What is the Jellinek Curve? Stages of Addiction & Recovery Explained

What Is the Jellinek Curve?

The Jellinek Curve, or the Jellinek’s Phases of Alcoholism, is a model developed by E. Morton Jellinek in 1952 to conceptualize the stages from occasional drinking to addiction.² The line between social drinking and addiction can be blurry, and the Jellinek stages can help identify the early warning signs of addiction and how a substance use disorder may progress if left untreated.

This model may not apply to every person’s experience with alcohol, dependence, and recovery. Experts have criticized it for not capturing the full range of substance use disorders, as its primary focus is alcoholism: it has also been criticized for its limited generalizability across several demographics, like culture and gender.³

Despite some flaws and inaccuracies, it is still widely used as an intervention aid in Alcoholics Anonymous (AA) and related support groups to help people understand the path that they may be on and where it has the potential to lead.

History of the Jellinek Curve

Jellinek’s original model termed the “Jellinek Chart,” only described the development of alcoholism, not recovery.⁴ It wasn’t until 1985 that Glatt conceptualized the upward part of the curve — i.e., the phases of recovery — to form a unified theory of the development of and recovery from alcohol addiction.⁵

Today, the Jellinek Curve is illustrated as an inverted bell curve, with the first half of the downward curve representing the progression into alcoholism and the second half (upward curve) representing phases of treatment and recovery.

What Is the Importance of the Jellinek Chart?

The Jellinek Curve helps people to understand addiction as a disease, not a weakness. At the time Jellinek was studying alcohol addiction, it was fairly common for people with substance use disorders to be stigmatized for being weak or voluntarily making poor choices. Based on an analysis of over 2,000 drinking histories, Jellinek’s theory destigmatized the experience of alcohol addiction by showing it to be a common and identifiable process. Glatt further illustrated a path to recovery, which provided hope and motivation for change.⁶

Defining addiction can reduce stigma, self-blame, shame, and guilt, allowing people to view their struggles as treatable conditions with hope for recovery rather than a character flaw. By seeing Jellinek and Glatt’s illustrated trajectory of addiction on a chart, individuals struggling with alcohol use may realize they are not alone and that others have gone through similar challenges.

The Main Phases of the Jellinek Curve

The Jellinek Curve illustrates several phases, from relief drinking to “rock bottom” to contentment in sobriety. The understanding and terminology of alcohol use and addiction have evolved since Jellinek’s initial publication. For example, what was then referred to as alcoholism is now understood as a type of alcohol use disorder (AUD). For this article, the updated and original terminology will be used where appropriate to describe the critical phases of Jellinek and Glatt’s model.

The actual course of addiction and recovery can vary from person to person due to environmental and biological factors, but understanding the general progression can help identify warning signs in oneself (or a loved one) before addiction progresses. By recognizing the path one is on, potential consequences may come into view, and this awareness can serve as a powerful motivator to seek help.

The critical phases of the Jellinek curve of addiction are:

Pre-Alcoholic Phase

The Pre-Alcoholic Phase is the initial stage of Jellinek’s curve, characterized by “relief drinking” or “grey area drinking,” in which one uses alcohol to relax, sleep or relieve stress, anxiety, or other emotional difficulties. As alcohol use is societally common for many, it is perhaps the most difficult stage to identify.

While this type of drinking may not seem problematic at first, repeated use leads to tolerance, whereby one needs more alcohol to feel its effects. Instead of developing healthier coping mechanisms for dealing with stress or anxiety, one may start to rely on alcohol to manage their emotions. This may manifest as drinking alcohol to unwind at the end of each day or starting to need two drinks instead of one to feel relaxed.

Prodromal Phase [Early-Stage Alcoholism]

The second phase of the Jellinek Curve is the Prodromal Phase (which Jellinek called “Early-Stage Alcoholism”) and is accompanied by increased frequency and/or amount of alcohol consumption. In this phase, one may experience negative consequences, such as impaired judgment, relationship problems, and sleep disturbances.

Gradually, moderate alcohol use may give way to binge drinking, possibly even leading to a “blackout” or drinking oneself to sleep. This stage can still be hard to identify but may become more apparent with behavior changes and a growing focus on drinking.

