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Colin MacKenzie M.D.
December 23, 2020

Late Alcoholic Stage

This is the fourth and final stage of alcoholism. It replaces the middle alcoholic stage which has been discussed in the blog titled “The Middle Alcoholic Stage of Alcoholism”.  At this stage, you may be completely addicted to alcohol meaning you have lost control over your alcohol use, you spend substantial time and money obtaining and using alcohol, nearly all your life activities revolve around alcohol, you continue to use alcohol despite persistent and recurrent problems, you have difficulty fulfilling major role obligations, you experience frequent and irresistible cravings, you have employed unsuccessful efforts to cut down, and you have developed tolerance.  You essentially become controlled by the alcohol and it often makes you feel powerless. Similar to the middle alcoholic stage, you may also feel withdrawal symptoms after stopping.  However, when you try to give up alcohol, the withdrawal symptoms may be so severe that you continue drinking just to avoid them.

Social and Behavioral Changes

The late alcoholic stage is characterized by drinking throughout most of the day. The cravings for alcohol may be driven by both the psychological desire to sustain an alcoholic “high” as well as to suppress withdrawal symptoms. Your priorities may shift to accommodate drinking as the most essential aspect of your life. You may lose interest in friends, family, previously enjoyed activities, and even typical, daily routines such as eating regular meals or going on a walk. By this stage, you most likely have lost at least one, if not multiple jobs due to alcoholism. Furthermore, impulsive behavior is more prominent in this stage and you may drink whenever and wherever you want, and become quickly angry when prevented from doing so. Drug use is not uncommon during this stage either to “cover-up” the effects of intoxication or to prevent withdrawal. 

Health Complications

During the late alcoholic stage, the consequences of long-term alcohol abuse become evident, and serious health complications may develop. You may suffer from liver cirrhosis, alcohol-induced hepatitis, gastro-esophageal bleeding, heart disease, pancreatitis[7], cancer, malnutrition, or neurological damage. Also, you may suffer from mental health disorders including depression and suicidal ideation. The risk of suicide is increased substantially during this stage, especially in older, Caucasian males.  Paranoia is also a typical feature of this stage. Additionally, you are at increased risk of having a complicated withdrawal syndrome that includes seizures and delirium tremens which typically requires emergency hospitalization if left untreated. 

Cirrhotic Liver

Liver Cirrhosis

Alcohol-induced cirrhosis typically results from years of excessive alcohol use. Alcohol is the second leading cause of cirrhosis with viral hepatitis C being the first.  Together, they account for 62% of all causes of cirrhosis.  

How does alcohol cause cirrhosis? When alcohol blood levels are high, normal metabolism of the alcohol cannot take place resulting in the accumulation of toxic by-products.  Over time, these toxic molecules destroy healthy liver cells causing an inflammatory reaction that creates scar tissue.  Cirrhosis develops when the scar tissue has accumulated to the degree that normal liver function cannot take place and normal regenerative activities no longer occur to replace the damaged liver tissue.  

Some individuals are genetically predisposed to develop liver cirrhosis even after a relatively short period of alcohol use. Though most people do not develop significant cirrhosis until after 10 to 20 years of heavy drinking, those who are genetically predisposed can develop the disease in their third decade of life. 

Cirrhosis and liver failure can lead to various other medical conditions including gastro-esophageal bleeding, inability to properly regulate glucose levels, inability to metabolize and remove toxins from the blood, alterations in cholesterol and fat metabolism, compromised immune function, vitamin deficiencies, and bleeding disorders. 

Abdominal fluid retention from cirrhosis

The signs of cirrhosis include fluid retention that can manifest as swelling of the abdomen and ankles.  Weight loss from loss of muscle mass, weight gain from fluid retention, generalized weakness, bruising, bleeding from the nose or bowels,  clay colored stool, dark or orange colored urine, confusion, and “yellowing” of the skin and eyes due to the accumulation of bilirubin called “jaundice."  If left untreated, cirrhosis can lead to kidney failure, diabetes, cancer, internal bleeding, bone disease, gall stones, and encephalopathy.  

 Treatment

The more advanced the stage of alcoholism, the more difficult it is to quit drinking, though not impossible by any means.  If you have entered late stage alcoholism, you need treatment as soon as possible to avoid any occurrence or progression of  alcohol-induced diseases such as cirrhosis or cancer. Treatment of this stage of alcoholism involves medically administered detoxification, intense therapy, medication management, and rehabilitation. Employing these activities, your mind and  body will heal, and you can embark on a journey to fix broke relationships, improve finances, and lead a more fulfilling life.

Bottom Line

This blog on the stages of alcoholism assist in defining a typical progression of alcoholism, but they are not set in stone. Wide variations exist including the length of each stage.  For most individuals who develop alcohol use disorder, the pre-alcoholic and early alcoholic stages usually manifest in the second to early third decades of life and progress to the late stage in mid-life.  However, some individuals do not enter the early stage until the fifth decade of life, while others will start the middle or even late stages before the age of 30 years.  The blog primarily helps to summarize the usual course of alcoholism and to outline the common progression in deterioration in social, psychological, occupational, and health status. 

You can recover from alcoholism no matter which stage you have reached. You should not wait until your consumption has destroyed the foundations of your life. Each year, thousands of people find a way out of their drinking through alcohol treatment. Therefore, you should never give up and always seek help.

 

References

1.      Petit, G., et al., Why is adolescence a key period of alcohol initiation and who is prone to develop long-term problem use?: A review of current available data. Socioaffective neuroscience & psychology, 2013. 3: p. 21890-21890.

2.      White, A.M., S. Tapert, and S.D. Shukla, Binge Drinking. Alcohol research : current reviews, 2018. 39(1): p. 1-3.

3.      Fillmore, M.T. and J. Weafer, Acute tolerance to alcohol in at-risk binge drinkers. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors, 2012. 26(4): p. 693-702.

4.      Wetherill, R.R. and K. Fromme, Alcohol-Induced Blackouts: A Review of Recent Clinical Research with Practical Implications and Recommendations for Future Studies. Alcoholism, clinical and experimental research, 2016. 40(5): p. 922-935.

5.      Park, S.-Y., et al., The Effects of Alcohol on Quality of Sleep. Korean journal of family medicine, 2015. 36(6): p. 294-299.

6.      Neogi, T., et al., Alcohol quantity and type on risk of recurrent gout attacks: an internet-based case-crossover study. The American journal of medicine, 2014. 127(4): p. 311-318.

7.      Irving, H.M., A.V. Samokhvalov, and J. Rehm, Alcohol as a risk factor for pancreatitis. A systematic review and meta-analysis. Jop, 2009. 10(4): p. 387-92.

8.      Osna, N.A., T.M. Donohue, Jr., and K.K. Kharbanda, Alcoholic Liver Disease: Pathogenesis and Current Management. Alcohol Res, 2017. 38(2): p. 147-161.