What Are The Stages of Alcoholism?
Alcoholism is not only one of the most rampant causes of addiction with alcohol being the substance that’s abused most globally, but it’s also the most difficult to define. Due to the nature of alcoholism, the disease affects people in different ways and often varies symptomatically, making it hard to quantify.
There’s no outright test a doctor can administer that determines whether or not a person has AUD (alcohol use disorder). Of course, they say you’re 4x more likely to become an alcoholic if either of your parents have a history of alcohol abuse.
However, over the years doctors and healthcare professionals alike have tried hard to create order out of entropy. They’ve tried to identify certain commonalities between alcoholics, and threaded those together to better understand the disease at large. Historically, alcohol substance abuse has been a part of our society since the birth of civilization. Nowadays it kills 2 million people annually (alcohol-related deaths).
We’re at a point now where we can identify that alcoholism doesn’t just exist in extremes.
While the quintessential idea–that of someone homeless, using every dime and dollar for booze, is still a reality, we’ve now understood that alcoholics come in all different forms.
Now we’ve exposed various alcoholics and tried to identify the path in which led them there.
One of the tools used to identify the different stages of alcoholism is the ‘stage paradigm.’ Those who study alcoholism advocate a series of stages that usually coincide with most alcoholics. Unfortunately–again, due to the nature of alcoholism–the stages aren’t always synonymous. There’s the seven stage model, the nine stage model, the five stage model, and most commonly: the four stage model.
In this article we’re going to detail what the four stage model looks like, and try to shed some light on the alcoholic’s natural progression. We want to reinforce that while many alcoholics do indeed follow this path, there are many which don’t.
Then lastly it’s important to note that not everyone agrees on these stages. By in large they’re used to quantify the experience of most alcoholics who have fallen victim to their disease. With that being said, if there is one paradigm that’s most commonly used and accepted, it’s this one.
Stage 1: Social Drinking and Tolerance
This, of course, could begin anywhere. In our society, however, it often starts with college. In environments where kids are encouraged to drink–and the drinking is accepted–the idea of monitoring intake isn’t shared amongst peers. This means that in Stage 1 it’s rare someone will notice an alcoholic. They’re still fully in control of their life (they have their job, responsibilities, and relationships in tact) but they often lose that control when they drink.
Of course this is a statement made explicitly towards blackout drinkers, as the most obvious way to see the signs of an early problem is if–among peers—the opportunity presents itself, the abuser doesn’t know how to stop. There is often a pattern created in their drinking habits, one that is disguised and masked in the presence of all the other ‘social drinkers.’ Unless the drinking problem is serious, it’s rare they’ll become unveiled.
In Stage 1, a tolerance is formed. And we’re not talking about the ability to drink a few more drinks, but creating a strong enough tolerance that a significantly larger volume is required to give the abuser the same drunk. You start creating an alcohol tolerance the first time it enters your body. But due to their propensity to drink to excess, their body will adjust and often that tolerance is noteworthy.
In this early stage, it is rare that the alcoholic has any semblance of a problem. Usually their behavior is encouraged, looked over, or goes unnoticed altogether. Usually, in this stage the disease has not yet begun to detract from their daily life.
Stage 2: Drinking for Normality
This stage occurs once the need to drink spills out from the person’s social life, and becomes part of their routine. It’s often directly attributed as being a coping mechanism. Meaning, drinkers will now seek solace in alcohol to help them with their stress, their state of being, and their general happiness. No longer do they keep their drinking exclusive to outings with friends, but now those two glasses at the end of the night become their main stress reliever. In fact, many alcoholics report that in this phase they couldn’t ever feel truly relaxed without a drink.
It’s not that they’d wake up every morning with a hangover, or even that they’d experience any form of withdrawals, but just that alcohol seemed to make everything better. In this vein, they also drink to improve their happiness (even if they’re happy) and to curb any outside pressures. Unfortunately, once the alcohol is fully integrated into their routine, the feeling of normality is often tied exclusively to it. They accompany themselves with how they are buzzed, and when they’re sober it’s now uncomfortable and insufficient.
In this stage, while some people might take notice out of sheer consistency in the alcoholic’s drinking habits, it’s still not associated with being detrimental to the alcoholic’s life. Their work and relationships don’t suffer and they haven’t fully lost control. In fact, in a lot of ways this could be thought of as the honeymoon phase of a relationship, as drinking seems to make life a bit more easy and beautiful, and the consequences haven’t come knocking on the front door yet.
Stage 3: Solitude and Consequences
In this middle stage, there’s no more hiding it. Those few glasses of wine to curb your stress at night often evolve into a bottle or two. The fact that you’re drinking more means you have a harder hitting hangover, so you drink in the morning to compensate for that. It’s said in this stage that it’s the first time the alcoholic feels health-related issues stemming from drinking. No longer manageable, they drink in higher volumes with less concern for other facets of their life.
Friends and family begin to notice. In Phase 3 relationships begin to wear. Often alcoholics remember a time when it made them uncomfortable to be around their loved ones when they drank. Reason being? They’d caught on and the act of drinking was no longer a social experience they could share, but a cause of worry for those that cared for the alcoholic most.
