The (Common) Stages of Alcoholism, According to Therapists

Experts advise on the typical stages of alcoholism—and tips for treating each stage.

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According to the National Survey on Drug Use and Health, nearly 30 million people ages 12 and older had a diagnosable alcohol use disorder in 2022. Alcohol use disorder (AUD), also known as alcoholism and alcohol abuse, is a medical condition that creates a physical and emotional dependence on alcohol. AUD is characterized by three core symptoms: intense cravings for alcohol, an uncontrolled drinking habit, and withdrawal when you don’t have alcohol. 

However, it’s important to remember that AUD doesn’t develop overnight. According to a physiologist and alcoholism researcher named Dr. Elvin Morton Jellinek, people typically transition through different stages as their drinking behaviors go from casual to severe. He proposed what’s known as the Jellinek Curve, a tool that describes the mental, physical, and social changes that result from alcohol misuse. Below, we outline Jellinek’s four stages of alcoholism, as well as expert advice on how to manage alcohol dependence and alcohol addiction. 

The stages of alcoholism 

The Jellinek Curve is considered a helpful guide for helping people assess their current alcohol habits. It involves four stages of alcoholism, and each has its own signs, symptoms, and solutions for healthy behavior change. 

“The phases of alcoholism, in my opinion, will aid in the recovery of an individual battling alcohol misuse since they will help them identify the underlying reason of their addiction and make progress toward treatment,” says Dr. Sha’Nard Clemons, Ed.D, Charlie Health Group Facilitator. “The phases of change—precontemplation, contemplation, preparation, action, maintenance, and termination—determine the course of alcoholism rehabilitation. These phases need patience, perseverance, and time, but they will eventually result in a fulfilling existence free from alcohol’s control,” continues Clemons. 

Stage 1: Pre-alcoholic

During the earliest stage of alcoholism, people’s relationship with alcohol will begin to change. For example, they may start to drink more frequently or consume larger quantities of alcohol in one sitting. Drinking alcohol may be a solution to social anxiety or to manage stress. 

This stage may even involve binge drinking, defined as five or more drinks for males and four or more drinks for females in two hours. Not everyone who binge drinks will progress to the next stage, but experiencing adverse childhood experiences or having co-occurring mental health conditions may increase your risk of alcohol misuse and addiction. 

Here are some other signs and symptoms of pre-alcoholism: 

• You drink when bored or to improve your mood
• You regularly drink until intoxicated (at least once per week)
• You start to notice physical effects, such as hangovers, trouble sleeping, and possible weight gain from increased calories 

Stage 2: Early-stage alcoholism

Also known as the prodromal phase, this stage involves the transition from casual or social drinking to more problematic drinking behaviors. People may drink on their own or in secret, and it’s common to experience memory lapses or blackouts. 

Other signs and symptoms of early-stage alcoholism include: 

• Your alcohol tolerance has increased
• You regularly drink at odd times, such as the morning or very late at night 
• You feel guilty or ashamed of your excessive drinking behaviors 
• You may be experiencing more severe hangovers, a weakened immune system, and the start of liver problems

Stage 3: Middle-stage alcoholism

Due to the amount of alcohol you consume and when you consume it, it’s probably clear to you and others that you have an unhealthy relationship with alcohol. You may not be addicted to alcohol at this point, but you’re definitely dependent on it. If you stop drinking alcohol or reduce the amount you drink, you will likely experience withdrawal symptoms, such as headaches, anxiety, and nausea.

Other signs and symptoms of middle-stage alcoholism include: 

• You feel like you can’t control your drinking
• You neglect important responsibilities at home and work
• You notice physical changes such as a bloated stomach, facial redness, and changes to your weight

Stage 4: End-stage alcoholism 

Also known as late-stage alcoholism, this is the most severe phase of the stages of alcoholism. At this point, you’re likely addicted to alcohol and might be drinking throughout the day to avoid alcohol withdrawal symptoms.

Your alcohol addiction can lead to dangerous behaviors like excessive drinking and driving, as well as complete isolation from family and friends. It can also contribute to severe health problems, such as liver damage, cardiovascular issues, and mental health concerns, including suicidal thoughts and behaviors. 

Your next stage: recovery

Regardless of what stage you or a loved one are experiencing, know that change and recovery are possible. “Relapse is a gradual process that occurs in stages. The purpose of treatment is to assist people in detecting the early phases when they have the best chance of success,” says Clemons.

With recovery, the goal is to detox from alcohol, manage symptoms, and prevent relapses. According to Clemons, there are several standards that can help people successfully achieve recovery. These include: 

• Modify your life to avoid temptations with alcohol 
• Being honest with yourself and others
• Seek assistance and support when you need it
• Practice self-care, such as regular exercise, nutritious eating, and consistent sleep
• Follow the rules of recovery

However, recovery is more than just stopping or reducing your alcohol consumption. “Simply ceasing to use addictive substances and engage in unhealthy behaviors is insufficient when one is addicted,” says Clemons. “It’s critical to go farther and address underlying trauma, cognitive patterns, and behaviors that initially contributed to drug or alcohol misuse in order to achieve holistic, profound healing.“

Is therapy an effective solution for addiction? 

Whether you want to reduce your alcohol intake or overcome an issue with heavy drinking, therapy is an effective tool for understanding your behaviors, what’s causing them, and how to change them. 

“As you progress through recovery, therapy provides a vital foundation and emotional release in addition to aiding in the mending of the addicted brain,” says Clemons. “Addiction is a potentially fatal illness that stems from a variety of underlying problems that must be addressed in the early phases of recovery. Substance abuse is frequently a sign of a more serious underlying issue brought on by trauma or emotional conflict.”

Here are three categories of therapy for AUD and other types of addiction:

1. Talk therapy

“Talk therapy will give you a secure, accepting environment in which to explore your traumas and pains,” says Clemons. One of the most effective types of talk therapy for AUD is cognitive behavioral therapy (CBT) — a treatment approach that shows people how to identify and change negative thoughts and behaviors that contribute to their alcohol misuse.

2. Expressive therapy 

Art and music therapy are two expressive therapies that can help people overcome AUD and other problems with alcohol. With art therapy, people may paint, draw, or even doodle to explore their emotions, understand their behaviors, and manage distress. Music therapy is where people play or listen to music to help them address any concerns and achieve their mental health goals.

3. Group therapy 

Group therapy sessions provide people with a safe and supportive environment to connect with others who share similar struggles. It can encourage accountability, healthier coping mechanisms, and the healing power of a trusted community. 

It’s worth noting that therapy alone may not be effective for some people. If you or a loved one have an AUD, consider speaking with a mental health professional about an addiction treatment program. Chronic alcoholism may require inpatient support and a medical detox alongside interventions like talk therapy. 

Manage your alcohol use with Charlie Health

If alcohol use is affecting your mental health, Charlie Health may be able to help. Our virtual Intensive Outpatient Program (IOP) provides more than once-weekly support for people dealing with serious mental and behavioral health conditions — including substance use disorder and co-occurring conditions like anxiety and depression and suicidal thoughts and behaviors. 

Charlie Health’s IOP combines group sessions, individual therapy, and family therapy to create a customized treatment plan tailored to your unique needs. Our qualified team of mental health professionals can support you in navigating the mental health issues associated with your AUD so that you can focus on recovery and healing. Fill out the short form below to get started today.