Think of alcoholism as a progression of events and circumstances. Are there multiple Alcoholism Stages in the development of the disease, or is alcoholism different for everybody?
Depending on what camp you’re in, there are three, four, or even five stages to this dreadful, chronic disease.
Like other diseases, alcoholism has its own symptoms, causes and treatments, but unlike other diseases, alcoholism also has a psychological and spiritual component that need also to be treated.
People want to know “Where am I at?”, "What stage of alcoholism am I in", when asking about the stages of the disease, so this section of the site is not so much about the medical progression of the disease, but about its personal impact and impact on the family. There are a couple of ways to look at a stage of the disease; as the one addicted and secondly, as a family member or concerned party.
For the alcoholic, the interpretation of where one stage ends and the next stage begins might be entirely different from that of an observer. Most people fight the idea of something being wrong. They believe they can “handle it,” or “cut back,” or even stop altogether. Some people even enter into treatment so they can regain control of their life and still enjoy a drink. They deny the Alcoholism Stages and ignore the transitions that usually occur.
Alcoholism Stages: Denial Stage 1
For some, drinking is an enjoyable and social activity. Whether it’s a cocktail in a stylish corporate watering hole in the downtown business district, or beers at the local sports bar, people gather for a few drinks and enjoy the crowd. However, for some, the drinks go beyond social contact, becoming not so much about social contact, but need. But if you were to ask them if they think they’ve had enough, the answer would be “no” and most likely followed by “There’s nothing wrong,” or “I don’t have a problem.” This is characteristic of the first of the Alcoholism Stages.
Denial is a powerful enemy to well being. The problem may be obvious to others, but the one in the clutches of early alcoholism is either oblivious, or makes a conscious choice to ignore that is clearly before him/her. In the early stage of the disease, the person has enjoyed the effect of alcohol and desires to repeat the experience. If one drink is good, then two must be better. However, as the disease starts to progress, it will take greater amounts of the drug alcohol to achieve the same feeling. In this stage of the disease, it is often difficult to tell an alcoholic from a heavy drinker.
People build up a tolerance to alcohol and its effects, which is why people who progress to the other stages of the disease can drink their buddies under the table and may not even appear to be tipsy. They may even have a couple of drinks before going to a party or social event, just to make sure they can get a buzz without being too obvious about it. That leads to the next stage.
Alcoholism Stages: The Cover Up Stage 2
Because people will develop a tolerance to alcohol, and because it will take more and more alcohol to achieve the desired effect, what used to be a couple of drinks after work turns into a drink at lunch as well. Drinking is no longer just a way to get a buzz and have a pleasurable experience, it becomes away to self-medicate and numb the pain.
As the disease progresses, a person might start drinking earlier in the day. Part of American culture is the proverbial “two martini lunch” which is sort of a twisted badge of courage, so to speak, as if being able to down alcohol at lunch makes one more of a player in the business world. The real problem is that people will drink during the day because they have to. It’s not about some psychological relief, or a way to reduce stress, it’s about dependence. People slipping into this middle stage of the disease will experience cravings for alcohol.
When people “need” a drink, rather than merely wanting to enjoy a drink, it’s a sign of dependence. People may not perceive a loss of control, but they may see that the one losing control needs to “cut back.” Husbands and wives, children, people at work all might notice that something is wrong. The drinker, who is still in denial, might make efforts to cover up his/her increasing habit. They may sneak into the washroom and have a drink, or in some other way cover up their need for alcohol. This is characteristic of the second of the Alcoholism Stages.
There may also be some physical side effects that go beyond merely having a hangover after a party. That hangover becomes a regular occurrence. As the tolerance to alcohol increases, the quantity of alcohol consumed may cause blackouts. People develop the “shakes” in the morning, hand tremors that others notice. They need a drink to calm down. Other health issues might arise at this second stage, such as stomach disorders. Blood pressure problems, etc.
As the disease progresses into this stage, we begin to see just how cruel alcoholism is, as the person with the problem denies it and covers up, and may even turn on those who are trying to help. It’s their fault that the alcoholic has problems. They may agree to cut back just to get the other person to shut up about it, but they can’t. The disease has crept forward, beyond the point of their ability to control it.
Alcoholism Stages: You’re Wrong, I’m Right Stage 3
My friend Chaplain Dwayne Olson states, “We use things, people, ideas, additively for our own pleasure.” When I first heard that I scratched my head and thought nothing of it. However, as I pondered its message, I soon realized that the operative word at the end of the statement was “additively.” Everything feeds the addiction. The alcoholic is losing control at this stage and alcohol becomes the center of his/her life.
What started out as the desire to have a couple of drinks, turns into several beyond that limit, mainly because the individual cannot stop drinking. By this time, the addicted person has probably had some warnings from family and friends that the drinking has gotten in the way. People miss work, or even begin to have some health problems directly linked to alcohol consumption.
People run into legal problems here, like DUI. People go to bars, get drunk, get into fights and maybe even commit felonies. By this stage, the alcohol is in control, not the person. He/she needs a drink in the morning or a drink in the afternoon, just to feel “normal.” This is characteristic of the third of the Alcoholism Stages.
If you are at this stage, trying just to get by, your view of your behavior is doing what is necessary. To others, you have become manipulative, self-centered, out of control and are at risk of throwing your life away. The people in your life want you to get treatment, but you say that isn’t necessary. Maybe you don’t eat, or take care of yourself, but you push all that aside to get your drink.
