Stages of Alcoholism: Early, Chronic and End Stage

Alcoholism, also known as alcohol addiction or alcohol use disorder, is the continuation of drinking alcohol in excess despite negative consequences. [1] The World Health Organisation (WHO) states that alcoholism is defined by the problems caused by drinking, mentally, physically, and socially.

WHO stated that in 2016, there were over 380 million people in the world suffering from alcoholism. [2] Their research showed that alcoholism is more common amongst the younger generations, specifically in males.

Alcoholism has a combination of causes, including mental health, environmental factors, and genetics. Those with mental health conditions are more likely to develop alcohol dependency and addiction, compared to those without. Individuals aim to self-medicate symptoms of mental health, using the sedative and calming effects of alcohol.

This is true taking into account the immediate effects of alcohol, but as a depressant, alcohol makes mental health worse in the long run.

The genetics that influences metabolism and bodily stature can influence the metabolism of alcohol, so alcoholism can run in the family. [3] [4] For example, those of Asian descent might find themselves constantly ‘flushing’ when drinking alcohol.

This is due to the inability to metabolise alcohol properly, lacking a metabolic enzyme that runs genetically.

Environmental factors such as trauma and stress are directly associated with the risk of drug and alcohol addiction. Lack of social support and loneliness is also associated with alcoholism, along with the use of drugs, nicotine, and personality traits such as impulsivity and risk-taking. [5]

Alcoholism is a disease, that changes the brain’s reward pathways and alters a person’s motivations and consideration of consequences. Without tailored help, alcoholism can get out of hand and damage many lives.

All alcoholism develops from some sort of alcohol use, specifically alcohol abuse including negative patterns of drinking. This affects all generations in all aspects of life; nobody plans on becoming an addict, unfortunately, it just happens to some people.

The severity of alcoholism lies on a spectrum from mild to severe, with three different stages.

Pre and Early Alcoholism

In the 1950s, E. Morton Jellinek created the Jellinek Curve showing the different phases of alcoholism and possible recovery. This form of research showed that addiction is progressive, trapping people in a vicious circle. These stages of addiction are predicted, but not everyone follows this specific pattern.

In the pre-alcoholism and early alcoholism stages, addiction is rarely noticeable and can be passed off easily. In the pre-alcoholism stage, people will drink mainly for social occasions but usually, because it relieves some kind of stress or anxiety.

This ‘early relief drinking’ turns from an occasional activity into a regular activity, and individuals will need to drink more as their tolerance increases.

The body and mind begin to adapt to the new levels of alcohol and endorphins released from the occasion. This increase in alcohol tolerance will require more alcohol to feel the same effects as before and may present symptoms after drinking such as ‘hangxiety’.

Constant relief drinking commences, building dependence on alcohol.

If this continues, individuals enter a prodromal stage, also called the ‘early alcoholic’ stage. Signs and symptoms of this stage begin to emerge, and so does the individual’s denial. Levels of alcohol consumption drastically increase, and individuals may become preoccupied with alcohol.

In this stage, individuals may experience common blackouts, drinking a high level of alcohol too quickly for the brain and body to metabolise it properly.

As an early alcoholic, symptoms may not be obvious to friends and family, especially if the individual has always been social and enjoyed partying. The individual may begin to hide their drinking or lie about their behaviour to avoid confrontation or judgement.

Individuals often appear urgent and very keen to drink the first drink very quickly. They might be unable to discuss their problems, creating excuses to avoid talking about alcohol or any specific behaviours.

Middle and Chronic Phases of Alcoholism

Following the prodromal stage, individuals will start to lose control over their drinking. Unfortunately, this lack of control also applies to the negative consequences of their drinking. Individuals will keep drinking despite the damage they may be causing to themselves and others.

This is the phase in that some individuals go ‘cold-turkey’ or try to reduce their intake, but these are usually failed attempts as the individual is unaware that they need medical help.

The individual will be completely dependent on alcohol, usually because they are self-medicating a new or exacerbated mental health problem. This may lead to malnutrition, due to alcohol and a poor diet.

All promises and projected resolutions will likely fail, as efforts to control their drinking end due to unreasonable and unobtainable goals. This leads to a loss of interest in work and other responsibilities. Alcohol is placed above work and relationships, causing rifts in families and friends.

In the chronic phase, also called ‘late alcoholic’, individuals experience episodes of binge drinking, defined as more than 4 or 5 drinks per occasion.

This usually happens when individuals try and contain their drinking but fail to do so. Both mental and physical health will decline, causing mental health conditions and medical emergencies.

At this stage, individuals no longer experience relief from their worries and anxieties as their physical dependence becomes so high. Cutting out alcohol immediately and completely would lead to life-threatening withdrawal symptoms.

Individuals are likely to experience early morning tremors and shaking, leading to early morning drinking.

Lengthy periods of drinking impair their thinking and behaviour, making them unable to initiate any form of recovery at this point on their own. Obsession with alcoholism takes over, and individuals may admit that they are an alcoholic.

End-Stage Alcoholism: ‘Rock Bottom’

All alibis, friends, family, and the individual become exhausted. This is the last stage of the progressive U-curve, and sometimes it is the terminal stage if the individual does not seek help.

