Stages of Alcoholism: From First to Third

Where do the stages come from?

Dividing alcoholism into three stages is a clinical tradition of Ukrainian addiction medicine. The international classifications of diseases, ICD-10 and ICD-11, do not use stages: they distinguish harmful use of alcohol and alcohol dependence (code F10.2 in ICD-10, 6C40.2 in ICD-11). Under ICD-10, dependence is diagnosed if at least three of six signs have occurred together during the last 12 months: strong craving, loss of control, withdrawal, tolerance, neglect of other interests, and continued use despite harm.

Stages are a convenient way to describe how the disease usually develops and what changes in the body and behavior. They help families understand what is going on. But a doctor bases the diagnosis and care plan on an examination and international criteria, not on the stage number alone.

Why does the stage matter?

The stage determines what kind of help a person needs. At an early stage, consultations with a psychologist and changing habits are sometimes enough. Once withdrawal syndrome has developed, stopping a binge requires medical help. At a late stage it is very hard to manage without long-term treatment and rehabilitation. That is why the doctor first assesses the person’s condition and only then suggests a care plan.

First stage: when it still looks like a habit

At the first stage, the person keeps working, sees friends and looks perfectly fine from the outside. That is why this stage is the easiest to miss.

What is actually happening:

• tolerance grows: the same level of intoxication takes more alcohol than a year or two ago;
• psychological craving appears; the urge to drink comes more often and in more and more situations;
• the person sometimes drinks more than planned and notices it themselves;
• there are memory blackouts for parts of the evening.

There is no physical dependence yet at this stage: a break from drinking does not cause tremor, sweating or insomnia. That is why the first stage is the easiest time to turn things around: the body has not yet adapted, and habits can still be broken.

Second stage: the body starts demanding alcohol

The hallmark of the second stage is withdrawal syndrome. This is no longer an ordinary hangover but a state in which the body physically suffers without the next drink and calms down only after it.

Typical signs of this stage:

• hand tremor in the morning, sweating, rapid heartbeat;
• anxiety and irritability that go away after a drink;
• drinking in the morning to ease the hangover;
• binges, when the person drinks for several days in a row;
• loss of control becomes systematic rather than occasional;
• problems at work and in the family are noticeable to others, although the person may deny them.

At the second stage, stopping on your own can already be dangerous. Quitting abruptly without medical support can cause seizures and severe withdrawal, so at this stage a binge is best stopped under a doctor’s supervision.

The symptoms of withdrawal syndrome, how many hours after the last drink it starts, and when seizures or delirium are possible are covered in the article “Alcohol Withdrawal Syndrome: Symptoms and Treatment”.

What happens to the body during a binge and after stopping abruptly is explained in the article “Coming Off a Binge: What Happens to the Body During Alcohol Withdrawal”.

Third stage: when tolerance drops and the consequences become hard to reverse

What sets the third stage apart is that the person gets drunk on much less alcohol than before. This is not an improvement but a sign that the body is worn out: the liver and nervous system can no longer cope with a load they withstood for years.

Typical of this stage:

• marked personality changes, narrowing of interests, apathy;
• heavy binges that can last for weeks;
• serious damage to the liver, heart and nervous system;
• risk of severe withdrawal states: seizures, hallucinations, confusion.

These conditions are life-threatening and need immediate medical care. If seizures, delusions or confusion appear after stopping drinking, call the 24/7 hotline or an ambulance right away instead of waiting for things to get better.

How do the stages compare?

How long does the transition between stages take?

There are no exact time frames: for some people addiction forms in a few years, for others over decades. The pace depends on age, sex, heredity, how much and how often a person drinks, and co-occurring mental disorders.

Women may run into problems sooner. According to the U.S. National Institute on Alcohol Abuse and Alcoholism (NIAAA), alcohol-related problems appear earlier in women and at lower levels of drinking than in men, and damage to the liver, heart and brain develops faster. Alcohol is especially harmful for teenagers because the brain is still developing at that age.

Can you stop the progression on your own?

At an early stage, some people really do change their habits without medical help, especially with support from their family. But relying on willpower alone is risky: it is hard for a person to assess their own condition objectively, and the moment when they should have sought help often passes unnoticed. A consultation with an addiction doctor or psychologist at an early stage does not commit anyone to starting treatment right away, but it does show where things stand and what to do next.

What can be done at each stage?

The approach depends on the person’s condition. At an early stage, working with a psychologist and changing one’s environment is usually enough. When withdrawal syndrome is present, medical care is added: managing withdrawal under a doctor’s supervision, followed by psychotherapy. The options are described on the alcohol addiction rehabilitation page.

At a late stage, the medical part takes longer, and afterward a full rehabilitation program is usually needed to restore not only the body but also the ability to live without alcohol. How the medical stage differs from rehabilitation is explained in the article “Addiction Clinic vs. Rehabilitation Center: What’s the Difference”.

If the situation is already acute — the person is on a binge or has pronounced withdrawal — alcohol withdrawal treatment at home or as an inpatient is needed, depending on the person’s condition.

Frequently asked questions

Can you determine the stage yourself from a description?

Roughly, yes, based on general signs. But only a doctor makes the assessment after an examination: signs of different stages often overlap, and the course is different for everyone.

Is the third stage always irreversible?

No, but recovery at this stage takes longer and is harder. Some body functions can recover with complete abstinence from alcohol and timely treatment, although some changes remain.

Why might a doctor not name the stage in the diagnosis?

Because the official diagnosis is worded according to ICD, which has no stages: it has harmful use and dependence syndrome. The doctor may mention the stage to explain how far the disease has gone and what to expect from treatment.

What should I do if a loved one denies having a problem?

Start with a consultation for yourself, without the person with the addiction. How to talk to someone who denies everything is covered in the article “How to Help a Loved One Who Drinks”. How to keep your inquiry confidential is explained in the article “Anonymous Addiction Treatment: What It Really Means”.

This article is for information only and does not replace a consultation with a doctor. The diagnosis and treatment plan are determined by a doctor after an examination. Self-medication may be harmful to your health. If the condition is acute, call the 24/7 hotline or an ambulance.