What Are the 4 Stages of Alcoholism?
The vast majority of people who drink alcohol do not develop an addiction. For some people, however, drinking will always be problematic and should be avoided.
The National Survey on Drug Use and Health (NSDUH) reports that around 14 million people in the U.S. struggle with alcoholism.
Understanding and recognizing the stages that lead to an alcohol addiction can be an effective tool in preventing addiction from developing in the first place.
The stages of alcoholism are generally considered to progress in four to five distinct phases.
While some schools of thought outline five stages, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), widely considered the bible of psychiatry, changed the terminology and differentiation from “alcohol abuse” and “alcohol dependence” to “alcohol use disorder (AUD).”
Alcohol use disorder, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), is a “chronic relapsing brain disease characterized by compulsive alcohol use, loss of control over alcohol intake, and a negative emotional state when not using.”
What are the Phases or Stages of Alcoholism?
Though the names of the stages may differ depending on the source, the progression follows the same path.
Here are two common expressions of the stages of alcoholism:
- Early Alcoholic
- Middle Alcoholic
- Late Alcoholic
- Early Use or Experimentation
- Increased Use and Tolerance
- Problem Drinking
- Addiction or Alcohol Use disorder
Knowing how to identify the signs of each distinct phase is more important than the semantics. These include some of the following:
Stage 1 of Alcoholism (Pre-Alcoholic or Early Use or Experimentation)
In the first stage of alcoholism, there is little to no evidence of alcoholism or alcohol use disorder yet because drinking behavior is mainly social. This is usually referred to as the “pre-alcoholic or early use stage.”
During this “honeymoon phase,” a person is just starting to drink alcohol, or experiment, and they are still able to function normally, although they begin to understand what all the “buzz” is about.
They have not developed a tolerance or dependence and haven’t even used alcohol as a coping mechanism for any of life’s problems.
Stage 2 of Alcoholism (Early Alcoholic or Increased Use and Tolerance)
In the second stage of alcoholism, sometimes a shift occurs, where drinking behavior moves from being a social activity to a means of coping with stress, drinking more often, or even preferring to drink alone as a way to reduce feelings of depression or anxiety. This is called the “early alcoholic or increased use stage.”
A person might have already noticed a change in their drinking behavior, such as an increased tolerance where they notice they need to drink more to feel the same effects.
At this point, some have tried and failed to stop drinking as much, or they switched up the type of alcoholic beverage they prefer to see if it limits their drinking.
They might find that the only time they’re comfortable in a social setting is when there’s alcohol involved and that most, if not all, of their activities revolve around alcohol.
If they’re not drinking, very often they have increased thoughts about when they will be able to drink again.
Suffering from a blackout drunk, where memories from the previous drinking session are cloudy or nonexistent, is yet another sign a person is advancing through the stages of alcohol use disorder.
Stage 3 of Alcoholism (Middle Alcoholic or Problem Drinking)
In the third stage of alcoholism, the signs of alcohol addiction become apparent to friends, family and, often, coworkers. This is known as the “middle alcoholic or problem drinking stage.”
A person in this stage might exhibit risky behaviors, such as driving while drinking, having drinks during the workday, or becoming increasingly angry while drinking around loved ones.
Physical changes, such as weight gain, weight loss, or constant fatigue may be taking root, as well as psychological issues, such as depression.
Ironically, many people drink to cope with depression, and it sometimes works to numb the symptoms in the short-term. But long-term use of alcohol as a coping mechanism for depression will inevitably backfire and actually “cause” depression as the brain becomes addicted.
Many people in this stage have tried and failed to stop drinking a number of times and might have even sought help with addiction treatment or support groups.
Stage 4 of Alcoholism (Late Alcoholic – Addiction or Alcohol Use Disorder)
The fourth phase or stage of alcoholism is considered the late alcoholic stage, where alcohol consumption is a person’s primary activity, taking priority over work, family or anything else important to them. This is where alcohol addiction or alcohol use disorder sets in.
Here, a person is also suffering from the long-term side effects of chronic alcoholism. These can include cirrhosis of the liver, tremors, hallucinations, wet brain, dementia and life threatening withdrawal that can only be treated by medically supervised detox.
It’s critical to note that intervention and alcohol rehab can help people regardless of what stage of alcohol use disorder they’re in.
The Jellinek Curve
The Jellinek Curve, created by E. Morton Jellinek, an early researcher into the stages of addiction, says that similar to the way a person moves down the stages of addiction, they can also move up and out of it.
One of the most important parts of the curve occurs when a person has a sincere desire for help and also learns that they’re not struggling from lack of willpower, but rather a treatable disease.
This should give people a sign of hope that it is possible to live a life free from alcohol.
Overcoming alcoholism or an addiction to alcohol can be extremely difficult, but it is a reality for so many people who are living proof that a successful recovery is worth the effort.
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