Becoming addicted to alcohol doesn’t happen overnight. In fact, like all addictions, severe alcohol use disorder (what some may call alcoholism) is progressive and is usually the result of long-term alcohol abuse. An individual battling an alcohol use disorder (AUD) typically goes through a series of five stages. They begin by experimenting with alcohol and then progress to regular drinking, problem drinking, dependence, and finally, addiction.
Now, that doesn’t mean everyone who drinks is abusing alcohol or will become an alcoholic. In fact, most people are able to handle moderate alcohol consumption and have a low risk of developing an alcohol use disorder. According to the National Institute on Alcohol Abuse and Alcoholism, research shows that women who have no more than 3 drinks in a single day and 7 drinks total in a week and men who have no more than 4 drinks in a single day and no more than 14 drinks per week are at low risk of developing an AUD.
With that being said, alcohol is the most abused drug in the United States. In 2015 The National Institute on Alcohol Abuse and Alcoholism reported that 15.1 million adults in the United States had an alcohol use disorder and only 6.7% of those suffering from an AUD received treatment. These numbers are concerning, because regardless of severity, alcohol addiction is treatable and recovery is possible. Consequently, it’s important to be familiar with the stages of alcoholism so that you can recognize when you or a loved one is developing an AUD and get treatment right away.
Difference Between Alcohol Use Disorder (AUD) and Alcoholism
Alcohol Use Disorder (AUD)
If you’ve spent time researching alcohol abuse, you may have come across the phrase “Alcohol Use Disorder” (or AUD) several times. Alcohol use disorder is a diagnosis used by medical professionals to describe someone who meets a specific set of criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). AUD is typically broken down further into three categories—mild, moderate, or severe. In the latest version, DSM-V, individuals are considered to be suffering from Alcohol Use Disorder if they have experienced at least 2 of 11 outlined symptoms over the past 12 months. These 11 symptoms include:
- Drinking more or for longer than intended.
- More than once wanting to cut down on or quit drinking, but couldn’t.
- Spending a lot of time drinking or being sick from it’s after effects.
- Wanting a drink so badly you can’t think of anything else.
- Drinking or being sick from drinking often interferes with work, school, or ability to care for family.
- Continuing to drink despite problems caused with family or friends.
- Giving up or decreasing participation in activities that were important or gave you pleasure in order to drink.
- More than once putting yourself in potentially dangerous situations while drinking (such as driving, swimming, or having unprotected sex).
- Continuing to drink even if it is causing depression or anxiety, adding to another health problem, or after blacking out.
- Having to drink more than you once did to experience the same desired effects.
- Experiencing symptoms of withdrawal such as shakiness, sweating, nausea, racing heart, or seizures.
Alcoholism, on the other hand, is a general term commonly used to describe problem drinking that has become severe. A doctor will not diagnose someone as an “alcoholic”, but instead will say they have an alcohol use disorder and determine its severity based on the criteria listed above. Consequently, it’s important to remember, that while alcoholism is a socially accepted term and addiction support groups, such as Alcoholics Anonymous, refer to individuals as “alcoholics”, alcoholism is not medical term.
The Five Stages of Alcoholism
Stage One: Experimental Use
Alcoholism doesn’t happen overnight. In fact, the first stage of alcoholism typically begins with experimentation. People in this stage may start experimenting with drinking in specific situations, such as college kids at a party or adults having a drink after work. This experimentation may stem from general curiousity about alcohol to feeling pressured to drink because friends are doing it.
Drinking in this stage is typically considered social, fun, or as a way to unwind. The individual is not dependent on alcohol to function and does not experience cravings. People in this stage may even engage in binge drinking on occasion, but still may not be alcohol dependent. Binge drinking is defined as a man having five or more drinks or a woman having four or more drinks within a two hour period. Although a single episode of binge drinking can lead to serious consequences (including accidental injuries, sexual assault, or even death), not every individual who binge drinks on occasion will go on to develop an alcohol addiction.
