The stages of alcoholism are a historical way of describing how serious alcohol problems can develop over time. In 1952, E. M. Jellinek published “Phases of Alcohol Addiction,” describing four phases marked by patterns such as relief drinking, blackouts, loss of control, and prolonged intoxication [1].
Modern research uses a different framework. The National Institute on Alcohol Abuse and Alcoholism describes alcohol addiction as a repeating three-stage cycle involving binge and intoxication, withdrawal and negative affect, and preoccupation and anticipation [2].
These stages can reinforce one another repeatedly rather than unfolding once in a fixed order, and people do not all follow the same path. If you recognize your own drinking here, alcohol addiction treatment in Minnesota can start with an assessment of your current needs.
- In Jellinek’s historical model, alcoholism is described through four phases commonly called pre-alcoholic, early, middle, and end stage. Modern clinicians diagnose alcohol use disorder separately using DSM criteria [1, 3].
- Jellinek placed relief drinking early in the progression and loss of control later, but people with alcohol use disorder do not necessarily develop symptoms in that order.
- Severe or long-standing alcohol use disorder can involve physical dependence, dangerous withdrawal, and alcohol-related organ damage, although those complications are not limited to a defined “end stage” [3, 4].
- Genetics, age at first drinking, mental health, trauma, environment, and drinking patterns can all influence the risk and severity of alcohol use disorder [3].
Where the Four Stages of Alcoholism Come From
Jellinek’s phase model grew out of several early studies. His controversial 1946 analysis used 98 hand-selected questionnaires from Alcoholics Anonymous members, while a later, more detailed questionnaire was administered to more than 2,000 men before his four-phase model was published in 1952 [1]. Max Glatt later adapted the progression into the well-known Jellinek Curve by adding an upward recovery side [1].
Alcohol research has moved well beyond those original samples. Several features Jellinek described, including impaired control, withdrawal, craving, and compulsive drinking, remain clinically relevant, but modern medicine does not require people to move through his four phases in order.
The current diagnosis is alcohol use disorder, which the Diagnostic and Statistical Manual grades by the number of symptoms present during a 12-month period: two or three criteria indicate mild AUD, four or five indicate moderate AUD, and six or more indicate severe AUD [3]. Those severity levels should not be treated as direct equivalents of Jellinek’s phases because the two systems measure different things. The full symptom list and broader warning signs are covered in our guide to the signs of alcohol use disorder.
Stage 1: The Pre Alcoholic Stage
The pre alcoholic stage in Jellinek’s historical model can look like ordinary drinking from the outside. Drinking socially, drinking with dinner, or drinking on weekends is not by itself evidence of alcohol use disorder. In Jellinek’s first phase, the important change was that alcohol began to serve a stronger emotional function, such as reducing stress, quieting anxiety, or dulling emotional discomfort [1].
Drinking to cope can increase the risk of developing alcohol problems, but it is not a diagnosis, and it is not the first symptom in everyone. Modern clinicians look at the broader pattern of impaired control, craving, consequences, tolerance, withdrawal, and functioning [3].
Repeated alcohol use can strengthen learned associations between drinking and reward or relief. NIAAA describes the binge and intoxication stage of the addiction cycle as involving basal ganglia systems that reinforce alcohol’s pleasurable effects, relief from anxiety, and social effects, helping drinking become increasingly habitual over time [2]. Some people also develop tolerance, meaning they need more alcohol to achieve the same effect, although tolerance is not required for AUD and does not emerge at the same point for everyone [3].
Binge drinking is one form of alcohol misuse and can occur with or without alcohol use disorder. Whether a weekend drinking pattern has crossed that line is covered in binge drinking vs alcoholism.
Stage 2: Early Stage Alcoholism
Early stage alcoholism, Jellinek’s prodromal phase, is when the drinking becomes something the person thinks about. The early signs are blackouts (drinking to the point of memory gaps), sneaking drinks or drinking alcohol before an event to get a head start, gulping the first drink, and a growing preoccupation with when the next one is coming [1]. Guilt arrives with the first rationalizations. Drinking habits become rules: only after six, only on weekends, never before the kids are in bed. The rules matter because they get broken.
