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    Stages of Addiction

    Substance use disorders (SUDs) affected the lives of 20.3 million adults in the United States in 2018, accounting for over 6% of all Americans. That same year, approximately 5.1 million young adults (ages 18 to 25) had a SUD. That’s 1 in 7 or about 15% of young adults. An estimated 916,000, or 3.7%, of adolescents (ages 12 to 17) had a SUD.

    The question to consider is how do substance use disorders develop? The truth is that there are many stages of addiction, each with its own signs and symptoms to monitor in yourself and others.

    The 8 Stages of Addiction to Rehab and Treatment

    Stage 1: Initiation

    According to a survey by the Substance Abuse and Mental Health Services Administration, about 3 million people (age 12+) used an illegal drug or abused a legal drug for the first time in 2018. The same survey showed that 4.9 million people drank alcohol for the first time.

    The first of the stages of addiction is called initiation, during which time the individual tries a substance for the first time. This can happen at almost any time in a person’s life, buaccording to National Institute on Drug Abuse, the majority of people with an addiction tried their drug of choice before 18 and had a substance use disorder by 20.  In 2017, nearly 20% of teens (ages 12-20) reported drinking over the past month. Many adolescents or teenagers try drugs or alcohol for reasons like:

    • Curiosity
    • Peer or social pressure
    • Lack of development in the prefrontal cortex, which manages decision-making and controlling impulses

    Just because someone has tried a drug, it does not mean that they are certain to develop an addiction. In many cases, the individual takes a drug out of curiosity, and then once that curiosity has been satisfied, stops use. This decision can also be impacted by other factors related to the drug’s role in the individual’s life, such as:

    • Availability of drugs and alcohol within the community
    • Whether or not friends use drugs or alcohol
    • Family environment, including physical or emotional abuse, mental illness, or alcohol or drug use in the house.
    • Mental health conditions like depression, anxiety, or trauma-related disorders

    Stage 2: Experimentation

    The experimentation stage is the second of the stages of addiction and begins when you start to use drugs or alcohol in specific situations, like teens in party atmospheres or adults in times of particular stress.

    At the experimentation stages of addiction, the user has moved past simply trying the drug on its own and is now taking the drug in different contexts to see how it impacts their life. Generally, in this stage, the drug is connected to social actions, such as experiencing pleasure or relaxing after a long day. For teenagers, it is used to enhance party atmospheres or manage stress from schoolwork. Adults mainly enter experimentation either for pleasure or to combat stress.  

    Substance use in this stage of addiction is a social behavior that you associate using with fun, ‘unwinding,’ and a lack of consequences. You only think of substances every so often, and there are no cravings. At this stage, substance use can be either controlled (i.e., you decide consciously to use with the risks in mind, and you can stop if you want to) or impulsive (i.e., you use unpredictably and unexpected accidents or harm can come from substance use, but you do not use regularly, and you are not dependent).

    Even if you consume a lot in a particular instance, the decision to use is made in the rational brain (i.e., you choose to use drugs or alcohol instead of being unconsciously ruled by an automatic response). You could even binge drink (i.e., a man having five or more drinks or a woman having four or more drinks within two hours) without straying outside of the experimentation stage.

    Stage 3: Regular Use

    At this point, substance use is more frequent for you, and this regular use marks the third of the stages of addiction. You may not use it every day, but there may be a predictable pattern (using every weekend), or you may use it under the same set of circumstances (when you’re stressed, bored, lonely, etc.).  The pattern varies based on the person, but a few instances could be that they are taking it every weekend or during periods of emotional unrest like loneliness, boredom, or stress. At this point, social users may begin taking their chosen drug alone, in turn taking the social element out of their decision.

    At this stage, you still probably use drugs or alcohol with other people, but you may begin to use it alone too. The drug’s use can also become problematic at this point and have a negative impact on the person’s life.  You may miss school and work due to hangovers. There may be worries about losing your drug source since substance use has become tied to the idea of escaping negative emotions or situations.

    There is still no addiction at this point, but the individual is likely to think of their chosen substance more often and may have begun developing a mental reliance on it. When this happens, quitting becomes harder but still a manageable goal without outside help.

    Stage 4: Problem/Risky Use

    As the name suggests, substance use at this point has begun to take a negative toll on your life, and problem or risky use marks the fourth of the stages of addiction.  If you drive, you may do so under the influence. You may have gotten a DWI/DUI or had other negative legal consequences.  Many enter treatment as a result of Ohio drug court or court ordered rehab as a result of these negative legal consequences. Your performance at work or school may be suffering, along with your relationships with others. You may have changed your circle of friends, and your behavior has almost certainly changed.

