“Because alcohol is encouraged by our culture, we get the idea that it isn’t dangerous. However, alcohol is the most potent and most toxic of the legal psychoactive drugs.”
~ Beverly A. Potter & Sebastian Orfali
In this post, we turn to a topic that is not often covered: explaining the various stages of alcoholism. While you may know some of the signs of addiction, this is not necessarily the same thing as recognizing all the stages of addiction. You may not even think of alcoholism as occurring in stages. If that is the case, you have come to the right place. 
The psychiatric understanding of alcoholism is that it is a mental disorder – that is, alcohol addiction is a disease that changes the makeup of the brain. This in turn affects individual choices, behaviors, and even personality. With this understanding of addiction to alcohol, it is important to realize that there are at least three stages to the disease. Becoming addicted is simply the initial stage, and entering recovery does not mean that alcoholism is no longer present. Instead, it is another stage in the progression and regression of the mental disorder.
“People drink to socialize, celebrate, and relax. Alcohol often has a strong effect on people – and throughout history, we’ve struggled to understand and manage alcohol’s power. Why does alcohol cause us to act and feel differently? How much is too much? Why do some people become addicted while others do not? While drinking alcohol is itself not necessarily a problem – drinking too much can cause a range of consequences, and increase your risk for a variety of problems.”
~ National Institute on Alcohol Abuse and Alcoholism
In this post, we address the major questions outlined by the National Institute on Alcohol Abuse and Alcoholism above. Alcoholism never develops in a vacuum. Instead, casual drinking can slowly transition into problem drinking, which in turn develops into dependence and can lead to withdrawal symptoms, a sure sign of alcohol addiction.
Understanding Alcoholism: A Progression of Stages
Many people think that alcoholism always looks the same in every instance: drinking large amounts of alcohol all day, everyday. While this kind of alcoholism may be the most dangerous to physical health, the reality is that it is only one of many different signs of alcoholism, which can take on many different forms. However, no matter what it looks like, alcoholism generally follows a progression of stages:
- Stage 1: Alcohol Dependence
- Stage 2: Withdrawal Symptoms
- Stage 3: Recovery from Alcoholism
Each of these stages of alcoholism is explained in turn. All three stages combine to show that alcoholism is a complicated mental disorder. This kind of addiction disease can develop quickly or over the course of years, it can be solitary or social, and it can be obvious or hidden. Because of these vast differences in alcoholism symptoms, one of the best ways to understand the mental disease is to explain the various stages of alcoholism. That is the idea behind this blog post. Here, we address all of the following questions:
- How does alcoholism or addiction begin?
- What are the major stages of alcoholism?
- What symptoms or signs of alcoholism should you look for?
- What is chronic alcoholism?
- What is the difference between end-stage and early-stage alcoholism?
- How does alcoholism manifest itself?
- Are there different types of alcoholism?
- How can you recover from alcoholism?
- What alcohol treatment options are there for treating alcohol addiction?
Stage 1 of Alcoholism: Problem Drinking and Alcohol Abuse
Before addiction to alcohol takes shape, many individuals tend to first become abuse the substance. One of the first alcoholism symptoms to take shape in this stage is a marked increase in how often and how much alcohol is consumed. Casual and social drinking can easily turn to binge drinking and occasional alcohol abuse, particularly for those who are genetically predisposed to addiction because of their family history. According to Dr. Timothy J. Legg, the health standard for responsible drinking is fourteen drinks each week for men and seven drinks each week for women (or no more than two drinks each day). Generally, one drink is equal to:
- 5 ounces of wine
- 8 ounces of malt liquor
- 12 ounces of beer
- 1.5 ounces of spirits or liquor (such as rum, gin, vodka, and whiskey)
In contrast, binge drinking is defined as having five or more drinks within the same two-hour period (or four drinks for women). Consistently binge drinking or abusing alcohol can lead to alcohol dependence, the first step toward alcoholism as a mental disease.
“Drinkers leave the experimental stage when their alcohol consumption becomes more frequent. Instead of just drinking at parties once in a while, you may find yourself drinking every weekend. Regular alcohol use is different from moderate drinking. There is usually a higher emotional attachment to it. A moderate drinker might pair a glass of wine with a meal, while a regular drinker uses alcohol to feel good in general. As increased drinking continues, you become more dependent on alcohol and are at risk of developing alcoholism.”
~ Dr. Timothy J. Legg, writing for Healthline
While binge drinking itself does not always lead to alcohol dependence or alcohol addiction, it is dangerous to your health regardless. Not only that, but frequent binge drinking is often associated with later stages of addiction. As individuals experiment with larger amounts of alcohol, they may need to consume larger amounts of alcohol at once to reach the same effects. Over time, this can lead to a dependence on alcohol, as well as its effects. This marked increase in alcohol consumption can lead to a physical dependence on alcohol. 
Alcohol dependence is not only physical. In the first stage of alcoholism, one of the major symptoms of simultaneous alcohol abuse and dependence is found in the motivation behind drinking. Your drinking habits may be problematic if you consume alcohol for any other reason than to be social or to enjoy the taste, including:
- Using alcohol (or other substances) as an excuse for social interaction.
- Conversely, using social interaction as an excuse to use alcohol.
- Drinking alcohol as means to reduce or deal with stress at the end of the day.
- Drinking alcohol because you are bored – feeling you have nothing else to do.
- Consuming alcohol to deal with negative emotions or experiences, such as a means of dealing with loneliness or sadness.
- Drinking to wake up, wind down, or go to sleep.
Finally, one of the major signs of alcoholism in its earliest stages is when alcohol begins to cause social problems. This can mean anything from experiencing issues in your closest relationships (as with family or significant others) because of your alcohol consumption, or having difficulty in talking to strangers without the aid of alcohol. If you start to see social problems as a direct result of your drinking habits, you should consider cutting back your alcohol use to see if these problems dissipate. If you are unable to stop using alcohol, it may mean you have already entered stage two of alcoholism. 
