The steps to addiction: stages of alcoholism

Understanding the progression of alcoholism is important so you’re able to recognise the early signs and take action before it gets worse.  

The journey from casual drinker to end-stage alcoholism is one that’s complex and unique to each person. Here, we discuss each stage of alcoholism, highlighting the pathway people take as their drinking progressively gets worse. 

What are the stages of alcoholism? 

The progression of alcoholism is often divided into distinct stages, and each stage is characterised by specific patterns of behaviour and physical symptoms. Studying this progression can help you to understand how casual drinking can evolve into a severe alcohol dependency. By understanding these stages, inidividuals and their loved ones can identify signs early on, empowering them to make informed decisions about getting the help they need.  

The stages of alcoholism were first introduced by researcher, Elvin Morton Jellinek. Jellinek was a significant figure in the realm of addiction studies, and pioneered research into the progression and phases of alcoholism. His four theoretical stages of alcohol addiction provide a structured understanding of the deepening severity of the disease. This offers professionals and people affected by drinking problems a framework to understand the journey of an alcoholic. 

Here's a brief overview of the stages he initially outlined: 

Stage 1 - pre-alcoholic (binge drinking/social drinking) 

In this initial phase, people might engage in social or binge drinking. It might appear harmless at first, but it's at this stage where the foundation of an unhealthy relationship with alcohol might start. Drinking can sometimes become a way for people to relieve stress or escape challenges, which can soon turn into a problematic pattern. 

Even at this early stage, if you find yourself relying on alcohol to manage stress, emotions or social situations, it might be useful for you to discuss your drinking habits with a professional or someone close to you who you trust. Early intervention can stop your drinking from progressing into more severe stages. 

Key signs of stage 1: 

• Drinking socially but in larger quantities than you intended 
• Using alcohol as a stress reliever or mood enhancer 
• Occasional overindulgence, leading to hangovers 
• Justifying excessive drinking during social events 

Potential consequences 

• Physical health: occasional hangovers, minor digestive problems, early signs of alcohol tolerance, disturbed sleep patterns, and potential weight gain due to excessive calorie intake from alcohol 

• Emotional wellbeing: mood swings the day after drinking, feelings of guilt or regret post-drinking, and increased stress or anxiety 
• Social and professional: minor lapses in judgement, leading to strained friendships, underperformance or absences from work, and potential risky behaviours such as drink driving 
• Financial: increased spending on alcoholic beverages, leading to some financial difficulties. This may be especially the case if cutbacks are made in other areas of your life to accommodate more spending on alcohol 

Stage 2 - early stages of alcohol abuse (prodromal) 

Often termed the 'prodromal' phase, this stage is when people start to drink more often, which can lead to some dangerous consequences. You might experience occasional memory blackouts as a result of your drinking, and you might find yourself drinking on your own or in secret. Over time, you might rely on alcohol more and more in order to navigate the complexities of your daily life, signalling that you’ve developed a dependency on alcohol. 

If you notice an increase in your drinking frequency, secretive drinking or memory lapses, it's a sign that the situation might be escalating. This is a crucial period, where getting help can significantly alter the course of your alcohol dependency. 

Key signs of stage 2: 

• Frequent memory lapses or 'blackouts' after drinking 
• A noticeable increase in alcohol tolerance 
• Drinking at unusual times, such as the morning 
• Hiding drinking habits from others 
• Feeling guilty about drinking behaviour 

Potential consequences: 

• Physical health: regular severe hangovers, onset of liver problems, weakened immune system leading to frequent illnesses, and insomnia 
• Emotional wellbeing: growing feelings of shame or guilt, low self-esteem, increased irritability, and heightened defensiveness when it comes to your drinking habits 
• Social and professional: strained personal relationships due to unexplained absences or erratic behaviour, criticism from colleagues or superiors at work, and decreased professional output 
• Financial: increased spending on alcohol, perhaps even at the cost of essential daily items, leading to mounting debts 

Stage 3 - middle stage (quite serious problem drinking) 

At this point, alcohol consumption starts to become an obvious problem. You might start drinking early in the day and try to hide your drinking from family and friends. Physical symptoms such as nausea, sweating and tremors may become apparent, especially if you haven’t had a drink. 

Daily or frequent consumption of alcohol, neglecting your personal and professional responsibilities, and visible signs of intoxication are clear indicators of a growing drinking problem. It's essential that you get help at this stage before the situation worsens. 

Key signs of stage 3: 

• Neglecting personal and professional responsibilities 
• Physical symptoms, such as shaking, when you haven’t had a drink 
• Increased secrecy or lying about your drinking 
• Failed attempts to reduce or stop drinking 
• Experiencing mood swings and irritability 

Potential consequences: 

• Physical health: pronounced liver issues (including fatty liver), digestive problems, vitamin deficiencies leading to skin and dental issues, weakened heart muscles and potential nerve damage 
• Emotional wellbeing: severe anxiety and depression, potential suicidal ideation, feelings of hopelessness and increased aggression 
• Social and professional: loss or change of employment, damaged relationships beyond repair, alienation from family and friends 
• Financial: serious financial problems which may be because of job loss, increased spending on alcohol, or both

Stage 4 – end stage alcoholism/fully developed alcoholism 

This stage represents the most acute and damaging phase of alcoholism. Your health may decline rapidly, as your essential organs become compromised. Drinking now becomes a relentless necessity, done to stave off severe withdrawal symptoms. You may experience a pronounced loss of control over your drinking habits, meaning that you’re completely dependent on alcohol. 

By this stage, the physical, emotional and social consequences of alcoholism are severe, and it’s crucial that you get immediate support. Though recovery is still possible, prolonged alcoholism can affect your health in the long-term.  

Key signs of stage 4: 

• Drinking non-stop throughout the day 
• Severe withdrawal symptoms, including tremors, hallucinations and seizures 
• A complete loss of control over your drinking habits 
• Neglecting your personal hygiene and nutrition 
• Isolating yourself from family and friends so you can indulge in drinking 

Potential consequences: 

• Physical health: critical damage to vital organs, including cirrhosis of the liver, brain damage leading to cognitive impairments, and increased risk of cancer 
• Emotional wellbeing: paranoia, hallucinations and severe mental health issues like depression and anxiety disorders 
• Social and professional: complete isolation from other people, estrangement from close family members, potential homelessness 
• Financial: complete financial destitution, dependency on social services or charities, and potential loss of assets 

Making a stage 5: recovery  

Thankfully, there are many effective treatments for alcohol addiction. This means that anyone who feels like they’re on the path to addiction in one of these four stages can create a whole new fifth stage – recovery.  

If any of the information listed in this article sounds familiar to you, or for a loved one, know that help and support is available and that recovery is within your reach. As a first step, speak to your GP for some initial guidance. They’ll be able to assess your symptoms, discuss your drinking habits with you and outline next steps for support. You could also consider private treatment for alcohol addiction with Priory. We provide world class treatment for addiction throughout our network of UK rehab centres. 

Use the information below to get in touch with Priory’s team and book a free, no-obligation addiction assessment.