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The Stages of Alcoholism

Moderate drinking isn’t a concern for most adults. However, when alcohol consumption spirals out of control, it can lead to addiction.

Alcoholism doesn’t develop overnight. Instead, it emerges from long-term alcohol misuse. Understanding the signs and symptoms of the stages of alcoholism can help you seek help and treatment options before the issue escalates into alcohol dependence and addiction.

It’s estimated that 17 million American adults have an alcohol use disorder (AUD.) Another 855,000 Americans between 12 and 17 years of age have an AUD.

The National Institute on Alcohol Abuse and Alcoholism (NIH), 2018

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What Is Early Stage Alcoholism?

Once someone experiences binge drinking sessions and alcohol-related blackouts, they are in the early alcoholism stage. This first stage is often characterized by an increasing discomfort with drinking combined with difficulties resisting it.

Early-stage alcoholics may find themselves lying about their drinking behaviors to friends or loved ones. They may also start hiding drinks. For example, they may spike their soda, coffee, or other beverages with alcohol when nobody else is around.

During this early stage, tolerance to alcohol continues to grow. Drinkers may also become overwhelmed with thoughts of alcohol. 

What Is Middle Stage Alcoholism?

During the middle stage of alcoholism, the symptoms become more apparent to friends and family members. Those experiencing middle stage alcoholism may start missing work or important social events due to their drinking issues or hangovers.

Middle stage alcoholics may drink at inappropriate times, like when looking after their children, driving, or at work. They may also become more irritable, arguing with their partner, friends, or family members. During the middle stage of alcoholism, the body starts to change due to substance use.

The following physical symptoms will begin to develop during middle stage alcoholism:

  • Facial redness
  • Stomach bloating
  • Sluggishness
  • Weight gain or weight loss

At this stage, some people make several attempts to stop drinking. Those suffering from middle stage alcoholism may attend support groups to help with their cravings and mental health issues.

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What Is End-Stage Alcoholism?

The last stage, known as end-stage alcoholism, is the most severe and dangerous. At this point, heavy drinkers experience intense mental and health problems. Their condition may be life-threatening.

These severe mental and health conditions may include:

  • Liver damage
  • Heart problems
  • High blood pressure
  • Brain damage
  • Hepatitis
  • Cancer
  • Dementia

During late-stage alcoholism, the effects of alcohol abuse are clear and visible. 

Drinking often becomes an all-day occurrence. Everything in life, including friends and family, becomes less important than drinking. If the drinker hasn’t lost their job yet, they often do at this stage.

Diseases can also develop at this stage, such as cirrhosis of the liver or dementia. End-stage alcoholics may also become paranoid or overly fearful without being able to explain why. Attempts to quit drinking may lead to delirium tremens or hallucinations. 

Physical Symptoms of End-Stage Alcoholism

End-stage alcoholics experience a variety of physical side effects and symptoms, including:

  • Cirrhosis of the liver
  • Jaundice from liver failure 
  • Itchy skin 
  • Fluid retention 
  • Fatigue 
  • Malnutrition 
  • Chronic pancreatitis 
  • Heart failure 
  • Anemia 
  • Wernicke-Korsakoff syndrome, otherwise known as alcohol dementia

One of the main symptoms of end-stage alcoholism is that the drinker is chronically drunk. If they are not drunk, they are likely to experience withdrawal symptoms of alcohol.

Alcohol withdrawal leads to many symptoms that are easy to spot. These symptoms include:

  • Enlarged, dilated pupils
  • Severe headaches 
  • Clammy, pale skin 
  • Loss of appetite and weight 
  • Nausea and vomiting 
  • Rapid heartbeat 
  • Shaking and Tremors 
  • Hallucinations 
  • Excessive sweating 
  • Seizures

Wernicke-Korsakoff Syndrome (WKS), also called alcohol dementia, typically occurs in late-stage alcoholism. With this condition, there is a shortage of vitamin B-1, which leads to dementia-like traits. 

This syndrome produces physical symptoms, including leg tremors, staggering, vision issues, and balance problems. Drooping eyelids, hallucinations, and double vision are also side effects and symptoms linked with this condition.

People experiencing WKS may also feel confused. They may have issues staying focused or learning new things.

How Long Does End Stage Alcoholism Last?

End-alcoholism is challenging to treat and has a high mortality rate. There are many ways the condition can kill, and most involve a significant amount of pain and suffering.