Symptoms of the prodromal phase include:

• Using alcohol to cope
• Frequent alcohol use, more than once a week
• Weekday drinking
• Increased tolerance (larger amounts needed to feel its effect)
• Recreational activities tend to involve alcohol
• Joking about one’s drinking habits but not talking seriously with others about it
• Planning one’s next drink
• Drinking in secret or hiding the amount of alcohol consumed
• Feeling guilt or shame about alcohol use
• Binge drinking to intoxication
• Blacking out more frequently and poor memory of periods spent drinking
• Increasing dependence on alcohol
• Diving under the influence (DUI) or while intoxicated (DWI)

Crucial Phase [Middle Alcoholic Stage]

During the Crucial Phase (also called the Middle Alcoholic Stage by Jellinek), the person can no longer control their alcohol consumption. Negative consequences notably infiltrate daily life, resulting in occupational, relationship, financial, and legal problems. Health and nutrition begin to deteriorate, and changes in the brain’s neural connections cause cognitive and behavioral changes that further beget the downward spiral into addiction.^{7, 8}

Symptoms of the crucial phase include:

• Trying and failing to stop drinking
• Morning drinking
• Failure to fulfill responsibilities (job, school, family)
• Less engagement in prior interests
• Avoiding family and friends
• Spending more time with others that have similar drinking habits
• Financial struggles
• Poor nutrition, health problems
• Weight gain, bloating
• Worsening sleep problems
• Physiological symptoms (sweating, shaking, facial redness)
• Cognitive symptoms (impairments to memory, attention, and decision-making)
• Mood changes (impatience, irritability, aggression)
• Dangerous behavior like driving while intoxicated

Chronic Phase [End-Stage Alcoholism]

The Chronic Phase, also called End-Stage Alcoholism, is the point at which the alcohol use disorder is fully established. At this stage, the disease of addiction has hijacked the individual, rendering alcohol a perceived need rather than a want.

Having hit rock bottom, this stage is fairly apparent to others as the individual prioritizes drinking over everything else, neglects responsibilities and relationships, and experiences worsening health complications. Trying to quit at this point will likely result in severe withdrawal symptoms (e.g., delirium tremens) and will likely need medical assistance.

Symptoms of the chronic phase include:

• Prioritizing drinking over all else
• Lengthy intoxications (e.g., all-day drinking)
• Poor hygiene
• Increased anxiety and paranoia
• Hallucinations
• Depression
• Increased aggression and impulsivity
• Memory loss
• Inability to focus
• Health complications (e.g., liver disease, heart disease)
• Severe sleep problems (e.g., insomnia, sleep apnea)
• Financial and legal problems
• Other substance use

Rehabilitation

At this point, we move from Jellinek’s descent into addiction to Glatt’s focus on rehabilitation and recovery. While the Jellinek Curve shows an idealized linear upward trend, the reality of recovery is that there may be several attempts and relapses along the way, more like a scissor pattern.

Furthermore, not everyone with an addiction to alcohol hits bottom during the Chronic or End-Stage phase. Each person’s journey is unique, and someone may have a transformative experience during an earlier phase, such as getting fired from job, hospitalization, car accident while intoxicated, or even a prophetic dream.⁹

While rehabilitation may be accompanied by several alternating periods of abstinence and relapse, medical and recovery support are more accessible now, with support groups like AA accessible in big and small towns worldwide and even online. While long-term recovery is possible, addiction is now understood as a lifelong disease requiring continued mindfulness to stay on a path clear of cues that could trigger a relapse.

Signs a person is in the rehabilitation phase include:

• Has an honest desire for help
• Still may have relapses but now has supportive resources to help
• Realistic thinking and reevaluation of ideals
• Learns alcohol misuse is a disease and recovery is possible
• Renewed feelings of hope
• Attends a support group, such as alcoholics anonymous (AA)
• Meets others who have recovered to see its possible
• New circle of stable friends
• Avoidance of places and situations that may cue craving and relapse
• Improvements in nutrition, hygiene, and sleep
• Learning healthy coping mechanisms to boost stress tolerance
• Improvements in emotional and behavioral control
• Takes steps toward financial, social, and occupational stability or improvement
• New interests or revisiting non-alcohol-related old interests
• Contentment in sobriety

The Jellinek Curve & Addiction Recovery

Glatt’s contribution to the Jellinek curve, the upward recovery trend, is theoretical and was not based on empirical data. While the overall progression may generally resonate with many people progressing through recovery from AUD, more recent treatment models deviate from this framework with the understanding that each person’s path is unique.¹⁰

The 6 Stages of Addiction Recovery

Many recovery programs today conceptualize recovery in six stages, starting from the faint glimmer of acknowledgment to extended abstinence and contentment in sobriety. Recovery stages may actually begin during the Prodromal, Crucial or Chronic stages of Jellinek’s Curve, not necessarily at rock bottom. Treatment plans for AUD also tend to be more multifaceted today than during Jellinek’s time, typically involving psychotherapy, medication, social services, and support groups.

