Colin MacKenzie M.D.
December 22, 2020

Middle Alcoholic Stage

The middle alcoholic stage is the third stage of alcoholism. It follows two other stages of alcoholism discussed in the blogs titled, “The Four Stages of Alcoholism: The Pre-Alcoholic Stage” and “The Four Stages of Alcoholism: The Early Alcoholic Stage." 

In the middle alcoholic stage, regular, unrestrained use of alcohol finally results in problem drinking. The phrase “problem drinking” describes habitual drinking that results in negative social, occupational, academic, and/or health-related consequences.

Social and Behavioral Changes

This stage is characterized by the loss of control over alcohol consumption and your life becoming significantly impacted by the side effects of alcoholism. The signs and symptoms of alcoholism are commonly apparent to your friends and loved ones, and possibly even those considered acquaintances or co-workers. You may often minimize the quantity of alcohol you consume and find excuses to explain your erratic behavior.

During this stage, you may start to miss work or social commitments due to drinking or hangovers. You may use alcohol during risky situations such as while driving, during work, or before an important test. As a consequence, your work or academic performance may suffer.  Family and close friends may find themselves needing to restrain your alcohol use or intervene after socially inappropriate behavior. You may have reduced social activity due to your unpredictable behavior or find that close friends and relatives no longer want to spend time with you. At this stage, you are more prone to face legal troubles as a consequence of your drinking. However, you may fall into a category of heavy drinkers identified as “highly functional.

Highly Functional Drinkers

A highly functional drinker is an individual who drinks heavily but has good job performance, maintains their home, supports their family, keeps social bonds, and fulfills expected major responsibilities. About 20 percent of individuals who drink heavily may be categorized as highly functional. They may seem to be okay or in control; however, they are not immune to the long-term consequences of severe alcohol use. The adverse effects of constant drinking ultimately become obvious. 

Health Complications

Health related complications from heavy drinking become apparent including withdrawal symptoms that may occur after just a few hours of abstinence forcing earlier use of alcohol each day.  Eventually, you may find yourself needing “eye-openers,” or drinks after waking each morning.   Alcohol abuse may start to affect your body with weight change, oral lesions, memory issues, mood lability, gastric ulcers, lethargy, gastro-esophageal reflux, chronic diarrhea, or facial redness. Moreover, you may become more and more irritable, frequently arguing with your friends and family. You may develop depression, anxiety, or begin losing sleep[5]. In some instances, excessive drinking may worsen other conditions like gout.[6]


Treatment can be very effective if you are at this stage of alcoholism. You have not yet arrived at a point where your health has deteriorated too much, and you can still make relatively easy adjustments in your habits. Support groups and professional counseling can prove to be quite effective. If you try to give up drinking on your own, you may experience acute withdrawal symptoms; therefore, consultation with medical personnel who specialize in the treatment of alcohol use disorders is advised as alcohol withdrawal can be very dangerous.  In addition, medical treaters can offer medication options to assist with alcohol cravings, acute and chronic withdrawal symptoms, and abstinence.