Some individuals never follow the recovery part of the process, and unfortunately, die from alcoholism when they reach end-stage alcoholism. On the other hand, others hit rock bottom and become motivated to seek help and start their recovery process.

There are no specific definitions for this stage of alcoholism, apart from mental and physical symptoms. What ‘rock bottom’ looks like for some people is entirely different from others.

It may, for example, be ending up in prison, having relationship breakdowns, or becoming homeless. Unless the individual has an “honest desire for help”, then it is difficult for them to break out of the cycle.

Quality of life becomes so low, that individuals come close to death or die because of addiction.

The Signs and Symptoms of Alcoholism

Signs and symptoms in each person differ, some may be concealed easily or others readily obvious.

The most common signs are:

Secretive behaviour
Lying
Drinking alone or during unsociable hours
Withdrawal
Loss of interest
Ignoring responsibilities
Tiredness and restlessness
Shaking, sweating, and anxiety
Mood swings
Nausea and vomiting
Low levels of personal hygiene
Change in weight
Blackouts and high alcohol tolerance

Conditions Caused by Alcoholism

There are multiple physical and mental conditions caused by alcohol, exacerbated by a lack of nutrition and a healthy lifestyle, such as:

Delirium tremens
Wernicke-Korsakoff Syndrome
Liver failure and cirrhosis
Fluid retention
Chronic pancreatitis
Heart conditions
Gastrointestinal issues

Delirium Tremens

Most people with severe alcohol addiction will experience delirium tremens when they try to quit alcohol cold turkey.

Delirium tremens (DTs) happen to around 5% of people who do not seek help for their alcoholism, lasting around 4 days. DT is characterised by intense seizures caused by hyperactivity of the nervous system.

Wernicke-Korsakoff Syndrome

Wernicke-Korsakoff Syndrome (WKS) is caused by a thiamine deficiency from alcoholism. Also called ‘alcoholic dementia’, the brain does not have the nutrients it requires to carry out its functions.

The first stage of WKS is Wernicke’s encephalopathy, where alcohol and malnutrition cause the brain to swell and become inflamed. If this is not treated, it will develop into Korsakoff’s syndrome.

Korsakoff syndrome affects the memory and storage of these memories, creating mass confusion and possible brain damage.

Liver Disease

Drinking alcohol in excess can lead to a build-up of fat in the liver, called alcoholic fatty liver disease. If the drinking continues, this may develop into alcoholic hepatitis. This second-stage liver disease is common in heavy drinkers.

During alcoholism, healthy liver cells are damaged and replaced by scar tissue. Scarring prevents blood flow around the liver, preventing it from working properly.

The liver will begin to fail and it will eventually reach end-stage liver disease, called cirrhosis. [6] This condition affects around 1 in 5 heavy drinkers and can cause death if left untreated.

Cardiovascular System

Alcohol causes the blood vessels to narrow. In the cardiovascular system, this causes an increase in both blood pressure and heart rate, causing significant pain and distress.

Long-term alcoholism may affect the shape of the heart, called alcoholic cardiomyopathy.

This condition is linked to strokes, heart failure, and cardiovascular disease.

Alcohol and The Kidneys

Alcohol causes significant changes to the kidneys, as they act as our main filtering system. Alcohol dehydrates the body, leaving less water to filter through the kidneys.

The kidneys then have to process a high concentration of fluid as the individual drinks more alcohol, affecting the ability to regulate the non-toxic substances.

Binge drinking has a harmful effect on the kidneys, often leading healthy kidneys to kidney failure. As stated, alcohol increases blood pressure, which can contribute to kidney disease. Multiple drinks a day drastically increases your chance of having high blood pressure, leading to chronic kidney disease.

End-stage kidney disease, also called end-stage renal disease, is the most advanced stage of kidney disease. The kidneys can no longer perform any function or filter fluid and waste.

Different stages of alcoholism cause different issues, with different addiction treatment options, including alcohol detoxification and alcohol rehabilitation. Some conditions are irreversible and cannot be treated, but most medical issues are helped by the cessation of drinking.

Seek Help as Soon as Possible

Heavy drinking and binge drinking leads to mental and physical dependence. Once you are stuck in the cycle of addiction, it is difficult to break free. Loss of control, inability to change on your own, and your cravings for alcohol lead you back down the same path.

As your tolerance for alcohol grows with your addiction, so do the negative consequences. Your mental health is likely to deteriorate, and you will end up drinking more in order to medicate these symptoms. This does not work, and will only exacerbate any underlying issues.

Alcohol withdrawal symptoms depend on the severity of the addiction. Be careful when trying to detox, as you may experience life-threatening symptoms. Get in touch with your healthcare provider and seek the medical care that is right for you and your stage of alcoholism.

Time is crucial, you could be helping your mental and physical health if you reach out now. This will not only increase your quality of life but the lives of those around you.

Alcohol addiction is a disease, and this is both progressive and treatable. To prevent end-stage alcoholism and the negative consequences that accompany addiction, get in touch with us today.