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The Stages, Symptoms & Effects of Alcoholism

Published 05/03/2008

Admitting to being an alcoholic is still taboo in the UK yet the problem continues to grow at a rapid rate. Sue Allchurch, director of the Linwood Group, the UK's only group of centres that solely treat alcoholism, looks at the stages of this progressive disease and how to deal with the problem.

Alcoholism is a disease. It affects one in 13 adults in the UK and, without treatment, will result in early death. This will either be through a drink-related illness such as liver failure or through an accident whilst under the influence - around 50% of fatal car accidents involve drink driving, for example.

In the UK, there is still a stigma attached to alcoholism due to the misconception that alcoholics are Special Brew-swigging vagrants who live rough. In reality, it affects men and women of every age and from every possible social demographic.

People believe that alcoholism is something they should be able to control using their own willpower - few people realise it is a disease and, once in the grip of it, it is impossible to stop without seeking help.

Alcoholism is a progressive illness - by the time it has really got you in its grips, you will be in a state of denial about your problem. There is no set time for addiction to develop - for some people it can take hold within a couple of years whilst for others, it can take up to 20 years.

What are the stages of alcoholism?

Social drinking

The majority of people are social drinkers. They know their limit, can leave a drink unfinished and would not contemplate driving when they have drunk too much. For social drinkers, drinking adds to an occasion and is not the focus of the occasion. It is rare for a social drinker to experience a hang-over on a regular basis.

The four stages of alcoholism

Stage 1


Drinking is no longer for social reasons - it provides relief from problems, stress and inhibitions

  • Drinking is to alter mood
  • The amount being drunk is increased - even slightly - to heighten the buzz
  • A person will stick to their usual choice of drink at this stage but increase the amounts consumed.
  • A person might have a few drinks before going out or attending a social function to help with confidence.
  • Social drinking increases to three to five units a day and a unit is over-estimated


  • Increased tolerance to alcohol
  • Lack of real recognition by the person to their change in drinking behaviour
  • Drinking more regularly and in larger amounts
  • Effort made to seek out more drinking opportunitie
  • View drink as an escape from circumstances
  • Over-confident behaviour e.g being loud, boasting

Physical effects

  • Occasional vomiting
  • Occasional headache
  • Occasional lapses in memory
  • Occasional uncharacteristic behaviour

Stage 2


  • Drinking becomes more intense and is likely to start earlier in the day.
  • Tolerance to drink increases
  • Drinking is because of a dependence on alcohol rather than as a psychological boost or to relieve stress
  • Loss of control becomes more regular and is gradually noticed by family and friends.
  • A person may start to feel ashamed or worried about their drinking. 
  • Regular attempts to quit drinking will be made but, inevitably, will prove unsuccessful. 
  • A change in their drink of choice might take place - either moving to something stronger because of their increased tolerance or 'only' drinking beer or wine in a bid to pretend they are still in control. 
  • If confronted, a person is likely to deny the problem and will also be in denial to themselves.
  • Any difficulties being experienced will be blamed on other people or external forces and never associated with their drinking.


  • Increasing physical problems
  • More frequent blackouts - periods when so affected by alcohol a person has no recall about what they did
  • Sneaking extra drinks when no-one is looking
  • Denial that the person has a problem with drinking
  • Unsuccessful attempts to stop drinking
  • Feelings of guilt and shame
  • Chronic hangovers

Physical effects

  • Hangovers
  • Stomach problems & gastro-intestinal problems
  • More frequent episodes of incontinence
  • More frequent blackouts
  • Hand tremors
  • Uncharacteristic behaviour increases

Stage 3


  • Hair of the dog becomes a regular pattern to life to kick start the day, lessen a hangover, calm nerves or help to deal with feelings of guilt or remorse from the last bout of drinking
  • Unable to drink normally - after the first drink, they are unable to control what will happen despite the intention to just have a couple
  • Loss of interest in things of previous importance e.g sports, past times
  • Likely to avoid friends and family
  • Might move from the area they live or work to escape the problem which, inevitably, follows them
  • Vague attempts made to seek medical help but unlikely to be honest with their doctor or follow the advice given
  • Aggressive or grandiose behaviour
  • The development of an alibi system - an elaborate system of excuses for their drinking
  • An increase in failed promises and resolutions to one's self and to others
  • Unreasonable resentments


  • Loss of control becomes a regular pattern in their life
  • Serious issues relating to work, relationships and financial problems begin to arise
  • A person will start to neglect personal responsibilities e.g stops eating a regular balanced diet
  • A decrease in tolerance to alcohol is likely
  • Frequent violent or destructive behavior
  • Problems with the law e.g drink driving offences / loss of license
  • Loss of willpower

Physical effects

  • Increasing tremors CNS effected
  • Possible damage to liver/kidney
  • Difficulty eating
  • Serious physical deterioration

Stage 4


  • Drinking likely to start early and continue throughout the day
  • Drinking binges that last several days are a regular feature during which time a person is helplessly drunk and regularly experiences black outs
  • Repeated pattern of promises to stop drinking following a binge which are inevitably broken - the vicious circle continues with increasing regularity
  • Total disregard for anything and everybody - family, friends, work, home and food
  • Obsessed with alcohol and access to a regular supply, on-tap, to ensure they can constantly top up
  • Bottles of drink will be hidden at work, around the house, in the car
  • Not discerning about brand or type of drink - vodka often a favorite as the alcoholic, mistakenly, believes that this cannot be smelt on their breath


  • Chronic loss of control.
  • Loss of job or full-time employment
  • Drinking is no longer a choice - it is the only way a person can now function
  • Friends and family constantly warn the person of the dangers and will be experiencing difficulties at work, home or even with the police
  • Blood test would show signs of dangerous drinking.

Physical effects

  • "The shakes" are experienced when an attempt to stop drinking is made - an indication of a serious nervous disorder that now affects the entire body
  • "The shakes" can be combined with hallucinations known as "the DTs" or delirium tremens - a potentially fatal type of alcohol withdrawal unless the alcoholic receives immediate medical care.
  • There is a high risk of physical and emotional damage.
  • At this stage, a person is unable to deal with the problem for themselves and will need help and support.

Asking for help

It is vital that an alcoholic has the courage to admit and confront their drinking at this stage.  Being too proud or ashamed to admit they need help could cost them their life

What to do

A person can jump off the downward spiral of alcoholism at any stage but only if they are prepared to be truly honest with themselves. Changing their drink of choice, confining drinking to the weekends and other controlled measures (or excuses) simply do not work for an alcoholic.

Abstinence, and a commitment to an on-going self-help programme, is likely to be the only effective route to recovery.

In more chronic stages of alcoholism, it is dangerous to stop drinking without medical supervision. A week-long detox programme followed by several weeks of treatment is recommended.

Often alcoholics are mis-diagnosed by the medical profession as being depressed. In most cases, it is the alcoholism causing the depression and a course of anti-depressants is not going to help. The local AA group is probably a better place to go for help in the early stages of alcoholism.

For advice or further information on recovering from alcoholism, either visit or call 0800 066 4173.

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