End Stage Alcoholism
What are the Signs and Treatment?

Medically Reviewed By Kayla Loibl | Last Edited : april 21, 
| 4 Sources

Chronic alcohol abuse can put a person in end stage alcoholism.

They are in the final of the alcoholism stages. End stage alcoholism.

At this point, the individual has two possible choices. One would be to stop drinking and work towards a healthier life style. The other option would be to make no changes, and die from the damage that drinking is causing.

For individuals who do not struggle with addiction, this seems like an easy choice. For someone struggling with an alcohol addiction, this may not be as simple. They may be struggling with  denial. For these individuals, they are unable to recognize the negative impact that drinking has had on their life, while others find that the negative impacts are quite obvious. Effects could be seen within relationships, finances, job security and behaviors.

For many, needing to experience “rock bottom” can be a turning point in their addiction where they begin to recognize that abstaining from alcohol use would be a wise decision. It is at this point that an alcoholic is more open to options such as addiction treatment and Alcoholics Anonymous.

Characteristics of Early/Adaptive Stage Alcoholism

The time it takes to progress from one phase to the next varies from one individual to the other. Generally, it takes 15 years to go from early to end stage alcoholism.

It is important to note that these stages do not occur separately, they overlap and combine.

The first signs of alcoholism become apparent at this stage.

Drinking is no longer social.

The individual drinks as a way to deal with their emotional problems or to make themselves feel better.

As they drink more so their tolerance increases and they can drink lots more than their 'normal' drinking friends.

Many at this alcoholism stage are able to drink a lot and not appear drunk at all.

Often those in the first stage do not get hangovers.

Physically there are no outward problems- at least not for now.

"Let one of our support assistants help you on your way to sobriety. With many having first hand experience, they have been in your shoes and understand the struggle. The free chat is confidential & they are available 24/7."

The drinker in this first stage is usually a functional alcoholic. This means they manage to hold down their job, any relationships they have and continue with interests and hobbies. Although, a lot of the time they may well be lying about the quantity they are drinking and how often.

The individual is usually not aware that they have a problem at this stage- they are in alcoholic denial.

end stagePhoto by Cristian Newman

Characteristics of Middle Stage Alcoholism

In this stage of alcoholism the person starts to act and seem more like the stereotypical drunk.

They now lose control of their drinking. Starting earlier in the day and drinking alone become normal.

Their drinking companions, if there are any, are fellow alcohol abusers.

There is no longer any joy in drinking only pain and misery. Feelings that the alcoholic manages by drinking more. A vicious circle.

It is a terrible state to be in.

The craving becomes more intense and practically impossible to control. Part of the reason for this is that the individual's body has become so attuned to drink that it can't manage without it.

If the body can't get alcohol it reacts alcohol withdrawals result in the addict suffering from intense anxiety, sweating, shaking, hallucinating and a whole lot more. There is no respite except for a drink.

Alcoholic blackouts also occur. Large periods of time pass which the individual can't remember. The brain, riddled with alcohol, fails to record experiences. Anything and everything can occur during these periods- there are stories of people taking cross country road trips, having business meetings etc. and not recalling anything.

Alcohol related health problem also begin appear at this stage of alcoholism. Alcoholic gastritis, bad hangovers etc. become more common.

Whereas in the adaptive stage the individual managed to perform in his job and maintain relationships, now it all begins to unravel. They get into trouble at work and at home.

The alcoholic is now on the edge of a precipice, if they don't get help soon they will fall and things will get a whole lot worse.

Final Stage Alcoholism/ End Stage Alcoholism

It is called end stage alcoholism because it is the end. Either the end of the life of the person or the end of their drinking days.

Although a life-threatening condition, end-stage alcoholism can be treated, read Treating Advanced Alcoholism for more details.

If they do not stop drinking soon they will die. It's as simple as that.

The final stages of alcoholism are not pretty.

For the sufferer and those living with the alcoholic or witnessing his or her decline.

