The Stages Of Alcoholism

know the stages of alcoholism

Most of us enjoy a drink or two every now and then. But for some people, alcohol becomes a compulsion. This can then become a chronic disease which affects your brain and brings on a barrage of negative emotions when you don’t use alcohol. It also means a loss of control over the amount of alcohol you take in. Medically known as “alcohol use disorder,” this condition includes alcoholism as well as alcohol abuse.1 Around 18 million adults in America are thought to suffer from it.2

What’s the difference between alcoholism and alcohol abuse, you ask? Alcoholism is an illness where you have a strong craving for alcohol, you need to drink larger amounts to feel the effects of alcohol, and you’re not able to stop drinking after you start. You’re also physically dependent on alcohol when you’re an alcoholic, that is, you tend to experience withdrawal symptoms if you stop. On the other hand, if you abuse alcohol, you’re not physically dependent on it though drinking might be causing serious problems at home, school, or work.


From raising your risk for certain cancers to damaging your brain and other organs, excessive alcohol consumption can cause various health issues. One organ that takes a severe beating is your liver. Alcohol can also increase your risk of death from injuries, car crashes, suicide, and homicide.3 In fact, it’s estimated that alcoholism could lower your life expectancy by around 10 to 12 years. And the earlier you start drinking excessively, the higher your risk of developing serious health issues.4 The scenario is quite bleak and one that you don’t want to find yourself in. One major step in getting a better grip on yourself is to understand how this disease progresses. Here’s what you need to know.

The Stages Of Alcoholism

While no clinical stages have been defined for alcoholism as in the case of cancer or HIV, experts have mapped the progression of alcoholism emotionally as well as physically.


Emotional Stages Of Alcoholism

One model looks at how the emotional response of an addict changes as the disease progresses. Four stages are described in this model: the first two stages represent “normal” drinking and the third and fourth stage represent alcohol-dependent drinking.

Stage 1

In the initial stage, the person experiences alcohol for the first time and likes the happy or good feeling that drinking produces. Depending on the culture that the person is from, this can happen at a young age. At this stage, there’s no negative impact or emotional cost.


Stage 2

In the second phase, the person starts drinking to experience the “good” feeling produced by alcohol again. As the person builds up tolerance to alcohol and more alcohol needs to be consumed to achieve that feeling, the drinking increases. However, there may not be any significant negative consequences at this stage either.

Stage 3

In this phase, the person starts experiencing social and physical consequences because of drinking. These could range from waking up with a hangover to having problems at home or work. However, the person continues to drink heavily in spite of the problems.


Stage 4

Severe damage can be caused in the last stage. The person now drinks alcohol to feel normal. And they block the feelings of remorse, guilt, shame, and anxiety which threaten to overwhelm them when sober. There’s a risk of premature death at this stage.5

Physical Stages Of Alcoholism

It is also possible to look at the stages of progressive physical deterioration that occurs with alcoholism. A model that explores this describes three stages:


Stage 1: The Adaptive Stage

At this stage, the person may not notice any negative symptoms. However, the person’s tolerance for alcohol is increasing during this time and related physiological changes are occurring. But this may not raise a red flag and the person may just assume they have a large capacity for alcohol.

Stage 2: The Dependent Stage

During the second stage, symptoms of alcoholism may gradually increase. An addict may confuse the signs of being hungover with withdrawal symptoms. These will include tremors, nausea, sweating, hallucinations, and even seizures in severe cases. They will now try to avoid withdrawal symptoms by continuing to drink, sometimes consuming small amounts of alcohol at frequent intervals. They may also try to avoid being visibly drunk in public and seek to hide the fact that they have a drinking problem.


Stage 3: The Deterioration Stage

At this stage, various organs may get damaged because of long term alcohol use. Medical treatment may be needed and pathological changes may lead to death.6

Alcohol related liver disease is a condition where the liver gets damaged due to excessive intake of alcohol. Whenever alcohol is filtered by your liver, it causes some liver cells to die. Your liver can usually form new cells but heavy drinking over the years lowers its capacity to regenerate, leading to permanent liver damage.


This condition typically doesn’t cause symptoms till the liver is seriously damaged. Then you may have symptoms like yellowing of the skin and eyes, nausea, weight loss, swelling in the abdomen and ankles, confusion, and blood in vomit or stools. In case you drink heavily, it makes sense to proactively ask your doctor to check how healthy your liver is.7

Alcohol-related liver disease has three stages though they tend to somewhat overlap.

Stage 1: Alcoholic Fatty Liver Disease

Drinking huge amounts of alcohol can cause fats to build up in the liver even when you only do it for a few days. This is the first stage of alcohol-related liver disease and it’s known as alcoholic fatty liver disease. You rarely experience symptoms at this stage but it’s still an internal warning sign that you’re drinking excessively. Fortunately, this condition can be reversed. In fact, if you stop drinking for a couple of weeks, your liver should go back to normal.

Stage 2: Alcoholic Hepatitis

Alcoholic hepatitis is characterized by inflammation of the liver through excessive drinking. It is typically a result of alcohol abuse over a long period of time but can also be caused by binge drinking sometimes. In mild cases, the liver damage associated with this condition can usually be reversed if you permanently give up alcohol. In severe cases, it can be life threatening.

Stage 3: Cirrhosis

Cirrhosis is the final stage of alcohol-related liver disease and there is significant scarring of the liver at this point. It is important to note that you may not experience any symptoms even when you have cirrhosis.

This condition is usually not reversible but if you stop drinking you can halt the damage and improve your life expectancy. People with alcohol-related cirrhosis who continue to drink, on the other hand, have less than 50% likelihood of living for another 5 years.8

There’s no particular treatment for alcohol-related liver disease other than to stop consuming alcohol. In cases where the liver has been severely damaged, a liver transplant may be needed.9

Do You Have A Drinking Problem?

In the initial stages, many people don’t realize that they have a drinking problem. If you’re wondering about your alcohol use, take a look at this simple screening instrument used by clinicians. It’s called the CAGE questionnaire and consists of 4 questions:

  • Have you ever felt you should Cut down on your drinking?
  • Have people Annoyed you by criticizing your drinking?
  • Have you ever felt bad or Guilty about your drinking?
  • Eye opener: Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

If the answer to 2 or more of these questions is yes, it’s considered to be significant enough to warrant further investigation.10