End Stage Alcoholism: Signs, Symptoms, & Treatments

What Is End Stage Alcoholism?

Alcohol use disorder generally progresses to end stage alcoholism. If someone doesn’t receive help for their condition or stop drinking on their own, their tolerance tends to grow over time. With that, alcohol affects every part of the body. Chronic drinking often leads to numerous physical and emotional health consequences. Research shows that 140,000 people die from alcohol-related causes each year. Alcohol is the fourth-leading cause of preventable death in the US.¹

Alcohol use disorder evolves through four different stages:

1. At-risk stage: Although someone might not meet the criteria for an alcohol use disorder, this stage is marked by problematic drinking. Someone may drink as a coping mechanism and begin developing a tolerance to alcohol.
2. Early-stage alcohol use disorder: The early stage tends to refer to periods of heavy, problematic drinking. However, someone may not face significant consequences at this time.
3. Middle-stage alcohol use disorder: During the middle stage of alcoholism, someone is experiencing consequences (physical or emotional). If they don’t reduce or stop drinking, the consequences continue evolving.
4. End-stage alcohol use disorder: This is the final stage of alcohol use disorder. The symptoms are most intense and can lead to death.

What Are the Symptoms of End Stage Alcoholism?

End-stage alcoholism can impact a person’s physical and mental health, and it may lead to problems in relationships, issues with work or school, decreased financial stability, and other consequences. These consequences may occur gradually,  but other times, they can happen quickly and intensely and may cause premature death.

Symptoms of end-stage alcoholism include:²

• Cirrhosis
• Malnutrition
• Fluid retention
• Excessive fatigue
• Anemia
• Heart failure
• Pancreatitis
• Liver failure
• Digestive issues
• Wernicke-Korsakoff syndrome
• Memory impairment

Identifying the Signs of End-Stage Alcoholism Conditions

End-stage alcoholism often consists of one or more serious health conditions. Early intervention and treatment may be paramount. In some cases, it is possible to reverse the effects of certain conditions. However, this depends on the severity of the condition and the individual’s capacity for following through with medical treatment and also making significant lifestyle changes.

Liver Cirrhosis

Some of the signs and symptoms of alcoholic liver disease include:

• Ascites: When the veins of the liver experience increased pressure over time, it can cause fluid to collect in the abdomen. This is also known as ascites.³
• Yellowing skin or eyes: Jaundice happens when the liver can’t get rid of bilirubin, and it’s often one of the signs of alcoholic liver disease.⁴
• Appetite loss: When the liver stops functioning properly, it can cause an immediate drop in appetite.
• Body weakness: Liver disease can affect how the body absorbs and processes nutrients, which can lead to body weakness.
• Confusion: The liver is responsible for breaking down hormones, nutrients, and other waste substances into toxic forms to be eliminated from the body, and when that’s compromised, it can result in people experiencing heightened confusion.⁵

Chronic Pancreatitis

Pancreatitis refers to having an inflamed pancreas, and symptoms may start suddenly or happen over many years. Common symptoms include nausea, vomiting, and chronic upper abdominal pain. When it’s chronic, pancreatitis causes scarring and stops the pancreas from making hormones and enzymes. Research shows that chronic alcohol consumption is responsible for 40%-70% of chronic pancreatitis cases worldwide.⁶

Cardiovascular Concerns

Alcohol use disorders can also lead to cardiovascular disease. Research shows a strong link between heavy, chronic drinking and future heart issues. Consuming alcohol can cause many different changes that affect the heart. Over time, these effects can cause problems, which may exacerbate the risk of having a stroke or heart attack.

Those with end-stage alcoholism may develop heart problems, including:

• Hypertension: Also known as high blood pressure, hypertension puts additional strain on the heart muscles and puts people at risk for more disease.
• Alcoholic cardiomyopathy: This refers to damage to the heart muscles. Although it’s relatively rare, it is one of the leading causes of heart failure.⁷
• Angina: This is a type of chest pain that’s caused by disease in the coronary arteries that provide oxygen to the heart muscles, and it may be associated with alcohol use.
• Myocardial infarction: A heart attack can occur when a blood clot prevents blood flow in one of the coronary arteries, leading to a weakened heart muscle. Many factors can cause a heart attack, but the risk is heightened in end-stage alcoholism.
• High cholesterol: High cholesterol causes narrowing of the coronary arteries, which can increase the risk of a heart attack.
• Stroke: Although it’s not directly a heart disease, heart issues, including heart attack, can increase the risk of having a stroke.

