The Four Stages of Alcoholism


Alcoholism is a disease that gets progressively worse as the alcoholic continues to drink and goes though the four alcoholism stages.

Barry was a senior at the largest public school in Philadelphia. Due to a number of students who were caught coming to school "under the influence" of alcohol, Miss Franklin, the health teacher, decided to teach her students about alcohol abuse and alcoholism.

Due to the importance of the subject matter, Miss Franklin told her students that they would be learning about alcohol abuse and alcoholism for an entire week.

When it came time to discuss alcoholism, Miss Franklin first decided to define what alcoholism was and then teach her students about the four stages of alcoholism. Before going any further, Miss Franklin made it a point to inform her students that alcoholism means the same thing as "alcohol addiction" and "alcohol dependency."


A Definition of Alcoholism

Miss Franklin then gave her class the following definition of alcoholism.

Alcoholism is a debilitating disease that gets increasingly worse as the person continues to drink in an abusive and excessive manner. Alcoholism is best characterized by the following four components.

The Four Components of Alcoholism

  • Loss of control. This means that once the alcoholic has had the first drink, he typically continues to drink until he is intoxicated. Another way of saying this is that the alcoholic cannot limit his drinking. As emphasized by Miss Franklin, at this point, alcohol is starting to control the drinker rather than the other way around.

  • Tolerance. This points to the fact that over time, the person needs to drink increasingly more alcohol in order to experience a "high" or a "buzz." For instance, while it may have once taken five bottles of beer before a person got intoxicated, it may now take nine or ten bottles of beer in order for the person to get drunk.

  • Craving. This means that alcoholics feel an extremely strong urge to drink. Often, alcoholics will think about drinking for hours until they "give in" and start drinking. Unfortunately, this strong "urge to drink" needs to be satisfied every day at best and multiple times throughout the day at worst.

  • Physical dependence. Not only are alcoholics physically dependent on alcohol, but when they try to stop drinking, they experience alcohol withdrawal symptoms. Essentially, alcohol withdrawal symptoms are responses by the drinker's brain to the sudden lack of alcohol--a situation that is contrary to the alcohol that the person's brain was accustomed to.

Alcohol Withdrawal Symptoms

Alcohol withdrawal symptoms typically manifest themselves between 6 and 48 hours after the alcoholic has had his last drink.

Unfortunately, not only do alcoholics crave drinking, but one of the reasons that they exhibit "out-of-control" drinking is the fear of facing alcohol withdrawal symptoms if they stop drinking.

At this point, many of the students raised their hands and wanted some examples of alcohol withdrawal symptoms. Miss Franklin stated that alcohol withdrawal symptoms ranged from mild to moderate to severe and that in general, they were similar to flu-like symptoms.

Miss Franklin then listed the following as some of the more common alcohol withdrawal symptom: nausea, anxiety, vomiting, excessive sweating, the inability to sleep, throbbing headaches, confusion, and fever.

Miss Franklin then stated that all alcoholics need to get immediate professional help when facing alcohol withdrawals due to the fact that in some instances, they can be fatal.

The Four Stages of Alcoholism: An Overview

Miss Franklin proceeded to tell her students that she was going to discuss the four stages of alcoholism that most alcoholics go through.

When one of the students asked why Miss Franklin was going to divide the topic of alcoholism into stages, she responded by saying that because alcoholism is such a complex subject, it is easier to understand when it is broken up into four stages.

As a general frame of reference, Miss Franklin told the class that the alcohol-related problems experienced by alcoholics typically get worse as they progress through the four alcoholism stages.

At this point, several students wanted Miss Franklin to give them some examples of the alcohol-related problems manifested by alcoholics.

Miss Franklin thanked the class for their interest, and then told them that most alcoholics experience serious problems in the following areas of their lives: health, relationships, finances, employment, and involvement with the law (such as getting one or more arrests for "driving under the influence") (DUI).

Miss Franklin then started her discussion about the different alcoholism stages.

The First Stage of Alcoholism

Miss Franklin stated that in the first stage of alcoholism, drinking loses it's social importance for alcoholics and becomes a way of escaping emotionally from problems, inhibitions, and from life in general. Another way of saying this is that in the first stage of alcoholism, the alcoholic moves from mainly a "social" orientation to a "psychological" frame of reference that is best characterized as an attempt to escape from pain and/or reality.

It also becomes apparent during the first stage of alcoholism, that the drinker needs to drink increasingly more before getting intoxicated. At this point Miss Franklin reminded the class that this is what she earlier described as "tolerance."

The Second Stage of Alcoholism

In the second stage of alcoholism, the craving for alcohol becomes more powerful. For instance, during this stage the alcoholic frequently starts to drink earlier in the day, often as soon as she awakens.

Not surprising, in this stage, the alcoholic's level of tolerance increases as she needs even more alcohol in order to get intoxicated.

Miss Franklin once again highlighted the shift from the social to the psychological in the first stage of alcoholism. She then pointed out that the shift from psychological stress-relief in stage one gives way in the second stage to drinking in order to satisfy the alcoholic's dependence on alcohol. Indeed, at this point, rather than aiming for an emotional escape from pain, the alcoholic needs to drink in order to simply function on a daily basis.

