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What are the Four Stages of Alcoholism?

While many people drink alcohol moderately as part of a generally healthy lifestyle, some struggle to limit their consumption. Over time, heavy, regular alcohol use can lead to alcohol addiction or alcoholism. According to the 2019 National Survey on Drug Use and Health, up to 14.5 million Americans over the age of 12 had an alcohol use disorder.[1]

Alcoholism is a lack of control over your drinking. People with alcoholism are physically dependent on alcohol, meaning their bodies cannot function without it.  Living with untreated alcoholism can put you at risk of severe damage to your physical, emotional, and social health and well-being.

If you or someone you love struggle with alcoholism, you must get treatment as soon as possible to avoid life-threatening complications of the condition. Recognizing the symptoms of alcoholism can help you or your loved one get the help you need to recover and move forward.

Alcoholism doesn’t happen overnight–it tends to happen in stages that get progressively worse. Seeking treatment in the earlier stages of alcoholism can reduce the risk of long-term adverse effects.

Reach out to the caring specialists at Next Step Recovery for more information on getting the treatment and support you need to overcome alcoholism.

What are the Four Stages of Alcoholism?

Generally, alcoholism occurs in four progressive stages. Knowing what happens during each of the four stages of alcoholism may help you identify and treat a problem sooner. Earlier treatment for alcoholism can lead to better, longer-lasting outcomes.

The Pre-Alcoholic Stage

The first stage of alcoholism is sometimes tough to recognize. Some of the behaviors may be subtle, or people may be able to appear to function normally. The pre-alcoholic stage marks the beginning of problematic drinking.

In the pre-alcoholic stage, people may self-medicate with alcohol. Self-medication occurs when someone drinks alcohol or uses other substances to dull or numb physical or emotional pain. In time, drinking may become a person’s only method of coping with their emotions–whenever they face challenging emotions, such as boredom, anxiety, or sadness, they drink.

Drinking alcohol can provide temporary relief from painful emotions, but at a cost. Over time, the effects of heavy or frequent drinking can catch up to you–and they can take you down a path toward alcoholism.

Early-Stage Alcoholism

Early-stage alcoholism is marked by increased tolerance, meaning someone needs to drink more alcohol than they used to to get the same “buzz.” People with early-stage alcoholism may talk or think about drinking a lot. Some drink alone or feel compelled to drink a lot. They may begin to feel out of control of their drinking and often engage in binge drinking.

Signs of problematic drinking may become more apparent at this stage. Binge drinking and alcohol blackouts are common in early-stage alcoholism as people begin to increase the amount they drink.

Middle-Stage Alcoholism

Middle-stage alcoholism has physical and behavioral symptoms. People may have a high tolerance and require a lot of alcohol to feel the desired effects. They may appear sober, even when heavily intoxicated. At this stage, a person meets the criteria for a formal diagnosis of an Alcohol Use Disorder (AUD).

People often develop physical symptoms, including:

  • Rapid weight loss or gain
  • Fatigue
  • Changes to skin
  • Tremors
  • Puffy or red face
  • Sweating
  • Bloating

Alcohol becomes the center of a person’s life at this stage. People often neglect responsibilities and relationships in favor of drinking. People may frequently miss work and other obligations because they are drunk or hungover.

End-Stage Alcoholism

End-stage alcoholism is the last, most severe stage of alcoholism. At this stage, a person’s body has become physically dependent on alcohol. People with end-stage alcoholism experience uncomfortable, sometimes dangerous, withdrawal symptoms if they do not drink. Alcohol withdrawal symptoms may include:[2]

  • Tremors
  • Sweating
  • Nausea
  • Insomnia
  • Anxiety
  • Hallucinations
  • Seizures

People with end-stage alcoholism can’t work, care for children, or even care for themselves because drinking is their top priority and their health is beginning to decline. Depression, paranoia, and isolation are common. People with end-stage alcoholism are at risk of becoming socially isolated, being the victim of a crime, losing relationships, injuring themselves and others, and many other serious consequences.

Chronic alcohol use can lead to severe health complications, including:[3]

  • Brain damage
  • Cirrhosis of the liver
  • Alcoholic hepatitis
  • Liver disease or failure
  • Pancreatitis
  • Cancer of the stomach, mouth, throat, breast, and colon
  • Pneumonia
  • Esophageal damage
  • Heart failure

People with end-stage alcoholism require intensive medical intervention and treatment for alcoholism as soon as possible.

Treatment for Alcoholism

Alcoholism progresses and can become life-threatening without treatment.

Alcoholism treatment occurs in stages, often beginning with a supervised detox program. During detox, people receive treatment and support to help them safely withdraw from alcohol. Detox treatments include:

  • Medications
  • Emotional support
  • Supervision
  • Medical care
  • Holistic therapies like massage, nutrition support, and exercise

After a complete detox, people must participate in a comprehensive treatment program that uses a combination of evidence-based and holistic therapies to support recovery. Treatments include:

  • Individual counseling
  • Group therapy
  • Family therapy
  • Medications
  • Medical and mental health treatment
  • Education
  • Holistic therapies to support overall wellness

Alcoholism can never be cured, only managed. People must develop and follow an aftercare plan to keep them engaged and active in recovery after treatment ends. This may include attending 12-step meetings, finding a support group, attending other types of treatment, or living in a sober community after completing treatment.

Learn More About Recognizing the Stages of Alcoholism at Next Step Recovery

If you struggle with alcoholism or problematic drinking, you are not alone. Contact the specialists at Next Step Recovery today to learn about your alcohol addiction treatment options. Our admission specialists can help you find the alcohol rehab program you need to begin your recovery journey.


  1. National Institute on Alcohol Abuse and Alcoholism (NIAAA): Alcohol Facts and Statistics, Retrieved Feb 2023 from
  2. National Library of Medicine: Introduction to alcohol withdrawal, Retrieved Feb 2023 from
  3. Centers for Disease Control and Prevention (CDC): Alcohol Use and Your Health, Retrieved Feb 2023 from

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