Today, many experts break down addiction recovery into these six stages:

1. Pre-contemplation

The individual begins to notice the negative consequences of their alcohol use but is not yet ready for change and may even be in denial or defensive about its impact. This stage of recovery may overlap most with Jellinek’s Prodromal or Crucial Phases. Legal or interventional (urging from family and friends) reasons may spur someone with AUD into treatment, which can establish a foundation for the next stage, but the person may still continue to drink.

2. Contemplation

Here, the individual begins to recognize that their alcohol consumption is problematic and may start to consider quitting or curbing their intake. This stage can last for months or years as one vacillates between drinking and quitting and may overlap most with Jellinek’s Crucial and Chronic phases.

3. Preparation

Preparation involves learning about treatment types and rehabilitation centers, reflecting on what lifestyle changes one would need to make to stay on a path to recovery, and readying oneself mentally to commit to change. This stage can take days to weeks and may involve talking to friends, family, or a helpline, as one moves toward action.

4. Action

Action involves choosing a path to sobriety and committing to it. This stage is comprised of many steps: The first step, detoxification, may require medical assistance at a hospital or rehabilitation center since withdrawal can be severe and lead to dangerous physical symptoms like seizures and hallucinations. There are treatment methods that can help ease the discomfort of withdrawal. After stabilization, a treatment plan may include individual, group, and family psychotherapy, medication to treat comorbid mental health conditions like depression or anxiety, and engagement in a treatment program.

5. Maintenance

Once a treatment program is completed, recovery moves into a maintenance phase, during which the focus shifts to preserving the progress made during the action phase and enjoying the benefits of sobriety. The individual exercises healthy coping mechanisms learned during treatment and continues to build oneself nutritionally, psychologically, professionally, and socially. This phase typically lasts six months to years, and the person may still experience temptation and relapse. However, they are now armed with the knowledge of how to get back to sobriety and where to find help.

6. Transcendence

This sixth stage is somewhat controversial as many experts view addiction as a lifelong disease that requires continual maintenance, with relapse possible even in individuals who have been sober for years (e.g., an unforeseen, traumatic event can reopen old habits). Others feel that this stage represents a final step in recovery (also called the “Termination Stage”) where the individual no longer craves alcohol, and there is no longer a risk for relapse because the person’s lifestyle, psychological and physiological makeup has changed so significantly that they are essentially a new person.

Addiction Recovery & Relapse

70% of people moving through addiction recovery will have relapses; however, unlike the first time , the person is now equipped with knowledge and resources.¹¹ While some individuals who relapse return to the pre-contemplation stage, most people return to the contemplation stage before progressing forward in recovery. The longer a person stays sober, the lower the risk for relapse.

Does the Jellinek Curve Represent All Addiction?

There are many ways in which a person can experience addiction besides alcohol, such as substance use, gambling addiction, and sex addiction.^{12, 13, 14, 15}
While the specific behaviors and consequences may differ, they all involve a common dysregulation of the brain’s reward and impulse control circuitry.

The Jellinek Curve applies to these other forms of addiction only in as much as it applies to alcohol use disorder, which is only a general intervention and treatment aid for patients to understand where they currently are in disease progression and what may lay ahead. The actual trajectory of addiction development and recovery will vary depending on the craving.

Contemporary models of addiction emphasize the neurobiological, genetic, and cognitive-behavioral dysregulation and how an individual can become caught in a vicious cycle of craving and impulsive behavior.¹⁶ Understanding this cycle that underlies much of what Jellinek observed in the 1950s has led to improved intervention and treatment strategies.

Supporting Rehabilitation & Recovery

The Jellinek Curve can serve as a valuable roadmap to guide individuals on their journey from addiction to recovery. By understanding the different stages and progression of addiction depicted by the Jellinek Curve, individuals can gain insight into their thoughts and behaviors and recognize how early intervention can prevent further decline and easier recovery.

Proven methods to support addiction recovery include:

Support Groups and Group Therapy

Support groups like Alcoholics Anonymous (AA) play a crucial role in the recovery process for many individuals and their families. AA or other group therapy interventions provide a safe, non-judgmental space where individuals can connect with others experiencing similar struggles with addiction.

Being surrounded by others at various recovery stages can be immensely beneficial as it offers a sense of understanding and hope, a preview of what may be ahead, perspective on what lays behind, and a feeling one is not alone in their journey.