Now that people have addressed the issue and made their stance clear to the alcoholic, even if only brought about by worry and concern, the alcoholic no longer prefers to have their vice in public or with friends, but alone. This can come from embarrassment, spite, insecurity, and a slew of other things, but once the alcoholic turns inward and begins to hide their drinking, the problem worsens immensely.
Then come the consequences. Usually, for the first time, the alcoholic’s drinking is now creating obstacles and conflicts for their life outside of booze. Commonly, these could be in the form of DUIs. Losing a job due to negligence or working while intoxicated. Ruining friendships or relationships due to excessive blackouts or bouts of extreme emotionality while intoxicated. And becoming altogether undependable.
This phase directly correlates with the alcohol taking control and beginning to seep into other facets of the abuser’s life. Then lastly, this phase usually comes with some form of depression. The alcoholic usually knows they’re an alcoholic, but they’re at a place where it’s too hard to put the bottle down, and this powerlessness causes emotional instability outside of being intoxicated.
We see kickback in the phase, as sometimes an alcoholic will try and create rules for themselves to try and monitor the drinking on their own, without ever giving it up. Sometimes they make a bit of a comeback. Or at least rally enough that it gives those they love hope. But more often than not they’re just prolonging the inevitable.
Stage 4: Health Issues and Complete Loss of Control
Stage 4 of alcoholism is usually directly linked with a deterring health and the consequences doubling. No longer is the alcoholic simply ruining their relationships and life in general, but they’re running their body into the ground. A physical change in appearance is often noted, with a much higher blood pressure and liver issues.
They’re completely dependent on alcohol to the point that they have anxiety if there isn’t alcohol within physical reach. They wake up each morning with a hangover and cravings, and their body physically impedes them if they don’t drink. At this point, most alcoholics know they’re killing their organs, but their loss of control is rooted so deeply in their disease, that they don’t see a way out.
This is the stage right before rock bottom, which is what many attribute as the starting point for recovery. Rock bottom usually happens when an alcoholic feels the full weight of their consequences, senses a physical change that inhibits them daily, and can’t see another end without drinking that they make the decision to seek help.
This stage is most associated with what the quintessential alcoholic is thought of. A person whose inhibitions have been drowned by booze and their entire life is about drinking. All else takes a backseat to their alcohol addiction and they suffer immensely. While Stage 4 can certainly vary in severity from alcoholic to alcoholic, even those that can drink daily and still make it to work on time suffer. Usually in these cases the alcoholic will hold onto one last consistency, but forgo everything else. Even then, often their work performance and presence as a whole suffers.
Being that alcoholism is progressive, it’s this stage that’s most commonly linked with death. Be it an alcohol-related accident (something external, like a drunk driving incident), or internal failure (health issues—most commonly the liver), this is when an alcoholic is most exposed and vulnerable. This, of course, is when they need help most. If Stage 4 continues—the recovery process becomes evermore difficult, and the risk that severe consequences will ensue increases.
Again, we want to drive the point home that these four stages we’ve listed aren’t law when it comes to alcoholism. They’re guidelines created by healthcare professionals that have studied the patterns of alcoholism, and can be applied generally. However, there are other paradigms, and they can be even more applicable.
For instance the seven stage paradigm, another which is widely accepted by professionals, goes as follows:
Abstinence: this is the stage before the user has begun drinking, thus not yet triggering their AUD. The alcoholism is currently dormant.
The Beginning: this is the stage right as the user is first introduced to alcohol. It’s not associated with heavy abuse or even consistent drinking.
High Risk: this is the stage in which the heavy drinker begins to show signs of alcoholism. They make irrational and poor decisions while intoxicated, increase their tolerance, and in some cases frequently blackout while drinking.
Consequences: this is the stage in which the drinker begins to see direct consequences from drinking. These can be DUIs, damaged relationships between friends and family, trouble at work, and the beginning of health complications.
1st stage of alcohol dependency: this occurs when everything begins to take a backseat to alcohol. Not only are they experiencing consequences from their drinking, but now they need it incessantly, and it becomes their main priority.
Middle stage of alcohol dependency: this stage occurs once the consequences of alcoholism are now irreversible. Often this is categorized by lifestyle changes, and it’s in this phase that we see the alcoholic losing control of their life (falling out of relationships completely, losing their job, find themselves in jail or legal trouble, etc.).
Crisis stage of alcohol dependency: this stage is the one most closely attributed with death. Not only does the alcoholic become a risk to themselves, but to everyone around them. Serious health problems and consequences ensue. This is the stage most commonly linked as the gateway to ‘rock bottom.’
As you can deduce from these two different paradigms, they’re not altogether different. There are consistencies threaded throughout each, and it’s these very similarities that healthcare professionals use to try and define the severity of someone’s AUD progression. Be it for you, a loved one, or anyone you see suffering, it’s important to at least know the framework of alcoholism’s progression.
If you’re armed with the knowledge, you could perhaps identify where they’re at in the spectrum, and provide the proper support. The road to recovery varies dependent on the stage they’re in. While we don’t promise it’ll be easy, we promise it’ll be rewarding. Luminance Recovery, a drug treatment center, is here to help. With our holistic approach to addiction recovery, we help clients detox from alcohol and overcome their addiction. Call us today to learn about our different addiction treatments.
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