The four stages of alcoholism and the five alcoholic subtypes are scientific definitions that are proven to be true. The stages describe the way that alcoholism progresses in an individual, and the subtypes give a kind of bird’s eye view of different categories of alcoholics. In this article, we will cover both topics, as well as some of the cultural myths and stereotypes surrounding the reality of alcoholism.
The Four Stages of Alcoholism
When we think of alcoholism, the picture that springs to mind is often the ailing addict, whose body, career and relationships are wrecked, and who can barely stop shaking long enough to pour a drink. We don’t usually consider the many years of abuse – the risky decisions, ignored warning signs, difficult hangovers and more – that led that person there. Alcoholism encompasses a wide spectrum of drinking habits that result in personal, social, financial, and legal problems, among many others.
There are four stages of alcohol use and addiction. They are simple and roughly consistent across the population.
1. Pre-Alcoholic (or Non-Problem) Drinking
A person in the pre-alcoholic stage is a person who drinks in moderation, without showing signs of problems with their behavior. They can enjoy a beer or glass of wine here and there, without repercussion. They can drink without feeling compelled, and don’t struggle to resist pressure that may come from circumstances, friends and family.
People in this stage are not alcoholics. They have not built up a tolerance to alcohol, they don’t binge or black out or otherwise drink in a way that causes them problems. The majority of drinkers are in this stage, and stay here their whole lives. However, a portion will begin to develop mild alcoholic symptoms without realizing that they’re starting to lose control.
2. Early (or Mild) Stage
A person in the early or mild stage of alcoholism has developed some unhealthy drinking habits, but usually still denies – to themselves and others – that they are an alcoholic. A person in the early stage faces problems like:
- Binge drinking, which for men is five or more drinks within two hours, and for women is four or more drinks.
- Blackout drinking – drinking so much that they forget what they said or did
- Breaking promises about how much they’re going to drink (for instance, telling themselves they will just have one, but going on to have multiple drinks.)
- A majority of their social activities involve drinking.
3. Middle Stage
For many people, entering the middle stage of alcoholism is the first time they realize that they may have a problem. Many alcoholics in this stage have become dependent on alcohol in certain situations (though they are not yet not addicted.) They experience the following signs and symptoms:
- Depression and anxiety
- Poor sleep quality
- A greater willingness to drink and drive
- Troubles with the law related to drinking
- Having alcohol-related social problems, including fights with friends or family members
- Warning signs of alcoholic neuropathy
- Drinking to “escape” difficult emotions such as grief, anger or sadness
- Compulsive drinking, especially in difficult emotional situations
- Experiencing hangovers that are intense enough to affect their work
- “Shame-overs,” or avoiding social outings because of embarrassment over previous drunken behavior
- A significant tolerance to alcohol
- Physical symptoms that include weight fluctuation, redness in the face and bloating
- Needing a drink to feel “steady” or “normal”
4. Late Stage
Late stage alcoholism is when a person no longer drinks for pleasure and often has severe withdrawal symptoms. An alcoholic in this stage has become a full-blown addict (there is a difference between physical dependence and addiction) and at this point, they have developed serious health issues, and will struggle to reclaim their lives from the influence of drinking. The signs of this stage include:
- Prioritizing drinking over family, friends and work
- Losing one’s job due to alcohol use
- Losing relationships with family members and friends due to their drinking
- Major physical health problems, like liver disease
- Major mental health problems, like paranoia and dementia
- Major withdrawal symptoms when attempting to quit drinking, including hallucinations and involuntary shaking
The Five Subtypes of Alcoholics
Scientists at the National Institute on Alcohol Abuse and Alcoholism have identified five subtypes of alcohol dependence. subtypes are different from stages. Two alcoholics in different stages may belong to the same subtype, and vice-versa.
1. “Young Adults”
The most common subtype of alcoholic in the United States is the young adult, making up nearly a third of all alcoholics in the country.
This group is stereotyped as loud, boisterous, Animal House-style rebels: heavy-drinking, hard-partying college students and twenty-somethings, engaging in stupid pranks, brazen hookups and other antics that are glorified in popular media. The myth is that this is a relatively harmless phase that most of these young people will simply grow out of.
The reality facing this subtype, however, is more dangerous than it has ever been. American adults are binge drinking more than ever, and an awareness of the heartbreaking ubiquity of alcohol-related sexual assault has exploded into the popular consciousness in the last decade. These alcoholics are also the least self-aware about their problematic drinking, and thus the least likely to seek help.
Sarah Allen Benton over at Psychology Today literally wrote the book on the “functional” alcoholic, which she calls a High-Functioning Alcoholic. She writes that this subtype “maintains an average level of outside functioning personally, professionally and/or academically while still drinking.” They often hold down friendships and romantic relationships, and may be well-respected at work and in school. But they are living a second, compartmentalized life in which they abuse alcohol.
One of the most famous myths involving the functional alcoholic is that of the troubled writer: People like Ernest Hemingway and Charles Bukowski, who by all appearances had serious drinking problems that they – and we – shrugged off because of their success. In our minds (and theirs), alcoholics are chronic, severe drinkers who lose their marriages and careers and physical well-being. This causes us to overlook the problematic drinking of people who are not obviously falling apart.