Finding online group therapy or support groups has become increasingly easier in recent years. Many organizations and mental health platforms offer virtual support groups where people can engage from the comfort of their own homes.

One-on-One Therapy

Individual therapy is a valuable and effective treatment approach for addressing addiction in a personalized way tailored to the person’s needs. The therapist works collaboratively with the individual to explore the underlying factors contributing to addiction (e.g., trauma), set realistic goals, develop coping strategies and skills to address problematic thoughts and behaviors and establish a relapse prevention plan.

Therapy options to manage addictive tendencies include:

• Cognitive behavioral therapy (CBT): A CBT therapist helps individuals identify maladaptive thought patterns and behaviors associated with addiction, develop healthy skills and coping strategies to challenge maladaptive thinking, and manage cravings. Over time, these new ways of thinking and behaving are reinforced with the goal being long-term change and relapse prevention.
• Dialectical behavior therapy (DBT): DBT is similar to CBT but focuses more on emotional regulation, mindfulness, and interpersonal skills to manage emotional distress. A DBT therapist will help an individual struggling with addiction accept current circumstances while actively working towards change.
• Motivational Interviewing: Motivational interviewing helps the individual to see change (in this case, recovery from addiction) as occurring in steps or stages similar to the stages of recovery described above (i.e., pre-contemplation, contemplation, preparation, action, maintenance). The therapist helps the individual discover their intrinsic desire for change and establish clear, realistic steps through guided but open-ended questioning and reflective listening.
• Family Therapy: Understanding and adjusting family dynamics can be a powerful tool for treating addiction. As addiction often involves the whole family and not just the person struggling, a family therapist will help the family members improve communication, support each other and find healthy ways to cope with challenges during recovery and instances of relapse. Sometimes simple adjustments in a family system can have a big impact.
• Contingency Management: Contingency management reinforces positive behaviors like abstinence, treatment attendance, and medication adherence with “agreed-on, immediate, tangible rewards.”¹⁷ It is particularly effective for individuals with a dual diagnosis of schizophrenia and AUD.

Intensive Outpatient Treatment

Intensive outpatient programs (IOPs) are for individuals who require a higher level of care than one weekly session can provide but for whom residential programs are unfeasible. This integrative approach provides 9-20 hours of weekly intervention in the form of individual, group, and sometimes family therapy with skills training, symptom management, and other related support.

IOPs allow the person to continue their daily activity outside of the scheduled program/treatment time. However, it requires the individual to be stabilized and reliably attend sessions. Partial hospitalization programs (PHPs) involve more intense day therapy than IOPs as they usually are 20 or more hours a week, but the individual lives at home.

Rehabilitation

There are rehabilitation programs across the country for several different levels of treatment, ranging from inpatient hospitalization to outpatient counseling. Cost, timeline, and treatment approaches are just a few factors that may vary depending on the severity and type of addiction. An inpatient hospitalization or residential program will likely be necessary if detoxification is required, with medical personnel and resources accessible. Outpatient programs may be appropriate for non-substance-related addictions, like gambling or food.

If you or someone you care about is interested in learning more about inpatient vs. outpatient rehab options, consider contacting your primary healthcare professional, insurance company or an addiction specialist from an online therapist directory as a first step.

Alcohol Dependence Vs. Alcohol Addiction

Dependence refers to physiological changes that happen in the body in response to chronic ingestion of a substance (e.g., caffeine, antidepressant medication, alcohol, cocaine). As the body becomes used to having a certain level of that substance, withdrawal symptoms may occur when it is unavailable. However, once the body readjusts to the absence of that substance, the individual does not experience a craving for that substance. This is not addiction; it is dependency.

On the contrary, addiction is a brain disease in which the brain’s reward and impulse control circuitry is disregulated. An individual addicted to alcohol will experience cravings even after withdrawal symptoms have abated and will have difficulty inhibiting oneself when presented with the substance. Not every heavy drinker or binge drinker suffers from addiction. However, chronic alcohol use can cause changes to brain circuitry in some individuals, resulting in addiction as a life-long disease in some people. This gray area distinguishing addiction from dependency or heavy drinking makes identification and intervention difficult.

In My Experience

While the Jellinek curve is perhaps an oversimplified perspective on addiction, it still has value.  Though the Jeliinek curve may not accurately describe the path of addiction and recovery for all people, it can help laypersons, family members, and those at the beginning stages of addiction to create a schema — with a visual representation — with which they can organize their thinking. In this way, it can help in understanding and accepting the experience and give people a set of expectations to quell their distress.