Stages of Alcoholism: What Happens in the Final Stages of Alcohol Addiction?

Alcoholism typically develops gradually over time. For many people, it starts with initial social drinking, weekend binge drinking, or utilizing alcohol as a relaxation mechanism. As a result of regular drinking, people may eventually find themselves consuming larger amounts of alcohol to produce the same effects. Eventually, drinking may become difficult to control, and withdrawal symptoms may appear when someone stops or cuts back.

Many times the term “stages of alcoholism” refers to a basic progression of development from drinking-related concerns to developing dependence on alcohol. Although the stages of alcoholism are an educational tool and not an official diagnostic category for clinicians, they can help individuals identify potential dangers related to excessive drinking behaviors.

According to the National Institute on Alcohol Abuse and Alcoholism, AUD is described in the DSM-5-TR as a problematic pattern of alcohol use that causes clinically significant impairment or distress, with severity based on the number of symptoms present in a 12-month period. [1]

What Are the Stages of Alcohol Addiction?

The stages of alcoholism refer to a general sequence of progression from high-risk drinking behaviors to severe dependence on alcohol. Individuals do not necessarily follow the same developmental path. Some individuals rapidly progress through stages, while others may spend many years progressing through various stages.

One commonly taught model of the stages of alcoholism includes:

• Pre-alcoholic stage
• Early stage
• Middle stage
• Late stage
• End-stage alcoholism

The stages of alcoholism can provide insight into changing levels of tolerance to alcohol, increased cravings, altered behavior patterns, and decreased physical and/or mental well-being. Nonetheless, there is more importance placed on determining whether or not your drinking is creating negative impacts upon your health, safety, relationships, or functioning.

Pre-Alcoholic Stage

The pre-alcoholic stage resembles typical social drinking in appearance. A person may drink at parties, dinners, sporting events, or after work. Concern about drinking arises when alcohol usage becomes a primary method to cope with stress and/or emotional feelings.

An individual within this stage might engage in drinking behaviors for reasons such as:

• To lower stress levels
• To sleep better
• To enhance confidence
• To escape feelings of anxiety or depression
• To forget painful experiences
• To feel more relaxed socially

During this phase, family members may not see a problem. The individual may not experience withdrawal symptoms, blackouts, or major consequences. Still, drinking may be shifting from occasional use to emotional reliance.

Early Stage Alcoholism

Individuals in the early stage may be engaging in more frequent, secret, or uncontrolled drinking. At this stage, an individual may exceed their desired limits or fail to honor previous commitments to decrease their intake.

Indicators for this stage include:

• Developing a greater tolerance
• Occasional blackouts
• Consuming alcohol to regulate moods
• Concealing the extent of their drinking
• Feeling defensive when questioned about their drinking
• Engaging in binge-drinking episodes
• More frequent hangover episodes
• Experiencing cravings due to stress

As stated by the CDC, excessive drinking consists of binge drinking, heavy drinking, and drinking among youth under age 21 or those who are pregnant. Additionally, according to the CDC, drinking less benefits overall health more than drinking more. [2]

While it’s simple to underestimate this stage since an individual may continue working, schooling, parenting, or fulfilling obligations, drinking has begun to play a greater role in daily activities.

Middle Stage Alcoholism

Middle stage alcoholism usually brings more visible signs. At this point, drinking may no longer feel optional. The individual may begin planning their day around drinking, drink alone, or have difficulty feeling comfortable unless they have access to drinking.

Possible signs at this stage include:

• Significant cravings
• Unstable moods
• Irritable behaviors
• Conflicts with relationships
• Absenteeism or work- or school-related absences
• Financial difficulties
• Impulsive or risky behavior while intoxicated
• Greater tolerance for alcohol
• Physical dependence on alcohol
• Consuming morning drinks
• Withdrawal symptoms such as sweating, tremors, nausea, anxiety, or insomnia

Generally speaking, at this stage alcohol has created noticeable physical and/or psychological damage. Depression, anxiety, sleep disturbances, and memory deficits may increase. Some people may also begin combining alcohol with other substances, which increases their risk for overdose, injury, or serious health complications.

Late Stage Alcoholism

Late-stage alcoholism is primarily defined by extreme physical dependence and numerous detrimental consequences. The person may feel unable to stop drinking even when alcohol is clearly damaging their body, liver, brain, mood, relationships, work, finances, and daily life.