A person can develop significant alcohol use disorder symptoms while still working, maintaining relationships, and appearing outwardly functional. That outward stability can make alcohol problems easier to miss, but it does not indicate how mild or severe the disorder is. Our chapter on the high-functioning alcoholic explains why visible competence does not rule out an alcohol use disorder.
Stage 3: The Middle Alcoholic Stage
In Jellinek’s historical model, the crucial or middle phase was marked by increasing loss of control: once drinking started, the person increasingly drank more or for longer than intended [1]. In modern diagnostic terms, impaired control is one of the central features of alcohol use disorder, but it does not appear at a fixed stage for everyone [3]. Some people with more severe patterns also develop physical dependence, with symptoms such as trouble sleeping, shakiness, sweating, anxiety, or drinking to relieve withdrawal symptoms [3].
Family members may notice secrecy, irritability, defensiveness, or changes in routines as alcohol problems become more severe. Those behaviors can reflect intoxication, withdrawal, efforts to conceal drinking, relationship strain, or co-occurring mental health conditions rather than a single “alcoholic personality.” Our chapter on alcoholic personality traits looks at those patterns in more detail.
NIAAA separately describes a withdrawal and negative affect stage within the repeating addiction cycle. During this stage, brain stress systems in the extended amygdala become more active as alcohol wears off, while reward systems become less responsive. Drinking may shift from seeking pleasure toward relieving anxiety, dysphoria, or other negative feelings associated with withdrawal [2].
Consequences such as missed work, relationship problems, financial strain, hazardous behavior, or repeated intoxication may also become more noticeable as AUD becomes more severe. Depression, anxiety, bipolar disorder, and other mental health conditions often co-occur with AUD, and heavy drinking or repeated withdrawal can worsen psychiatric symptoms in some people. The relationship is explored further in drinking with bipolar disorder
Stage 4: End Stage Alcoholism
“End stage alcoholism” is an informal term commonly used for severe, long-standing alcohol problems with substantial dependence, functional impairment, or medical complications. It corresponds most closely to Jellinek’s historical chronic phase rather than to a separate modern diagnosis. Jellinek described this phase as involving prolonged intoxication, repeated benders, and drinking that increasingly displaced other priorities [1]. He also described decreased tolerance in some people, although declining tolerance is not a universal feature of severe AUD.
NIAAA separately describes a preoccupation and anticipation stage within the repeating addiction cycle, involving craving and impaired executive control associated with prefrontal-cortex systems [2]. That neuroscience model should not be treated as a direct equivalent of Jellinek’s fourth phase. Whether alcoholic or addict is the right term is mainly a question of language rather than a separate clinical condition.
What End-Stage Alcoholism Does to the Body
Long-term heavy alcohol use can affect nearly every organ system, although complications vary widely and do not appear in a fixed sequence [4]. Alcohol-associated liver disease can include steatosis, alcohol-associated hepatitis, fibrosis, cirrhosis, and liver cancer, and these conditions can overlap rather than developing through one mandatory progression [4].
Heavy drinking can also contribute to cardiomyopathy, high blood pressure, pancreatitis, and several cancers, including cancers of the mouth, throat, esophagus, liver, breast, and colon [4]. People who are physically dependent can also experience severe withdrawal, including seizures or delirium, if alcohol is abruptly stopped [3]. CDC estimated that excessive alcohol use caused about 178,000 deaths per year in the United States during 2020–2021 [5].
Why Some People Move Through the Stages Faster
Alcohol problems can develop gradually or become severe more quickly, but there is no standard timeline through Jellinek’s historical stages. NIAAA identifies several factors that increase vulnerability to alcohol use disorder, including genetics and family history, drinking at an early age, mental health conditions, and a history of trauma [3]. Genetic differences contribute substantially to population-level risk, with AUD heritability estimated at approximately 60 percent, but genes interact with environment and drinking patterns rather than determining an individual outcome [3].
