Stages of Alcoholism
What Are the Stages of Alcoholism? Identifying the Progression of Alcohol Use Disorder
In most cases, alcohol addiction is a condition that progresses gradually over time. Little by little, a person’s drinking can progress from what was once experimental or casual drinking to an addiction that has negative effects on many important aspects of their life. Anyone who suffers from an addiction to alcohol, clinically known as alcohol use disorder (AUD), most likely developed the affliction over the course of months or years.
Everybody has a unique life story, biology, and upbringing. As humans, we are the sum of these parts and so much more. Because everyone is unique, no two people will develop AUD in the same way. Particular triggers, causes, and timelines for the development of alcohol addiction will vary from person to person. Despite this, as AUD progresses, there are certain patterns, symptoms, and behaviors to look out for that suggest a person may be heading down the negative road toward severe AUD.
Early research into the progression of alcohol addiction helped us understand the issue more clearly by outlining four stages of alcohol misuse: pre-alcoholic, early alcoholic, middle-stage alcoholic, and end-stage alcoholism.
20th Century Research Into the Issue of Alcoholism
Alcohol consumption has been happening for as long as there has been recorded history. After all, alcohol occurs in nature quite frequently. For example, have you ever bought a pineapple and left it on the counter for too long?
You may notice that the fruit becomes overripe and very soft. If you cut into it, you may also notice that it smells like wine or beer on the inside. This is because the sugars in the pineapple have started to convert into alcohol in a biological process known as fermentation.
Some historians argue alcoholic beverages helped to further human civilization by providing a much-needed source of hydration to early people when there was no access to clean water.
Even in early civilizations, there were people who struggled to control their alcohol consumption. For a long time, people who struggled with drinking were thought to have a moral failure or lack of willpower. It wasn’t until the mid-1900s that scientists started to delve a little deeper into the factors that contributed to harmful, habitual drinking.
Developing the Stages of Alcoholism
The foundation for our modern understanding of the ways in which AUD can progress was developed by a scientist named E. Morton Jellinek. His research on the subject led him to publish the first report on the progressive nature of alcoholism in 1946. To gather data for his research, he called upon a pool of people who were members of the recently formed organization Alcoholics Anonymous (AA).
Founded a little over a decade earlier in 1935, AA provided the perfect pool of subjects to draw from for Jellinek’s research. Not only did these people suffer from harmful drinking habits, but they also recognized that alcohol was a negative force in their lives, a fairly uncommon way to view drinking at the time. Because of this, they had a certain amount of self-awareness that would prove useful for research purposes.
While his initial research helped lay a good foundation for exploring the issue, Jellinek knew he would have to expand the sample size to better analyze and understand the issue of alcohol addiction and how it progresses.
In 1952, he expanded on the ideas from his earlier research with his follow-up paper, “Phases of Alcohol Addiction.” This paper outlined the stages of alcohol misuse as it progresses, categorized by drinking patterns and behaviors.
Jellinek starts this paper by describing the patterns of people in what’s known as the “pre-alcoholic” stage, which is marked by casual or social drinking patterns. As the drinking progressed, he found that his research subjects would reach a point where they were no longer drinking for social reasons, they were drinking for psychological reasons.
From there, he reported, alcohol misuse progressed into alcohol addiction and eventually to the point of chronic, uncontrollable alcohol use disorder. His research led to the development of the “Jellinek Curve,” which outlines the behaviors, patterns, and symptoms seen during a person’s progression through the stages of alcoholism.
According to Jellinek, the four stages of alcoholism are:
- The Pre-Alcoholic Stage
- Early-Stage Alcoholism
- The Middle Alcoholic Stage
- End-Stage Alcoholism
While further research has disproved some of the conclusions Jellinek reached in his research, he still helped lay the foundation for the ways in which we understand the progression of alcohol use disorder to this day.
Each of these stages is marked by certain patterns and behavioral milestones, starting with:
1. The Pre-Alcoholic Stage
The first stage of the Jellinek Curve may be the hardest to identify in loved ones and yourself. Everyone is affected differently by alcohol, and the ways in which alcohol interacts with the body and mind can vary from person to person.
The effects of alcohol are a result of its interaction with parts of the brain that release “neurotransmitters,” or chemicals that can give you energy and tell you to feel happy or content.
As drinking progresses, the brain and body adjust to the presence of alcohol. The brain gets used to having alcohol tell it to release these happy chemicals and stops releasing them on its own. This is the basis for physical dependence.
In this first stage, a person may drink as an activity that helps them relax, sleep, or feel more comfortable in social situations. Because drinking is a very common part of American adult activities, the pre-alcoholic stage can be very difficult to spot.
People in the pre-alcoholic stage may drink more or more often than others, but it’s not always obvious. You may notice they always have a drink in their hand at events and social functions. You may also begin to notice drinking has become their preferred way to unwind after a long day of work or a difficult week.
If the person starts to habitually drink alcohol as a way to cope with the difficulties of everyday life, this is a good sign they may be in the pre-alcoholic stage.
2. Early-Stage Alcoholism
When a person starts to regularly binge drink and have blackouts, this is a sign they’ve progressed to the second stage of alcohol use disorder. Many times, especially with young adults and teens, these patterns are simply a sign of alcohol experimentation. Other times, it can be a serious sign that a person’s alcohol consumption is progressing in a negative way.