In the final stage of alcoholism, sometimes, the drinker has passed the point of no return and will die from their alcoholism. However, even if death is inevitable, treating the condition still has its benefits.

First, quitting drinking can prolong the life of the drinker. How long quitting drinking extends the individual's life during the final stage of alcoholism varies with various factors. 

These factors include:

  • How much damage has already been done to the body when they stop drinking
  • The quality of medical care the patient is receiving
  • How committed the patient is in beating the disease

When faced with this devastating fate, the drinker may or may not decide to overcome their alcohol addiction. If they fight, they can die knowing they have finally beaten the condition that has affected their life for so long. They can also try to enjoy their last moments on the planet to their fullest if they are sober.

At this stage of alcoholism, quality of life matters over quantity. For a disease that takes over someone’s quality of life, stopping is a victory under any circumstances. This victory can improve the individual’s mental health immensely, even at the end. 

Why Is End-Stage Alcoholism Deadly?

End-stage alcoholism is dangerous and deadly because it often leads to various health complications. First, liver damage occurs, which can be permanent. The liver gains fats and becomes inflamed, leading to liver scarring. Liver damage can often lead to liver disease or cirrhosis. 

This liver damage can lead to other severe complications in the body as it is a vital organ. The liver is responsible for hundreds of tasks to ensure the body is working as healthily as possible.

Additional health complications also occur from end-stage alcoholism, including heart problems and brain stroke stem. Risks of dementia and cancer also increase. End-stage alcoholics may also develop brain damage and hepatitis.

According to the CDC, more than one million people die each year of cirrhosis, including over 40,000 people in the United States.


Is it Possible to Recover from End-Stage Alcoholism?

End-stage alcoholism has a high mortality rate. However, even in the last stages of alcoholism, various treatment options are available, including therapy, detox, and rehabilitation.

The first stage of alcohol addiction treatment is likely to be a medically supervised detox at an alcohol rehab treatment center. This helps rid the body of toxins and manages withdrawal symptoms.

Alcohol withdrawal symptoms in an end-stage drinker can be fatal, so medical supervision is crucial. Seizures occur in over five percent of patients experiencing the abrupt stop of alcohol following years of heavy use. Most seizures happen within four days of cessation of alcohol. If the patient does not experience a seizure within the first four days of detox, the chances of it occurring reduces by 90 percent.

Alongside medical detox, a strong support group and ongoing rehabilitation program can help patients fully recover from alcoholism. As long as the condition has not passed the point of no return, there is hope that it can get better instead of worse.

Alcoholism Statistics



People in the United States have Alcoholism



Of Americans with AUD have received treatment.



People die from alcohol-related cases each year.

Common Questions and Answers

How many alcoholics die from alcoholism?

In the U.S., about 95,000 people (68,000 men and 27,000 women) die from alcohol-related causes every year.

What causes death from alcoholism?

Alcohol-induced cancers, drunk driving car accidents, alcohol poisoning, heart failure, violence, and liver damage are the leading causes of alcohol-related death.

Can alcoholism cause sudden death?

Yes, alcoholism can cause sudden death, especially if you overdose or experience alcohol poisoning.

What is the average age of death for an alcoholic?

Sudden death from alcoholism is most common in men older than 50, but it can happen to any chronic alcoholic at any time.

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Alcohol use disorder (AUD), National Institute on Alcohol Abuse and Alcoholism (NIH), 

Rehm, Jürgen., The risks associated with alcohol use and alcoholism., Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism vol. 34,2, 2011, 135-43, 

Alcohol facts and statistics, National Institute on Alcohol Abuse and Alcoholism (NIH), February 2020, 

Singal, Ashwani K MD, MS, FACG1; Bataller, Ramon MD, PhD, FACG2; Ahn, Joseph MD, MS, FACG (GRADE Methodologist)3; Kamath, Patrick S MD4; Shah, Vijay H MD, FACG4 ACG Clinical Guideline: Alcoholic Liver Disease, American Journal of Gastroenterology: February 2018 - Volume 113 - Issue 2 - p 175-194,

Zahr, Natalie M, and Adolf Pfefferbaum., Alcohol's Effects on the Brain: Neuroimaging Results in Humans and Animal Models., Alcohol research : current reviews vol. 38,2 (2017): 183-206, 

Alcohol’s damaging effects on the brain, National Institute on Alcohol Abuse and Alcoholism (NIH), October 2004,

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