Most adults can drink a moderate amount of alcohol without it becoming a drinking problem. However, there are some whose drinking gets out of control, and soon enough, they develop an addiction to alcohol.
The levels of alcohol drinking are different for women and men. Moderate drinking for women is considered one drink per day and two drinks for men on the same day. Binge drinking is defined as consuming five or more drinks (men), or four or more drinks (women), in about two hours. Excessive drinking is when men consume four drinks on any day or women consuming more than three drinks on any day. Binge or excessive drinking by either gender can cause alcohol use disorder (AUD), also called alcoholism.
There were 14.1 million adults aged 18 and older with alcoholism in 2019, and an estimated 414,000 adolescents aged 12 through 17, as reported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).
It is vital to know what the stages of drinking or alcoholism are so you can seek help for yourself or your loved one.
Stages of Drinking or Alcoholism
Back in the 1950s, a physiologist and alcoholism researcher E. Morton Jellinek created what is known as The Jellinek Curve, which charts the typical phases of the disease and recovery. The curve was later tweaked by British psychiatrist Max Glatt. These two researchers conducted their work to inform people that alcohol addiction can progress and that there is a vicious circle associated with it, with very much to lose if the drinker does not get help.
The curve relays that the life and health of the drinker can worsen if the cycle of dependence is not broken, but life and health can improve through recovery. It starts at problem drinking and drops down to obsessive drinking but curves up to relay what recovery can do for an alcoholic.
Here are the five stages of alcoholism and what they include.
Stage 1: Pre-Alcoholic
Drinking to feel better about yourself, to dull physical and emotional pain, to forget, stop worrying, or to get rid of anxiety. People who drink for these reasons might escalate their alcohol consumption if they do not get help.
Stage 2: Early Alcoholic
The early alcoholic will black out from drinking too much and will also lie about their drinking. They may also drink excessively and think about drinking obsessively.
Stage 3: Middle Alcoholic
Middle alcoholics might miss workdays, school days, and/or forget important chores. They are irritable and show physical signs of alcohol abuse, such as facial redness, weight gain or loss, stomach bloating, and being sluggish. People in this stage would benefit from attending support groups or 12-step groups.
Stage 4: Late Alcoholic
Late alcoholics will drink no matter what consequences occur. Drinking is everything to them. People in this stage may lose their job, have serious relationship problems, and deteriorating health. If a late alcoholic abruptly stops drinking, they might experience tremors or hallucinations. Medical detoxification and addiction therapy can help them get their life back.
Stage 5: Recovery
A person with alcohol addiction can move from medical detox, once stabilized, to alcohol addiction treatment and onward to the journey of recovery to maintenance.
Which Stage of Alcoholism is The Most Difficult to Recover From?
Late alcoholism, Stage 4, is the most difficult stage for most people to recover from. You or someone you love may have short periods of being sober, but stress will likely bring on drinking, getting in trouble, and feeling ashamed and guilty. Drinking alcohol feels like it is relieving those emotions. The person might fall into despair and then drink again. This cycle can keep occurring until the late drinker gets help. When the person is sober, they will probably be feeling physically poor and mentally defeated.
What is it Like to be a Late-Stage Alcoholic?
People in this stage of alcohol use disorder (AUD) will display erratic and unpredictable behavior. At times, it may appear as though the alcoholic has early Alzheimer’s disease. A neurological condition called Wernicke-Korsakoff Syndrome, nicknamed “wet brain,” is entirely possible. The syndrome is caused by a lack of Vitamin B (thiamine) in the brain, which is common in late-stage alcoholics.
The syndrome stems from Wernicke’s encephalopathy and entails confusion and loss of mental activity, loss of muscle coordination that can produce leg tremors, vision changes like double vision and drooping eyelids, and alcohol withdrawal.
Korsakoff syndrome consists of the inability to form new memories, loss of memory, making up stories, and hallucinations. Korsakoff syndrome usually develops when Wernicke’s encephalopathy symptoms start to diminish. Korsakoff psychosis results from permanent damage to the brain pertaining to memory.
