Understanding End Stage Alcoholism

Alcohol use disorder (AUD) is a medical condition that involves heavy or frequent alcohol consumption. Those with an alcohol use disorder struggle to stop drinking alcohol even when it causes problems in their lives.

End-stage alcoholism has led to the person experiencing significant and serious health conditions, which can include organ failure, certain cancers, and early death. Stopping drinking in late-stage alcoholism typically requires medical care, including detox, rehab, and behavioral health therapy.

Alcohol Use Disorder

Alcohol use disorder (AUD) is a medical condition that involves heavy or frequent alcohol consumption. Those with an alcohol use disorder struggle to stop drinking alcohol even when it causes problems in their lives. Alcohol use disorder is also known as alcoholism, alcohol dependence, alcohol addiction, and alcohol abuse.

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), includes the following criteria to diagnose an alcohol use disorder.  If you have 2-3 symptoms, you have a mild alcohol use disorder, 4-5 symptoms indicate a moderate alcohol use disorder and six or more symptoms indicate a severe alcohol use disorder. The following are the symptoms of an alcohol use disorder. [1]

In the past year, have you:

• Have you had times when you ended up drinking more or longer than you intended?
• More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
• Spent a lot of time drinking? Or being sick or getting over other aftereffects?
• Wanted a drink so badly you couldn’t think of anything else?
• Found that drinking, or being sick from drinking, often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
• Continued to drink even though it was causing trouble with your family or friends?
• Give up or cut back on activities that were important or interesting to you or gave you pleasure to drink.
• More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
• Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
• Had to drink much more than you once did to get the effect you want? Or did you find that your usual number of drinks had much less effect than before?
• Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure? Or sensed things that were not there?

Stages of Alcoholism

Alcohol use that progresses into an alcohol use disorder, or alcoholism, develops over five stages. They are: [2]

Stage 1: At-Risk Stage

Do you drink to relieve stress, to feel better, to stop worrying, to forget, to dull pain, to relieve your anxiety? These are risk factors for developing a tolerance to alcohol and can easily escalate to a problem level without addressing the core issues that are causing you to use alcohol as a coping skill.

Stage 2: Early-Stage Alcohol Use Disorder

In this stage, you are experiencing cravings, thinking about alcohol a lot, drinking alone or in secret, lying about or trying to hide your drinking from others, drinking excessively, and experiencing blackouts.

Stage 3: Mid-Stage Alcohol Use Disorder

In this stage, your alcohol use has taken over your life. Your drinking is out of control and is causing problems in your ability to complete your daily responsibilities (school, work, relationships, health).  You begin to experience physical health issues related to your drinking, such as weight gain, bloating and flushed skin on your face. Lab tests and medical scans may reveal organ damage.

Stage 4: Late-Stage Alcohol Use Disorder

In this stage, drinking has now taken over your life. Even taking precedence over eating, intimate relationships, finances, happiness, and health. The effects of organ damage are now apparent, and death is often imminent without intervention. Attempts to stop drinking at this stage can result in seizures, tremors, hallucinations, and life-threatening withdrawal symptoms. To stop drinking at this stage requires medical care, including detox, rehab, and behavioral health therapy.

Health Complications in End-Stage Alcoholism

Long-term, heavy alcohol use results in significant health conditions in end-stage alcoholism. Alcohol impacts all body systems and can have life-threatening consequences after chronic use. End-stage alcoholism health complications include: [3]

Liver Disease

90% of alcohol is metabolized in the liver, making it vulnerable to severe and chronic injury. Alcoholic liver disease (ALD) plays a major role in alcohol-related morbidity and mortality. Alcohol-associated liver disease includes fatty liver, cirrhosis of the liver, and alcohol-associated hepatitis.

Pancreatitis

Alcohol is a leading cause of chronic pancreatitis and a significant cause of acute pancreatitis. Smoking raises the risk of both types of pancreatitis.

Gastrointestinal System

Several gastrointestinal system complications due to heavy alcohol use. Alcohol can damage the epithelial lining of the gastrointestinal tract, causing inflammation and GI bleeding. There is a high correlation between alcohol consumption and gastroesophageal reflux disease.

Immune System

Binge drinking and chronic heavy drinking both can interfere with multiple aspects of the immune response. This impairs the body’s ability to defend against infection, impedes recovery from tissue injury, causes inflammation, and contributes to alcohol-related organ damage.

Endocrine System

Heavy drinking causes hormonal disturbances within the endocrine system and disrupts the release of neurotransmitters. For those with diabetes, any alcohol intake can limit their ability to control blood glucose levels. Heavy drinking may increase the risk of developing Type 2 diabetes.

Pulmonary System

Alcohol damages ciliary function in the upper airways and diminishes the barrier function of the epithelia in the lower airways. Alcohol lung damage often goes undetected until there is a respiratory infection. Chronic alcohol users experience higher rates of pneumonia, Acute Respiratory Distress Syndrome, and worse prognosis of COVID-19.

Cardiovascular System

Heavy drinking is linked to numerous cardiovascular problems, including heart disease, strokes, blood pressure issues, arrhythmia, cardiomyopathy, and myocardial infarction. Heavy alcohol use causes 9,000 deaths per year from heart disease and stroke.[4]

Neurological System

Alcohol use disorder causes central nervous system and peripheral nerve damage. Brain damage from alcohol use can cause cognitive functioning difficulties and result in amnesia and dementia.

Cancer

Long-term use of alcohol increases your risk of developing different types of cancers due to alcohol being a carcinogen. Esophageal, liver, breast, and colorectal cancers are most often connected to alcohol use.

Treatment for Alcohol Use Disorder

Depending on the severity of your alcohol use disorder, you may need to undergo medical detoxification from alcohol. Inpatient medical treatment monitors your alcohol withdrawal symptoms to ensure a safe detox. Other treatment settings include residential alcohol rehabilitation, intensive outpatient therapy, and outpatient maintenance programs.

Treatment often includes a combination of behavioral therapies and support groups.

Behavioral therapy or mental health counseling approaches frequently used to treat alcohol use disorder include motivational interviewing, cognitive behavioral therapy, and contingency management.

Support groups are meetings with other people who have alcohol use disorder and together support each other in staying sober. Many of these groups are community-based and free, such as Alcoholics Anonymous, SMART Recovery, and Celebrate! Recovery, and Recovery Dharma.

Alcohol use disorder is a serious medical condition that requires treatment to overcome. End-stage alcoholism is life-threatening. If you or a loved one are struggling with end-stage alcoholism, speak with a healthcare provider immediately to assess treatment needs and, if necessary, receive a referral to a treatment center that specializes in alcohol use disorder.

Frequently Asked Questions About End-Stage Alcoholism