Addiction is one of the most common and devastating mental disorders that can significantly affect a person’s ability to function in daily life. Understanding how the condition develops and the stages involved in it can enable someone to find the right treatment and recover fully.
According to reports 1 , over 5.1 million American young adults and 20 million of American adults suffer from substance use disorders (SUDs). Unless it develops unintentionally or accidentally in someone, for instance, prescription drugs, addiction typically progresses in stages and follows a set path. Usually, the process begins as a fun or exciting activity which eventually becomes damaging and deadly leading to a lot of trauma in the addict and their loved ones.
5 Stages Of Addiction
By understanding and identifying the different stages, one can become more aware and control their addictive thoughts and emotions to overcome the negative effects. Here are the different stages 2 that one should know about:
Most people don’t become addicts intentionally. They often use a substance or engage in a behavior out of curiosity. It has been observed that most people are introduced to a substance by a friend or family member. They may also be trying it for the first time along with another friend or associate to have some ‘fun’ or may be as a thrill-seeking behavior. Although the individual may only intend to use or experience it only once, experimentation is often the first step towards the devastating loop of addiction. Peer pressure is one of the primary reasons why someone starts smoking or drinking initially which can eventually lead to the consumption of illicit drugs, like heroin or cocaine. Adolescents and teens are especially at risk of this stage as they feel a strong need for acceptance by others and to be popular. However, adults can also be prone to experimentation, but tend to have better control over themselves in general.
Some others may experiment with drugs or risky behavior as a way to cope with mental or physical distress and discomfort. Moreover, it can also be a social behavior as someone may be introduced to drugs while at a party where the objective is to relax and have fun. Other factors may include easy availability of alcohol and drugs, family environment, abuse, adverse life experiences and mental health issues. A 2017 study 3 states “Adolescent substance-related attitudes and use patterns have evolved over time, informed by adult and peer behaviors, public policy, media messaging, substance availability, and other variables.” During the experimentation, a person may stop after exploring their curiosity or may progress to the next stage.
2. Regular use
Regular or frequent use is the second step towards addiction. This stage involves frequent use or engagement for social purposes which eventually becomes a regular habit. Researchers 4 have found that “Substance (alcohol, marijuana, opioids, cocaine, etc.) use often initiates during adolescence, a critical period of physiological and social development marked by an increase in risk-taking due, in part, to heightened motivation to obtain arousal from rewards.” As a result of motivation and reward, people who simply experiment with drugs may feel encouraged to become regular users. As substance abuse or the addictive behavior occurs on a daily basis and becomes a part of their normal routine, the individual may take the drugs even when they are not in a social setting and without their friends and peers. This stage can be hard to identify as the person still tends to function normally in daily life and enjoys the rewards of their addiction.
However, regular use can also mean occasional use like on the weekends or whenever they are stressed, anxious, depressed, lonely or bored. Whether they use it daily or periodically, there is a predictable pattern of use. Eventually, the person will exhibit symptoms of addiction as it becomes more prominent and important for them. As the addictive behavior or substance use becomes a lifestyle, this eventually starts to become a problem.
3. Problem or risky use
At this stage, the person engages in extreme use without any concern for the outcomes. Their addictive behavior or use tends to have serious adverse effects on their life. The person may experience physical, psychological, emotional, social and even legal complications. Their addictive habits start to affect their daily functioning, their performance at school or work, and cause relationship problems. It can also alter their behaviors and a drastic change in their social circle can be observed. They may take substance or drink at odd times, while at school, work or even driving which may cause further problems, not just for them but for others as well. Family and friends should encourage the individual to seek treatment at this stage before the condition gets worse.
One 2016 study 5 has found that “recent research indicates that environmental factors, including access and exposure to substances of abuse, neighborhood disadvantage and disorder, and environmental barriers to treatment,” can influence risky or problem use behaviors.
4. Dependency & tolerance
As the person goes through problematic use, they become increasingly reliant and tolerant of the substance or behavior. Hence, they increase the amount of substance to experience the same volume of reward or pleasure. By becoming mentally and physically dependent on the addictive substance or behavior, the person may be incapable of controlling their cravings and feel they are unable to function while sober. They may require higher amounts of substances to counter their tolerance and experience homeostasis. With time, both dependence and tolerance can become a serious problem for the individual. They may engage in riskier behaviors, spend more money to acquire the substance more frequently, interact with people who are not safe for them and engage in criminal activities to fund their addiction.