Alcoholism Stages: Out of Control Stage 4
In the previous stages of the disease of alcoholism people are able to function in their every day life. They are struggling with losing control over their drinking, but they can usually hold down a job, and even appear to be perfectly healthy to someone who does not know them well. However, as the disease of alcoholism progresses, the need for alcohol trumps all other desires or needs in life. The person has completely lost control.
The person may have been a “problem drinker” or may have had a couple too many from time to time, or may have been able to mask his/her disease by putting on an act, but as the disease tightens its grip in the neck of the alcoholic, any semblance of control is gone. They drink throughout the day, needing the alcohol to function. This is characteristic of the fourth of the Alcoholism Stages.
In earlier stages, the alcoholic may have had a small measure of control, a choice, but that choice is now wiped away and replaced with dependence. Chaplain Dwayne says “One drink is too many and Lake Michigan isn’t enough.” The statement illustrates the predicament the alcoholic finds him/herself in at the end stage of the disease. They can’t stop drinking. That little checkpoint in the brain that indicates enough is no longer functional. People go on benders, drinking uncontrollably, sometimes for days. They never reach that point of satisfaction they had when they first experienced that pleasurable buzz when they first began.
After several drinks, people may pass out on the couch. This is not necessarily true of the alcoholic who has slipped into the end stage of the disease. They continue to drink and “function” only they have to recollection if it. These are blackouts. They may not remember going home, or having an argument with a friend, or sideswiping parked cars or even running over and killing a pedestrian. They cannot control their behavior and they lost any possible control with the first drink. These blackouts can occur during earlier stages of the disease, but are more common the longer the disease progresses.
If denied alcohol, the alcoholic in this stage will display serious withdrawal symptoms. The shakes they may have experienced earlier in the progression of the disease are now more severe. He/she may experience hallucinations along with the convulsions, known as the DT’s (delirium tremors). When people are at this point, withdrawal can be fatal, and therefore medical intervention is necessary. Even with the medical intervention, the DTs are an extremely difficult experience for the alcoholic. Alcohol withdrawal is particularly nasty and ugly to witness.
Even after having the DTs, and needing a hospital stay to recover from the withdrawal, an alcoholic is very likely to go back to their drinking habit. They may nearly have killed themselves with the toxic drug, but they are still addicted. Even if they are “dry” they are still a “dry drunk.” Treatment is necessary to place any kind of management component in their lives. They promise never to drink again, but without treatment, in most cases, they will surely start the cycle all over again, only this time going from stage one to stage four will be rapid. Left to their own devices, the alcoholics got into terrible, life-threatening trouble. Their own devices will not likely sustain them moving forward.
Alcoholism Stages: Deterioration Stage 5
Alcohol, unlike other drugs, affects all areas of the body. It’s not just the brain, or the lungs, but also the heart, liver, kidneys, intestines, etc. Alcohol is extremely toxic, especially at this point, where a person drinks heavily and constantly. We mentioned self-medicating earlier, which speaks to a psychological issue, but the damage done by the alcohol effects the organs as well, so the alcoholic at this stage may suffer from many conditions. Think of alcohol as the common link. In speaking to the patient care manager of a medical respiratory intensive care unit at a large urban hospital, it was shared that in 50 to 75 percent of all cases that come through that unit, alcohol is a major player. This is characteristic of the fifth and final of the Alcoholism Stages.
Still, in this serious stage, the alcoholic will continue to drink, unless prevented from doing so. While it seems “crazy” to some that a person would continue down this destructive path, by the time they reach this point, they are completely out of control, have no ability to reason through the problem and they probably are delusional. In earlier stages, they are in denial, but in this stage, they are not capable of understanding what is happening to them. They crave the drug and they will do anything to get a drink. The addiction is in TOTAL control.
Denial, once again, is a strong enemy. Had it not been for denial, the progression of the disease might have stopped long before the person’s body starts to shut down or fall apart. Any spiritual or psychological issues might have been addressed. Problems in life might have been solved. Sadly, even with intensive and expert medical intervention, if a person has been down the path for too long, the alcohol may win the war and kill the person.
Treatment and Recovery
At any point in the progression of the disease, treatment and recovery are possible. Obviously, if a person can get through the denial of the problem, the process of returning to a healthy life is made smoother. The earlier the better, before irreparable damage is done to the body. In treatment there are medical and educational pieces, psychological pieces and people can learn management tools to help them cope. In recovery, alcoholics are receiving the benefit of support, counseling, guidance and encouragement.
Recovery is a process and a lifestyle shift. There are many paths to take in recovery, but the important factor, no matter what path is chosen, is to allow the process to move forward.
Common question about alcoholism:
Brother an alcoholic?
How can i help my brother, i have an older brother whom i very close
too. He has drunk all his life but has got worse over the last few
Has had rehab once, he drinks a litre of vodka a day, he shuts himself away in his room as his marriage has broken up and doesn't come out for days, he has lost a huge amount of weight.
I cry constantly as to see him is so pityfull, I've tried all sorts to help him but he just says i am what i am.
He used to be a big strong man and worked hard on the engines in the biceps, now he is a skeleton, he would walk on hot coals for me, and now i cannot do nothing to help him. I did get a nurse to visit but he got angry and told him to leave, what else is there?
I know he has got to want to do it but he doesn't want to?
Hard to Watch
by: Ned Wicker
Alcoholism, as it advances, is suicide by the installment plan. It's hard to love someone and watch them waste away, and frustrating to know that the alcoholic doesn't want treatment.
Groups like Al-Anon have been helping family members for years, so I would encourage you to seek them out. The web address is:
and you can find a meeting. They are a wonderful source for help and support. You can try to talk to your brother, but he won't listen.
Give Al-Anon a call.