Recognising the Last Stages of Alcoholism: Signs to Know

‘Last-stage alcoholism’ refers to what tends to be the last stages of alcoholism in terms of severity and harm, and usually involves a long-standing alcohol dependence accompanied by serious health and social consequences.

Despite the name suggesting an inevitable progression in alcohol use disorder, it’s worth remembering that not everyone will reach this stage, or they may not experience stages at all. Addiction is always manageable, and treatment is always an effective option to consider.

 

What Is Meant by the Last Stages of Alcoholism?

The last stages of alcoholism, also known as end-stage or late-stage alcohol use disorder, are generally used to refer to the most severe and destructive phases of long-term alcohol dependence.

Although not an official clinical diagnosis, late-stage alcoholism is recognised through a number of issues. These might include a loss of control, severe physical dependence and continued drinking despite extensive harm. This harm might include physical and mental ill-health but could also involve lifestyle and situational factors such as relationship breakdown, financial difficulties and housing issues.

Serious complications can develop gradually, but in some cases they may present more suddenly.

 

Changes in Drinking Behaviour

This stage of alcohol dependence is characterised by heavy and sustained drinking. This may involve starting to drink soon after waking up and drinking throughout the day. Alcohol may be needed to relieve shaking, sweating, nausea or anxiety – essentially staving off withdrawal symptoms that can otherwise be debilitating.

At this point, there may have been numerous unsuccessful attempts to stop or cut down on drinking. The person may have been medically advised that this is something they need to do. Tolerance may increase initially, meaning alcohol appears to have less effect, but can fall again as health and liver function deteriorate.

The drinker may become secretive or defensive, or they may become more isolated, cutting off contact with friends and family. Securing more alcohol to drink may become a main preoccupation and priority.

 

Physical Signs of Severe Alcohol Dependence

Some physical signs of severe alcohol dependence can include tremors, excessive sweating, frequent nausea and disrupted sleep, accompanied by extreme tiredness and fatigue.

An individual at this stage is unlikely to be looking after themselves very well and may experience significant weight loss, symptoms related to poor nutrition and signs of physical weakness. They might also have repeated falls, injuries and accidents. Other elements of self-care might include things like neglecting personal hygiene.

Individual symptoms are not sufficient to diagnose the stage or severity of dependence alone, but there may be an overall pattern of increasing severity.

 

Signs of Advanced Alcohol-Related Liver Disease

Alcohol-related liver disease can be relatively symptomless at first, but symptoms of it advancing could include jaundice, abdominal swelling, swollen legs or ankles, easy bruising, itching, fatigue and loss of appetite.

Vomiting blood, black stools and confusion can be more serious warning signs.

 

Effects on the Brain and Nervous System

Long-term heavy drinking can have serious effects on cognitive abilities and motor skills, including:

• Confusion
• Memory issues
• Poor concentration
• Unsteady walking
• Peripheral neuropathy (nerve damage causing numbness, pain or weakness in the hands and feet)
• Changes in behaviour

Wernicke’s encephalopathy and Wernicke–Korsakoff syndrome are related conditions caused by a vitamin deficiency and associated with severe alcohol use disorder.

Confusion, abnormal eye movements or unsteady walking in a dependent drinker requires urgent medical assessment.

 

Mental Health and Behavioural Changes

People at this stage may suffer from depression, anxiety, irritability and emotional instability. These issues may be exacerbated by withdrawal from friends, family and previously valued activities.

Dependency and frequent heavy drinking are also associated with impaired judgement, neglect of responsibilities and possible suicidal thoughts.

You should call 999 if you believe there is an immediate risk of suicide or a person causing serious harm to themselves or others.

 

Wider Health Complications

Alcohol is associated with many other physical and mental health problems. These can include cardiovascular problems, pancreatitis and conditions associated with weakened immunity.

Excessive alcohol use can cause or increase the risk of gastrointestinal bleeding, malnutrition and increased infection risk. It can also worsen existing medical conditions and interact with medication in various ways.

 

How to Know If Your Symptoms Are Serious

There may be other signs and symptoms prompting you to seek urgent medical attention, but you should definitely call 999 if a person experiences:

• Vomiting blood
• Black stools
• Sudden severe abdominal pain
• Seizures
• Severe confusion
• Hallucinations
• Loss of consciousness
• Slow or irregular breathing
• Chest pain and signs of stroke

The person with these issues should not be left alone or allowed to drive to the hospital by themselves.

 

Why Abruptly Stopping Alcohol Can Be Dangerous

Severe dependence can cause life-threatening withdrawal symptoms, as the brain and body have made compensations to adjust for the presence of alcohol in the system.

Delirium tremens is at the most severe end of the alcohol withdrawal spectrum and can cause severe agitation and confusion, tremors and seizures. It is a medical emergency and can prove fatal.

A clinical assessment can determine the appropriate withdrawal setting, but a person with severe alcohol dependency should never try detoxing alone.

 

Can Someone Recover From Severe Alcohol Dependence?

Even the most severe addiction is treatable. Some related health conditions may improve or stabilise, but some may require ongoing care depending on type and severity.

Medically assisted withdrawal can help you to detox safely, while rehabilitation can address the psychological aspects of addiction and the management of related health conditions.

 

How to Help Someone With Severe Alcohol Dependence

There’s no one-size-fits-all approach, but non-judgemental communication is always preferable to confrontation. It will generally be best to choose a time when the person is as sober and medically stable as possible.

Professional intervention support can be helpful in some cases, but remember, if you’re going to stage an intervention, you need to prioritise relatives’ and other loved ones’ safety and wellbeing.

 

Finding Professional Treatment

The best way to tackle serious alcohol dependence and addiction is generally through a holistic rehab programme. This can offer medically supervised detoxification, along with a structured programme of therapy and relapse prevention sessions. Inpatient rehab can also provide round-the-clock care and additional benefits like planned and balanced nutrition.

Addiction Advocates offers expert assistance in finding suitable inpatient alcohol treatment, with a wealth of experience in supporting families and people with complex needs.

In an alcohol-related emergency, call 999 or take the person to A&E. But if you’re looking for long-term treatment for yourself or a family member, you can contact Addiction Advocates for confidential advice and guidance on next steps.