End-Stage Alcoholism: Signs, Symptoms, Management

Key Takeaways

• End-stage alcoholism can lead to severe health issues like liver cirrhosis and heart failure.
• Quitting alcohol during the end stage can cause dangerous withdrawal symptoms like delirium tremens.
• Chronic alcohol use can result in malnutrition due to poor absorption of essential nutrients.

Alcohol use disorder (AUD) is a serious condition that can have devastating effects on a person’s life, relationships, and health. End-stage alcoholism, or late-stage alcoholism, is the final stage of an alcohol use disorder, resulting in severe physical and mental conditions as well as other life consequences from years of alcohol misuse. At this stage, the effects of long-term alcohol use become apparent and more severe, affecting a person’s health and quality of life.

Alcohol use disorder is a progressive disease that includes a beginning, middle, and end-stage, which can result in life-threatening health conditions. It’s not often talked about, but left untreated, alcohol use disorder can be a fatal disease. In fact, it contributes to about 178,000 deaths annually in the U.S., making alcohol one of the leading preventable causes of death in the United States.

By the time a person reaches the end stages of alcoholism, drinking has taken over their lives and has likely hurt relationships, work or school, finances, and overall health. If a person tries to quit drinking on their own during end-stage alcoholism, they may experience severe symptoms of withdrawal, including tremors and hallucinations. One of the most severe consequences of alcohol withdrawal is called delirium tremens (“the DTs”), which, if left untreated, can be fatal.

Even in the most advanced cases, support and treatment are available. Keep reading to learn more about the signs of the end stages of alcoholism, the effects it may have on health, and what you can do to get the help and support you or your loved one need.

Symptoms of the End Stages of Alcoholism

End- or late-stage alcoholism can cause a variety of physical and mental health conditions, including:

Alcoholic Liver Disease/Cirrhosis

When the liver is exposed to excessive alcohol. over time there is a progression of liver disease from hepatitis (inflammation) to fibrosis (hardening) and eventually to scarring of the tissue (cirrhosis). Cirrhosis is the final stage of alcohol-related liver disease.

Complications of cirrhosis can lead to death, often due to increased pressure within the veins of the liver, which causes problems such as fluid collection in the abdomen (ascites) or massive bleeding of the veins lining the esophagus (varices). A poor diet may exacerbate the problem.

In 2022, the Centers for Disease Control and Prevention (CDC) reported that 54,803 people over the age of 18 had died of cirrhosis, making it the 10th leading cause of death in the U.S.

In the early stages of alcoholic liver disease, you may not have any symptoms at all. However, after years of heavy use, may you recognize the following:

• Digestive problems: Abdominal swelling, dry mouth, bleeding from enlarged esophageal veins
• Dermatological issues: Yellowing of the skin (jaundice), red spider-like veins, redness on your feet
• Brain and nervous system: Memory problems, numbness in extremities, fainting

Malnutrition

Chronic, long-term drinking can contribute to malnutrition by replacing foods needed for essential nutrients and by interfering with absorption, storage, or metabolism of the essential nutrients. This can also lead to anemia when your red blood cell (RBC) count is lower than normal or there’s a problem with the hemoglobin protein inside those cells.

Chronic Pancreatitis

Damage to the pancreas from drinking alcohol may cause no symptoms for many years, before culminating in a sudden attack of pancreatitis. Roughly 70% to 80% of cases of chronic pancreatitis are due to chronic alcohol use.

People with chronic pancreatitis tend to experience three primary health problems: pain, malabsorption of food leading to weight loss, or diabetes.

Cardiovascular Health

By the time you or someone you love reaches the end stages of alcoholism, you may be contending with a host of heart troubles, including:

• Angina, caused by a stable blockage in a coronary artery
• Damage to the heart muscle (alcoholic cardiomyopathy)
• High blood pressure, which is a risk factor for coronary artery disease
• Increased risk of heart failure and stroke
• High blood triglycerides, which increases the chance of developing heart disease

Brain Disorders

Research has shown that long-term alcohol misuse can have a lasting impact on the brain, although some areas may recover with abstinence. Alcohol can damage the brain in many ways. The most serious effect is Korsakoff’s syndrome, characterized in part by an inability to remember recent events or to learn new information.

