Like many health conditions, alcoholism presents itself in stages which are fairly simple by definition - early, middle and late. However understanding where someone may lie within any given stage isn't quite as simple.
It is, however, important to understand the stages of alcoholism in order to determine the most effective treatment and support options. It's also helpful in assessing the level of physiological damage that has been done.
The early alcoholism stages begin when a person transitions from the occasional drink with dinner or friends to beginning to drink to ‘feel better," to moderate their mood or cope with problems. Their thoughts are becoming focused more on alcohol and drinking. For example, many people may have a beer with a burger at a restaurant, however, when they begin to look forward to that beer as a way to unwind, as a stress reliever, or as the main focus of the meal then they're in the early stages of alcoholism.
It’s easy to misinterpret the early stages of alcoholism and they often go unnoticed, because they can occur quite gradually. One beer or glass of wine to relax after work can turn into two because one glass no longer provides the same relaxing effect. Two glasses turn into three and so on. Alcohol tolerance begins to increase during the early stages of alcoholism, meaning they now need more alcohol to achieve the same effects, and people may actually feel like they can ‘handle their liquor’ better now than they could before.
As tolerance increases, the amount of alcohol increases to achieve the same desired effect. People in the middle stages of alcoholism will find themselves beginning to drink earlier in the day. They're drinking earlier and earlier to combat the ill feelings caused by drinking. Tolerance actually starts to decrease in the middle stages of alcoholism. The body and mind has become dependent on alcohol and withdrawal symptoms will begin to occur. Hangovers, blackouts, headaches, tremors and stomach distress will now be quite common.
This is usually when a person begins to realize they have a drinking problem and mood swings, guilt, depression and anger or irritability will start to present. The person will begin to feel out of control of their life and their drinking, and in fact, they most often are. They often engage in behaviors that violate their values and experience deep remorse, but feel incapable of stopping, so they rationalize. They're dependent on the substance and the need and desire to drink will be quite profound at this point. In the middle stages of alcoholism it also begins to become more obvious to others that there is a problem. Their behavior will start to have an impact on their job, family and friends.
This is also often referred to as advanced stage or end stage alcoholism. This is the point where alcohol has taken the primary role in a person’s life and their physical and mental health begin to deteriorate drastically. They no longer have the ability to control their drinking at all and they are drinking in the morning, noon and night just to function. They will do, say, or be anything if it means being able to fill their body’s craving for alcohol. At this point, the alcoholic is no longer able to hide behind excuses and work performance, family and personal relationships will be suffering deeply. It is common for alcoholics to have problems with the law and their finances.
Malnutrition, depression and an overall loss in health will be prominent at this point. Unfortunately, at this point it's still common for someone suffering from alcoholism to be in denial. They may become angry, defensive or even reclusive when confronted. The brain has begun to deteriorate, memory is impaired and rational thinking and judgment are often obscured. Morals and values begin to dissipate.
At this point, it is usually obvious to everyone around them that there is indeed a serious problem. End stage alcoholism often ends in death. Approximately 5% of the U.S. population dies from late stage alcoholism. Heart disease, cancer, and liver disease are all common causes of death at this late stage, as well as accidents and suicide.
It's also important to note that sometimes there may actually be three stages within each stage itself. For example, you may exhibit some symptoms of middle stage alcoholism but not all of them, or some symptoms of late stage alcoholism, but not all of them. So essentially, this would mean that you are in the early stages of the middle stage or early stages of the end stage. Consequently, this factor often leads some professionals in the field to break up the alcoholism stages into four or five stages instead of three. Additionally, you may think of each stage as being on a continuum.
Unfortunately, those who make it to the final stage of end stage alcoholism, where they are exhibiting most symptoms, rarely seek help at this point. If they're not in denial, they often feel incapable of changing the situation and don't bother to try. Brain function deteriorates so greatly that seeing the reality of the situation and making decisions that are good for them is nearly impossible and withdrawal symptoms are so unbearable they can't get through it. Additionally, for many, drinking has become their identity, they don't know who they are without it.
So, if you recognize yourself or a loved one in the early or middle alcoholism stages, now is the time to take action.