What Are the Stages of Alcoholism? Identifying Alcohol Use Disorder as It Progresses
Like most conditions that involve human behavior, alcohol addiction is a condition that progresses over time. Over the course of months or even years, a person’s drinking habits can worsen from what was once an effective way to wind down with friends at the end of the week to an addiction that takes priority over family, friends, and career.
Alcoholism, clinically known as alcohol use disorder (AUD), can develop differently in different people. Everyone has a unique background, biology, and home environment, and all of these factors can play a part in the development of AUD. Specific causes, triggers, and timelines will vary from person to person. Despite this, there are certain symptoms, patterns, and behaviors to look out for that suggest a person may be heading down a path that ends in severe AUD.
20th-century research into the progression of alcohol addiction helped lay the groundwork for how we understand the stages of alcohol misuse. This research laid these four stages out as pre-alcoholic, early alcoholic, middle-stage alcoholic, and end-stage alcoholism.
Pioneering Research Into the Progression of Alcoholism
For as long as history has been recorded, people have been drinking alcohol. The process of sugar converting into alcohol, called fermentation, actually happens in the wild quite often. The most common example of this occurs when an overripe fruit falls from the tree and onto the ground.
As it sits on the ground, the fermentation process begins, converting the sugars in the overripe fruit into alcohol. There are many humorous videos online of animals snacking on the ripe African marula fruit and displaying classic signs of being drunk.
Many historians even argue that fermented beverages helped push civilization forward by providing essential hydration during times when clean drinking water was unavailable. The alcohol in fermented beverages makes them more resistant to water-borne bacteria and illnesses, making them safe for traveling and storage.
As long as people have been drinking alcoholic beverages, there have been people who struggle to control their alcohol consumption. After all, alcohol is a biologically addictive substance and always has been. For a long time, people who struggled with their drinking habits were thought to suffer from a moral failure or a lack of willpower.
It wasn’t until the mid-20th century that scientists started to dig a little deeper into the factors that contributed to harmful drinking patterns.
Forming the Stages of Alcoholism
The basis for our understanding of how alcohol addiction can progress was developed by an American scientist named E. Morton Jellinek. He published his first scientific paper on the progressive nature of alcohol addiction in 1946. To put together data for his research, he called upon members of the newly formed organization Alcoholics Anonymous (AA).
Formed in 1935, AA was only a little over a decade old but provided the perfect pool of possible research subjects for many reasons. Not only did these people suffer from unhealthy drinking habits, but they also had a sense of self-awareness about the negative consequences of their drinking. This was not a common way to view alcohol consumption at the time, and that self-awareness would prove very useful in Jellinek’s research efforts.
This initial paper laid a good foundation for his exploration into the issue of alcohol addiction, but Jellinek knew he would need to further expand his sample size to fully analyze and understand the complex issue of alcohol addiction.
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In 1952, Jellinek released his follow-up paper, “Phases of Alcohol Addiction,” which outlined the stages of alcohol misuse as it progresses. These stages are grouped by certain patterns and behaviors.
This paper starts with Jellinek describing the drinking behaviors of people in what he calls the “pre-alcoholic” stage. This stage is marked by casual and social drinking patterns. As alcohol addiction progressed, he found that people would no longer drink for social reasons, but rather they’d drink for personal psychological reasons.
From there, he reported that alcohol misuse progresses into alcohol addiction and eventually ends up as a chronic, out-of-control alcohol use disorder. He developed the “Jellinek Curve” to outline his findings. This chart visually shows how alcohol addiction can progress by showing all of the behaviors, symptoms, and patterns a person may display.
According to Jellinek’s findings, the four stages of alcoholism are:
- The Pre-Alcoholic Stage
- Early-Stage Alcoholism
- The Middle Alcoholic Stage
- End-Stage Alcoholism
While further research has shown some of his findings to be wrong, Jellinek’s early research into the issue of alcoholism helped lay the groundwork for many of the ways we understand the progression of alcohol addiction to this day.
Each of Jellinek’s stages is marked by certain behavioral milestones and patterns, starting with:
1. The Pre-Alcoholic Stage
The first stage in Jellinek’s findings may be the most difficult to identify in yourself or a loved one. This is because, at this point, drinking habits haven’t started to affect daily life in a negative way. The key to what makes this first stage so dangerous lies in the way alcohol works in our brains.
Alcohol enters the brain and tells it to release certain chemicals responsible for excitement, pleasure, and relaxation: glutamate, dopamine, and GABA. These chemicals are what’s known as “neurotransmitters,” which act as chemical messengers in the brain that tell you to feel certain feelings and emotions. Over time, the brain will start to rely on alcohol to release these chemical messengers and stop releasing them on its own. This is the basis for physical dependence and can be a slippery slope toward the next stage of alcohol addiction.
During this stage, drinking alcohol is something a person may do to relax, feel more comfortable in social situations, or help them sleep. You may notice this person always has a drink in their hand at social gatherings, but it’s not always easy to notice they’re drinking more than anyone else.
If you find drinking has become the go-to way for you or a loved one to cope with the stresses of everyday life, this may be a sign that you or they are in the first stage of alcohol addiction.
2. Early-Stage Alcoholism
The next stage in the progression of alcohol addiction is marked by binge drinking and blackouts. In many cases, especially in teens and young adults, these behaviors are simply experimentation. In other cases, it can be a sign that a person’s alcohol misuse is progressing in a negative way.
This doesn’t mean the person drinks every day, but it does mean most of their social activities revolve around drinking. The more often a person consumes alcohol, the more likely it is their brain and body will adjust, leaving them in danger of progressing to AUD.