Malnutrition

Long-term alcohol use can cause malnutrition. Some people simply don’t get adequate calories or nutrition from food when they’re drinking heavily (alcohol contains no essential vitamins or minerals). In addition, when the liver is metabolizing alcohol, it can’t use essential vitamins like niacin, thiamine, and other B vitamins for their essential purposes. Alcohol is also diuretic, which means it can affect electrolyte levels.

Alcohol-Related Dementia

Alcohol-related dementia can occur as a result of excessive drinking. This type of dementia impacts processing, learning, memory, and other necessary brain functions. Symptoms include personality changes, issues with logical/critical thinking, balance issues, and decreased sense of taking initiative. Men over the age of 45 appear to be at a greater risk for this condition.⁸

In most cases, dementia is chronic and irreversible. However, some research shows that people can stop or reverse the effects if a person stops drinking. They will also need to adhere to specific treatment recommendations, which often include maintaining vitamin supplementation and consuming a well-rounded diet.

Eye Conditions

Chronic drinking can cause both short-term and long-term eye problems. Over the long term, alcohol consumption can cause premature cataract formation. Other people might experience permanent blurring with either single or double vision due to the eye muscles weakening. Optic neuropathy or optic atrophy can also occur, particularly if someone uses nicotine while drinking. It is important to consult with an optometrist to review treatment options.

Cancers

Chronic drinking can increase the risk of many cancers in the liver, stomach, pancreas, prostate, throat, breast, colon, rectum, and mouth. Research shows that drinking 3+ drinks a day may double or triple this risk. The body breaks down alcohol in a chemical called acetaldehyde. This damages DNA, and it also blocks the body from repairing that damage. Over time, cells can grow erratically and create cancer tumors.⁹

How Is End Stage Alcoholism Diagnosed?

In most cases, a physician will diagnose end-stage alcoholism, although some people may be able to self-diagnose their own symptoms. Alcohol use disorder is typically diagnosed by a healthcare professional after evaluating certain symptoms listed in the DSM-5. The DSM also lists how many symptoms must be present to warrant a mild, moderate, or severe qualifier.

Those presenting six or more of the following symptoms may be diagnosed with severe alcohol use disorder:

• Drinking more or longer than planned
• Experiencing cravings or urges to drink alcohol
• Becoming irritable when not drinking
• Persistent desires or attempts to stop or control alcohol use
• Drinking despite recurrent social or interpersonal problems
• Drinking causing problems in fulfilling major obligations at work, school, or in relationships
• Drinking despite knowing that a psychological or physical issue is being exacerbated due to alcohol consumption
• Having an increased tolerance to the effects of drinking
• Experiencing withdrawal symptoms when stopping or cutting down alcohol
• Spending excessive time obtaining, using, or recovering from the effects of alcohol
• Drinking alcohol in hazardous situations (driving, operating machinery, looking after children)

Treatment for End Stage Alcoholism

Although things may seem scary or even futile, all is not hopeless. It’s possible to treat alcohol use disorder at all stages. In some cases, treatment may prolong someone’s life or even save it altogether. Stopping drinking will be the first step toward establishing a baseline recovery and determining the best prognosis.

Medically Supervised Detox

Alcohol withdrawal in the final stages of alcohol use disorder can be life-threatening. It is essential that someone who decides to stop drinking at this time seek professional support. Medically-supervised detoxes offer round-the-clock treatment and stabilization. They also provide medical interventions, including electrolyte balancing, psychiatric medications, and withdrawal medications, that can aid the detox process.

Support Groups

You are not alone in your struggles, and social connection can be vital during this vulnerable time. Alcoholics Anonymous and other support groups can help someone seeking rehabilitation for AUD. There are numerous online group therapy and support groups available to people valuing connection and proactive coping skills to manage their cravings.

Behavioral Therapy

Long-term therapy may be beneficial for supporting people recovering from AUD. Evidence-based treatments including cognitive-behavioral therapy, dialectic behavioral therapy, and motivational interviewing may help aid the healing process. It’s important to work with a therapist that deeply understands addiction and can also help treat the underlying issues causing you to drink.

Medications

Some people benefit from taking medications to treat their alcohol use disorder. Disulfiram (Antabuse) treats chronic alcoholism and causes people to experience unpleasant effects if they drink while taking the medication. Acamprosate and naltrexone are both associated with reducing alcohol cravings. These medications are all FDA-approved and widely used in various treatment settings.

In My Experience

Treatment can be helpful in all stages of alcohol use disorder. It’s important to hold onto hope and seek support during this time. You are not alone in how you feel, and you can stop drinking and regain some of your physical and mental health back. The first step is reaching out for help. Having just a small amount of willingness can make a significant difference in getting better.