Other signs the late-stage alcoholic might display:
- A memory the person remembers might be incorrect, and if they are corrected, he or she might become verbally abusive to the point that no one wants to be in the same room. Just about anything and everything can set this person off. They also forget that these attacks happened.
- Their disruptive behavior occurs frequently and results in alienating those who love them. After an abusive attack, they could become apologetic and give their loved ones gifts.
- They sneak alcohol into non-alcoholic beverages, claiming it calms their nerves, soothes an upset stomach, etc.
- They holler and threaten those who live with them and their loved ones, sometimes forcing the loved one to leave the house and/or get out of the car and walk home.
- They rarely eat. If they do eat something, it is a small bite or two to appease their loved ones. But all they want is alcohol.
What Are The Physical And Mental Symptoms of End-Stage Alcoholism?
There are very significant physical signs and symptoms for end-stage AUD, as noted by Verywell Mind.
- Yellowing of the skin and eyes stemming from jaundice from liver failure
- Itchy skin
- Fluid retention
- Wernicke-Korsakoff syndrome (“wet brain”)
- Stroke, heart failure
- Portal hypertension – blood backs up in the vein that runs through the liver due to swelling and scarring. When the abdomen is swollen, it is called ascites and is a build-up of fluid that can cause swollen feet and legs.
- Alcoholic hepatitis
- Chronic thrush-overgrowth of Candida yeast in the mouth and other parts of the body
- Cancer of the liver and colon, and breast cancer in women
- Intestinal bleeding
Mental signs or symptoms related to end-stage alcoholism may include memory loss, dementia, brain damage, confusion, and an inability to focus. People in this stage might be struggling with severe depression, suicidal ideation, anxiety, and guilt.
What Stage of Alcoholism Does Delirium Tremens Occur?
Delirium tremens or the DTs, as they are commonly known, can occur during any stage of alcoholism, although it mostly occurs in the later stages of the disease, when the brain has been severely compromised by the long-term effects of chronic alcohol abuse. This condition is described as a severe symptom of alcohol withdrawal involving extreme and sudden mental or nervous system changes. It can happen when someone stops drinking after a period of heavy drinking. It is fairly common in those who drink heavily every day for several months and those who abuse alcohol for more than 10 years.
Delirium tremens can start 48 to 96 hours after the last drink but might occur seven to 10 days after the last drink. Once symptoms start, they can get worse quickly. They are characterized as sudden, severe confusion (delirium), and body tremors. Emergency medical help is often needed when a person is undergoing the “DTs.”
Is Mild Alcoholism as Insidious as Full-Blown Alcoholism?
That is a loaded question that we will try to answer. Insidious, relating to disease, is defined as “developing so gradually as to be well established before becoming apparent.” Moderate drinkers will have a glass of wine with dinner. A regular drinker will drink to make themselves generally feel better. Drinking helps them emotionally.
Symptoms Of Alcoholism
- Cannot limit the amount of alcohol you drink
- Making unsuccessful attempts to cut down on alcohol use
- Spending a lot of time drinking, obtaining alcohol, or recovering from alcohol use
- Experiencing strong urges or cravings to drink alcohol
- Unable to meet major obligations at work, school, or home due to alcohol use
- Continually drinking despite the physical, social, or relationship problems it causes
- Not enjoying or engaging in social, work or other activities once enjoyed
- Drinking when driving, operating heavy equipment, or using alcohol in unsafe situations
- The body is tolerant of the effects of alcohol, so you need more to feel the same effects as before.
- You are experiencing withdrawal symptoms, such as sweating, shaking, nausea, when you are not drinking or have not had a drink recently, or drinking to avoid feeling these symptoms.
Alcoholism can be mild, moderate, or severe based on the number of symptoms a person has. As noted in Psychology Today, taken from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), it is divided into three grades:
- Mild: Presence of two to three symptoms
- Moderate: Presence of four to five symptoms
- Severe: Presence of six or more symptoms
Mild alcoholism is as insidious as “full-blown” or severe alcoholism. Both grades of the disease can cause alcohol dependence and gradually develop before becoming apparent to the person struggling with AUD and those who love and care for them.