Stages of Alcoholism: Early, Middle, & End-Stage Alcoholism

Alcoholism is a progressive condition affecting over 14 million people every year. It can lead to serious health problems, but it is treatable.

The 3 Stages of Alcoholism

Alcoholism is a chronic disease that progresses through early, middle and late stages. In 2019, it affected 14.5 millionAmericans aged 12 and older, or 5.3% of the population.

When a person with alcoholism reaches end stage alcoholism, they have reached a point that is dramatically different from the initial stages. During the early stages of the disease, the person may drink heavily and may experience hangovers in between drinking episodes. However, during the end stage, the addiction has taken over, and the person may no longer be able to control their drinking impulses.

Are you currently struggling with alcoholism? Or, do you have a friend or loved one who is? If so, you may have questions about this disease, such as:

• What is early-stage alcoholism?
• What does middle-stage alcoholism look like?
• What are the signs of late-stage alcoholism?

Regardless of the stage, alcoholism is treatable. The nuances of treatment evolve, and any program should be catered to an individual’s unique needs. Understanding what the stages of alcohol addiction look like can help you or a loved one decide whether rehab treatment is necessary.

Stage 1: Early-Stage Alcoholism

Early-stage alcoholism is the beginning of the person’s chronic use and pathway to abusing alcohol.

The disease begins to feed itself. The person’s experience is positive, and they don’t perceive their use to be harmful.

Alcohol provides a positive experience for the user. To others, the person may not look like they have a problem with alcohol. They may appear normal to those around them, other than the perception that they are drinking more.

Common Early Stage Alcoholism Behaviors include:

• Drinking more than normal
• Being more social and relatable when drinking than when sober
• Creating reasons to incorporate alcohol into more social settings
• Drinking to combat stress, boredom, or loneliness

A person with early-stage alcoholism may also exhibit a high tolerance to alcohol. Their tolerance may go unnoticed by everyone except the people they spend the most time with.

Alcohol Tolerance

When most people drink to their tolerance level, they exhibit signs of intoxication. Those signs include slurring words, loss of balance and poor physical coordination.

Related Topic: What happens when you drink alcohol every day

When casual drinkers move into early-stage alcoholism, their tolerance begins to rise. As it does, they display signs of intoxication less often. They can often hold conversations without stuttering or slurring. They may appear to maintain coordination and motor skills to some degree. A person with a higher tolerance may not look intoxicated, despite drinking a large amount of alcohol. Others who have had less to drink may look more intoxicated than a person with a high tolerance. Many factors affect alcohol tolerance, including a person’s biochemistry, race, ethnicity, body mass and how an individual consumes alcohol.

Alcohol’s Role Taking Hold

It may sound backward, but the person may feel that they function better when they are intoxicated. This is because they only feel the negative effects of alcohol when they stop drinking. In early-stage alcoholism, the person maintains and may increase their alcohol use.

When alcohol enters the bloodstream, one of the central impacts is slowing the rate of communication between nerve cells. This produces the noticeable effects of intoxication. The rate of communication returns to its typical levels once alcohol leaves the body. If a person drinks frequently or more heavily, the nerve cells in the brain adapt by reducing the number of places they can receive these messages.

For a person who drinks occasionally, this adaptation is distinct and temporary. But for a person who drinks heavily, the body adapts the majority of the time. This can make it more difficult to show the effects of intoxication. Eventually, their tissue cells may become dependent on alcohol to function normally.

As the stage progresses, the disease takes hold and develops into middle-stage alcoholism.

Stage 2: Middle Stage Alcoholism

The primary way a person with early-stage alcoholism differs from someone in middle-stage alcoholism is that alcohol is no longer leveraged for a quick high. In the middle stage, drinking may become a staple of daily life.

A Physiological Trap

As a person with a high tolerance continues to drink heavily, their body adapts to the presence of alcohol. After ongoing heavy use, the body may develop a physical dependence. A person with a dependence may go through withdrawal symptoms without a certain level of alcohol in their body. When the normally high level of alcohol in a person’s body begins to drop, they may feel physically ill. They may only feel well when they maintain a consistent level of alcohol in their bloodstream.

However, sustained heavy drinking can simultaneously lead to damage to vital organs, including:

1. Heart cells: Drinking alcohol can temporarily elevate a person’s heart rate or trigger an irregular rhythm. Patterns of heavy drinking can lead to prolonged periods of elevated or irregular heart rate, which can lead to higher blood pressure. High blood pressure can damage the heart muscle and blood vessels over time.
2. Liver cells: The liver is responsible for breaking down toxins in the bloodstream. Enzymes break down alcohol when it passes through, and the processed substances can lead to inflammation of the liver. Excessive drinking can create so much inflammation that liver cells are not able to function well. Persistent inflammation can lead to more damaged tissue, which can prevent blood flow to the liver.
3. Digestive system: Alcohol acts as an irritant when it enters the digestive system. It can trigger an inflammatory reaction, interfering with digestion and potentially damaging the lining of the stomach.

