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Four Stages of Alcoholism

author image Mark Kaushal, M.D.
Dr. Mark Kaushal is the founder of MedEdPathways, a Chicago-based educational consultancy, and sits on the board of two nonprofit organizations. A summa cum laude graduate, he obtained his M.D. in 1999, and is also a certified Reiki master. He has been writing health-related articles for more than 10 years. His educational work has been highlighted in the Chicago Tribune and USA Today.
Four Stages of Alcoholism
Alcohol is pervasive in our culture Photo Credit DimaSobko/iStock/Getty Images


Alcoholism is a chronic and progressive disease. It can affect people regardless of age, gender or race. This complex condition affects the mind as well as the body. Alcoholism is characterized by an obsession to drink and an inability to control the amount of alcohol consumed. Left untreated, the prognosis proves poor, with individuals suffering recurrent relapses and eventually death.

First Stage: The Adaptive Stage

A problem drinker crosses the line from ‘normal’ drinking to the first stage when drinking becomes a means of psychological escape from reality. At this point, drinking no longer remains social but becomes a habitual means of emotional escape from inhibitions, problems and fears. The most significant process in the first stage includes the development of tolerance. This stage is a progressive state where the drinker has to consume larger quantities of alcohol to achieve the same feeling. Physically, the person’s body changes at the cellular level to adapt to the increased amounts of alcohol. Outwardly, there is little if any indication of the development of the disease at this stage.

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Second Stage: Dependence

As a person continues to drink larger quantities of alcohol over a time, he develops the hallmark characteristic of the second stage of alcoholism: dependence. Because his body has adapted to higher levels of alcohol, he begins to feel uncomfortable and irritable when not drinking. At this stage, a person consciously plans his schedule to involve drinking and may begin drinking earlier in the day. At this stage, alcoholics may not be able to stop after taking his first drink.

Outwardly, during this stage of the disease, the person’s drinking becomes noticeable to those close to him such as family members, friends and co-workers. In many cases, they may feel more concerned and embarrassed about his drinking. He may begin trying to conceal his behavior by isolating himself, avoiding people and lying about his drinking.

Physical consequences including: hangovers, blackouts, hand tremors and stomach problems increase as this stage progresses. Psychologically, alcoholics are usually in denial of their condition, and tend to blame other people and circumstances for their problems.

Third Stage: Progression

As the disease progresses, the loss of control becomes more apparent. Typically, alcoholics intend to have one or two drinks and finds herself unable or unwilling to stop after the first drink. Outwardly, they begin experiencing the consequences of her drinking, especially those relating to family, job, financial or legal issues. Her isolation from friends and family becomes more pronounced. At this stage, they begin to neglect like hobbies and interests, but eventually, she neglects more basic things like personal hygiene, food and shelter. During this stage, they may try to stop drinking altogether, but find herself unable to do so.

Fourth Stage: Conclusion

The fourth stage of alcoholism is characterized by a chronic loss of control. In previous stages, the loss of control began after taking the first drink or two. However at this stage, the problem drinker does not have control over the first drink–he must drink to function. A problem drinker at this stage can rarely hold a steady job, and may have financial distress. He has likely alienated his friends and family, and finds himself alone fighting a losing battle against alcoholism. At this stage, attempts to stop drinking are accompanied by severe withdrawal symptoms including: irritability, tremors, headache, hallucinations, seizures and even death. Delirium tremens are a potentially deadly kind of alcoholism withdrawal that almost always takes place unless the alcoholic receives immediate alcoholism treatment. A 2006 article in the “Journal of the American Medical Association” indicates that problem drinkers require medical intervention to detox at this stage. After medical detox, patients should receive emotional and psychological rehabilitation for long-term treatment of the disease.

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