They may not drink every day, but they drink frequently, and most social activities and nights out involve drinking. When a person regularly drinks alcohol to excess, their body and mind start to physically and psychologically adjust, leaving them open to the progression of AUD.
It is considered binge drinking when a woman consumes about four standard alcoholic drinks within a two-hour period, or a man drinks five drinks in the same amount of time. Blackouts from drinking occur when alcohol shuts down the area of the brain responsible for making memories, leading to periods of time the person doesn’t remember. If a person enjoys the feeling of rapidly getting drunk, or seeks intoxication as quickly as possible, this may indicate the beginnings of a deeper issue.
The signs of this stage on the Jellinek Curve are much easier to spot than those of the pre-alcoholic stage. The person will regularly binge drink and black out. Often they’ll even joke about their drinking habits and swear to never drink again. This is the stage in which drinking starts to become very unhealthy and is a cause for concern.
3. The Middle Alcoholic Stage
When a person has progressed to this stage, their drinking habits start to become noticeable to friends and loved ones. Some people are good at hiding their drinking or lying about the extent of their drinking. At this stage, a person starts to see the negative consequences of drinking as it begins to affect their performance at school or work, and their relationships.
Some major signs that a person may have progressed into the middle alcoholic phase are when they start drinking at work, are drunk while driving, or while looking after their children or other loved ones.
Because the body and brain have started to adjust to the frequent presence of alcohol in their system, they need to drink more frequently and in higher amounts to reach the desired level of intoxication. Physical signs like weight gain or bloating, facial redness, shaking, sweating, and memory loss are good ways to identify a person in this stage of alcohol use disorder.
Middle-stage alcoholism occurs when a person starts to prioritize drinking above their relationships, their career, and/or their education. This is also the stage where treatment for drinking can be the most beneficial. This is because the impact of drinking on their health has typically not progressed to a level that can’t be reversed with healthy lifestyle changes.
4. End-Stage Alcoholism
When a person enters this phase, the long-term effects of heavy drinking start to become impossible to hide. The person may have already tried to stop drinking multiple times with little to no success. Drinking is no longer just for social occasions; it becomes an all-day activity.
Priorities shift to make drinking alcohol the No. 1 priority in the person’s life. This may cause a person to lose their job and even their family. It can quickly become a cycle of negative alcohol consumption that may be impossible for them to overcome on their own.
A person in end-stage alcoholism can expect to have some very major health problems that include liver damage, heart disease, and other alcohol-related illnesses.
This is the most dire stage to reach in alcohol use disorder as it begins to severely impact a person’s health, relationships, career, finances, and overall mental and emotional well-being. Someone in this stage needs to seek professional treatment as soon as possible as they are likely to drink themselves into serious health problems or even death.
Alcoholism Vs. Alcohol Use Disorder (AUD)
In American society, the term “alcoholism” is commonly used to describe someone who has an unhealthy relationship with alcohol. It’s important to understand this is not a medical term, and there are no specific criteria that tell us whether a person suffers from alcoholism. However, there are specific criteria that tell us whether a person may be suffering from alcohol use disorder (AUD), the medical diagnosis of alcoholism.
A person may be diagnosed with AUD if their drinking has started to negatively affect important aspects of their life. Addiction is not always an easy condition to identify, especially from the outside. That said, there are a number of certain behavioral patterns to look out for when determining if you or a loved one is suffering from AUD.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) states anyone who meets 2 of the 11 following criteria within a 12-month period may be diagnosed with an AUD. Here are some questions to consider to accurately assess whether you or a loved one may be suffering from a problem with alcohol.
In the past year, have you:
- Had times when you ended up drinking more, or longer, than you intended?
- More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
- Spent a lot of time drinking? Or being sick or getting over the aftereffects?
- Experienced a craving — a strong need or urge — to drink?
- More than once gotten into situations while, or after, drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
- Found that drinking, or being sick from drinking, often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
- Continued to drink even though it was causing trouble with your family or friends?
- Given up or cut back on activities that were once important or interesting to you, or gave you pleasure, in order to drink?
- Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
- Had to drink much more than you once did to get the effect you wanted? Or found that your usual number of drinks had much less effect than before?
- Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating? Or sensed things that were not actually there?
If any of these symptoms are things you or a loved one has experienced, your drinking habits may already be cause for concern. The more symptoms you’ve had, the more likely it is you’ve become physically dependent on alcohol.
Treatment at Serenity Lane Can Help You Quit Alcohol For Good
When choosing a treatment center for alcohol rehab, it’s important to choose one that understands addiction and the best ways to help promote strong, lasting change.
You’re stronger than you may think. Call today at (800) 543-9905 for a no-cost consultation with one of our mental health professionals.
What are the stages of a drinking problem?
Jellinek’s four stages of alcohol use disorder include: pre-alcoholic, early alcoholic, middle-stage alcoholic, and end-stage alcoholism.
What is the final stage in the development of alcoholism?
End-stage alcoholism is the final, and most dire, stage of alcohol misuse. When a person enters this phase, the long-term effects of heavy drinking start to become impossible to hide. Drinking is no longer just for social occasions or to unwind at the end of the day; it becomes an all-day activity. Priorities shift to make drinking alcohol the No. 1 priority in the person’s life. This may cause a person to lose their job and even their family.
What is the life expectancy of an alcoholic?
The average life expectancy for heavy drinkers is reported to be 24-28 years less than for people in the general population. This amounts to a life expectancy of 47-53 years for men and 50-58 years for women.