Understanding the Stages of Addiction

The first stage often starts with curiosity, peer influence, or as a way to alleviate anxiety and stress or enhance confidence. For some individuals, this initial use may occur due to being prescribed medication. For others, this first exposure occurred at a social event or gathering. Factors contributing to an increased likelihood of progressing through this first encounter include: history of substance use in family members, a peer culture that is permissive, trauma, and co-existing mental health issues.[4]

Please keep in mind that not all individuals who experiment with substances will eventually develop an addiction. Protective factors such as supportive relationships, healthier coping mechanisms, and education can prevent progression from the first stage.

This stage denotes established or repeated use. Early indicators of this stage include consuming substances by itself, rationalizing or justifying the use, and ignoring obligations related to employment, school, or home life.[5] Risk-taking behaviors such as driving while intoxicated may also emerge.

Some treatment experts merge experimentation and regular use into one stage, whereas others divide them into separate categories. Regardless of categorization, both frequency and degree of psychological dependency are increasing.

Hazardous use is characterized by consuming substances in manners that cause harm. Examples include ingesting greater quantities of drugs, using multiple substances simultaneously, using medications that were originally prescribed for another purpose, and so on. Someone using substances in harmful ways might continue to appear functional day-to-day, but cracks begin to emerge. Relationships appear strained, work and school performance decreases, irritability and mood swings become apparent.[6] 

The brain adapts behind-the-scenes, and dopamine pathways responsible for releasing natural chemicals associated with normal satisfaction and reward are increasingly reliant on the substance used. When the substance is not available, cravings and irritability ensue.

Tolerance develops when the body needs more of the substance to elicit the desired effects achieved by lesser amounts initially consumed. [7] This usually results in higher dosages and frequency.

There are two types of dependencies. Physical dependency causes withdrawal symptoms (e.g., nausea, sweating, shaking) when stopping use. Psychological dependency is comprised of extreme cravings and inability to derive gratification from activities without using substances. Dependency does not necessarily signify addiction. An individual can be physically dependent on asthma medication to breathe without being addicted to it. The distinction lies in compulsively continuing substance use despite obvious harm.

Addiction, also referred to as substance use disorder, is a recognized mental health condition. The Diagnostic and Statistical Manual, Fifth Edition (DSM-5) lists diagnostic criteria for substance use disorder, including:

• Consuming more than you intended
• Unable to cut down or stop
• Spent excessive time acquiring or consumption of substance
• Neglected responsibilities, work, social, or academic commitments
• Experienced strong cravings
• Continued substance use despite negative consequences
• Engaged in hazardous situations while under influence
• Tolerance developed
• Withdrawal symptoms appeared upon discontinuing consumption

Substance use disorders are categorized according to severity (mild, moderate, or severe) based on how many criteria are met.[8]

Addiction is not morally based; it is a disease affecting behavior and neurochemistry. Frequent characteristics exhibited by addicts include:

• Loss of interest in previously enjoyable activities or hobbies
• Persistent relationship issues
• Financial difficulties
• Concealing usage from loved ones, meaning those who know you

Relapse is extremely common among chronic conditions and equally so with addiction. Relapse should be viewed less as evidence of failure and more as an indication that treatment requirements need reassessment.

Treatment or Recovery

The treatment or recovery stage begins when an individual recognizes the necessity for assistance. Treatment typically commences with medical detoxification, when healthcare providers assist clients with managing withdrawal symptoms safely using pharmacological agents.

This is combined with alternative mental health treatments (cognitive behavioral therapy, or CBT, a type of psychotherapy focusing on identifying and altering maladaptive behaviors, and dialectical behavior therapy, or DBT, a type of psychotherapy assisting clients in managing overwhelming emotions and intense behaviors).[9]