What Are the Four Stages of Alcoholism? Identifying and Addressing Alcoholism at Every Stage

In the vast majority of cases, addiction doesn’t happen overnight. Alcohol addiction in particular is a condition that progresses over time. What starts out as experimental or casual drinking will continue to advance into addiction and dependence. In reality, anyone who suffers from alcohol addiction, medically referred to as alcohol use disorder (AUD), developed the condition over the course of months and even years.

Because everyone has a unique upbringing, biology, and environment, no two people develop AUD in the exact same way. The specific causes, triggers, and timeframes for addiction development will vary from person to person. That said, the signs of alcohol addiction will show general patterns as the condition progresses.

To better illustrate this progression, four stages of AUD have been identified: pre-alcoholic, early alcoholic, middle-stage alcoholic, and end-stage alcoholism.

Alcoholism Research of the Early 20th Century

People have been drinking alcohol since the dawn of civilization. In fact, many historians argue that alcohol, specifically wine and beer, played a critical role in the advancement of civilization at times when access to clean drinking water in cities was very rare.

There have been certain people who have struggled to limit their drinking for as long as alcohol has existed. While problems with alcohol use were always a well-known affliction, the public didn’t start to understand alcohol addiction until the mid-1900s.

Very little research into alcohol and alcohol addiction existed in the early 20th century. Many people had issues with controlling their drinking, but no one took the time to delve deeper into understanding why the issues existed and how they developed. The general understanding was that anyone who suffered from “alcoholism” did so because of a personal moral failure or lack of willpower. This false belief would remain the widely accepted cause of alcohol use issues until the middle of the 20th century.

Developing the Stages of Alcoholism

Much of the modern understanding of how alcohol use disorder can progress was developed by a scientist named E. Morton Jellinek. In 1946, his research on the subject led him to publish a report on the progressive nature of alcoholism. To conduct this research, he called upon a small group of people who were members of the relatively new organization Alcoholics Anonymous (AA). Founded in 1935, AA provided the perfect pool to draw from because these were people who recognized that alcohol was a negative force in their life, and because of that, they had a better sense of self-awareness that would prove useful to his research.

While this first study was a great place to start, Jellinek knew he would need to expand his sample size to more accurately portray the issue of alcohol addiction. His follow-up research paper, “Phases of Alcohol Addiction,” was published in 1952, and it expanded on the ideas he developed in his first paper. The paper outlined the stages of alcohol use categorized by drinking patterns and behaviors.

Jellinek started by observing the way alcohol use started in the “pre-alcoholic” stage, which was marked by drinking in a casual, social manner. As alcohol use progressed, he found that his subjects reached a point where they were no longer drinking for social reasons, they were drinking for personal psychological reasons. From there, he found that alcohol use progressed into alcohol dependence and eventually to the point of chronic alcohol use.

His work and studies led to the formation of the “Jellinek Curve,” which outlines the behaviors and symptoms seen during a person’s progression through the stages of alcoholism.

According to Jellinek, the four main stages of alcoholism are:

  1. The Pre-Alcoholic Stage
  2. Early-Stage Alcoholism
  3. The Middle Alcoholic Stage
  4. End-Stage Alcoholism

While some of Jellinek’s conclusions about the ways alcohol use can progress have been disproven, his work did lay the groundwork for the way the medical community understands alcohol use to this day.

Each of these stages is marked by certain behavioral milestones, starting with:

1. The Pre-Alcoholic Stage

This first stage of alcohol use can be the most difficult to identify in yourself and loved ones. This is because the ways alcohol interacts with the body and mind can be different from person to person. The effects of alcohol are a result of its interaction with the parts of the brain that are responsible for releasing “neurotransmitters,” or chemicals that give you energy and tell you to feel happy or content.

As a person starts to drink more and more, their brain starts to get used to alcohol telling it to release these happy chemicals and stops releasing them on its own. This is the basis for physical dependence.

In this first stage, drinking becomes an activity someone does to relax, help them sleep, or make them more comfortable in social situations. Because drinking is a very common element of adult social activity, the pre-alcoholic stage can be difficult to spot as an outsider or within yourself.

People in the pre-alcoholic stage may engage in drinking more often than others, but it’s not always noticeable. You may spot that they always have a drink in their hand at social functions. You may also notice that drinking has become their “go-to” way to unwind after a long day or a difficult week. If it becomes a habit for them to use alcohol as a way to cope with the difficulties of everyday life, this is a good sign they are in the pre-alcoholic stage.

2. Early-Stage Alcoholism

A person is said to progress to the second stage of alcohol use when they start regularly binge drinking and having blackouts. Many times, especially with teens and young adults, this behavior is simply a sign of alcohol experimentation. Other times, it can be a serious sign that a person’s alcohol use is progressing. They may not drink every day, but they drink frequently, and most nights out and social activities involve drinking. When a person regularly drinks to excess, their body and mind start to physically and psychologically adjust, leaving them vulnerable to the progression of alcohol use.

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, that is considered binge drinking. Blackouts 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 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 alcohol use becomes very unhealthy and is a cause for concern.

3. The Middle Alcoholic Stage

When a person has progressed to this stage, their drinking problem starts to become noticeable to friends and loved ones. Some people are good at hiding their alcohol use 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, or their relationships.

Some major signs that a person may have progressed into the middle alcoholic phase is when they start drinking at work, are drunk while driving, or while looking after their children and other loved ones. Because the body and brain have started to become tolerant 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, sweating, shaking, and memory loss are good ways to identify a person in this stage of alcohol use.

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 alcohol use 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 extensive lifestyle changes.

4. End-Stage Alcoholism

When a person enters this phase, the long-term effects of heavy alcohol use 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 totally shift to make alcohol use 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 use 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 as it begins to severely impact a person’s health, relationships, career, finances, and overall mental and emotional wellbeing. 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 that 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 that you’ve become physically dependent on alcohol.

Treatment at East Coast Recovery Center is Here to Help You Reclaim Your Health at Any Stage of Alcoholism

For those suffering from addiction issues, it’s easy to be overcome by feelings of loneliness and isolation. At East Coast Recovery Center, we believe the opposite of addiction is connection. As humans, we are at our best when we feel a genuine connection to our community. Through a sense of community and top-notch healthcare, we’re able to provide treatment for alcoholism that is both effective and compassionate.

It’s important to understand that no matter how bad things have gotten, it’s never too late to connect with a community that cares.

Call East Coast Recovery today at (617) 390-8349 to walk the path with us toward success in recovery.


Which stage of alcoholism is the most difficult to recover from?

When alcohol use has progressed into the fourth “end-stage,” it is very difficult to recover from. At this stage, a person’s whole life may revolve around alcohol use, and it may have already affected their health in serious ways. However, it is never too late to seek professional treatment for alcohol use disorder.

What is the first stage in the development of alcoholism?

The first stage is known as the pre-alcoholic stage. In this stage, a person may drink only in social situations or when they need to relax. Many people do not progress past this stage, but alcohol use can be a very slippery slope and progress quickly.

What is the life expectancy of someone with alcohol use disorder?

According to the National Institutes of Health, people hospitalized with an alcohol use disorder have an average life expectancy of 47-53 years for men and 50-58 years for women.

How long do heavy drinkers live?

The average life expectancy for heavy drinkers is reported to be 24-28 years less than people in the general population. This amounts to a life expectancy of 47-53 years for men and 50-58 years for women.

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