According to the National Institute on Alcohol Abuse and Alcoholism, 18 million Americans are considered to have alcohol use disorder, or AUD. More commonly referred to as alcoholism, it is considered to be a psychological disorder and appears in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The condition can be mild, moderate, or severe, depending on how many symptoms the individual is experiencing.

No one is born with alcohol use disorder, though there is evidence suggesting that there is a genetic component to the disease. Heavy alcohol use is required to develop AUD, and it typically progresses in five stages.


Stage 1: Binge Drinking


Many Americans engage in this initial stage when they’re young. Teenagers and college students often experiment with alcohol via occasional binge drinking at parties. Binge drinking is defined as five or more drinks within two hours for men and four or more drinks in two hours for women. This behavior is performed with the goal of becoming highly intoxicated for entertainment. During this stage, alcohol tolerance develops, and more alcohol is required to reach the same level of intoxication.

As common as this stage is, it can still be dangerous, especially for those who are underage. Inexperienced drinkers may not know their limits and mix different types of alcohol, increasing their risk of alcohol poisoning. Because alcohol is a depressant, too much will slow breathing, heart rate, and lower body temperature – sometimes to the point of death. According to the Centers for Disease Control and Prevention, 2,200 Americans die from alcohol poisoning every year.

Even though most people are aware of the risks of alcohol overdose, more than 38 million adults in the US report engaging in binge drinking around four times every month. These individuals could very well be in the next stage of AUD.


Stage 2: Increased Frequency and the Beginning of Dependence

Once the initial experimentation is over, many people reduce their usage and engage in more healthy, moderate, or rare alcohol consumption. For others, the frequency of binge drinking increases, and/or they begin drinking multiple times per week in order to cope with negative emotions or a difficult situation. College students who binge drink at parties every weekend would likely be considered to be in this stage, especially because many do so in order to cope, or “unwind,” after the constant stress of classes, tests, and homework.

Individuals at this stage may find themselves drinking for the following reasons:

  • To relieve or let out stress
  • To numb or deal with unpleasant emotions
  • To escape seemingly inescapable situations
  • To alleviate boredom
  • Out of habit (partying every Friday night)

The more dangerous aspect of this stage is not the frequency, but the increasing emotional dependence on alcohol to feel good or a feeling that you can’t get through the week without it. There’s a world of difference between those who have a glass of wine or beer during dinner because they enjoy the taste and those who drink to feel good.

This psychological dependence is a precursor to physical dependence, which makes it much more difficult and unpleasant to quit due to the symptoms of withdrawal.


Stage 3: Initial Physical Dependency and Social Consequences

Once alcohol is used in order to feel good, it becomes difficult to stop. However, further use will lead to physical dependence as the afflicted individual’s brain chemistry changes to accommodate the frequent appearance of the foreign chemical substance.

Withdrawal symptoms are likely minor at this point, and if the individual does not recognize that a problem is developing, these symptoms may not be enough to make the person stop drinking. Irritability when sober becomes more likely, as well as depression and anxiety, headaches, and insomnia. These symptoms may also appear even while the person is drinking, especially since alcohol interferes with the sleep cycle. The individual may begin to feel sick while drinking, but continue anyway because the rewards are greater than the pain.

Another significant indicator of this stage is becoming what is often called a problem drinker. Drinking begins to interfere with the person’s life and the lives of loved ones. Changes in social patterns begin to appear, and relationships with others are significantly affected.

Signs of stage three include:

  • Sudden loss of friends or change in social groups
  • Decreased social activity
  • Difficulty relating to others
  • Avoidance of social situations
  • Difficulty making it to work or decreased performance at work
  • Increased conflict with family and/or romantic partners

It’s important to note that some people can reach this stage and further stages with few or no detectable changes in their lives. High-functioning alcoholics can do well at work, take care of their families, and lead a rich social life while still being dependent on alcohol to enjoy life or function at all. It’s estimated that 20 percent of those with late-stage alcohol addiction are high functioning. However, even these capable individuals suffering from AUD are not immune to the myriad of health problems that come with ongoing heavy alcohol use.

If the warning signs aren’t heeded at this point, the individual may begin to use alcohol to cope with new problems and move into full dependence.


Stage 4: Dependence

Once one’s life begins to revolve around alcohol, dependence has begun, both psychological and physical. Instead of adjusting drinking habits around work, family, and social relationships, the dependent person adjusts life around alcohol consumption. At this point, it’s likely that the afflicted person is aware that the drinking has become a problem but feels unable to stop. Alcohol has begun to control the person, and the individual may feel that escape is impossible.

People at this stage of AUD have a high tolerance to alcohol, and even heavy drinking may not cause a change in mood or behavior. At this point, they need to drink just to feel normal and to avoid intense withdrawal symptoms.

Alcohol withdrawal symptoms typically appear eight hours after the person’s last drink. According to MedlinePlus, common signs include:

  • Anxiety or depression
  • Headache
  • Clamminess
  • Pale skin
  • Nausea and vomiting
  • Loss of appetite
  • Irritability
  • Insomnia and fatigue
  • Mood swings
  • Shaking or tremors
  • Jumpiness
  • Difficulty concentrating
  • Rapid heart rate
  • Dilation of the pupils

These symptoms can often be so unpleasant that quitting seems impossible and is in fact difficult to do without professional help.


Stage 5: Addiction

At stage five, the individual is in full, end-stage alcoholism. Fully addicted people likely cannot get through the day without a drink and almost always drink throughout the day. They’ll sneak alcohol if they need to during work, frequently drive drunk, and avoid situations that would make it impossible to drink. They are entirely controlled by their addiction and drink just to feel normal and to avoid withdrawal symptoms even if they don’t enjoy it anymore.

At this point, trying to quit without medical help will be extremely difficult and can be dangerous. Long-term heavy alcohol users can develop a set of severe and life-threatening withdrawal symptoms called delirium tremens or DTs. Symptoms include:

  • Severe tremors
  • High blood pressure
  • Fever
  • Profuse sweating
  • Confusion/disorientation
  • Hallucinations
  • Intense anxiety
  • Irregular heartbeat
  • Seizures

Only 1-4 percent of people who experience these symptoms die from them, but the confusion, high anxiety, and hallucinations can cause individuals to hurt themselves or others, and it’s not worth the risk. People at this stage of addiction should always seek medical assistance with any attempt to detox.

If alcohol use disorder at any stage is suspected, the first thing to remember is that no one is alone in the experience. With tens of millions of individuals falling into disordered alcohol use in the country, there are always people around who can sympathize and help. Alcoholism is a disease that anyone can develop, and there’s no shame in seeking help with recovery. Without help, alcohol use disorder tends to only get worse, and the damage to the body can be irreversible. With education, medication, and support, anyone in any stage of alcoholism can get better.