While the alcoholic does not exhibit a total loss of control over her drinking in this stage, those who are closest to the alcoholic, such as family members and friends, begin to notice the inability of the drinker to limit her drinking. Also during this stage of the disease, the alcohol-related problems of the alcohol become more observable by coworkers, family members, friends, and in some instances by neighbors.

In this stage, various physical symptoms of the disease such as the following increase: stomach problems, blackouts (that is, a kind of alcohol-induced amnesia), hangovers, and tremors of the hands.

Miss Franklin then highlighted another "sign" during this alcoholism stage: rather than looking in the mirror and seeing the cause of her alcohol-related problems, the alcoholic starts to blame others and circumstances that are external to herself.

Another key characteristic of alcoholics during this stage are the half-hearted attempts they make at getting alcohol treatment for their drinking problem. While some alcoholics during this stage do in fact try to stop drinking, most of them start drinking again as soon as they start to experience alcohol withdrawal symptoms.

The Third Stage of Alcoholism

Due to the fact that alcoholism is a progressive disease, Miss Franklin noted that it should come as no surprise that the alcoholic's loss of control over his drinking becomes even worse and more noticeable during the third stage of alcoholism. For example, even if the alcoholic intended on having only one or two drinks, once he reaches this stage, he typically drinks until he is intoxicated.

In a similar manner, the alcoholic starts to experience even more serious relationship, employment, financial, health, and legal problems in this stage.

In the third stage of alcoholism, the alcoholic becomes even more alcohol-centered as he starts to avoid family and friends and displays a lack of interest in events and activities that he used to enjoy. For instance, the alcoholic may have been a passionate baseball fan all of his adult life. Once he reaches this stage of alcoholism, however, he may totally avoid going to baseball games or refuse to watch them on TV.

In a similar manner, during this stage, the alcoholic starts to neglect basic necessities such as personal hygiene, food, water, shelter, and, as mentioned above, personal interaction with others.

Eye-openers are another characteristic behavior of this stage of alcoholism. Essentially, eye-openers reflect the need to drink whenever the alcoholic awakens. While the alcoholic occasionally had a drink the first thing in the morning during the second alcoholism stage, during the third stage, this behavior, however, becomes more routine.

When questioned by others about this need to drink the first thing in the morning, most alcoholics claim that they do so in order to take away the discomfort of a hangover or to "calm" their nerves. Sadly, eye-openers are often an attempt to quiet the remorseful feeling the alcoholic many have about his drinking behavior.

The Fourth Stage of Alcoholism

According to Miss Franklin, the fourth and final alcoholism stage is best typified by the alcoholic's total loss of control over her drinking. This usually means that alcoholics during this stage get inebriated several times throughout the day. To a great extent, this is mainly because they need to drink in order to function on a daily basis and also because they are terrified of going through alcohol withdrawals if they don't get the alcohol they need.

Since alcoholics during this stage drink so frequently, they obviously have a very difficult time maintaining a job.

Miss Franklin pointed out that not unlike the other alcoholism stages, alcoholics in this stage experience increasingly more severe alcohol-related problems. For instance, during the final stage of alcoholism, alcoholics often go on benders. That is, they get extremely drunk and remain intoxicated without interruption for several days or weeks.

As another example of the final stage of alcoholism, alcoholics during the earlier stages may have exhibited trembling hands in the morning after getting inebriated the previous night. In the final stage of alcoholism, however, alcoholics not only regularly experience trembling hands but they also have tremors that affect their entire body.

Unfortunately, when "the shakes" (as these tremors are called) are experienced along with visual and auditory hallucinations, alcoholics experience a condition known as "the DTs." Miss Franklin stressed to the class that the DTs are not only terribly uncomfortable and disturbing but that they are also a potentially fatal type alcoholism withdrawal that usually takes place in the final stage of alcoholism unless alcoholics get prompt alcoholism treatment.

Not surprisingly, when alcoholics experience "the DTs" many of them promise to themselves and to others to quit drinking for good. Unfortunately, most alcoholics at this stage of alcoholism do not and cannot follow through on their promise. As a consequence, most of them return to their hazardous and abusive drinking and, in turn, the vicious cycle of their alcohol-related problems start once again. 

Conclusion: The Four Stages of Alcoholism

It should come as no surprise that the students in Miss Franklin's classroom were sad to learn what alcoholics go through as their alcohol addiction progresses through the four alcoholism stages.


To counter their sadness, Miss Franklin told her students that in most cases, professional alcohol treatment is indeed the best response to alcoholism and that alcohol treatment can be successful and lead most alcoholics on the road to sobriety and alcohol recovery.

Having said this, Miss Franklin pointed out that in certain instances when alcoholics have progressed too far into their disease, however, some of them are too far gone to receive any significant benefit from alcohol treatment.

Even though the students were bothered by the realities of alcoholism in Miss Franklin's presentation, they were grateful that Miss Franklin cared enough about them to teach them about alcoholism and the four stages that alcoholics typically go through as they progress through their alcohol addiction.