects. The individual may start to neglect their responsibilities at home and work, and their personal relationships may begin to suffer. They also may start to experience significant health problems such as liver disease, high blood pressure, and other physical health conditions.5

The late stages of alcoholism are characterized by severe physical, psychological, and social consequences. Individuals may suffer from chronic health conditions and experience significant emotional turmoil. They may have lost their job, their home, and their relationships. They may have been arrested or have legal problems as a result of their drinking. The individual’s primary focus becomes obtaining and consuming alcohol, and they may lose the ability to function in their daily lives.5

Not all individuals will progress through all three stages of alcoholism. Some individuals may be able to stop drinking before the disorder progresses to later stages, while others may experience rapid progression to the final stages of alcoholism. The key point is that alcohol use disorder is a chronic and progressive disease, and early intervention and treatment can help to prevent it from becoming more severe.5

Treatment Options at Different Stages of Alcohol Use Disorder?

Alcoholism is a serious condition that can have long-lasting effects on an individual’s physical and mental health. It is important to recognize the signs of alcoholism and seek treatment as early as possible. Depending upon the stage of alcoholism, there are different types of treatments available for individuals suffering from alcohol addiction.7

For those in the early stages of alcoholism, there are non-medical treatments such as counseling, support groups, education programs, or behavior modification therapies. These interventions can help individuals learn healthier coping skills and develop strategies to reduce their risk for relapse. In addition, many people find it beneficial to attend Alcoholics Anonymous meetings or other 12-step programs which provide peer support and accountability throughout their journey toward sobriety.7

Those who have been abusing alcohol for a longer time and have progressed to the middle stage of alcoholism may require more intensive treatment, such as inpatient or residential programs. These programs often involve detoxification and medical care, as well as group and individual therapies to help people understand the root cause of their addiction.7

For individuals in the late stages of alcoholism, a combination of intensive inpatient and medication-assisted treatment may be required. Medication-assisted treatment (MAT) for alcoholism typically involves using medications such as naltrexone, acamprosate, and disulfiram. These medications can help reduce cravings and withdrawal symptoms, making it easier for individuals to abstain from alcohol.7

Different stages of alcohol use disorder may require different types of treatment and support, and an individualized approach is often the best way to achieve lasting recovery. A healthcare professional, such as a doctor or a licensed therapist, can help to assess the needs of an individual and develop a treatment plan that is tailored to their specific circumstances.7

Seeking professional help is a crucial step for anyone who is struggling with alcoholism. Whether it’s attending support groups, undergoing therapy, or entering an inpatient treatment program, there is hope for recovery with the right treatment plan. With proper care, individuals can learn to manage their addiction and live a sober life.

If you or a loved one is struggling with alcoholism, American Addiction Centers can help. Their team of addiction experts provides comprehensive and individualized treatment plans that are tailored to meet each person’s needs and budget. AAC accepts most major insurances, and their admissions team can help verify coverage quickly over the phone.

Frequently Asked Questions