End stage alcoholism is the last stage of alcohol addiction wherein the patient’s mental and physical health is severely impacted due to long term alcohol abuse.
The Final Phase Of Alcoholism
It is a condition characterized by a persistent urge to drink alcohol despite having major life-threatening consequences. In this phase, long term alcohol abuse becomes evident from the patient’s inability to function without alcohol. Alcohol consumption tends to become a daily affair. The individual’s priorities also change with time in order to facilitate drinking. Recovery is not easy at this stage. A 2011 study 1 pointed out that if it’s left untreated, it can be fatal. Alcohol is also found to be a leading underlying cause for more than 30 conditions. According to a 2019 survey 2, almost 14.5 million people in the US have alcohol use disorder.
If a person attempts to cut back or withdraw from alcohol during this stage, they may experience severe withdrawal symptoms. Withdrawal symptoms may include nausea, sweating, or headache. The most severe withdrawal symptoms of alcohol withdrawal are called delirium tremens. This condition causes shaking, confusion, high blood pressure, fever and hallucination. If this condition is left untreated, it can also be fatal. Thus, it is crucial to understand the different stages of alcoholism in order to avoid such dire consequences.
Stages of Alcoholism
Alcohol dependence and addiction is a progressive disease that advances with time. There are three main stages of this condition. They are as follows:
1. Early Stage Alcoholism
This stage is the beginning phase of the alcoholic’s persistent abuse of alcohol. The early stage is usually characterized by binge drinking and blackouts. It is typically prevalent among young people who experiment with their limits. Initially, it is a positive experience for the user since they don’t appear to be sick. Gradually, as the user engages with this behavior, the tolerance level increases. It also often goes unnoticed by the people around them. The high tolerance level displays signs of alcoholism. In this stage, the individual may enjoy drinking more frequently in social settings. When casual drinkers advance towards the early stage, their tolerance levels begin to rise.
Signs of Early Stage Alcoholism
Some of the common signs of early-stage alcohol addiction are:
- Drinking more than usual
- Recurrent drinking to avoid stress, boredom, or loneliness
- Attempting to drink more in social settings
With time, the body becomes more dependent on alcohol as the cells in the body develop a high tolerance to alcohol. The individual progresses towards middle-stage alcohol dependence as they engage in more alcoholic behaviors.
2. Middle Stage Alcoholism
In this stage, drinking becomes a necessity and not an option. Due to regular drinking, the body’s organs start to actively get damaged. The drinker starts to experience the negative effects of drinking. When alcohol levels in the body aren’t as high, they experience physical discomfort. They feel fulfilled when they are intoxicated. In this stage, if the drinker stops drinking, the body experiences a sudden shock since it requires alcohol to function better. Alcohol addiction signs are quite visible in this stage.
Signs of Middle Stage Alcoholism
Some of the common signs of this stage are:
- Consistent drinking even in non-social settings
- Experiencing withdrawal symptoms such as nausea, or sweating
- Reduced social activity
- Erratic behavior
- Experiencing difficulty maintaining healthy relationships with friends or family
- Prioritising drinking over their family, job or education
3. End-Stage Alcoholism
In this final stage, the addict cannot seem to function without alcohol. The individual in the end stage of alcoholism tends to exhibit both physical and mental issues. The alcoholic’s body starts to deteriorate at a rapid rate. Long term alcohol abuse causes a wide range of physical conditions in the heart, liver, kidneys, and other major organs. The liver of the alcoholic’s body tends to struggle to maintain and leverage the nutrients necessary for the body. Nutritional deficiencies pose certain mental challenges such as emotional instability, mental confusion, and inability to remain alert.
Signs of End-Stage Alcoholism
Alcohol dependence and addiction doesn’t develop in a single day. End-stage alcoholism can cause a number of physical and mental health conditions. They are as follows:
- Heart failure
- Fluid retention
- Itchy skin
- Liver cancer
- Liver failure
- Alcohol dementia
- Mouth cancer
- Throat cancer
- Breast cancer
Diagnosis Of End Stage Alcoholism
There is no official diagnosis for this condition. The Diagnostic and Statistical Manual of Mental Disorders laid out the diagnostic criteria for alcohol use disorder. If an individual meets six of the following criteria, they are diagnosed with this condition.
- Frequent intoxication leading to failure to meet daily obligations
- Recurrent use despite having physical consequences
- Increasing consumption due to high tolerance level to attain the same effects
- Drinking to avoid or relieve withdrawal symptoms
- Drinking large amounts or for a long period of time than intended
- Unsuccessful attempts to cut down or quit drinking
- Ample amounts of time spent using, obtaining or recovering from drinking
- Avoidance or reduction of important social or recreational activities due to alcohol use
- Continued drinking despite having knowledge of a recurrent or persistent psychological or physical problem caused or exacerbated by alcohol use
- Recurrent alcohol cravings
Treatment for End-Stage Alcoholism
Alcohol addiction can have dire consequences. Hence, it is essential to seek treatment for alcohol use disorder. The first step towards recovery is to have a medically supervised detox that will rid the body of toxins and manage the withdrawal symptoms. Here are some of the most effective treatment options for this condition:
One of the most commonly used methods of treatment is cognitive behavioral therapy (CBT). Cognitive behavioral therapy involves identifying the thoughts and patterns that govern the negative behavior. These thoughts are then replaced with positive thoughts to attain the desired behavior. A 2010 study 3 demonstrated the efficacy of CBT in treating patients with alcoholism. Another 2009 study 4 also found efficacy in relapse prevention when CBT was combined with pharmacotherapies. The doctor may also help the patient to learn different coping methods and identify the underlying causes that are triggering this behavior. Other therapy methods that are used are:
- Rational behavior therapy
- Dialectical behavior therapy (DBT 5 )
- Group therapy
A 2018 study 6 pointed out that many patients have lapses during their lifetime and will require initiation of different therapy treatments throughout their lifetime.
