What is “End-stage Alcoholism?”

“End-stage alcoholism” is an outdated though still widely-used term used to describe advanced alcohol use disorder (AUD). While still used among laypeople and some medical professionals, especially in English-speaking countries outside the United States, neither “alcoholism” nor “end stages” are considered current concepts in the American Psychiatric Association’s latest Diagnostic and Statistical Manual of Mental Disorders (DSM–5).^1,2,3,4

However, while the idea of “end-stage alcoholism” has serious flaws, namely its potential for discouraging further treatment, it can still be occasionally useful for communicating certain ideas about advanced AUD.^1,4

Here we’ll explain the concept of the stages of alcoholism, focusing on the end or late stage. If you feel that you have a problem with alcohol consumption, please get in touch with a medical professional for full diagnostics. You can also contact Boston Drug Treatment Centers to find specialized AUD treatment programs in the Greater Boston area.

What are the Stages of Alcoholism?

The term “alcoholism” is no longer used officially among most American mental health professionals, except when communicating to laypersons and in legacy names such as the “National Institute on Alcohol Abuse and Alcoholism”. In the current DSM-5, alcohol abuse and alcoholism are both covered under alcohol use disorder, with some minor distinctions.^1,2,3,4

In any case, alcoholism was commonly described as having “three stages”, following other conditions covered under the “disease model”, such as cancer. These were:

• Early/adaptive stage.Marked by an increased tolerance to alcohol i.e. being able to consume greater quantities without being obviously impaired. This higher tolerance is caused by physical changes in the body triggered by regular drinking. This is the stage that is hardest to detect and most people won’t see any serious issues with the individual’s drinking.^1,2
• Middle stage.This is the stage where the affected individual begins to feel withdrawal symptoms such as irritability and discomfort when ceasing drinking. Individuals at this stage not only have intense cravings for alcohol but require more alcohol to offset the discomfort caused by ceasing drinking. Their drinking problem will usually start to become obvious to outside observers at this stage, as the cravings may cause regular inappropriate behavior. Memory loss also starts to become common at this stage.^1,2
• End/stage/terminal/deteriorative stage.This is the stage where the effects of alcohol are most evident. Affected individuals likely have multiple physical and psychiatric issues as a result of their drinking.^1,2

What are the signs of End-stage/Late-stage AUD?

Commonly cited signs of “end-stage alcoholism” include the following:^1,4,5 

• Physical alcohol-related illnesses (liver cirrhosis, brain damage, heart disease, throat cancer, stomach cancer, etc.)
• Severe withdrawal symptoms (tremors, anxiety, seizures, etc.)
• Neglected personal and professional responsibilities
• Physical changes (disheveled appearance, extreme weight changes, puffy appearance, etc.)
• Frequent risky behavior

While occasionally useful, please note that this way of viewing of alcohol use disorder does not necessarily reflect current understanding or treatment practices. If you suspect that you or someone close to you has a drinking problem, it’s best to get in touch with a qualified mental health expert immediately. They should be able to offer a more current approach to treatment that uses more up-to-date knowledge of AUD and other substance use disorders.^3,4,6

Benefits of Early Treatment

While the so-called “end-stage” is not necessarily the hopeless situation it was previously thought of, it’s best to seek treatment for AUD before it becomes worse. According to the U.S. Office of the Surgeon General, early treatment for AUD and other substance use disorders offers a number of benefits for affected individuals, including:⁶

• More easily covered by insurance
• Reduces treatment costs
• Prevents further harm
• Fewer complications
• Improves long-term recovery rates
• Reduces need for invasive treatments
• Reduces the chances of relapse

Find Early Treatment for AUD in Boston

If you suspect that you or someone close to you has problems controlling their alcohol consumption, it’s best to see a qualified clinician immediately. Better diagnostics methods have enabled physicians to accurately diagnose AUD and other mental health issues before they manifest serious physical and psychiatric symptoms.

Call Boston Drug Treatment Centers today at (617) 517-6448 to find evidence-based treatment programs and intervention specialists in the Greater Boston area.

Resources:

1. S. Office of Personnel Management. (n.d.). Alcoholism in the Workplace: A Handbook for Supervisors.

2. McEwen, D. (1998). End-stage alcoholism. AORN journal, 68(4), 674-678.

3. Regier, D. A., Kuhl, E. A., & Kupfer, D. J. (2013). The DSM-5: Classification and criteria changes. World Psychiatry: official journal of the World Psychiatric Association (WPA), 12(2), 92–98. https://doi.org/10.1002/wps.20050

4. National Institute on Alcohol Abuse and Alcoholism. (2020). Alcohol Use Disorder: A Comparison Between DSM–IV and DSM–5.

5. S. Substance Abuse and Mental Health Services Administration & U.S. Department of Health and Human Services. (2020). Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health.

6. S. Substance Abuse and Mental Health Services Administration & U.S. Office of the Surgeon General. (2016). Early intervention, treatment, and management of substance use disorders. In Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health [Internet]. US Department of Health and Human Services.