Treating end-stage alcoholism is complicated and difficult. There are many different symptoms and changes that occur across all four stages of alcoholism, including liver failure. According to data from 2018, nearly half of the 83,517 deaths due to alcohol involved liver disease. About 48 percent of cirrhosis deaths were alcohol-related in 2013. One in three liver transplants was the result of liver disease due to alcohol.

Addiction treatment and the medications available to those living with alcohol addiction have been improving exponentially. It is important to seek treatment as soon as substance is acknowledged.

The Four Stages of Alcoholism

The stages of alcoholism are broken down into experimental, social, instrumental and compulsive stages. They have specific markers and each stage progresses into the next.

Initially, people are simply experimenting with different types of alcohol and exploring their limitations. Most often, young adults are in this phase as they are experimenting with substances

A person in this stage may drink occasionally, but it is not a daily occurrence, and they are not drinking in every situation that it may seem appropriate to drink.

Binge drinking is likely to occur in this stage. Binge drinking involves drinking several alcoholic beverages in a short amount of time. For women, this amounts to four drinks in two hours, and for men binge drinking means five alcoholic beverages in two hours.

What many young people do not understand is that binge drinking can significantly harm organs in the body, more than drinking the same amount over a longer period of time.

When a person starts drinking more frequently, they have moved into the second stage, Social Drinking.

Someone in this phase may choose to drink every weekend. They also may use drinking to reduce stress, something to do, push out negative feelings, or an excuse to hang out with friends.

Using alcohol regularly puts a person at risk for developing an alcohol use disorder. A regular drinker is not the same as a moderate drinker, or someone who uses alcohol regularly to increase positive feelings and to avoid feeling negative.

Problem drinking occurs when a person drinks alcohol frequently and uncontrollably. Up to this point, the person may not have experienced consequences of their alcohol consumption habits.

However, at this stage, the person starts feeling the negative effects of their drinking, such as:

increased depression
more anxiety than normal
problems sleeping
having hangovers more frequently
legal issues
erratic behaviors
relationship problems
different friends (ones who drink more often than the old ones)
less social activity (due to behaviors while drinking)

It is also during this stage that tolerance and dependence are noticeable. The person will need to drink more to achieve the desired results.

A person will typically only willingly engage in situations that involve alcohol consumption. They also drink to manage day to day stressors or to stop feeling emotions they would like to avoid.

At this stage a person is completely addicted to alcohol. The person thinks about and uses alcohol obsessively.

People at the compulsive stage may hide their drinking because they are ashamed of it, but can’t stop. Alcohol consumption becomes a compulsion and is no longer a choice.

The person also starts losing people and things that were previously valued, such as relationships, jobs, freedom, belongings, or even their home.

It is at this point that the health of the person becomes noticeably degraded. In addition, a person in this stage of alcoholism is either hungover, drunk, or in withdrawal.

Alcohol Withdrawal

People with severe alcohol addiction can face life-threatening dangers when they stop drinking suddenly. During the first few days without alcohol, some people may have seizures or other medical problems related to alcohol withdrawal, which is why it’s crucial to get professional medical help when trying to quit drinking.

Many treatment centers offer medically supervised alcohol detox programs where trained medical staff watch people closely and provide medications to make withdrawal safer. These programs are specifically designed to help people get through the dangerous withdrawal period while keeping them safe and comfortable .

Alcoholic Liver Disease

There are three types of alcoholic liver disease, alcoholic fatty liver disease (or steatosis), alcoholic hepatitis, and cirrhosis. These diseases are indicative of a person who heavily abuses alcohol.

This is an early form of liver disease where fat begins to accumulate inside the liver cells, which make it difficult for the liver to function. There are not many symptoms of this disease, although if the liver becomes enlarged, pain will radiate from the right side of the abdomen.

Alcoholic fatty liver disease will resolve if the person stops drinking.

Alcoholic hepatitis symptoms include inflammation, swelling, and cell death in the liver. The cell death causes scarring (fibrosis).

