Many see alcohol use disorder, the clinical term for alcoholism, as a binary issue. A person is either an alcoholic or they are not. According to experts, this is not an accurate representation of the spectrum of alcohol use. In the early 60’s researchers started to notice discernable stages of alcoholism. Over time, due to continued research, these stages have continued to evolve. The realization that alcohol use disorder has recognizable stages has been helpful for healthcare providers as they seek to provide quality care. Understanding these stages can also be helpful for individuals who are figuring out if they need to reduce or stop their alcohol intake.
Here are the four main stages of alcoholism:
The Pre-Alcoholic Stage
If you have recently increased your drinking, or you just started experimenting with alcohol use, you might be in the pre-alcoholic stage. Often, a stressful life situation can spark a situation where a person turns to alcohol for relief. Examples of situations that can do this can be job-related stress, the death of a family member, or the end of a significant relationship. Similarly, a person might start to use alcohol to take the edge off stressful situations such as social gatherings, or to unwind after a stressful event. Someone in the pre-alcoholic stage does not have alcohol use disorder, but they are demonstrating behaviors that may lead to alcohol dependence in the future. However, often a person in this stage regulates their drinking independently as they adjust to the changes in their lives.
We could imagine a scenario where Jack just ended a relationship with his girlfriend of 5 years. Jack knows that it was for the best, but he feels empty without her and is drinking more to compensate for these negative emotions. Jack’s drinking could escalate from this point, but it is also likely that he will make time for friends, engage in a new hobby, or start to exercise more to deal with the new gaps in his life.
Someone who is in the early stage will start to behave in ways that are problematic in regards to alcohol use. Examples of these behaviors include:
- Binge drinking
- Blacking out after drinking
- Drinking every day
- Prioritizing activities that include drinking
A person in the early stage might be commonly labeled as a functioning alcoholic. They go to work every day, and they still are able to care for themselves and their loved ones, but they also often feel the effects of their increased alcohol use. They likely experience frequent hangovers, and their overall mood or energy level is likely decreased due to alcohol consumption.
Deb has entered the early stage of alcoholism. She is successful at work, and always makes time to check in on her elderly grandmother, but she also has several drinks every night to “take the edge off.” On weekends, when she does not have her normal responsibilities, she lets herself drink until she blacks out. At this point, Deb needs to address her drinking habit before it leads to serious health and social consequences.
The Middle Alcoholic Stage
The middle stage is characterized by alcohol use that starts to noticeably impact a person’s life. At this stage, it is likely that a person’s friends and family will start to notice that a person is using alcohol in a way that is harmful. Also, during this stage problems like shaking, memory loss, bloating, or weight gain may start to develop. Someone in the middle stage should consider seeking treatment for alcohol use disorder before their alcohol use starts to cause serious health problems and negative life consequences.
Steve has recently started keeping a small bottle of alcohol in his desk at work. No one has noticed yet, but they have observed that he is often late, and usually not performing at the same standard as when he started this job 3 years ago. Steve has quit participating in hobbies he used to enjoy, instead choosing to visit his local pub every evening after work. On weekends Steve usually drinks alone at home all day.
End-stage alcohol use disorder is characterized by a person making alcohol consumption their main priority in life. A person at the end-stage probably consumes alcohol all day if they are able. It is likely that individuals at this stage have tried many times to overcome alcohol use disorder but have not been able to do so. Due to heavy alcohol use, someone at this stage will struggle to keep a job or maintain important relationships. Also, they will likely experience potentially deadly alcohol-related complications such as kidney failure, or heart disease. Even at this stage alcohol use disorder is treatable, but a person at the end-stage will usually need the assistance provided by a licensed treatment center to recover from this level of alcohol use.
Hank started drinking more when he retired and did not know what to do with himself. Now he drinks all day, every day. His family has asked him to cut down or quit, but he is not able to do so. He knows that it is affecting his health, but he does not want to go to the doctor and find out how. Hank has stopped receiving invitations to gatherings of family and friends because they know he is not able to get sober enough to attend.