They may neglect their family, work or financial responsibilities at this stage to focus primarily on the substance or behavior. They can also feel certain harmful bodily changes as a reaction to the drugs or alcohol. “Drug dependence is a major cause of morbidity and loss of productivity,” clarifies a 2007 study 6 . Dependence and tolerance can involve the following features:
- Constantly consuming drugs or alcohol in dangerous situation, like while driving
- Psychological dependence and intense cravings
- Increased use or engagement due to increased tolerance
- Inability to fulfil important responsibilities towards school, career or family due to repeated use
- Experience withdrawal symptoms when trying to stop
However, according to a study 7 , addiction may not be specifically associated with dependence and tolerance. Addictive behaviors may develop even when observable dependence and tolerance are not present. The study states “Alcohol and drug addiction is probably more complex than tolerance and dependence.” But both dependence and tolerance may still be strong indicators of substance use and abuse, according to the researchers. “Tolerance and dependence may only be incidentally associated with addiction as a result of a nonspecific adaptation by the body to the presence of a drug. The cellular adaptation may be the same in all organs,” adds the study.
When a person reaches this final stage, they have become fully addicted to the substance or behavior and have no control over themselves. They engage in compulsive use, lack the willingness or self-control to stop and feel either distressed or comfortable with all the adverse effects and consequences. Now they are more focused on acquiring and engaging in their addictive behavior and may appear to be a completely different individual. A recent research 8 explains “These patients can be on one of two sides of the coin. They may be distressed by their continued use but require it despite serious life problems that have resulted, or they may be in denial of the addiction and continue to spiral further into their addiction.”
They may realize that they are causing problems for their family and friends, but their addiction rules over their concern for loved ones. They may repeatedly try to stop by themselves but without any success. They tend to neglect basic requirements, like sleep or food, avoid self-care and hygiene, may lose their jobs and run into debts or bankruptcy and even engage in criminal behaviors. They now suffer from substance use disorder 9 , which is a mental health condition that requires immediate treatment.
Recovery Is Possible
Despite the damaging effects of addiction, effective treatment can help addicts completely recover from the condition. However, it is crucial that friends and family learn to identify the signs and symptoms for each stage and encourage the addict to seek professional help immediately. When left untreated, the disorder can worsen with growing dependence and tolerance. This is why consulting a licensed doctor is crucial before the situation becomes worse. Healthcare professionals can enable the addict to learn coping skills through therapy, medication and emotional support.References:
- SAMHSA – Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf
- Hovnanian L. Les quatre stades de la toxicomanie (d’après une expérience clinique de 5,000 drogués) [The four stages of drug addiction (based on clinical experience with 5,000 drug addicts)]. Bull Acad Natl Med. 1994 Jun;178(6):1029-37; discussion 1037-42. French. PMID: 7994578.
- Gray, K. M., & Squeglia, L. M. (2018). Research Review: What have we learned about adolescent substance use?. Journal of child psychology and psychiatry, and allied disciplines, 59(6), 618–627. https://doi.org/10.1111/jcpp.12783
- Nock, N. L., Minnes, S., & Alberts, J. L. (2017). Neurobiology of substance use in adolescents and potential therapeutic effects of exercise for prevention and treatment of substance use disorders. Birth defects research, 109(20), 1711–1729. https://doi.org/10.1002/bdr2.1182
- Mennis, J., Stahler, G. J., & Mason, M. J. (2016). Risky Substance Use Environments and Addiction: A New Frontier for Environmental Justice Research. International journal of environmental research and public health, 13(6), 607. https://doi.org/10.3390/ijerph13060607
- Gupta, S., & Kulhara, P. (2007). Cellular and molecular mechanisms of drug dependence: An overview and update. Indian journal of psychiatry, 49(2), 85–90. https://doi.org/10.4103/0019-5545.33253
- Miller NS, Dackis CA, Gold MS. The relationship of addiction, tolerance, and dependence to alcohol and drugs: a neurochemical approach. J Subst Abuse Treat. 1987;4(3-4):197-207. doi: 10.1016/s0740-5472(87)80014-4. PMID: 3325655.
- Fluyau D, Charlton TE. Addiction. [Updated 2020 Nov 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549783/
- McLellan A. T. (2017). Substance Misuse and Substance use Disorders: Why do they Matter in Healthcare?. Transactions of the American Clinical and Climatological Association, 128, 112–130.