Addiction is a complicated, multifaceted disease. There are many factors that can contribute to drug addiction, including genetic and environmental influences, socio-economic status, personal behavioral patterns, and more. The road to addiction is different for every person. Some people use drugs or alcohol for many years before developing a problem while others become addicted and start using problematically in a very short period of time. 

It can be difficult for loved ones of an addict to understand where and why addiction starts. Gaining a baseline knowledge of the various stages of addiction can be helpful in setting expectations for both an addict and the people who care about them.

What Is Addiction?

Addiction is a disease that affects millions of Americans each year. According to a report by the National Survey on Drug Use and Health, 19.7 million American adults (aged 12 and older) battled a substance use disorder in 2017. The American Psychiatric Association defines addiction as, “a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequences.” It is impossible for an addict to stop using substances, even when facing life-threatening repercussions of their addiction. Addiction can wreak havoc on every aspect of a person’s life: their relationships, work, mental health, finances and more. 

No matter how long a person’s path is, most addictions run the course of the four main stages of substance use: experimentation, regular use, risky use and drug and alcohol addiction and dependency. Not every person in the first or second stage becomes an addict, but individuals who reach the third stage, which is risky and problematic use, have a high chance of developing a substance use disorder.

What Are the Four Stages of Substance Use Addiction?

Understanding these stages of substance use addiction can help identify a problem before substance use becomes a dependency. 

Stage One: First Use/Experimentation

Alcohol or drug use starts with experimentation. In this stage, most people are using infrequently and are often using drugs or drinking socially, with friends, or as a result of peer pressure. Adults who start to use drugs or drink heavily often start doing so because of major life stressors, such as transitions in housing, employment, or relationships. 

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This stage of addiction is heavily influenced by environmental factors and access to drugs, alcohol or other substances. Drug experimentation is defined as the voluntary use of drugs or alcohol, without experiencing any negative social or legal implications.

There are a handful of reasons people may begin to experiment with substances, whether it be to conform to a favored social group, to deal with a problem, or just out of curiosity. Some people in this stage are able to stop using on their own. Others, however, might believe their substance use is solving their problems or making them feel better. They might continue drinking more alcohol or taking more drugs, escalating to daily use. Use of drugs and alcohol by adults is often socially acceptable, which makes it easier for a person to continue using until risky use or dependence develops. 

Stage Two: Regular Use

Stage two is when drug or alcohol use starts to become more regular. While some can use drugs or alcohol regularly without developing dependency, the risk for substance abuse greatly increases in this stage. The more regularly people use substances, the higher the chances are that they are engaging in high-risk behaviors, like driving under the influence, emotional volatility, or depression.

In this stage, drug use starts to become a pattern and warning signs of addiction may start to appear. Sometimes use may occur only at certain times, for example only on weekends or at parties, but substance use will start to become a habit. It is very important to keep an eye out for changes in mood and behavior, or early physical symptoms of addiction, like needing more of the substance to remain calm or stable. A person may withdraw from friends and family members or have trouble limiting the amount of drugs or alcohol being used. People during this stage may start to feel worried or ashamed of their behavior, but they will generally continue to justify it or come up with excuses for their use. 

Even if an individual is a social user, and only will use drugs or other substances when out with friends, they are developing a pattern that can later become an addiction.

Stage Three: Risky and Problematic Use

The transition between stages two and three might happen very quickly, which can make it hard to detect in themselves. During this stage, the drug user starts to prioritize drug use over other areas of life. They might have a hard time staying accountable to friends and family or keeping up with obligations in their environment, like at home or with work. Warning signs to watch for are physical or psychological cravings, depression, irritability, or fatigue if the drug is not accessible.

As regular use increases, an individual may begin to display extremely dangerous behaviors, such as driving under the influence. While regular use (stage two) and risky use (stage three) can have similarities in behaviors, in stage three, an individual will continue to engage in substance use even when faced with social or legal problems.

In stage three, the signs of addiction will likely be evident, as the user will probably experience cravings and possible withdrawal symptoms such as depression, irritability, and fatigue if they are not using the substance. Additionally, substances may start to create interpersonal or familial issues. Risky or problem use threatens the user’s personal safety and the safety of others, but it still might not be a full-fledged addiction. 