There are several medications that can be used to treat alcohol addiction. An alcohol sensitizing drug, disulfiram may be prescribed to reduce the desire by making the patient sick when they consume alcohol. After ethyl alcohol is absorbed by the body, it is converted to acetaldehyde that is oxidized in the liverby the mitochondrial enzyme aldehyde dehydrogenase (ALDH). Disulfiram produces an irreversible inhibition of ALDH activity. According to a 2014 study 7, “disulfiram is a safe and efficacious treatment compared to other abstinence supportive pharmacological treatments or to no disulfiram in supervised studies for problems of alcohol abuse or dependence.” A 1992 study 8 found that even small amounts of alcohol consumed with disulfiram can produce mild reactions.
Another medication acamprosate may also be prescribed to combat alcohol cravings by restoring the chemical balance in the brain. A 2008 study 9 confirmed significant improvements in abstinence rates when subjects with 7 or more years of alcohol dependence were prescribed this medication. Naltrexone 10, another medication for alcohol abuse, helps in restricting the feel-good effects of alcohol. This makes the patient less inclined to drink. A 2017 research 11 has found that naltrexone has proven to be a “promising” treatment approach for alcohol addiction and dependence. However, according to a 2012 study 12, “Numerous trials have found that acamprosate is not significantly more efficacious than naltrexone or disulfiram.
3. Other Treatment Options
Some of the other treatment options for alcoholism may include:
- Clinician’s advice on the harms of alcohol abuse
- Joining AA groups
- Encouraging patient to remove all alcohol from their house
- Practicing mindfulness and refocusing in other activities
- Signing up for a rehabilitation centre
Recovery From End-Stage Alcoholism
End stage alcoholism is visible when the individual’s physical and mental health is severely impacted. However, it is important to keep in mind that alcohol dependence is a medical condition that can be effectively treated. Sticking to the treatment plan is crucial to avoid relapses. Recovery can be challenging but it is possible to recover at any stage of alcohol addiction.References:
- Rehm J. The risks associated with alcohol use and alcoholism. Alcohol Res Health. 2011;34(2):135-43. PMID: 22330211; PMCID: PMC3307043.
- Alcohol facts and statistics. (2020). National Institute on Alcohol Abuse and Alcoholism (NIAAA). https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics
- McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive behavioral therapy for substance use disorders. The Psychiatric clinics of North America, 33(3), 511–525. https://doi.org/10.1016/j.psc.2010.04.012
- Magill, M., & Ray, L. A. (2009). Cognitive-behavioral treatment with adult alcohol and illicit drug users: a meta-analysis of randomized controlled trials. Journal of studies on alcohol and drugs, 70(4), 516–527. https://doi.org/10.15288/jsad.2009.70.516
- Dimeff, L. A., & Linehan, M. M. (2008). Dialectical behavior therapy for substance abusers. Addiction science & clinical practice, 4(2), 39–47. https://doi.org/10.1151/ascp084239
- Kranzler HR, Soyka M. Diagnosis and Pharmacotherapy of Alcohol Use Disorder: A Review. JAMA. 2018 Aug 28;320(8):815-824. doi: 10.1001/jama.2018.11406. PMID: 30167705; PMCID: PMC7391072.
- Skinner, M. D., Lahmek, P., Pham, H., & Aubin, H. J. (2014). Disulfiram efficacy in the treatment of alcohol dependence: a meta-analysis. PloS one, 9(2), e87366. https://doi.org/10.1371/journal.pone.0087366
- Johansson B. A review of the pharmacokinetics and pharmacodynamics of disulfiram and its metabolites. Acta Psychiatr Scand Suppl. 1992;369:15-26. doi: 10.1111/j.1600-0447.1992.tb03310.x. PMID: 1471547.
- Kranzler HR, Gage A. Acamprosate efficacy in alcohol-dependent patients: summary of results from three pivotal trials. Am J Addict. 2008 Jan-Feb;17(1):70-6. doi: 10.1080/10550490701756120. PMID: 18214726.
- Anton R. F. (2008). Naltrexone for the management of alcohol dependence. The New England journal of medicine, 359(7), 715–721. https://doi.org/10.1056/NEJMct0801733
- López, C. M., Barr, S. C., Reid-Quiñones, K., & de Arellano, M. A. (2017). Efficacy of Naltrexone for the Treatment of Alcohol Dependence in Latino Populations. Journal of studies on alcohol and drugs, 78(4), 629–634. https://doi.org/10.15288/jsad.2017.78.629
- Witkiewitz, K., Saville, K., & Hamreus, K. (2012). Acamprosate for treatment of alcohol dependence: mechanisms, efficacy, and clinical utility. Therapeutics and clinical risk management, 8, 45–53. https://doi.org/10.2147/TCRM.S23184