Alcoholism doesn’t happen overnight. The development of alcohol addiction may not have appeared at first. Gradually, however, alcohol addiction may develop, resulting in stages that escalate the drinking problem until the addiction takes over all aspects of life. We’re going to take a look at what alcoholism is, what the stages of alcoholism are, and what kinds of effects alcohol use can have on physical and psychological well-being.
You may have heard of alcoholism referred to as alcohol use disorder. This term, abbreviated AUD, refers to a range of drinking disorders that cause harm to the body, including alcohol abuse and alcoholism.1 These two conditions were previously diagnosed separately, but in 2013, the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) by the American Psychiatric Association merged alcohol abuse and alcohol dependence into the one diagnosis of alcohol use disorder.2
AUD is classified by severity levels: mild, moderate, and severe. These are not the same as the stages of alcoholism. According to the DSM-5, a person must have a minimum of 2 out of 11 symptoms to be diagnosed with AUD. The symptoms must be present within 12 months. The severity levels of AUD and the number of symptoms required to be diagnosed at each level are:
The severe diagnosis level is equivalent to alcohol dependence, also called alcoholism.
These are the symptoms used to diagnose AUD according to the DSM-5:
“In the past year, have you:
The diagnostic criteria above list many of the signs of alcoholism. The more signs a person has, the more likely that they suffer from an alcohol use disorder. Also, the following signs and symptoms may indicate that a person has severe AUD or alcoholism:6
Research has shown that genetics account for about half of the risk for developing an AUD. Environmental factors, as well as the connection between genetics and environment, account for the other half.3 A 2013 article reported that two genes that affect the metabolism of alcohol by the body have the strongest impact on the risk for AUD.4 Several other genes also impact AUD or factors related to the risk for AUD. Researchers have not found an “alcoholism gene” however.
According to the 2019 National Survey on Drug Use and Health (NSDUH), 14.1 million adults age 18 and older had AUD. This accounts for about 5.6% of all adults in the United States. Of those with AUD, 8.9 million were men and 5.2 million were women.
The 2018 NSDUH found that 7.9% of adults with AUD received treatment. Also, the 2019 survey estimated that 414,000 teenagers age 12 to 17 had AUD, including 163,000 males and 251,000 females. The overall number accounts for about 1.7% of this age group in the United States.5
In this first stage of alcoholism, the transition from a social drinker to an emotional drinker begins. Drinking to relieve stress and to cover up or avoid emotions rather than facing a stressful situation may occur more frequently. Drinking alone and out of boredom may also begin. While in the pre-alcoholic stage, drinking more alcohol more often starts.
Once in the early stage of alcoholism, the increase of alcohol continues more frequently. At this stage its possible to begin to feel the health effects of increased alcohol intake, including depression, anxiety, and insomnia. Other problems that are associated with drinking may begin at this stage, including:
The middle stage of alcoholism is the start of alcohol dependence. Drinking becomes more important than other activities, and the effects of drinking may be experienced in a more direct and damaging way. Missing work due to drinking or starting to drink at work may occur, leading to job loss. Drinking may also interfere with family and social obligations. There also may be some acceptance of the problem and attempts to quit alone, often unsuccessfully.
At this stage of alcoholism, physical and psychological dependence on alcohol has occurred. Drinking occurring all day and, in all situations, even if it is not appropriate appears in this stage. During this stage, alcohol has taken a toll on life and health. People at this stage are unable to quit drinking without experiencing significant withdrawal symptoms, including seizures, severe depression, and panic attacks. The liver begins to show signs of advancing disease and the abdomen may become bloated and hard in the area of the liver. Continued drinking at this stage will lead to severe health problems and possible death.
During any of the above stages, alcoholism treatment can begin to enter the recovery stage. This stage is usually possible with help from medical professionals and either an inpatient or outpatient treatment program. Once entering a program and completing the detoxification process, the recovery stage begins. Since the risk of relapse is very high, the recovery stage is considered to last the rest of your life.
People who have AUDs for long periods of time run the risk of developing some significantly damaging long term effects. These include:
Called “the DTs”, delirium tremens is a severe form of alcohol withdrawal that can occur when someone in the middle or late stages of alcoholism stops drinking. The symptoms of delirium tremens are severe and require medical management. These symptoms include:
Wernicke’s Encephalopathy: This is a severe, short-term condition that confuses, impairs muscle coordination, and paralyzes the nerves that move the eyes
Korsakoff’s Psychosis: This is a chronic condition that involves memory and learning problems. People with this condition have significant short term and milder long- term memory problems, difficulty with coordination, and trouble walking
While in any of the above stages of alcoholism, recovery can happen with treatment. Effective treatment programs are offered on either an inpatient or outpatient basis, depending on the severity of the condition. Treatment usually begins with medically supervised detoxification, or “detox”, during which alcohol is removed from the body. Following detox, treatment may include:
Several medications may be used during the treatment of AUD to help reduce cravings for alcohol or to create an aversion to alcohol. The medications currently approved for use during treatment for alcoholism in the United States are:
Disulfiram – also known as Antabuse®, this drug produces increased sensitivity to alcohol in the body. Adverse symptoms such as headaches and nausea result when a person drinks alcohol
Acamprosate – used during detoxification, this drug stabilizes the chemical signals in the brain that are normally disrupted by withdrawal symptoms
Naltrexone – this anti-opioid drug helps to reduce cravings for alcohol
Addressing the root causes of alcoholism is very important in helping to make sure that relapse doesn’t occur after treatment is completed. Behavioral treatments may include:
Cognitive Behavioral Therapy – counseling that helps change the behaviors associated with drinking
Marital and Family Counseling – therapy that involves family members and helps to repair relationships and family dynamics affected by alcohol use
Motivational Enhancement Therapy – builds self-confidence and motivation to change drinking habits
People who struggle with alcohol use often benefit from the support of others who have been through the same thing. Support groups and 12 step programs such as Alcoholics Anonymous help provide encouragement and accountability to stay sober.
The later the stage of alcohol use, the longer treatment will take. However, even being in the late stages of alcoholism means you can recover from alcohol addiction. If you or someone you love is struggling with alcoholism, encourage them to seek help as soon as possible.