If a person gets positive reinforcement for using alcohol or drugs in stages one and two, it can push a person toward stage three. Positive reinforcement is when a person feels rewarded or euphoric after using the substance. They come to desire this feeling so much that they keep consuming the substance in order to obtain it. But, as tolerance builds, it is harder and harder to achieve that initial high. At this point, the drug has become a reward for the body and a person wants the drug more intensely and will keep taking the drug repeatedly. The physical dependency on the drug combined with the mood-boosting reward can be a strong recipe for addiction and full dependency in stage four. 

Stage 4: Dependence and Addiction

As use continues, addiction and dependence will develop. Once an individual is addicted, the substance has chemically altered their brain and the brain will struggle to function without it. With this physical dependence, individuals will experience withdrawal symptoms and compulsive desire to use drugs or alcohol despite severe negative consequences to their relationships, physical and mental health, personal finances, job security, and criminal record. Because of the effects of drugs and alcohol on the brain, it is seemingly impossible for an individual to quit despite all of these implications.

There are three steps to dependence:

  1. Tolerance is defined as what happens when a person needs more and more of the substance to get the same effect. 
  2. When having a withdrawal response when not using a substance, that is defined as a physical dependency. People can develop a tolerance even when prescription drugs are taken as instructed. 
  3. When a person has cravings for a substance, is using more and using more frequently, and/or is using again after attempting to quit, this is defined as a psychological dependency. 

The stages build on one another. For instance, a person can develop a tolerance without having a physical or psychological dependency, but they cannot be psychologically dependent without having developed a tolerance. 

In the old edition of the Diagnostic and Statistical Manual of Mental Disorders, there were two separate categories of addiction: substance use and substance dependence. In the fifth and most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), these two categories are now combined into “substance use disorder.”

These substance use disorders are, “patterns of symptoms resulting from the use of a substance they continue to take, despite experiencing problems as a result.” In this final stage, a substance use disorder has impacted an individual to an extent that significantly affects one’s functioning in their environment.

The characteristics of dependence include:

  • Chronic use of alcohol or other drugs that leads to major consequences and failure to follow through on responsibilities. 
  • Repeatedly drinking or using drugs in hazardous situations, like driving.
  • Increased tolerance, meaning more of the drug or alcohol is needed to have the same effect.
  • Withdrawal symptoms if a person doesn’t have the substance or attempts to cut back.

At this stage, substance use is compulsive and likely out of one’s control. A person is likely experiencing adverse effects in all areas of life. The substance has likely taken a toll on their physical and mental health, their relationships, their social life, their finances, their employment, and more. A person in active addiction is usually suffering from a lower quality of life. That is why it is important to seek help from a reputable treatment center like Cardinal Recovery. 

The primary symptoms of addiction are obsessive and compulsive alcohol or other drug craving, seeking, and use.

If you or someone you love is using drugs or abusing alcohol, seek help from a health care provider or substance use professional.

Treatment for Addiction

The disease of addiction is both progressive and terminal, but thankfully, it is also fully treatable. There are many options available for treating drug and alcohol addiction and it’s important to seek help that treats the underlying roots of addiction as well as the symptoms that have developed. 

Cardinal Recovery can help if you are experiencing any of the following:

  • Can’t envision a life without drugs or alcohol.
  • Cannot control their use. 
  • Keep using despite all the harm they are causing themselves and others. 
  • Lying about their substance use. 
  • Avoiding friends and family.
  • Gave up activities they used to enjoy.
  • Can’t see the problems in their own life. 

A substance use disorder is a chronic, progressive disease. The good news is that, with support, a person can regain complete control over their life, health and wellbeing, as so many other people have done. A high-quality addiction treatment program like Cardinal Recovery can help a person identify and heal the root cause of their addiction and help them learn coping skills that will prevent relapse. 

Regardless of the stage of addiction someone may be in, it is important to seek help before it is too late. If you are struggling with addiction, you are not alone. In order to prevent more harm, there are many treatment options available that have been proven successful. 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, and Al-Anon. These groups and types of therapy help support long-term recovery.

Understanding the stages of addiction is important in understanding how substance use can evolve into something that harms a person’s relationships, sense of self, and overall health. If you or someone you love is struggling with addiction, Cardinal Recovery can help. Our treatment program coordinators can answer your questions and help you understand the different treatment options to help you or your loved one in your time of need.