Eye Problems

During the end stages of alcoholism, a person may struggle with involuntary rapid eye movement (nystagmus) or weakness and paralysis of the eye muscles due to thiamin (vitamin B1) deficiency. This deficiency can also cause dementia if not treated immediately.

Cancer

Chronic drinking also increases the risk of cancer, including:

• Mouth
• Throat
• Liver
• Esophagus
• Colon
• Breast cancers

Diagnosis

While there’s no official diagnosis for end-stage alcoholism, your doctor will be able to diagnose you with an alcohol use disorder and be able to identify your stage based on the severity and amount of time you’ve been misusing alcohol as well as your current health.

The 5th edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5-TR) by the American Psychiatric Association uses the following 11 symptoms to indicate an alcohol use disorder. If you have six or more, you’re diagnosed as having a severe alcohol use disorder:

1. Alcohol is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
4. Craving, or a strong desire or urge to use alcohol.
5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
8. Recurrent alcohol use in situations in which it is physically hazardous.
9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
10. Tolerance, as defined by either of the following: a) A need for markedly increased amounts of alcohol to achieve intoxication or desired effect, or b) A markedly diminished effect with continued use of the same amount of alcohol.
11. Withdrawal, as manifested by either of the following: a) The characteristic withdrawal syndrome for alcohol b) Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

Treatment for the End Stages of Alcoholism

Being in the end stages of alcoholism is dire but not hopeless. It may still be possible to treat the alcohol use disorder and the health problems caused by chronic, heavy drinking.

The first step will likely be a medically supervised detox, which will help rid your body of toxins and manage the symptoms of withdrawal.

Rehabilitation for alcohol dependence will also be necessary, including:

• Medications: Antabuse (disulfiram), Revia or Depade (naltrexone), Campral (acamprosate)
• Behavior therapy: Cognitive therapy, rational emotive behavior therapy, rational behavior therapy, rational living therapy, and dialectic behavior therapy
• Support groups: Alcoholics Anonymous (AA), SMART Recovery, Rational Recovery, Women For Sobriety, Secular Organizations for Sobriety (SOS)

Once you quit drinking, your body can begin to recover from some of the damage or, at the very least, prevent it from getting worse.

Coping With End-Stage Alcoholism

By the time a person is in the end stages of alcoholism, there can be no denying that drinking has taken over their life and damaged their health. Recovery will not be easy at this point, but it will be worth the work.

Now is the time to line up support from addiction specialists, mental health professionals, friends and family, and others living with an alcohol use disorder. You don’t have to be alone during this difficult and scary time.

For Friends and Family

Watching a loved one endure the end stages of alcoholism can be frustrating and lonely. The feeling of powerlessness is stifling as you watch someone you care about slowly deteriorate physically and mentally while they may even continue to refuse to admit their drinking is problematic.

For those who need help and don’t want it, intervention may be the only alternative.

Even if your loved one seeks help, you may still need help and support to overcome the effects. Many people refer to alcoholism as a “family disease” because it can have a major impact on all members of the family, whether they realize it or not. It’s essential to seek out support and resources to help yourself and other family members who may have been affected by their loved ones drinking.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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2. National Institute on Alcohol Abuse and Alcoholism. Alcohol-related emergencies and deaths in the United States.

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6. Centers for Disease Control and Prevention. Chronic liver disease and cirrhosis.

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8. Gibbs R, Gibbs W. Alcoholic pancreatitis. InnovAiT: Education and Inspiration for General Practice. 2021;14(8):479-483. doi:10.1177/17557380211014233

9. Zahr NM, Pfefferbaum A. Alcohol’s effects on the brain: Neuroimaging results in humans and animal models. Alcohol Res. 2017;38(2):183–206.

10. Jun S, Park H, Kim UJ, et al. Cancer risk based on alcohol consumption levels: a comprehensive systematic review and meta-analysis. Epidemiol Health. 2023;45:e2023092. doi:10.4178/epih.e2023092

11. American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Washington, D.C.; 2022.

By Buddy T

Buddy T is a writer and founding member of the Online Al-Anon Outreach Committee with decades of experience writing about alcoholism. Because he is a member of a support group that stresses the importance of anonymity at the public level, he does not use his photograph or his real name on this website.

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