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Stages of Alcoholism: Pre, Early, Middle & End

Last Updated: November 3, 2023

Editorial Policy | Research Policy

If you have alcoholism, you aren’t alone. Nearly 14.5 million Americans face alcohol use disorder and struggle with harmful impacts on their lives.

Alcoholism progresses through stages that identify the severity of one’s addiction. These stages shed light on the individual's problems and the support they need. Effective treatment can be lifesaving, and the earlier you receive help, the more likely you are to have a successful recovery and prevent alcoholism from progressing. 

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What Is Alcohol Use Disorder?

Alcohol use disorder is a chronic medical condition that requires intentional and supportive treatment. While much stigma surrounds addiction and mental health concerns, alcoholism is not a moral failing. 

Alcohol use disorder involves heavy or frequent drinking, leading to serious health and personal life consequences. These may include accidents, disease, death, criminal charges, housing and job instability and loss of relationships. 

The 7 Stages of Alcoholism

Each person is unique, as is their experience with alcoholism. The condition ranges from mild to severe and differs in how quickly it develops. For one person, it may develop over years, while another may rapidly enter addiction. There is no specific timeline for a person to move through the stages of alcoholism. 

Understanding the stages of alcoholism can help when personalizing a treatment plan for lasting recovery. Receiving treatment in the early stages can prevent harmful consequences and death. 

Stage 1: Abstinence

Addiction can begin forming before someone even drinks. This takes place when you’re predisposed to addiction. You may have a family history of alcoholism. This also includes having similar beliefs and thoughts to those addicted to substances.

Example: Chris’ mother and grandfather usually drank to relax and cope with stress. He thinks having a few drinks would help him calm down after work or better handle social situations. 

Stage 2: Initial Use

During this stage, someone may try alcohol for the first time or drink occasionally. They may even drink heavily once a year or so, but their drinking has not become an issue or dependence. 

Example: Chris periodically drinks when he goes out with his friends and usually gets drunk at the company holiday party.

Stage 3: High Risk Use

At this point, a person’s alcohol consumption increases, and they begin making mistakes or harmful decisions while under the influence. They start forming a drinking pattern that is dangerous to themselves and those around them. 

Example: There have been multiple occasions where Chris has driven home under the influence. He has also started arriving late to work in the morning after a night of drinking.

Stage 4: Problematic Use

Those with problematic use begin facing issues directly connected to alcohol use. Their health is negatively impacted, or they face legal concerns. At this stage, their loved ones will likely become concerned about their alcohol use and well-being. 

Example: Chris received a DUI and has noticed that he’s having difficulty concentrating at work.

Stage 5: Early Stage of Dependence

When people enter early dependence, they often struggle with regular drinking problems. Their work or relationships suffer, but they continue to drink despite negative consequences because of a growing alcohol dependence.

Example: Chris is regularly late to work, and his performance suffers. He and his partner have started arguing about his drinking, but he continues drinking regularly. He noticed that he gets irritable when he doesn’t drink.

Stage 6: Middle Stage of Dependence

By the middle stage of dependence, a person’s problems caused by alcohol are piling up. Multiple mistakes and issues lead to bigger consequences affecting their well-being and livelihood. For example, drinking may have caused them to make several mistakes at work, like coming in late or missing days. Their employer may then decide to fire them. Or, they have caused frequent strife and arguments in their relationships due to their behaviors and drinking, leading to those relationships ending. 

Example: Chris’ boss fired him last month after he was written up for the third time. Frequently drinking has made it difficult to obtain a new job, leading to financial instability. His partner broke up with him, stating they couldn’t watch him “drink himself to death.”

Stage 7: End Stage of Dependence

When a person reaches this stage, they’re at a crisis point. They see they have a problem, as does everyone else around them. They face severe alcohol-related health consequences, such as liver failure. Folks who reach end-stage dependence are at a high risk of alcohol-related death if they don’t receive treatment. 

Example: Chris ended up in the hospital after an alcohol-related car crash. While in the ER to assess his injuries, the doctor found signs of heart disease, likely due to long-term heavy drinking. 

Treatment Options for Alcoholism

No matter where you are in the stages of alcoholism, you can receive lifesaving treatment. The earlier you begin treatment, the more significant health, personal and relationship consequences you can prevent. 

Your treatment plan will likely include a combination of approaches and support. Talk to your doctor or treatment team about the treatment that will work best for you. Common options include:

  • Individual therapy
  • Family therapy
  • Group therapy
  • Psychoeducation (e.g., build coping skills)
  • Medication (e.g., naltrexone and acamprosate)
  • Support groups (e.g., Alcoholics Anonymous (AA))

These may be provided through residential rehab, partial hospitalization programs (PHPs), intensive outpatient programs (IOPs) or outpatient or aftercare services. 

Evidence-Based Alcohol Addiction Treatment in Missouri

If you or a loved one are searching for support regarding alcohol use, we’re here to help. Our team at The Recovery Village Kansas City offers trauma-informed residential rehab, a partial hospitalization program (PHP) and an intensive outpatient program (IOP). We’ll meet you where you are and provide intentional support to help you on your recovery journey. Reach out to one of our Recovery Advocates today, and they’ll guide you through the admission process.

Sources

Cleveland Clinic. “Alcohol Use Disorder.” June 2, 2021. Accessed August 11, 2023. 

Substance Abuse and Mental Health Services Administration (US), Office of the Surgeon General (US). “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. CHAPTER 4, Early Intervention, Treatment, and Management of Substance Use Disorders.” US Department of Health and Human Services, November 2016. Accessed August 11, 2023.