Stages of Alcoholism: Early, Chronic, and End Stage

3 min read · 5 sections
The term “alcoholism” is commonly used in American society, but it is a nonclinical descriptor. Unlike laypersons, researchers, doctors, therapists, and a host of other professionals require a consensus on what constitutes the different levels of alcohol use. The Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5), a publication of the American Psychiatric Association, provides professionals in the mental health field with an indispensable diagnostic tool that helps them to identify the various mental health disorders, including alcohol use disorder, the clinical term for alcohol addiction.1 Stages of alcohol use disorder include the early stage, chronic stage, and end stages where individuals progress from occasional binges to daily drinking and then addiction.

What Is Alcohol Use Disorder?

According to the 2022 National Survey on Drug Use and Health, approximately 29.5 million people, aged 12 or older, had a diagnosable alcohol use disorder.1 In 2022, more men than women had an alcohol use disorder—almost 17.4 million men compared to 12.2 million women. Additionally, 753,0000 adolescents—aged 12-17—had an alcohol use disorder that year.2

No two individuals who experience alcohol misuse or addiction are the same; however, the DSM-5 provides clinicians with a set of 11 criteria they use to diagnose an alcohol use disorder (AUD) as well as the severity of it. A physician may diagnose a person with a mild AUD if they meet 2-3 of the 11 criteria (or signs and symptoms) within a 12-month period, 4-5 indicates a moderate AUD, and 6 or more denotes a severe AUD.3

Think you might have a problem? Take our short (it takes less than 5 minutes) questionnaire based on the DSM-5 criteria to assess the severity of your alcohol use.

Chronic alcohol use doesn’t always lead to addiction. Tolerance develops when the same amount of alcohol no longer produces the same effects.

Dependence occurs when the body becomes so used to having alcohol present that without it, potentially dangerous withdrawal symptoms—including anxiety, confusion, shakes or tremors, racing heart, nausea, vomiting, and/or sleeplessness.4,5

Experiencing tolerance and dependence can be signs of an alcohol use disorder, which is a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse consequences.3,5,6

But addiction is so much more than a physical disease. It impacts and causes changes in the brain—some of which can be lasting.5 The psychological component of addiction does not refer to the effects alcohol has on one’s mental state, such as disordered thinking. Rather, it refers to how the person’s thoughts and behaviors become focused on obtaining, consuming, and recovering from alcohol use even to the exclusion of important responsibilities.7

Early Alcohol Misuse

In terms of the DSM-5, individuals who begin drinking could display 0-2 of the 11 criteria mentioned above. The difficulty is that one never knows if social or occasional drinking will lead to the development of an alcohol use disorder. In the early phases of alcohol use, a person experiences the rewarding effects of alcohol, such as euphoria, stress reduction, and social interaction ease. However, misuse places them at risk for experiencing physical health problems, mental health issues, and social problems.8,9

Repeated activation of the brain’s reward system, which is responsible for these feelings of euphoria, less stress, and lowered inhibitions, reinforces alcohol drinking behaviors and increases the likelihood of repeated consumption.8

Drinking in this phase typically takes place in a social setting. Repeated alcohol consumption can also lead to habit formation. For instance, binge drinking can increase an individual’s risk of developing alcohol use disorder. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), binge drinking occurs when, within 2 hours, a person reaches a blood alcohol concentration of 0.08% or 0.08 grams per deciliter or greater. For women, depending on body weight, this usually happens after the consumption of 4 or more drinks; and in men, 5 or more drinks drinks in 2 hours. However, many binge drinkers exceed the 4 or 5 drink mark and experience higher BACs as well as acute harms, such as blackouts and overdose.10

Not everyone who participates in patterns of binge drinking progress to alcohol dependence or addiction. However, those who do may have environmental or genetic factors that increase their overall risk of alcohol misuse and addiction.11 For instance, research suggests that exposure to adverse early life experiences, learned behaviors combined with brain changes, and psychiatric factors, some of which may have a genetic component, may also increase an individual’s risk of alcohol misuse and addiction.12-17

Environmental and genetic factors aside, any excessive drinking can put an individual at risk for developing an alcohol use disorder. Women, who consume 8 or more alcoholic beverages in a week, are considered at risk. Men, due to their physiological differences from women, are considered to be at risk if they partake in 15 or more drinks per week.18

Problematic Alcohol Use

When a person has become physiologically dependent on alcohol and they suddenly stop drinking or drastically reduce their intake, withdrawal symptoms may surface. As previously mentioned, these effects might include sweating, headaches, anxiety, tremors or shakes, sleep disturbances, nausea and vomiting, heart palpitations, increased blood pressure or heart rate, hyperthermia, and hallucinations.19-21 These symptoms can be extremely distressing and uncomfortable, and it’s not uncommon for individuals to return to drinking to relieve their discomfort, which is why detoxing at home or quitting drinking cold turkey isn’t recommended.3,8

Withdrawal symptoms vary depending on how much, how often, and how long alcohol was consumed, but medically supervised detox may be advised.20 In rare cases, alcohol withdrawal can present heightened risks and even lead to death.19 Therefore, it’s best to seek advice from a primary care physician or addiction treatment specialist.

Severe Alcohol Use Disorder

Meeting 6 or more of the criteria outlined in the DSM-5 for an alcohol use disorder indicates the need for treatment to address the thoughts, emotions, and behaviors that led to the addiction. Treatment looks different for everyone but a comprehensive treatment plan may begin with medical detox and include inpatient or outpatient care.3,5

Chronic alcohol use is linked to many social consequences, including interference with personal relationships, motor vehicle accidents, violence, crime, and suicide.8 Additionally, alcohol can take a toll on an individual’s physical health, contributing to potentially severe health issues, including:11,22

  • Memory and coordination issues, brain changes, and neurological conditions.
  • Cardiovascular issues.
  • Liver damage.
  • Pancreatitis.
  • An increased risk of certain cancers.
  • A weakened immune system.

Alcohol can either cause or exacerbate these health conditions, and in some instances, these conditions can lead to death.3

Alcohol Use Disorder Outlook and Treatment

Alcohol misuse and addiction can have harrowing and hazardous side effects at every phase. However, it’s never too late to seek treatment. Effective, evidence-based treatment can help and recovery is possible.

American Addiction Centers (AAC) has facilities throughout the United States, and can provide a personalized treatment plan to meet your needs. If you or a loved one struggle with alcohol use or aren’t sure if your use has become problematic, call AAC at to speak to one of our compassionate and knowledgeable admissions navigators, who can listen to your story, answer your questions, explain your options, and even verify your insurance to help you get on the path to recovery today.

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