Stage Two: Regular Alcohol Use
The next stage of alcoholism begins when alcohol consumption becomes more frequent. Individuals may find that their drinking begins to follow a predictable pattern, such as drinking every weekend or consistently reaching for alcohol under certain circumstances, like when they’re stressed or lonely. These individuals may start to develop an emotional attachment to drinking. This more an individual turns to alcohol to “feel good”, the more at risk they are of developing an alcohol use disorder.
It’s important to note that regular alcohol use is not the same as moderate drinking. The difference lies in both the frequency and amount of consumption, as well as the intention behind the drinking. While moderate drinkers may enjoy a glass of wine with dinner or have champagne at a celebration, regular drinkers typically use alcohol as a way to escape negative emotions or feelings.
Stage Three: Problematic Alcohol Abuse
The third stage of alcoholism begins when individuals start to lose control over their alcohol consumption and/or when drinking begins to take a negative toll on their life. People in this stage may experience:
- Financial or legal troubles as a direct result of drinking (e.g. getting a DUI/DWI)
- Relationship issues with family or friends
- Lowered productivity or performance at work or school
- Emotional or behavioral changes such as depression, anxiety, or erratic sleeping patterns
In the stage of alcoholism, individuals may or may not be physically dependent on alcohol. In other words, they may or may not experience symptoms of withdrawal when they stop drinking. However, individuals in this stage of alcoholism typically have a high emotional attachment to drinking, meaning they may feel they need it “to have a good time” or to relax.
People who continue to drink in spite of the negative effects that alcohol has on their life are more likely to transition to the next stage of alcoholism: severe alcohol abuse and dependence.
Stage Four: Severe Alcohol Abuse and Dependence
The next stage of alcoholism begins when an individual starts to become dependent on alcohol.
Dependence has three components:
- Tolerance: Over time, as problem drinkers start to drink more frequently and in greater amounts, they will begin to build a tolerance to alcohol. When a tolerance is built, individuals will need to consume more and more alcohol to experience the same desired effects.
- Psychological dependence: When individuals begin to experience cravings for alcohol or feel that they need to drink to feel “normal”, they have developed a psychological dependence. Individuals with a psychological dependence to alcohol will continue to drink even though they may see the damage that alcohol is having on their body, relationships, job, etc.
- Physical dependence: Those who are physically dependent on alcohol experience withdrawal symptoms when they stop drinking. Withdrawal symptoms may occur as early as two hours or as late as four days after alcohol consumption has ceased.
Common alcohol withdrawal symptoms include:
- Loss of appetite
- Nausea or vomiting
- Irritability or agitation
- Fast heart rate
For those with severe physical dependence, alcohol withdrawal may result in dangerous withdrawal symptoms such as seizures or even death. Consequently, in this stage, most addiction professionals recommend detoxing from alcohol under medical supervision.
Stage Five: End-Stage Alcohol Abuse and Addiction
Addiction is what characterizes the final stage of alcoholism. In this stage, those who are addicted to alcohol no longer drink for pleasure and have no control over their alcohol consumption. At this point, it’s a compulsive behavior and the individual’s life revolves around drinking.
In end stage alcoholism, the body also begins to break down. Alcohol affects the heart, liver, respiratory system and digestive system, and many end stage alcoholics will start to experience severe health conditions. These can include:
- Mouth, throat, liver, and breast cancer
- Alcoholic hepatitis
- Cirrhosis of the liver
- Heart disease
- Chronic Bronchitis
Alcohol Addiction Treatment
Like all addictions, alcohol addiction is a chronic brain disease which affects the reward-related pathways of the brain. It also affects memory, emotions, judgment, and motivation.
However, for those suffering from an alcohol addiction, there is hope. Alcohol use disorder is treatable at any stage, and undergoing detox and rehabilitation in a medically-managed treatment facility may give you or your loved the best chance of getting sober and maintaining that sobriety long-term. Successful treatment for alcohol abuse and addiction typically combines medication, behavioral therapy, and an aftercare program.
If you or a loved one is suffering from alcohol addiction, Nexus can help. Learn more about alcohol addiction treatment at Nexus or contact us today and speak with a trusted recovery advisor to discuss treatment options.