What Are Some Signs of Problem Drinking
You may be wondering if you or someone you love is experiencing one of these stages of alcohol use disorder. There is a lot of stigma around excessive alcohol use, so it may be difficult to admit that your amount of drinking is a problematic amount of drinking. This may cause someone to justify the amount they consume. Individuals who consume alcohol need to do their best to make an unbiased assessment of their alcohol intake. Some of the signs of problem drinking are:
- A desire to drink that makes it difficult to focus on anything else
- Disregarding important relationships to focus on alcohol consumption
- Regular hangovers and other symptoms of heavy alcohol use
- Dangerous behaviors such as drunk driving
- Withdrawal symptoms such as trouble sleeping, shakiness, nausea, high heart rate sweating, seizure, or seeing and hearing things that are not really there when you have not been able to consume alcohol
- Consuming more than you had planned to consume regularly
A person who is experiencing these signs should take steps to address their alcohol use.
Should Your Drinking Concern You
Every year in the United States, 95,000 people die from alcohol-related deaths. Because of this, everyone who chooses to use alcohol should regularly take time to consider if their alcohol use is becoming problematic. If you read about any of these stages of alcohol use and think to yourself “that sounds like me” it is cause to be concerned, but it is not cause to be hopeless. Recovery from alcohol use disorder is possible. 75 percent of people who receive quality treatment for substance use recover. You can be among those who get the help they need to get your life back from alcohol use!
Strategies for Dealing with A Loved One’s Drinking
If you have a loved one with alcohol use disorder you know that it can be an extremely difficult task to support them through their struggles with alcohol use. It is easy to forget that they are more than their alcohol influenced behaviors as you experience the worst of all their actions, but the truth is that a person struggling with alcohol use is worthy of respect and love.
A non-judgmental approach can be helpful when speaking about a person’s drinking. You may want to say something like “Your drinking caused our anniversary trip to be a disaster!” and that may be completely true, but you can communicate the same information with less judgment by saying “I feel like drinking caused you to be unable to engage in our trip. I was really hoping to enjoy this time with you.” Communicating this way is taking advantage of an “I Statement” which is a communication tool that can help you share feelings that may be difficult for a person to hear. Talking about a person’s drinking is difficult and will require you to be honest, but also kind, as you explore strategies to decrease the harm involved in drinking.
If you have a loved one who suffers from alcohol use disorder, you will need support. This is a good issue to discuss in a therapy session with a licensed mental health professional. They can help you work through feelings about your loved one’s alcohol use, and give you perspective on how to stay mentally well during this trying time. You might also try meeting with a support group. PAL and Al-Annon are examples of support groups for individuals who are helping their loved ones battle alcohol use. The experience provided in these kinds of groups can help you have insight from the experience of others, and make you feel less alone.
Get Treatment for Alcohol Use Disorder
If you are ready to receive rehabilitation for alcohol use disorder, or if you are attempting to support a loved one through their alcohol use recovery, it may be a good time to get help. Contact Shadow Mountain Recovery Center at 855-596-0196 to talk to our staff about treatment options. Our individualized care can make all the difference as you recover from alcohol use disorder and achieve wellness!
FAQs About the Stages of Alcoholism
What is the correct order of the stages of alcoholism?
The stages of alcoholism are the pre-alcoholic stage, early stage, middle stage, and end-stage.
What are the three stages on the path to alcoholism?
The pre-alcoholic stage, early alcoholic stage, and middle alcoholic stage are steps leading to alcohol use disorder. During these stages, many people are able to attend to their important life tasks, but alcohol use will make this increasingly difficult.
What are the 4 types of drinkers?
According to LaTrobe University, there are four kinds of drinkers. These types of drinkers are the social drinker, the person who drinks to conform, the person who drinks for enhancement, and the person who drinks to cope. Often individuals with alcohol use disorder are drinking to cope and an underlying issue has prompted their alcohol use.
How long is the life expectancy of an alcoholic?
The life expectancy of someone with alcohol use disorder is 47-53 years for men and 50-58 years for women.