The Four Stages of Alcoholism: Exploring The Different Stages of Alcohol Use
Addiction, like many other health conditions, typically doesn’t occur overnight. Alcohol use disorder in particular is a condition that progresses, getting more and more severe over time. What can start as a fun and relaxing way to unwind at the end of a long week has the potential to lead a person down a dark path toward addiction and physical and psychological dependence. In the vast majority of cases, someone who suffers from alcohol use disorder (AUD) developed the condition over months or even years.
No two people develop an addiction to alcohol in the same way because everyone is unique. Everyone’s unique biology, environment, and upbringing can play a role in how addiction can develop and affect their lives. The specific triggers, progression, and causes of addiction will always vary from person to person. That said, certain universal signs and symptoms begin to show themselves as a person progresses into AUD.
To help clarify how alcohol use disorder can progress, medical professionals have outlined four stages of AUD: pre-alcoholic, early alcoholic, middle alcoholic, and end-stage alcoholism.
Early 20th-Century Alcoholism Research
Alcohol has been an important part of culture since the beginning of civilization. In times when clean water was not always readily available, fermented beverages like beer and wine became the primary source of hydration. These alcoholic beverages no doubt played an important role in the advancement of human civilization.
For as long as alcoholic beverages have existed, there have always been people who struggled with limiting their drinking. It wasn’t until the mid-20th century that medical professionals and researchers started working toward understanding alcohol addiction.
There was very little research on alcohol and alcohol addiction in the early 1900s. While there were many people who struggled with controlling their drinking habits, no one had yet taken the time to explore why and how issues with alcohol use began and progressed.
It was widely believed that anyone who suffered from “alcoholism” did so because of a lack of willpower or a moral failing. This false notion continued until scientists started delving deeper into the causes and effects of alcohol addiction in the mid-20th century.
Researching and Developing the Stages of Alcoholism
The first person to shape the modern understanding of how alcohol use can progress was a scientist named E. Morton Jellinek. His research on the topic led him to publish a 1946 report on the progressive nature of alcohol use. He found a perfect pool of research subjects in the relatively new organization Alcoholics Anonymous (AA).
AA was founded in 1935, and Jellinek used members of that organization for his research because they had a certain degree of self-awareness about their alcohol use. They recognized that drinking had a negative impact on their lives and were willing to talk about why and how their addiction started and progressed.
While Jellinek was pleased with the insight he gained from his initial research, he knew he would have to expand his sample size to help fully portray and understand the widespread issue of problematic alcohol use. In 1952, he published his follow-up report, “Phases of Alcohol Addiction.” This paper expanded the ideas he established in his initial research and outlines the stages of alcohol use based on certain drinking patterns and behaviors.
Jellinek found that alcohol use started as a casual, social activity. He identified this stage as the “pre-alcoholic stage.” From there, he found that alcohol use would progress to the point where it was no longer a social activity.
Once people started drinking for personal psychological reasons, it became a slippery slope that progressed into alcohol dependence and chronic alcohol use. He eventually formed the “Jellinek Curve” that outlined people’s behaviors and symptoms as they progressed through the stages of alcohol use.
Jellinek’s research identified the four main stages of alcohol use as:
- The Pre-Alcoholic Stage
- Early-Stage Alcoholism
- The Middle Alcoholic Stage
- End-Stage Alcoholism
While some of his findings on the progression of alcohol use have been disproven, Jellinek is still given credit for laying the groundwork for how the medical community understands alcohol use to this day.
Each stage in the progression of alcohol use is marked by particular behaviors, starting with:
1. The Pre-Alcoholic Stage
The first stage in the progression of alcohol use is perhaps the most difficult to spot in a loved one or yourself. The signs of the pre-alcoholic stage can vary from person to person due to the different ways alcohol can affect different people. Alcohol’s initial energizing and mood-elevating effects are a result of the way the drug interacts with the brain. When alcohol reaches a person’s brain, it tells it to release “neurotransmitters” or chemical messengers. These messengers are responsible for feelings of pleasure, happiness, and contentment.
As a person starts to drink larger amounts and more often, the brain stops releasing these chemical messengers on its own. Before long, a person will need alcohol to tell the brain to make the person feel pleasure. This situation is the basis for physical and psychological dependence.
During this first stage, alcohol use is an activity that may help the person relax, feel more comfortable in social situations, and even help them sleep. Because drinking alcohol is such a large part of many activities American adults engage in, it may be very difficult to identify whether or not a person is in the pre-alcoholic stage.
A person in this stage may engage in drinking more than average, but it hasn’t necessarily started to affect their life in a negative way. You may notice they always have a drink in their hand at social events, or they turn to drinking as their preferred way to relieve stress. If a loved one is regularly using alcohol to cope with the difficulties of daily life, they may be in the middle of the pre-alcoholic stage.
2. Early-Stage Alcoholism
If a person’s drinking has progressed to the point where they are binge drinking on a regular basis and having memory blackouts, they have most likely progressed to the second stage of alcohol use. While these behaviors can simply be a sign of experimentation, especially in teens and young adults, other times it can be a sign that a person’s alcohol use is progressing in a negative way.