In the end stage alcoholism, the individual's body has been poisoned to such an extent that it is suffering. There are many physical problems that can appear at this stage such as heart disease, fatty liver, cirrhosis of the liver, alcoholic hepatitis, pancreatitis, malnutrition, brain damage and so on.

All of these are SERIOUS, if not life-threatening conditions.

Vitamin deficiency, particularly in B-1, can also cause many other problems

Not only are there physical problems but mental too. The individual will, at this stage, be suffering from delusions, is mentally confused and perhaps psychotic. In short, very unwell.

Relationships have, in most cases been irreparably damaged. Jobs have been lost. Drinking is now the sole focus of the individual- nothing else matters. All other needs are ignored- food, shelter, warmth, water etc.

Astonishingly, many people at this stage are still in denial about their condition. They still blame everything for their problems except alcohol.

Characteristics of End Stage Alcoholism

Continual loss of control. Loss of control over drinking is a common characteristic among alcoholics. Many surrender to this and stop trying to fight it. At this point, alcohol has become the focus of their life and everything else falls to the back burner. Legal troubles may be present as well, at this end stage alcoholism.

  • Feelings of impending doom and destruction. The dependent drinker feels great fear of unspecified things/events. They are constantly anxious and often foresee their own destruction (death). For many, this concern is the result of realistic possibilities if they are to continue drinking. It is also important to recognize the long term effect that alcohol, a depressant, can have on a persons mood and mental health. Common depressive symptoms include loss of hope, sadness and loss of interest in activities previously enjoyed.
  • Tolerance falls. Where before they were able to drink large amounts now their tolerance for alcohol falls and they get intoxicated very easily.
  • Delirium Tremens. Violent shaking and sweating can occur when a heavy drinker stops drinking. This is known as Delirium Tremens (DT’s) and can occur when an individual is detoxing from alcohol. In fact 1 in 5 alcoholics who try to withdraw from alcohol without medical supervision die in the process. There are several factors that influence the severity of a person’s withdrawal symptoms which includes multiple detox’s in the past. Consult with a doctor before attempting to detox on your own.
  • Ongoing remorse and guilt. Not surprisingly the drinker now feels continually remorseful. Guilt is his shadow. The feeling of guilt is often present throughout the day. Not just remorse for his drinking and his powerlessness over alcohol but toward all the pain he has caused himself and others. The missed opportunities, the shame the whole thing. These are common experiences that individuals process and work through in treatment and/or therapy. Guild is the sense of “I’ve done bad” whereas shame is more “I am bad”.
  • Resentments are amplified. He or she feels unjustified anger and bitterness towards the world and everything/everybody in it. This just fuels his drinking. A me vs. the world complex. Resentments rarely impact the person they are against, and really have a negative impact on the person carrying them. Similar to shame and guilt, resentments are a common concern addressed in treatment and/or therapy.
  • Alcoholic blackouts. The alcoholic blackouts are now getting longer. Days or even weeks go by without the alcoholic remembering anything. To others he may seem lucid but the drinker is on autopilot. As a result, these can be physically dangerous for the alcoholic and others around them.
  • Obsession with drinking. Alcohol is on the drinker’s mind day and night. Nothing else matters. Maintaining a constant supply of drink is foremost, whatever the cost. There is also nothing that will get in the way of getting alcohol. For example, an alcoholic low on drinks would likely not think twice about walking to a gas station during a blizzard to buy alcohol. To someone who is not an alcoholic, this sounds like a crazy idea, however for the alcoholic, it is all they can think about.
  • Needs system comes crashing down. All other needs including water, food, sex, shelter warmth take second place to drink. In many cases the chronic alcoholic becomes homeless but this doesn’t matter as long as drink can be found. As a result, it is not uncommon for end stage alcoholics lose weight and become dehydrated. They can encounter health concerns related to poor nutrition. Many marriages and romantic relationships do not last past this point. Living with an end stage alcoholic can become unbearable. The alcoholic has likely gotten in trouble at work or has lost their job. They have distanced themselves from friends and family due to their preoccupation with drinking. 
  • Frequent contact with law enforcement. Chronic alcoholism usually results in the sufferer having more and more brushes with the law. This could be for drunk driving, drunk and disorderly, assault etc. For loved ones, this can easily turn into a situation where they are enabled.
  • Personal relationships collapse. Where before the dependent drinker had at least made some sort of effort to keep people in his life (though often by lying) now he just can’t be bothered. Any relationships he had left now dissolve in the drink. It takes a strong person to stand by someone in end stage alcoholism. This can include friendships, family and, unfortunately, children. Again, this is the result of their preoccupation with alcohol and drinking.

