The Stages of Alcoholism: Early, Chronic, and End Stage

Key Takeaways

• Alcoholism, which is usually called alcohol use disorder (AUD) by healthcare professionals, is a complex condition with genetic, psychological, social, and environmental influences.
• Early-stage alcoholism is marked by behavioral changes, increased tolerance, and sometimes blackouts.
• Chronic stage alcoholism leads to symptoms including physical dependence and significant health issues, as well as psychological and social consequences.
• End-stage alcoholism is characterized by life-threatening conditions, severe health complications, and a poor prognosis.
• Evidence-based treatments for AUD include FDA-approved medications, behavioral therapies, and support groups, often used together for the best treatment outcomes.

Alcoholism & Alcohol Use Disorder

Alcoholism, clinically known as alcohol use disorder (AUD), is a complex condition characterized by an uncontrollable desire to consume alcohol despite adverse consequences. It encompasses a range of behaviors from mild to severe addiction and is influenced by genetic, psychological, social, and environmental factors. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) provides diagnostic criteria for AUD based on the DSM-5.

AUD is unfortunately common, with 28.6 million U.S. adults being affected by AUD as of 2021. Even more unfortunately, 178,000 people die in the U.S. each year from excessive alcohol use, according to the Centers for Disease Control and Prevention (CDC). 

Fortunately, by recognizing the early signs of AUD, individuals can obtain the help they need to adopt a sober lifestyle and repair some of the damage AUD causes.   

Early Stage Alcoholism: Signs, Symptoms & Health Effects

Early-stage alcoholism, often a precursor to more severe addiction, can manifest through various signs and symptoms that may initially be subtle. Understanding these early indicators is crucial for timely intervention and prevention of progression to chronic alcoholism. 

• Behavioral Changes: Behavioral changes are among the first signs of early alcoholism, including an increased frequency of drinking, a tendency to drink alone, or drinking to cope with stress or emotions. 
• Tolerance: Individuals may also exhibit a growing tolerance to alcohol during the early stages of AUD, as they require more alcohol to achieve the desired effects.
• Blackouts: Those with early stage alcoholism may experience blackouts – periods during which they experience a temporary loss of memory and remain unable to recall events that occurred while drinking.
• Mood Changes: Physical and psychological symptoms of early stage AUD can include unpredictable changes in mood or demeanor while drinking, such as becoming suddenly aggressive or violent. 
• Craving Alcohol: Those with early stage AUD may also exhibit a preoccupation with alcohol and spend a lot of time thinking about drinking (or recovering from the effects of excessive drinking). 
• Experimentation: The early stage of AUD may involve experimentation with different types of alcohol – something that’s especially common among young adults and teenagers.

It’s important to note that these symptoms can vary widely among individuals. Some may show obvious signs of problematic drinking, while others may not. However, if there are at least two of the DSM-5’s 11 factors for alcohol use disorder present within a year, a diagnosis may be warranted. 

Recognizing these signs early on can lead to more effective treatment outcomes and can prevent the severe health and social consequences associated with the later stages of alcoholism.

Chronic Stage Alcoholism: Key Signs, Symptoms, & Health Effects 

Chronic stage AUD represents a critical phase in the progression of alcoholism. 

This stage is characterized by the individual’s increased tolerance to alcohol and the presence of withdrawal symptoms when not consuming. The transition from early to chronic alcoholism is marked by a shift from voluntary to compulsive drinking habits, often leading to significant physical, psychological, and social consequences.

Some of the key physical symptoms and effects of chronic-stage AUD include:

• Liver Damage: Both cirrhosis and hepatitis – which cause scarring and inflammation of the liver, respectively –  can occur during chronic-stage AUD.
• Gastrointestinal Issues: The inflammation of the stomach lining (gastritis) and the pancreas (pancreatitis) are common in individuals who’ve been abusing alcohol for some time. 
• Cardiovascular Problems: Those with chronic AUD may experience a variety of heart-related health problems, including high blood pressure (hypertension) and cardiomyopathy. 
• Neurological Damage: By the time AUD has progressed to the chronic stage, several neurological conditions may be present, including peripheral neuropathy and a serious vitamin deficiency illness called Wernicke-Korsakoff syndrome.
• Immune System Suppression: People with chronic stage AUD are at an increased risk of infections due to weakened immune response.

The psychological symptoms and consequences of AUD in the chronic stages are also serious and include:

• Memory Loss: Significant short-term and long-term memory issues are common among those who have been drinking excessive amounts of alcohol and entered the chronic stage of AUD.
• Confusion: Many people suffer from frequent disorientation and an inability to concentrate while struggling with chronic-stage AUD.
• Depression: Persistent feelings of sadness, hopelessness, and worthlessness are common among those with AUD, in part because of the way alcohol consumption can alter brain chemistry.
• Anxiety: Worry, panic attacks, and social anxiety are common symptoms of people suffering with chronic-stage AUD .
• Psychosis: Psychosis, which may manifest as hallucinations or delusions, may also occur following long-term alcohol abuse. 