Repeated heavy alcohol exposure can also contribute to tolerance, physical dependence, habit formation, and other brain adaptations involved in addiction [2]. Mental health conditions and other substance use can complicate AUD and influence severity, but they do not determine a specific rate of progression through four stages. What a family history may mean for someone’s own risk is covered in is alcoholism genetic
Getting Help at Any Stage
Alcohol use disorder can be treated at any level of severity, but the appropriate level of care is based on the person’s current clinical needs rather than a Jellinek stage. Many people receive treatment in outpatient settings, while people at risk of severe alcohol withdrawal may need medically supervised withdrawal management [3]. Withdrawal can range from shakiness, sweating, anxiety, and sleep disturbance to serious complications such as seizures and delirium.
Medical conditions, psychiatric symptoms, other substance use, previous withdrawal history, living situation, and the severity of AUD all help determine whether outpatient, intensive outpatient, residential, or hospital-based care is appropriate. Glatt later added an upward recovery side to the historical Jellinek Curve, emphasizing that worsening alcohol problems are not inevitable and recovery remains possible [1].
Frequently Asked Questions About the Stages of Alcoholism
What Is the First Sign of Alcoholism?
There is no single first sign of alcohol use disorder. In Jellinek’s historical model, increasingly drinking for relief from stress, anxiety, or emotional discomfort appears early [1]. In modern diagnosis, early warning signs can instead include drinking more than intended, unsuccessful attempts to cut down, craving, increasing tolerance, hazardous use, or other AUD criteria [3]. The first noticeable sign differs from person to person.
Are There Four, Five, or Seven Stages of Alcoholism?
Jellinek described four phases, and Glatt added recovery as a fifth on the curve that bears Jellinek’s name [1]. Seven-stage versions split the same progression into finer steps. NIAAA’s current model uses three stages of a repeating brain cycle [2]. The count matters less than the direction, which runs toward less control.
Can Someone Recover From End-Stage Alcoholism?
Recovery is possible even after severe, long-standing alcohol use disorder. People who may be physically dependent should be medically assessed before stopping because severe alcohol withdrawal can include seizures and delirium [3]. Alcohol-related medical conditions also need their own evaluation and treatment.
Some damage, particularly cirrhosis, may not fully reverse, but abstinence can help prevent further alcohol-related injury and substantially improve prognosis [4]. The appropriate treatment plan depends on withdrawal risk, medical complications, psychiatric needs, and the severity of the alcohol use disorder.
Finding Help in Minnesota
Wherever you or someone you love recognizes themselves in this description, worsening alcohol problems are not inevitable. Northwoods Haven’s intensive outpatient program provides treatment for alcohol use disorder when IOP is an appropriate level of care, with referral for medically managed withdrawal or other services when needed. Treatment can also address co-occurring anxiety, depression, stress, or other mental health concerns when they are present. Reach out for a confidential assessment and help determining what level of care fits.
Sources
- Jellinek EM. “Phases of Alcohol Addiction.” Quarterly Journal of Studies on Alcohol 1952;13(4):673-684, as described in Ward JH, “From the CAS Archives: Phases of Alcohol Addiction,” Rutgers Center of Alcohol Studies Archives, December 26, 2012. https://sites.rutgers.edu/alcoholstudies-archives/from-the-cas-archives-phases-of-phases-of-alcohol-addiction-the-story-behind-bunkys-doodle/
- National Institute on Alcohol Abuse and Alcoholism, “The Cycle of Alcohol Addiction,” 2021. https://www.niaaa.nih.gov/publications/cycle-alcohol-addiction
- National Institute on Alcohol Abuse and Alcoholism, “Understanding Alcohol Use Disorder,” updated January 2025. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder
- National Institute on Alcohol Abuse and Alcoholism, “Alcohol’s Effects on the Body,” updated June 2025. https://www.niaaa.nih.gov/alcohols-effects-health/alcohols-effects-body
- National Institute on Alcohol Abuse and Alcoholism, “Alcohol-Related Emergencies and Deaths in the United States,” Alcohol Facts and Statistics, updated March 2026. https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics-z/alcohol-facts-and-statistics/alcohol-related-emergencies-and-deaths-united-states