Alcoholic hepatitis can develop over time, but binge drinking can result in immediate symptoms. These symptoms include abdominal pain and tenderness, jaundice, vomiting, nausea, and fever.

Over 30 percent of “heavy” drinkers develop alcoholic hepatitis, ranging from mild to severe. The mild cases are reversible if alcohol consumption stops.

Cirrhosis is the most serious form of alcoholic liver disease, and occurs when the whole liver is completely scarred. The result is a shrunken, hardened liver that cannot function properly.

Eventually this leads to liver failure and is irreversible in most cases. A person who drinks heavily is at nearly a 20% chance of developing cirrhosis after about 10 years.

Additional Risk Factors for Alcoholic Liver Disease

Heavy drinking over time is the main cause of alcohol-related liver disease, but some people are at higher risk than others. Several factors can make someone more likely to develop serious liver problems from drinking, even if they consume the same amount of alcohol as someone else.

Contributing factors may include:

Genetics: some people inherit genes that make it harder for their liver to break down alcohol safely, putting extra stress on the organ and increasing damage risk
Demographics: men are generally at higher risk than women due to differences in body composition and alcohol processing, and certain ethnic groups have genetic variations that affect alcohol metabolism
Malnutrition: people who drink heavily may replace nutritious food with alcohol’s empty calories, depriving the liver of essential nutrients needed for repair and protection
Being Overweight: excess weight, especially around the midsection, adds extra strain to the liver and can lead to fatty liver disease that worsens with alcohol use
Previously Diagnosed with Hepatitis: people with hepatitis B or C already have liver damage, making the organ much more vulnerable to additional harm from alcohol
Age: older adults process alcohol more slowly and are at higher risk for liver damage due to natural aging of liver cells
Gender: women develop alcohol-related liver disease faster than men, even when drinking smaller amounts, due to differences in body water content and enzyme levels

People with multiple risk factors should be especially careful about alcohol consumption and discuss their individual risk with a healthcare provider.

Painful Symptoms Of Alcoholic Liver Disease

There are many symptoms of alcoholic liver disease, and as the disease progresses it becomes painful.

These symptoms progress and include:

jaundice
blood in the digestive tract
high blood pressure
confusion
swelling in lower extremities
fluid accumulating in the abdomen (ascites)
severe abdominal pain
variceal hemorrhage
hepatic encephalopathy
enlarged spleen
kidney failure
liver failure
death

As alcoholic liver disease progresses, the liver becomes unable to function properly and blood flow is compromised. Ascites may occur at this stage. The accumulation of fluid makes it difficult to breath, and is incredibly painful and uncomfortable. Kidney failure occurs and eventually death due to organ failure.

Liver failure due to alcoholism is extremely painful, as the body shuts down slowly, and the complications from alcohol liver disease can be all-encompassing. It is important that a person battling long-term alcoholism understands that seeking alcohol use disorder treatment can help them to stop drinking. While some of the effects of alcohol abuse are irreversible, there is a chance that becoming sober may help heal some of the damage.

Written by the Addiction Resource Editorial Staff

This page does not provide medical advice. See more

Article resources

Addiction Resource aims to provide only the most current, accurate information in regards to addiction and addiction treatment, which means we only reference the most credible sources available.

These include peer-reviewed journals, government entities and academic institutions, and leaders in addiction healthcare and advocacy. Learn more about how we safeguard our content by viewing our editorial policy.

Environmental Research and Public Health - Sudden Unexpected Death in Alcohol Misuse-An Unrecognized Public Health Issue?
https://pmc.ncbi.nlm.nih.gov/articles/PMC2800334/
Mayo Clinic - Alcoholic Hepatitis
https://www.mayoclinic.org/diseases-conditions/alcoholic-hepatitis/symptoms-causes/syc-20351388
National Institute on Alcohol Abuse and Alcoholism - Alcohol Facts and Statistics
https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics

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