This person may not drink every day, but they drink multiple times per week, and most of their social activities center around drinking. If a person makes a habit of drinking to excess on a regular basis, their body and mind begin to adjust, leaving them in danger of a rapid progression of alcohol use.
When a woman consumes about four standard alcoholic drinks within a two-hour period, or a man drinks five drinks in the same period, that is considered binge drinking. Memory blackouts occur when alcohol shuts down the area of the brain responsible for making memories, leading to periods of time the person doesn’t remember. If a person enjoys the feeling of rapidly getting drunk, or tries to get drunk as quickly as possible, this may indicate the start of a deeper issue.
This stage of alcohol use is much easier to spot than the first stage. The person will regularly binge drink and have memory blackouts. They may even joke about how hungover they are and swear to never drink again, only to return to binge drinking a couple of days later. This is the stage where alcohol habits start to be cause for serious concern.
3. The Middle Alcoholic Stage
At this stage, a person’s drinking habits become easily noticeable to friends and loved ones. While some people are skilled at hiding or lying about their drinking habits, if they’ve progressed to this stage, it becomes very difficult to hide. They will start to see the negative consequences of their drinking as it affects their performance at work and/or school, and it takes a toll on their personal relationships.
Some of the noticeable signs of this stage in alcohol use progression include drinking while at work, being intoxicated while driving, or drinking while looking after children. Because their body has built a tolerance to alcohol, they have to drink more often and in higher amounts to get drunk. Some signs to look out for include facial redness, bloating, shaking, sweating, weight gain, or memory loss.
When a person is in the middle stage of alcohol use, they start to prioritize drinking above their career, their relationships, and/or their education. At this stage, treatment for alcohol use can be very helpful as their drinking typically hasn’t started to cause serious damage to their brain and body. Much of the impact can be reversed if the problem is properly addressed.
4. End-Stage Alcoholism
During this stage in the progression of alcohol use, the consequences of a person’s long-term drinking habits become impossible to hide. Drinking becomes an all-day activity, not just at night or to be social. The person’s priorities totally shift to make alcohol the most important thing in their life. Because of this, it may be impossible for them to hold down a job or maintain relationships. When a person is in the end stage of alcohol use, it can be very difficult, if not impossible, to quit drinking on their own.
A person in this stage can expect to have some very major health problems that include liver damage, heart disease, and other alcohol-related illnesses.
This is the most dire stage of alcohol use because it has most likely ruined all aspects of a person’s life, including their relationships, employment, schooling, finances, and even their mental wellbeing. Someone in this stage needs to seek professional treatment as soon as possible as they will likely drink themselves into serious health problems or even death.
Alcoholism Vs. Alcohol Use Disorder (AUD)
In the past, the term “alcoholism” was commonly used to describe a person who has an addiction to, or an unhealthy relationship with, alcohol. In modern medicine, this term has been replaced with “alcohol use disorder” or AUD. This is not only a matter of care and sensitivity, but it’s also a matter of accuracy.
While there are no specific criteria that tell us someone suffers from alcoholism, there are specific criteria that tell us a person is suffering from AUD.
A person may be diagnosed with AUD if their drinking has started to negatively affect important aspects of their life. Addiction is not always an easy condition to identify, especially from the outside. That said, there are a number of certain behaviors to look for when determining if you or a loved one is suffering from AUD.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) states that anyone who meets 2 of the 11 following criteria within a 12-month period may be diagnosed with an alcohol use disorder.
Here are the questions to consider to accurately assess whether you or a loved one may be suffering from a problem with 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 experienced, the more likely it is that you’ve become physically dependent on alcohol.
Vertava Health Massachusetts Is Here to Help at Every Stage of Alcoholism
At Vertava Health Massachusetts, we believe it is never too late for someone to begin their recovery from alcohol use or dependence. We’re here to help form a compassionate, evidence-based alcohol treatment program. Admitting you or a loved one needs help for drinking can be scary, but it will take you one step closer to a healthier and happier future.
Contact us today at 844-906-0978 to learn more.
What is the life expectancy of an alcoholic?
According to the National Institutes of Health, people hospitalized with an alcohol use disorder have an average life expectancy of 47-53 years for men and 50-58 years for women.
How do alcoholics die suddenly?
People with severe alcohol use disorder may die suddenly from acute intoxication (extreme drunkenness), choking, or pre-existing conditions worsened by alcohol use. It isn’t always easy to determine what caused a person with severe AUD to die suddenly, but it does happen.
When are you considered an alcoholic?
You may be suffering from an alcohol use disorder if your drinking has started to negatively affect important aspects of your life, including employment, finances, schooling, and personal relationships.
Is alcoholism always a progressive disease?
Yes. If left untreated, a person’s alcohol use will progress from the pre-alcoholic stage to end-stage alcoholism. The condition will only get worse if a person continues to drink as they will soon require higher amounts of alcohol to get drunk.