End-Stage Alcoholism: Signs, Symptoms, Management

End-stage alcoholism, or late-stage alcoholism, is the final stage of an alcohol use disorder, resulting in serious physical and mental conditions as well as other life consequences from years of alcohol misuse.

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 88,000 deaths annually in the U.S., making alcohol the third leading preventable cause of death in the United States.

By the time a person reaches end-stage alcoholism, drinking has taken over their lives and has likely had a negative impact on 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.

Symptoms of End-Stage Alcoholism

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

• Cirrhosis
• Jaundice from liver failure 
• Itchy skin
• Fluid retention
• Fatigue
• Malnutrition
• Chronic pancreatitis
• Heart failure
• Anemia
• Wernicke-Korsakoff syndrome (also called alcohol dementia) 

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 cause 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.

According to the CDC, more than one million people die yearly of cirrhosis, including over 40,000 people in the United States.

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 end-stage 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 end-stage 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

After drinking chronically for many years, a person increases their risk of several cancers, 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) 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 End-Stage Alcoholism

End-stage alcoholism is dire but not hopeless. Treating the alcohol use disorder, along with the health problems caused by chronic, heavy drinking, may be possible. 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 end-stage 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 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.