Seeing one or two of these alcoholism symptoms in your own life is not necessarily a sign that you suffer from the disease. However, when you begin to see a pattern of behavior and experiences reflective of what is described above, it is probably time to reconsider your drinking habits. Abusing alcohol in any of the ways outlined above can be a precursor to stage two of alcoholism, described below.
Stage 2 of Alcoholism: Dependence and Withdrawal Symptoms
Not everyone who engages in binge drinking will become an alcoholic, but alcohol abuse is a natural precursor to full dependence and addiction. One of the primary signs that an individual has progressed from the early stages of alcoholism into full dependence on the substance is when they begin to experience withdrawal symptoms. Experiencing withdrawal is a signal that your body has become dependent on the effects of alcohol, and only diminishes by either enduring detoxification in its entirety or indulging your body with more alcohol. 
While withdrawal looks different for everybody, some of the most common withdrawal symptoms include:
- Sweating
- Nausea (longer lasting than a hangover)
- Trembling in the hands
- Irritability or unexplained flashes of anger
- A marked increased in heart rate
- Sleeping problems (either sleeping too much or being unable to sleep)
- Vomiting
- A long-lasting headache
- Anxiety
- High blood pressure
- Confusion or fogginess
- Fever
In extreme cases, these symptoms can extend to include hallucinations, seizures, itching, and even numbness. Alcohol addiction (otherwise simply known as alcoholism or alcohol use disorder) is dependence in its extreme form. If you experience withdrawal symptoms, it is a likely sign that alcohol is a problem in your life. End-stage alcoholism often manifests in both mental and physical symptoms, and shows that an individual has completely lost their control over their substance.
“The final stage of alcoholism is addiction. At this stage, you no longer want to drink just for pleasure. Alcohol addiction is characterized by a physical and psychological need to drink. People with alcohol addiction physically crave the substance and are often inconsolable until they start drinking again. They may be addicted to other drugs as well. Compulsive behaviors are prominent in addiction, and people with alcohol addiction often drink whenever and wherever they desire.”
~ Dr. Timothy J. Legg, writing for Healthline
Stage 3 of Alcoholism: Recovery and Getting Help
Even chronic alcoholism (characterized by cravings, a loss of control, physical dependence, and increased tolerance) can be effectively treated with professional help. In the treatment stage, alcoholics are able to detox from the effects of alcohol and begin to address the issues that this dependence has caused in their lives. Treatment can take a variety of forms, ranging from simply attending support groups to entering into more formal treatment. First and foremost, weekly attendance of Alcoholics Anonymous meetings offers an effective means of dealing with alcoholism, particularly for those who have only recently come to terms with their alcohol addiction. These support meetings offer those struggling with alcoholism the opportunity to receive the accountability and the mental encouragement needed to both begin and continue recovery. Another, more professional, approach to recovery is through an intensive outpatient program. Otherwise known as an IOP, this approach to treatment has been shown to be particularly effective for those who have either struggled with alcoholism for a long time, or else tried getting sober on their own without being able to. These programs allow participants to remain at home, but usually require treatment for about ten hours each week. IOPs also include both group support meetings and individual counseling, addressing both the effects and the underlying causes of all three stages of alcohol addiction.
“One of the biggest concerns with risky drinkers is when they don’t think they have a problem. Any stage of alcoholism is problematic. Moderate drinking is the only safe way to consume alcohol, but drinking in general isn’t safe for everyone. Identifying problems with alcohol early can help prevent dependence and addiction. Medical treatment may be necessary to detoxify the body of alcohol and to obtain a fresh start. Since many people with alcoholism endure psychological problems, individual or group therapy may help in overcoming addiction.”
~ Dr. Timothy J. Legg, writing for Healthline
It is worth noting that relapse is a very real possibility for those going through alcohol treatment and beginning their road to recovery. In fact, relapse is relatively common either during or after recovery. The reality is that at least 50% of those who enter recovery eventually relapse. This is not meant to be discouraging – instead, it is helpful to have a healthy understanding of what recovery looks like. You can avoid becoming part of this statistic by setting up a realistic expectation for what recovery looks like. The truth is recovery does not end when the treatment phase comes to a close, nor is alcoholism effectively cured as a result of treatment. Alcoholism is a mental disorder that you will struggle with throughout your life. Staying sober and avoiding relapse requires staying committed to recovery for the long-haul, attending group support meetings, and having a support system you can reach out to when the going gets tough. The recovery stage of alcoholism may be the most difficult, but it is certainly more than worth the effort. We spent the most amount of time on the first of the stages of addiction: problem drinking and the abuse of alcohol. This is because people rarely realize that becoming addicted to alcohol can often be a slow process, and can be avoided if the early warning signs are recognized and dealt with directly. If you have already progressed to the dependence and alcohol addiction stage, it is time that you get the professional help you need to overcome your alcoholism. No matter what stage you are in, it is important to find help. If you have more questions about this explanation of the stages of alcoholism, do not hesitate to contact us or leave a comment below. National Institute on Alcohol Abuse and Alcoholism. (2017). Overview of Alcoholism Consumption. Retrieved from: https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption Substance Abuse and Mental Health Services Administration. (2005). Substance Abuse Treatment: Group Therapy. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK64208/ Howard C. Becker. (2009). Alcohol Dependence, Withdrawal, and Relapse. Retrieved from: https://pubs.niaaa.nih.gov/publications/arh314/348-361.htm Timothy J. Legg. (2016, November). Stages of Alcoholism. Retrieved from: https://www.healthline.com/health/stages-alcoholism#alcoholism1
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