    While a periodic hangover at work or an event is acceptable for Stage 3, at Stage 4, instances like that become a regular occurrence, and its effects become noticeable. Many drinkers are arrested for a DUI at this point, and all users will likely see their work or school performance suffer notably. The frequent use may also lead to financial difficulties where there were none before.  

    Although the user may not personally realize it, people on the outside will almost certainly notice a shift in their behavior at this point. Some of the common changes to watch out for in a drug user include:

    • Borrowing or stealing money
    • Neglecting responsibilities such as work or family
    • Attempting to hide their drug use
    • Hiding drugs in easily accessible places (like mint tins)
    • Changing peer groups
    • Visiting multiple doctors or rapidly changing doctors (if using a prescription drug)
    • Losing interest in old hobbies

    Stage 5: Dependence

    The mark of entering Stage 5 is that a person’s drug use is no longer recreational or medical but rather is due to becoming reliant on the substance of choice. This is sometimes viewed as a broad stage that includes forming a tolerance and dependencebut the individual should already have developed a tolerance by now. As a result, this stage should only be marked by dependence, which can be physical, psychological, or both.  

    There are three steps to dependence:

    • Tolerance describes the effect that happens when you start to require more of a substance to achieve the same “high.”
    • Physical dependence has been achieved when going without drugs or alcohol elicits a withdrawal response. It is important to note that physical tolerance can happen even when prescription drugs are taken as your doctor has instructed.
    • Psychological dependence describes the state where you experience drug cravings, a high rate of substance use (using more, using more frequently, or both), and using again after attempting to quit. This can also be known as “‘chemical dependency.”

    These stages are cumulative. For example, you can have a tolerance for a substance without being physically dependent and be physically dependent without being psychologically dependent, but you cannot be psychologically dependent without being physically dependent and having developed a tolerance.

    Stage 6: A Substance Use Disorder

    A substance use disorder (SUD) is diagnosed when you meet a specific set of criteria. Substance use disorders can be mild, moderate, or severe, depending on the number of criteria met. The assessment will include criteria like:

    • You “cannot face life” with drugs or alcohol.
    • You cannot control your use.
    • You continue to use a substance despite the harm that comes to your health and life.
    • You lie about your use, especially about how much you are using.
    • You avoid friends and family.
    • You have given up activities you used to enjoy.
    • You cannot recognize the problems with your behavior or with your relationships with others.

    A substance abuse disorder is more than its symptoms. It is a chronic disease, meaning that it is slow to develop and of long duration. Substance use disorders are often relapsing, meaning that recovery will often entail setbacks. Relapse rates for substance use disorders are similar to relapse rates for other chronic diseases like asthma and hypertension.

    SUDs affect the memory, motivation, learning, movement, emotion, judgment, and reward-related circuitry in the brain. This happens because chronic substance use floods the brain with dopamine, first teaching you to use more of the substance that produced such a pleasurable effect, then keeping your brain from producing enough dopamine on its own. You then have to continue to use the substance in order to feel happy or even normal.

    Stage 7: Crisis

    There are ways to treat SUDs, though, so you can regain control over your life, health, and wellbeing. After an initial detox period, behavioral therapy combined with medication is often the best course of treatment. A high-quality addiction treatment program can help you identify and heal the root cause of your addiction and teach you coping skills that will help prevent relapse.

    The final stage of addiction is the breaking point in a person’s life. Once here, the individual’s addiction has grown far out of their control and now presents a serious danger to their well–being. It is sometimes referred to as the crisis stage because, at this point, the addict is at the highest risk of suffering a fatal overdose or another dramatic life event.

    Stage 8: Rehab and Treatment

    Of course, while the crisis is the worst-case scenario for this stage, there is also a positive alternative that fits here instead. Either on their own or as a result of a crisis, this is when many individuals first find help from a rehab center to begin receiving treatment. As a result, this stage can mark the end of their addiction, as well as the start of a new life without drugs and alcohol that is filled with hope for the future.

    There is also counseling available for you, your family, and friends to help with recovery after leaving treatment, as well as support groups like AA, NA, Al-Anon, and Nar-Anon. These groups and types of therapy help support long-term recovery.

    Understanding the stages of addiction is important to help you understand how substance use can evolve into something that harms your relationships, sense of self, and overall health.

    If you or someone you love is on the path of addiction, PUSH for Recovery can help. Our compassionate intake coordinators can answer your questions and help you understand treatment options that can work well for your specific situation.


    Donate to help the Life Recovery Society provide a safe, sober, supportive, and flexible way for individuals to earn an income while in treatment.  Life Recovery Society also plans to add a men's and women's sober living home in the Hilltop Community.