A Quick Guide to Understanding the Six Stages of Addiction

What is regret

Addiction is a complex brain disorder, characterized by a persistent and compulsive urge to use a substance or engage in a particular behavior, despite the psychological and/or physical harm it causes.

In recent years, thanks to science, we now know more than ever about the compulsive nature of addiction, and our views about those who become addicted have changed dramatically. We have a far better understanding of how easy it is for people to become addicted, why it is so difficult for them to stop, and why addiction is a relapsing disorder. 

Key environmental and biological risk factors (and protective factors) that can influence the development/progression of addiction have also been identified, and effective responses to the problem are now available – including both prevention and treatment options

Here we take a look at the six stages of addiction. Understanding these stages is a critical step in recognizing if you or a loved one have a problem and need to reach out for professional help.

Stage 1. Initiation

The first time a person tries a particular substance, like drugs or alcohol, is called initiation.

The decision to take this first step is typically voluntary and most commonly occurs during the teen years due to:

  • peer/social pressure
  • curiosity
  • asserting independence
  • trouble at home and/or school pressures
  • a tendency to engage in riskier behaviors (as the brain’s frontal cortex is not yet fully developed).

Initiation can also occur in other circumstances, for example, if a person needs drugs before/after surgery or medication is prescribed to manage pain or a mental health issue.

It is rare for anyone to become addicted after their first try, but it is possible. The earlier the initiation stage, the higher the likelihood of developing a substance use disorder later in life.

2. Experimentation

Behavioral addiction

When a person has tried a substance for the first time, they may move on to the experimentation stage. This very much depends on individual circumstances and risk factors, including:

  • availability of substances at home or in the community
  • family history of substance abuse or other mental health disorders
  • whether friends and family regularly use substances
  • the age of the individual and what they are taking
  • family environment, including abuse, neglect, chaotic home life 
  • mental health issues, such as ADHD, depression, and anxiety.

Typically, experimentation involves the voluntary use of substances on a more regular basis without experiencing any negative consequences. This stage – accepted and even encouraged in teenagers and young adults in many cultures – is usually centered around social settings and associated with relaxation, fun, and friendship. 

In adults, experimentation may also start as a way to reduce stress and unwind at the end of the working week or to occasionally relieve mental or physical health issues like depression or back pain.

At this stage, usage is casual, and there are no cravings or signs of dependency. Many individuals will stay at this level for their entire lives and be able to stop whenever they choose. 

However, others will develop a stronger desire to use substances to feel better, enhance an experience, or cope with problems that arise in life. The latter has a significant risk of progressing to the next stage: frequent use.

3. Frequent/regular use

The risk of dependency increases at this stage as substance use becomes more frequent and a predictable pattern begins to emerge. 

Typically, substances are still used in a social setting, but using them alone may also begin to creep in. Rather than using a substance purely for the social aspects, individuals start using substances specifically for the ‘high’ or relief they bring – to numb feelings or ‘escape’ from challenging life situations. A level of reliance begins to develop as substances are used to self-treat mental or physical issues and feel better.

During this stage, some adverse effects of regular use will be felt – and health will start to be affected – such as hangovers, mood swings (coming down), and increased anxiety. Individuals in this stage tend to maintain a false sense of security that they can easily stop whenever they choose.

4. High-risk use

High-risk use is when substance use has become a bigger problem in a person’s life and begins to put their safety at risk, along with the safety of others. For example, they may drink and drive, use substances at work, or engage in risky behaviors when ‘high’/drunk. 

At this stage, substance use may not yet meet the criteria for substance use disorder, but it is a very fine line.

Negative effects will occur more regularly, and increasingly risky behaviors begin to develop. What started out as a way to temporarily relieve/escape from reality now takes over other areas of a person’s life, and personal and professional responsibilities are neglected in favour of the next fix.

5. Dependence

addiction intervention man with substances

Once a person has reached the dependence stage, substance use has a physical and psychological hold over them and is no longer optional. The brain and body have become dependent on having the substance to function ‘normally’ – creating a vicious cycle that is incredibly difficult to break.

Any attempts to stop using at this stage, or even to just cut back, result in a range of unpleasant physical withdrawal symptoms. The easiest and quickest way to relieve these symptoms is to take more of the substance, which is why it is so hard to break the cycle.

In addition, psychological dependence creates intense cravings, a need to use more of a substance (and more frequently) to achieve the same results, and plays a significant role in relapse following a period of abstinence. 

As the National Institute on Drug Abuse explains, not all substance dependence is an addiction – but many types of dependence will lead to addiction if left untreated. 

6. Substance use disorder (SUD)

Substance use disorder (SUD) is the medical term used for addiction and is a diagnosable mental health disorder.

In this final stage, a person is entirely dependent on their substance(s) of choice and can no longer go a day without using it. The changes in the brain’s structure and function created by the SUD cause distorted thinking and problem behaviors, affecting:

  • learning
  • memory
  • movement
  • motivation
  • emotion
  • judgment
  • reward-related circuitry.

During this stage, a person cannot function in daily life unless they continue with compulsive substance use despite the harmful effects across all areas of their life. The longer this stage continues without treatment, the more powerless and out of control the person begins to feel.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is a vital diagnostic tool – published by the American Psychiatric Association – and lists 11 criteria for SUDs. These criteria fall under four main categories: impaired control, physical dependence, social problems, and risky use. 

Depending on the number of criteria met, a person may be diagnosed with a mild, moderate, or severe SUD. In all cases, effective treatments are available.

Treatment for addiction

Addiction is a complex and chronic condition that can cause many mental, physical, and behavioral problems. Every person’s situation and history will be unique, so treatment programs must be tailored to individual needs. 

Recognizing the signs and symptoms and acknowledging that there is a problem is the first step toward healing. Help is available through a number of effective treatments, and recovery without relapse is possible with professional guidance and support.

Modern methods of treating addiction – combining addiction treatment medicines with behavioral therapy – are shown to achieve the most favorable and lasting results. This treatment approach should also address any co-occurring mental health disorders.

Addiction treatment at Tikvah Lake

If you feel that you or a loved one needs help to overcome a substance use disorder, we are here to listen and guide you in the right direction.

To learn more about our addiction treatment programs (including the right aftercare), please contact us or call 1-954-698-4054, and take that first vital step on your recovery journey.

David Hurst - Tikvah Lake Recovery

About David Hurst

David Hurst has four books published on mental health recovery, including 12 Steps To 1 Hero, The Anxiety Conversation and Words To Change Your Life. He has written for national newspapers and magazines around the world for 30 years including The Guardian, Psychologies, GQ, Esquire, Marie Claire and The Times. He has been in successful continual recovery since January 2002.

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