Tolerance and Cell Resistance to Alcohol

As alcoholism progresses, the cells in the body become more and more resistant to the short-term effects of alcohol. As a person continues drinking excessively, the cells will continue to adapt. Eventually, the presence of alcohol becomes the norm for the body, and the long-term damage continues.

Visible Signs of Alcohol Addiction Taking Hold

Visible signs of alcoholism may become apparent during middle-stage alcoholism. The overwhelming need for the body to operate with alcohol in the system begins to put the disease in the driver’s seat.

The strong physiological needs of the body may make it difficult for an individual to resist drinking. When they do attempt to stop drinking, they may experience withdrawal symptoms. The body can become distressed even when a person stops drinking for a short time.

Common middle stage alcoholism behaviors include:

• Habitual drinking in non-social settings
• Relationship issues, including changes in friends and difficulty engaging with strangers
• Erratic behavior and/or a decrease in social activity
• Withdrawal symptoms when not drinking such as nausea, sweating and severe irritability

Related Video: What’s the difference between social drinking, alcohol abuse, and alcohol dependency?

Stage 3: Late-Stage or End-Stage Alcoholism

Late-stage, or end-stage alcoholism, is a full-blown addiction to alcohol, almost always requiring alcohol detox to start recovery. The person now spends the bulk of their time servicing the disease by drinking. In this last stage of alcoholism, the individual often exhibits both physical and mental health issues.

Physical Effects and Deterioration in End-Stage Alcoholism

• Malnutrition: When a person consumes most of their calories in the form of alcohol rather than nutritious food, malnutrition may develop. Alcohol can also interfere with the absorption of nutrients in the food they do eat.
• Immune system: A person’s immune system can be weakened over time, making them more vulnerable to illnesses. Among heavy drinkers, 18% reported a weakened immune system. They were 61% more likely to have the problem than light or moderate drinkers.
• Liver disease: After years of processing excessive amounts of alcohol, the liver may be damaged beyond recovery. In a liver disease called cirrhosis, scar tissue eventually replaces healthy tissue, interfering with its ability to function. Among heavy drinkers, 23% reported having liver disease, and 16% reported cirrhosis. People who drank heavily doubled their risk of having liver problems versus those who didn’t.
• Heart disease: Heavy drinking can cause long-term damage to the heart muscle, leading to a higher risk of heart attack, high blood pressure, and stroke. In a recent survey, 40% of heavy drinkers reported high blood pressure. They’d doubled their risk compared to light or moderate drinkers.
• Nerve damage: Alcoholic neuropathy is long-term nerve damage resulting from chronic heavy drinking, and 16%of heavy drinkers report this health issue to some extent. This can lead to numbness, pain, muscle problems, unsteady walking and problems urinating.

Mental Effects and Deterioration in End-Stage Alcoholism

• Co-occurring mental health disorders: People with alcoholism are more likely to also have other mental health disorders, like depression or anxiety. More than half of all heavy drinkers report drinking impacting their mental health (53%). Treating addiction and any co-occurring mental health issues simultaneously, called dual diagnosis, is often necessary to support long-term recovery.
• Relationship problems: After years of centering their life around alcohol, a person’s relationships can suffer. They may struggle with isolation and impaired social skills. In a recent study, 52% of heavy drinkers reported alcohol-related impacts on their relationships.
• Blackouts and memory loss: Prolonged heavy drinking can also lead to blackouts and memory loss, which can interfere with relationships and work life. One in every three heavy drinkers reports alcohol had a significant negative impact on their career or job.

End-Stage Alcoholism and Associated Health Disorders

A person with end-stage alcoholism often develops heart, liver, respiratory and gastrointestinal disorders, according to the CDC. The list of conditions includes but is not limited to:

• Alcoholic Hepatitis
• Chronic Bronchitis
• Cirrhosis
• Emphysema
• Tuberculosis
• Pneumonia
• Heart Failure
• Cancer

In fact, recent research by The Recovery Village has found heavy drinking can increase your risk of cancer by 48% by itself.

Is It Possible To Recover From End-Stage Alcoholism?

Being at a later stage can make recovery more challenging, but recovery is possible at any stage of alcoholism. There are no quick fixes to addiction, and alcoholism is no different. The safest course of action is to seek treatment in a professional environment that is catered to the individual needs, preferably with holistic treatment.

We encourage you to learn more about The Recovery Village’s approach to health and wellness during alcohol treatment and to seek help, especially if your or a loved one’s alcoholism has reached the end-stage. You are not alone.

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Medically Reviewed By – Erika Krull, LMHP

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