Symptoms of late-stage alcoholism can consist of:

• Regular blackouts
• Drinking daily or nearly daily
• Severe cravings
• Shaking or trembling without drinking
• Sweating or nausea without drinking
• Hallucinations during withdrawal
• Seizures during withdrawal
• Memory loss or cognitive impairments
• Depression or thoughts of suicide
• Worsening liver disease
• Cardiovascular problems
• Elevated risk for stroke
• Poor nutrition
• Social isolation

Withdrawal from alcohol can pose medical danger in this stage. According to NIAAA, some people with AUD will need detoxification to manage potentially severe withdrawal symptoms prior to entering further treatment. [3]

No one should attempt to quit heavy drinking cold turkey without consulting with medical professionals, especially those with histories of seizures, hallucinations, confusion, or severe withdrawal symptoms.

Alcoholism Final Stages and End-Stage Alcoholism

Alcoholism final stages, also called end-stage alcoholism, refers to the point where repeated alcohol use has led to severe physical, psychological, and functional deterioration. At this point, the possibility exists for life-threatening consequences. Regardless of this fact, treatment remains a viable option.

Possible physical signs include:

• Liver cirrhosis or severe liver damage
• Hypertension or high blood pressure
• Cardiovascular disease or cardiovascular dysfunction
• Stroke risk
• Immune system weakness
• Chronic malnutrition or poor nutritional status
• Repeated injuries or falls.
• Severe withdrawal symptoms
• Seizures, tremors, and sweating
• Gastrointestinal problems
• Brain damage or cognitive decline

Chronic excessive use of alcohol can lead to multiple chronic diseases and serious health complications, including cardiovascular disease, liver disease, stroke, cancer, AUD, or weakened immune systems. [4]

Possible psychological manifestations can include:

• Depression
• Anxiety
• Irritability
• Mood swings
• Paranoia
• Hallucinations
• Memory loss
• Poor judgment
• Social withdrawal
• Loss of motivation
• Suicidal thoughts

In addition, some individuals may develop Wernicke-Korsakoff syndrome, a potentially life-threatening brain condition strongly associated with chronic alcohol misuse and severe AUD. NIAAA describes Wernicke-Korsakoff syndrome as a serious neurological condition usually linked with chronic alcohol misuse and severe alcohol use disorder. [5]

Why End-Stage Alcoholism Is So Dangerous

End-stage alcoholism is dangerous because the body may be physically dependent on alcohol while also being harmed by it. This creates a hazardous vicious cycle. Continued use of alcohol produces additional harm to the liver, brain, cardiovascular system, and mood, as well as an elevated risk for accidents or injuries. Stopping suddenly can trigger withdrawal symptoms that may become severe, depending on the duration and quantity of past alcohol consumption.

Serious withdrawal from alcohol may produce hallucinations, seizures, or delirium tremens. These symptoms require immediate medical evaluation and possibly hospitalization. A supervised medical detox can help alleviate these dangers.

Additionally, end-stage alcoholism can produce feelings of shame and hopelessness in affected individuals. They may believe that they are so damaged that recovery is impossible. This view is inaccurate. With more intensive treatment, medical supervision, and continuing treatment over time, recovery is feasible.

Supportive Care During Recovery

Withdrawal is only one part of recovery. Long-term healing often requires support beyond stopping alcohol use. When people have reached late-stage alcoholism, their care may include medical support to monitor their condition, nutritional support to prevent malnutrition, counseling for emotional issues, managing medications prescribed by doctors, helping educate families on how to handle addiction and avoid enabling, creating ways to maintain abstinence from alcohol, and supporting the individual in developing healthy patterns of living again.

In addition to therapy to deal with feelings such as shame, guilt, grief, trauma, cravings, depression, and relationship difficulties, support groups can offer individuals opportunities to interact with others who are going through similar experiences. They also provide an opportunity to obtain peer accountability. Additionally, family members may benefit from receiving education about what their loved ones are going through, since they may be struggling with enabling behaviors.

Recovery from end-stage alcoholism may take time, and there are no guarantees that each day will represent progress. Each decision to seek treatment is another positive decision that contributes to reducing the overall risk associated with late-stage alcoholism and helps stabilize the situation.

Alcohol Addiction Treatment at Epiphany Wellness

If you or a member of your family has experienced the effects of late-stage alcoholism and/or is showing signs of physical dependence on alcohol, including withdrawal symptoms, blacking out, liver damage, and/or depression, we encourage you to reach out to us at Epiphany Wellness for help.

Our goal is to help you move through withdrawal, understand the patterns behind alcohol use, and develop a realistic plan for continued recovery.