What Are the Stages of Alcoholism?

Millions of Americans are living with alcoholism or alcohol use disorder (AUD). In fact, according to data from The National Institute on Alcohol Abuse and Alcoholism (NIAAA), almost 15 million Americans over the age of 12 years have an AUD. In addition, more people die each year from alcohol-related effects than from drug overdoses. According to The National Center for Drug Abuse Statistics, 95,000 people die each year from alcohol-related causes. 

Our nation has an alcohol problem that is largely being overlooked. However, if you or someone you care about is struggling with alcohol dependence, you simply can’t overlook it forever. When it comes to alcoholism many people have questions. Whether you are concerned about yourself or someone you love, you probably want to know more so you can determine whether you or your loved one has a problem with alcohol. 

Sometimes it’s difficult to determine if you (or your loved one) actually have an issue. In addition to high-functioning alcoholics, it’s important to understand that not every case of AUD looks like the next. In fact, AUD and addiction are very personal and often unique experiences. What’s more, AUD and addiction are both progressive diseases. This means they get worse over time, never better. 

Someone may begin drinking and not experience many of the symptoms they’ve typically considered to be signs of alcoholism. However, they may in fact be at an earlier stage of alcoholism or AUD. If they continue to drink, they almost undoubtedly will reach the later stages. 

So just what are the stages of alcoholism or addiction? If you do a quick search for ‘the stages of alcoholism’ or ‘the stages of addiction’ you’ll receive a mix and variety of results. There are different schools of thought or philosophies on what the exact stages of alcoholism are. No matter which you or your health care practitioner see as accurate, all have the same or very similar symptoms and patterns. 

Diagnostics and Statistical Manual of Mental Health Disorders-V (DSM-V) and Alcoholism Stages

The DSM-V is the manual published by the American Psychiatric Association. It is a diagnostic tool with standard classifications of mental health disorders used by mental health professionals to diagnose certain mental health conditions. In the DSM-V, alcohol use disorder is outlined as it progresses in the user. Formerly alcohol abuse in the DSM-IV, this new diagnosis of AUD also has a severity scale of mild, moderate, and severe. 

Here are the criteria as outlined by the DSM-V for alcohol use disorder also known as alcoholism:

• Drank more than planned or ended up drinking longer than planned?
• Tried to cut down on or stop drinking and were unsuccessful?
• Spent significant time drinking or recovering from the effects of drinking (hangover)
• Craved a drink so much that it consumed your thoughts?
• Experienced drinking (or the aftereffect of drinking) causing issues with taking care of your responsibilities such as family, work, school, etc.? 
• Continued to drink despite problems being caused?
• Increased the amount of alcohol you drink to get the same effect?
• Experienced alcohol withdrawal symptoms when the effects of alcohol wore off? (Sleeping issues, shakiness, nausea, sweating, racing heart, seizure)
• Cut back on activities you used to enjoy to spend more time drinking? 
• Found yourself in high-risk or dangerous situations when you were drinking? (driving, unsafe sex, being in a dangerous area, etc.)
• Continued drinking despite the issues it causes such as health problems, depression or anxiety, or after having a blackout? 

The diagnosis is based on how these 11 questions are answered. According to the DSM-V criteria, if you answer ‘yes’ to at least two of these above-listed questions, you fit the diagnosis of having an AUD. The more that someone answers ‘yes’ to the more severe the diagnosis is. It is diagnosed as follows:

• Mild: Answering yes to two or three questions
• Moderate: Answering yes to four or five
• Severe: Answering yes to six or more

Often, AUD will begin with the person exhibiting maybe just one or two of the issues listed. The initial symptoms can be excused away or overlooked. For example, the first listed criteria are ‘drinking more than planned or longer than planned’. Once in a while, this can happen and often this one is easy to make excuses for too; ‘It was a holiday party so I stayed longer’ or ‘I was with old friends I never see so we hung out longer’. 

However, as mentioned, these symptoms will continue to progress as the drinking continues. As the symptoms accumulate, it can be harder to deny there is an issue, but many people still do so. It is said that AUD is a disease of denial. That’s one reason why it’s important to not only understand the symptoms but also understand the ‘stages’ of alcoholism or more about how it progresses. 

The Jellinek Curve to Help Understand the Stages of Alcoholism 

There is much more known about alcohol use disorder and addiction than ever before. At one time, alcoholism was considered to be a moral failing. There weren’t effective treatment programs and many alcoholics ended up dying in asylums and sanitariums. Today, this has changed a lot. One of the pioneers who helped orchestrate this much-needed and life-saving change was E. M. Jellinek or Elvin Morton Jellinek. Jellinek was a biostatistician, physiologist, and alcoholism researcher. 

Jellinek’s work was instrumental in changing the school of thought about alcoholism now referred to as alcohol use disorder. He coined the term ‘the disease concept of alcoholism. In addition, in his 1960 book he talked about five types of alcoholism. From these classifications, the Jellinek Curve emerged. The Jellinek Curve is often used to help healthcare professionals diagnose and understand alcoholism. 

The Jellinek Curve is a U-shaped curve in which the journey or stages of alcoholism are outlined. During each of these ‘phases’ of alcoholism, the individual is behaving in certain ways and undergoing certain emotions.  The first part of the curve is the ‘Crucial Phase’. 

During this initial phase, the individual is transitioning from alcohol being used normally to one in which they use it to help them cope with life. The person begins to drink in greater quantities and more frequently. They may also begin to experience increased tolerance, increased loss of willpower, drinking earlier in the day, blackouts, and more. 

The next phase in the Jellinek Curve is the “Chronic Phase’. During this stage of alcoholism, the drinker is getting closer to hitting rock bottom. They most likely are drinking and thinking about drinking all the time, they probably spend time with others who drink as they do, and they may even begin to see there is an issue that they may need help for soon. It’s not uncommon for the drinker in this stage to try to go ‘on the wagon’ but be unable to sustain it for very long. 

The third and final phase on the Jellinek Curve is the ‘Rehabilitation Phase’. This phase begins with the drinker having an honest and sincere desire to get help and stop drinking. This is the beginning of recovery. As the curve continues, there is hope and in general, getting one’s life back on track and eventually thriving. 

As illustrated, these phases or stages of alcoholism very much follow the DSM-V and most all of the various schools of thought or theories of the stages of alcoholism. Whether you believe in three stages of alcoholism, four stages, six stages or seven stages of alcoholism, most of the symptoms and exhibited behaviors are the same. It’s important when you look at whether you or a loved one have any form of AUD or alcoholism to keep in mind the various symptoms and how they generally progress. 

Additionally, it’s vital to remember that people progress through the various stages of alcoholism at different rates. And, above all, everyone’s journey is unique to them, no matter what stage of alcoholism or addiction they are in at the time. And, no matter how far down a person has gone, recovery is possible. It all begins with asking for help and finding the treatment program that’s right for you or your loved one. The NIAAA reports that in 2019 only 7% of those who had an AUD got treatment for it. But treatment does work and has helped many begin their recovery journey. 

At Futures Recovery Healthcare, we believe everyone deserves a chance to recover. We have three different programs to treat alcohol use disorder and substance use disorders. Core, Orenda, and Rise. If you or someone you love needs help take a moment to explore our programs and see if we may be a good fit. Or just call us to learn more at 866-804-2098.