Once people have reached the chronic stage of AUD, they often exhibit several behavioral symptoms and patterns associated with the disorder. A few of the most noteworthy include: 

• Neglecting Responsibilities: Things like frequent absences, poor performance, and eventual loss of job or expulsion from school frequently occur in people with chronic-stage AUD. 
• Compulsive Drinking: By the time individuals with AUD reach the chronic stage of the disorder, they often exhibit an inability to control the amount and frequency of alcohol consumption.
• Risky Behaviors: Many individuals struggling with chronic-stage AUD exhibit risky behaviors, such as driving under the influence behaving inappropriately in public.
• Financial Problems: Financial instability due to spending money on alcohol and failing to behave in a financially responsible manner is a common challenge for individuals with AUD.
• Social Withdrawal: Pulling away from friends, family, and social activities are common symptoms exhibited by people with chronic-stage AUD.

Overall, chronic-stage AUD not only deteriorates physical health but also erodes the fabric of social interactions, often leading to isolation and conflict within personal relationships. The complexity of its impact necessitates a multifaceted approach to treatment and recovery, addressing the disorder’s physiological and psychological dimensions.

End-Stage Alcoholism: Key Signs, Symptoms, & Health Effects 

End-stage alcoholism, also known as late-stage alcoholism, is a critical phase of alcohol use disorder characterized by severe health complications and a dire prognosis. 

At this stage, the cumulative effects of chronic alcohol abuse become overtly manifest. And while the symptoms of end-stage alcoholism are similar to those experienced during the chronic stage, they have often progressed to a life-threatening stage. 

By the time AUD has reached the end stage, individuals struggling with the disorder often experience: 

• Severe Liver Disease: One of the most significant health issues associated with end-stage alcoholism is alcoholic liver disease, including cirrhosis. At this point, the liver has often sustained irreversible damage due to prolonged alcohol exposure.
• Increased Risk of Cancer: Another grave concern is the increased risk of various cancers by this stage of the disorder, notably those affecting the esophagus, mouth, throat, liver, and breast. 
• Continued Problems with Heart Health: Cardiovascular health continues to deteriorate during end-stage AUD, with individuals experiencing a range of heart-related problems, including cardiomyopathy and arrhythmias. 
• Worsening Neurological Problems: Neurologically, AUD continues to cause brain disorders including memory loss, cognitive impairment, and coordination problems in the late stages.
• Malnutrition: The replacement of nutritious food with alcohol often causes malnutrition by the end-stage of AUD. This further exacerbates the body’s ability to recover and fight infections, making end-stage alcoholics particularly vulnerable to illnesses.

The prognosis for individuals with end-stage alcoholism is generally poor, with a significantly reduced life expectancy and quality of life. 

However, even at this advanced stage, treatment options are available, focusing on abstinence, nutritional support, and management of complications. It’s crucial to note that early intervention offers the best chance for recovery and can prevent the progression to end-stage alcoholism.

Evidence-Based Treatment Approaches for Alcohol Addiction

Effective treatment for AUD is not a one-size-fits-all solution. There are a variety of different approaches that have proven helpful, including medications, mutual support groups, and behavioral therapies tailored to individual needs. 

• Medications that have been empirically demonstrated to help individuals stop drinking include disulfiram, naltrexone, and acamprosate. Disulfiram causes those taking it to have very unpleasant reactions when they consume alcohol, while naltrexone blocks the euphoric and sedative effects of alcohol. Acamprosate, on the other hand, helps to balance the neurotransmitters in the brain and eases some of the mental symptoms associated with alcohol withdrawal.    
• Mutual support groups play a crucial role in helping individuals with AUD. These types of groups provide a supportive community, give individuals the chance to share experiences, and provide practical strategies for maintaining sobriety.
• Behavioral therapies are crucial in modifying attitudes and behaviors related to alcohol use. Cognitive-behavioral therapy (CBT), in particular, can occur one-on-one or in small groups and is instrumental in developing coping strategies and avoiding triggers. Family therapy also plays a significant role in treatment, addressing the broader impact of substance use on the patient’s family.   

The important thing to remember is that early intervention and care help provide people struggling with AUD a better chance at achieving sobriety and avoid some of the long-term health effects caused by long-term alcohol abuse. 

Treating Alcohol Addiction at The Recovery Village Palmer Lake

Understanding what makes someone addicted to alcohol can be the first step in helping a person seek treatment. Depending on how bad their alcohol abuse has been or if medically-assisted alcohol detox will be needed for withdrawal symptoms, entering into a treatment center may be a necessary option. Professional medical staff can assist in the difficult process of withdrawal, making the transition into sobriety less daunting.

Alcohol abuse treatment programs teach people how to move into an alcohol-free lifestyle while teaching them healthy coping strategies. They can simultaneously help treat any co-occurring mental health issues. 

Contact The Recovery Village Palmer Lake if you have questions about treatment or if you’re ready to get on the path to recovery and end your addiction to alcohol.