It would be unusual for the chronic alcoholic to display all these characteristics. Some of these characteristics can be observed earlier than others. For example, someone may experience trouble with law enforcement in the beginning of their addiction compared to the tail end of it, or their personal relationships can begin to collapse early. 

However, if three or more are evident then it is very likely that they are in the end stage alcoholism.

late stage alcoholismPhoto by Kat J

How to Help Someone in End Stage Alcoholism

Without wanting to sound like a pessimist, the odds are against anybody trying to get through to a chronic alcoholic are pretty low. However, try not to let that deter you. There is never a point in addiction where it is “too late” to get sober. No matter how late it may be, a person can choose to stop drinking which may stop the adverse effects from progressing further than they already have.

To have got to this stage a person will have generally rejected many offers of help and probably been through alcoholism treatment at least once. They will be so consumed by drink and all the resentment and guilt that comes with it.

There are a few different levels of treatment that they could have tried already. This includes:

  • Detoxification- Detox from alcohol and other substances (if applicable) in a medically supervised. Due to the dangers associated with alcohol detox, it is ideal that an alcoholic be supervised by health professionals.
  • Inpatient Treatment Programs- Can easily follow a detoxification. The length of treatment can vary on the program itself, the severity of the person’s disease as well as insurance coverage. While in treatment, the alcoholic will be engaged in individual sessions, group sessions and psychoeducational sessions. They will learn more about the disease concept of addiction as well as how to cope with their addiction.
  • Outpatient Treatment Programs- Engaging in an outpatient program is the common recommendation from inpatient programs. Returning to your normal, everyday life, can present challenges. Some predictable, and some not. Outpatient would likely include group and individual sessions to continue supporting the alcoholic through their recovery.

It is important to remember that if the individual does not want help then there is NOTHING that can be done. The individual needs to want to be in alcoholism treatment for the intervention to be effective.

It is essential you don’t blame yourself if an offer of help is rejected by someone in end stage alcoholism. This tells you more about where the person is in their addiction than anything else.

"Let one of our support assistants help you on your way to sobriety. With many having first hand experience, they have been in your shoes and understand the struggle. The free chat is confidential & they are available 24/7."

If you or someone close to you wants help and advice on quitting drinking then take a look at the following pages:

Lead Writer/Reviewer : Kayla Loibl

Licensed Medical Health Professional 


I am a Mental Health Counselor who is licensed in both New York (LMHC) and North Carolina (LCMHC). I have been working in the Mental Health field since 2015. I have worked in a residential setting, an outpatient program and an inpatient addictions program. I began working in Long Island, NY and then in Guelph, Ontario after moving to Canada. Read More


Information about the signs and symptoms of alcoholism:                                Alcoholism: Symptoms and Signs (americanaddictioncenters.org)

Information regarding the diagnosis and treatment of Alcohol Use Disorder: Alcohol use disorder - Diagnosis and treatment - Mayo Clinic

Additional information regarding treatment of Alcohol Use Disorder: Treatment for Alcohol Problems: Finding and Getting Help | National Institute on Alcohol Abuse and Alcoholism (NIAAA) (nih.gov)

A clinical article discussing the complications that can occur with alcohol withdrawal: Complications of Alcohol Withdrawal (nih.gov)

Return from End Stage Alcoholism to What is Alcoholism? 

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