Binge drinking occurs when a male consumes five or more standard alcoholic drinks in a two-hour period, or when a female drinks four or more standard alcoholic drinks in the same amount of time. Of course, body sizes vary, so levels of drunkenness after this point will vary as well.
Blackouts occur when a person drinks enough alcohol for the part of the brain responsible for creating short-term memories to temporarily shut down, leading to whole periods of time the person doesn’t remember.
Another sign the person may be trending toward deeper alcohol addiction is if they enjoy getting drunk as quickly as possible. They may even joke about their drinking habits.
This stage is much easier to spot than the pre-alcoholic stage as there are set behaviors. This is the stage where drinking habits start to become very unhealthy and a legitimate cause for concern.
3. The Middle Alcoholic Stage
When a person enters the third stage in the progression of alcohol addiction, their drinking habits become clear to family, friends, coworkers, and anyone close to them. There are some people who have developed the skill of hiding their drinking habits or lying about the extent of their alcohol consumption.
The middle alcoholic stage is when a person starts to prioritize drinking above relationships, career, or education. Even people who are good at deception regarding their drinking habits start to see the consequences of their addiction as it begins to negatively affect these important aspects of their life.
Some behavioral signs that a person may have progressed to this stage of alcohol addiction can include risky behavior such as driving while drunk, drinking while at work or on the clock, and drinking while fulfilling home duties such as elder or child care.
At this stage, due to tolerance to alcohol that has built up over time, the person will have to drink more to get as drunk as they desire. The body’s adjustment to higher levels of alcohol can also carry some physical signs as well. It’s not uncommon to notice weight gain, shaking, and skin flushing or redness in someone whose addiction has reached this stage.
Stage three is when treatment for alcohol addiction can be the most helpful as the impacts of drinking have typically not caused damage that can’t be reversed by healthy lifestyle changes.
4. End-Stage Alcoholism
In stage four, the long-term consequences of a person’s heavy drinking are impossible to hide. They may have tried to enter treatment or stop drinking on their own with limited or no success. Drinking alcohol becomes an activity that takes up every waking hour as priorities shift to make alcohol the number one priority in the person’s life.
Often, people experiencing end-stage alcoholism are stuck in a negative cycle of drinking that has become impossible to quit on their own. They’re also most likely having health consequences that could include liver damage and other alcohol-related conditions.
A person who has reached end-stage alcohol addiction must seek the help of trained professionals as soon as possible as their drinking habits are likely to cause very serious health problems or even death.
From Alcoholism to Alcohol Use Disorder (AUD)
In the past, the term “alcoholism” has been used to describe the condition when someone has a negative relationship with alcohol. It’s important to know that alcoholism is not a formal medical term, and modern clinicians prefer using the term “alcohol use disorder.” AUD is a formal medical diagnosis with its own set of criteria.
Someone will most likely meet the criteria for AUD if their drinking habits have started to negatively affect important aspects of their lives. Alcohol addiction can be a difficult condition to identify, especially as an outsider. There are a number of behaviors and signs to look out for that can help determine whether you or a loved one is suffering from AUD.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) states anyone who meets two of the 11 following criteria within a 12-month period may be diagnosed with an AUD. Here are some questions to consider to accurately assess whether you or a loved one may be suffering from an addiction to alcohol.
In the past year, have you:
- Had times when you ended up drinking more, or longer, than you intended?
- More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
- Spent a lot of time drinking? Or being sick or getting over the aftereffects?
- Experienced a craving — a strong need or urge — to drink?
- More than once gotten into situations while, or after, drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
- Found that drinking, or being sick from drinking, often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
- Continued to drink even though it was causing trouble with your family or friends?
- Given up or cut back on activities that were once important or interesting to you, or gave you pleasure, in order to drink?
- Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
- Had to drink much more than you once did to get the effect you wanted? Or found that your usual number of drinks had much less effect than before?
- Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating? Or sensed things that were not actually there?
If any of these symptoms are things you or a loved one has experienced, your drinking habits may already be cause for concern. The more symptoms you’ve had, the more likely it is you’ve become physically dependent on alcohol and should seek the help of an alcohol treatment program to overcome the habit.
Treatment for Alcohol Use Disorder at Vertava Health – Mississippi Starts with Detox
Alcohol withdrawal can be particularly dangerous if not done under the close supervision of compassionate medical professionals.
At Vertava Health Mississippi, before being cleared for alcohol rehab, patients undergo a supervised detox to ensure the alcohol and its toxins are out of their system. We address their physical dependence on alcohol and help to manage uncomfortable withdrawal symptoms that start when drinking is reduced or stopped. Specialized medications may be used in this phase of care. Our goal is to make this process as comfortable as possible as you prepare to build a foundation for lasting success in recovery.
Once your withdrawal symptoms have stopped, you’ll transition into the rehab phase of treatment, where we focus on the underlying psychological conditions that influence your alcohol addiction. We’ll help to retrain your brain and body to function normally without alcohol. You’ll also learn how to manage cravings and triggers that can cause relapse.
Reclaim Your Health From the Grips of Alcohol Addiction at Vertava Health – Mississippi
At Vertava Health Mississippi, we are committed to giving you or your loved one the treatment they deserve for alcohol use disorder. We understand how difficult it can be to detox from alcohol, which is why we offer alcoholism rehab that starts with medically supported detox.
Call (888) 956-6369 to start your journey to recovery today.
What is the life expectancy of someone who suffers from alcohol use disorder?
The average life expectancy for heavy drinkers is reported to be 24-28 fewer years than for people in the general population. This amounts to a life expectancy of 47-53 years for men and 50-58 years for women.
What qualifies as heavy alcohol consumption?
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines heavy drinking as follows: For men, consuming more than four drinks on any day or more than 14 drinks per week. For women, consuming more than three drinks on any day or more than seven drinks per week.