This sub-type of alcoholic tends to only abuse alcohol, rather than any other drugs, and has the lowest risk for legal problems resulting from their alcoholism. They typically drink every other day, and often don’t start to struggle with dependence until around their mid-thirties. Though this sub-type tends to be male (men are at greater risk for alcoholism than women across the board,) heavy drinking is on the rise among women as more of them move into high-statues, high-stress jobs.
3. “Intermediate Familial”
This is a jargon-y way to describe a story that hits close to home for many of us: The “intermediate familial” subtype is an alcoholic who grew up with parents or other relatives that were also alcoholics. There is often a genetic component to their drinking, and they tend to struggle with other mental health issues. For this subtype, alcoholism and all of the problems that come with it are a kind of perverse family heirloom.
Often, intermediate familial alcoholics are not the only drinkers in their family – they may be part of a marriage of two alcoholics, or have close adult relationships with alcoholic parents or siblings. As a result, they feel immense social pressure from the people closest to them to continue to drink in problematic ways.
The myth about these alcoholics is a difficult one to dispel, because it involves genetics and history. These folks often have a story about addiction that runs in their family for generations, making their own drinking problems seem like destiny. If their parents and grandparents weren’t able to escape it, why would they? If their current family members aren’t able to escape it, why should they?
This myth is simply wrong: Genes are not fate, and a family’s history or present is not a family’s future. The intermediate familial subtype also tends to face a difficult obstacle with their current family members, who sometimes feel judged or inferior when the alcoholic attempts to quit drinking. This can create enormous pressure against the alcoholic’s attempt at recovery.
4. “Young Antisocial”
The young antisocial subtype of alcoholic consists of young adults – usually in their mid-twenties – but their drinking habits don’t conform to the “young adult” subtype described above. You won’t often find this kind of alcoholic at crazy keg parties or rowdy nightclubs; most of these drinkers have persistent mental health issues of the variety that are particularly frowned on by society, and these behaviors (and the social stigma) are often close to the heart of their alcoholic habits.
Young antisocial drinkers are more likely to get in fights or otherwise get aggressive when they’re under the influence of alcohol, which could be why they have a tendency to drink alone. When they drink, they really drink – they get drunk around two out of every three days of the year, and report having between 5 and 17 drinks in a single sitting. This puts this subtype at increased risk for alcohol poisoning.
These alcoholics start drinking the youngest out of all the subtypes (around 15 years old) and three-quarters of them are male. They are also the most likely to be smokers.
The majority of young antisocial drinkers are named because many of them have antisocial personality disorder, or have some of its traits. People who suffer from this disorder have, in years past, been stigmatized by society. The myth about these people is that they are “sociopaths” and “psychopaths” that are violent, manipulative and irredeemable.
The truth is that young antisocial alcoholics do tend to be difficult, aggressive and confrontational. Psychologists would say that most of them have “antagonistic personalities.” But much of this comes from a naturally higher level of aggression, poor impulse control and difficulty understanding the effect of their behavior on other people. They also usually struggle with toxic levels of shame and guilt that society has laid on them simply for being born with a “difficult” personality. When young antisocial drinkers learn to overcome their shame and embrace who they are, they are often able to learn better impulse control, empathy and social skills. All of these contribute to a healthier individual that feels less driven to drink themselves into oblivion.
5. “Chronic Severe”
The chronic severe subtype of alcoholic is a person who has drunk their way into a nightmare state. They are almost always in late-stage alcoholism, often suffering from all of the emotional, mental and physical health problems listed above, and they spend two days drunk for every day they spend sober. About half of them have antisocial personality disorder, and the majority of them suffer from major depression and other mental health problems.
The stereotype in popular culture here is Nicolas Cage in Leaving Las Vegas or Billy Bob Thornton in Bad Santa. They are portrayed as isolated people who have lost all hope and are resigned to a fate of drinking themselves to death. They are portrayed as people who have given up.
This myth has done enormous damage to alcoholics seeking recovery over the years. The truth is that chronic severe alcoholics do struggle with isolation and feelings of hopelessness, but they definitely do not give up. Fully two-thirds of chronic severe alcoholics seek help, in almost every treatment mode. This sub-type of alcoholic is usually willing to try anything and everything that it takes to get their lives back – and when they do get help, they start to recover quickly after detox. These folks are far from being a lost cause. In fact, hope is very close at hand.
Going Off The Map
Myths about alcoholism are just what they are: myths. They may contain kernels of truth, but they are stories that can’t capture our vastly complicated individual experiences. However, the scientific truth – the stages and sub-types you just read about – has the same problem. These terms were invented for the use of doctors and professionals who are often dealing with problems on community- or society-wide scales. A word that was invented to describe millions of people will do a poor job of describing an individual. It is possible for a person to be between stages, or to show signs of two or three different subtypes of alcoholism, making them impossible to easily categorize. A person can not be a category, anymore than a territory can be a map.
Help Is Available
Did you recognize some the signs and symptoms of the stages of alcoholism? Or did you see yourself reflected, however imperfectly, in the sub-types of alcoholics? If so, help is available. It’s possible to have a drinking problem without being addicted to alcohol – and it’s wise to get help before your habits lead to more serious issues in the future. Contact Northpoint Recovery today.