four stages of addiction

Over the years that I have worked in treatment I have been exposed to many people who are attempting to recover from addiction. Helping people recover is something that I am passionate about and I take care to educate clients and their families about addiction. I write extensively on my own therapy blog, One Mind Therapy, about addiction, recovery, and mental health.

One topic that often comes up in my work is the different stages of addiction. There are many different models that provide stage theories of addiction. However, the most widespread model is SAMSHA’s four stages of addiction.

The Stages of Addiction

stages of addiction infographic1. Experimentation

What it is: The first stage of substance use and misuse is experimentation. At this stage people are trying different substances for the first time and discovering their effects. Developmentally, experimentation is a normal part of adolescent so many people begin experimenting during their teen years.

How to identify it: You can identify if someone is experimenting with drugs or alcohol if they have used the substance only once or at most a few times. The key component of experimentation is that someone is learning what drugs and alcohol feel like and how they affect them. After you try something a couple of times it is likely that you know what it is like.

If someone has begun using drugs or alcohol regularly they have likely moved on to one of the later stages of addiction. If you are interested in learning more about how experimentation can lead to addiction this article from Psychology Today explains it well. However, it is also important to remember that at this phase some people stop using and do not develop addiction problems.

2. Regular or Social Use

What it is: At this stage, someone begins using substances regularly. The person who is using might begin using substances as a way of coping with difficult emotions or just as a way to fit in. The key is that they have begun to develop a pattern of use. You might think of this stage as habitual use. The person using is not physically or psychologically addicted, but they are beginning to get used to the positive effects of substances.

How to identify it: If someone you know is using drugs and alcohol every weekend they are probably in this stage. They key is that someone is using regularly but does not experience negative effects like withdrawal when they stop using. Someone in this stage can sometimes use regularly and then stop for a period of time if they need to.

It is important to note that teens and young people are expecially suseptible to social pressure, as has been shown in extensive research. Some studies have found that social media can affect social use of drugs and alcohol. This is especially true for teenagers. Teens who look at photos of friends drinking and using also have higher rates of social substance use.

3. Problematic or Risky Use

What it is: The third stage of addiction is problematic or risky use. At this stage substance use begins to become a problem for the person who is using. Someone who is in this stage might continue using despite negative consequences with work or loved ones. The DSM-5 lists the criteria for different substance use disorders (https://online.epocrates.com/diseases/19836/Alcohol-use-disorder/Diagnostic-Criteria). The diagnosis includes symptoms of problematic use as well as dependence.

How to identify it: The National Institute on Alcohol Abuse and Alcoholism offers a list with a number of questions that might help you identify if you or someone you love is struggling with problematic of risky use.

  • Had times when you ended up drinking more, or longer than you intended?
  • Found that drinking — or being sick from drinking — often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
  • Continued to drink even though it was causing trouble with your family or friends?
  • Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
  • More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
  • Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?

4. Dependence and Addiction

What it is: The fourth and final stage of addiction is when someone becomes psychologically and physically dependant on the substance. At this stage someone is experiencing tolerance meaning that they need more and more of the substance in order to get the desired effect. They are also experiencing dependence which means that when they don’t take the substance they have symptoms of withdrawal.

How to identify it: You can tell if you or someone you know is in the fourth stage of addiction if they experience withdrawal when they are not taking a substance. Withdrawal symptoms can vary slightly depending on the drug but they generally include:

  • Anxiety
  • Shaking
  • Nausea
  • Vomiting
  • Insomnia
  • Sweating
  • Fever
  • Racing heart
  • Confusion
  • Seizures

It is important for someone at this stage to get help for their addiction. It can be dangerous to stop taking certain substances without medical assistance. In rare cases, detox can cause death. It is therefore imperative that someone consult medical professionals if experiencing symptoms of withdrawal.

Other Stage Models of Addiction

In addition to the list described above there are other stage models of addiction. Some models have more to do with the physical and psychological cycle of addiction and others are colloquial stages that come up in popular culture.

The Neurocircuitry Model of Addiction (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805560/) lists three stages:

  1. Compulsion to take the substance
  2. Inability to limit the amount taken
  3. Negative emotional states after use

This model refers to people who are already addicted to a substance. It starts with the person’s compulsion to take take drugs or drink alcohol. Then, once the person has then take the substance they are unable to control or limit how much they take. In the final stage someone experience negative psychological effect from taking the substance like depression or anxiety. Depending on the substance being used this whole cycle might take as little as a few hours for someone to go through.

The AA Model of Addiction:

  1. Fun
  2. Fun with Problems
  3. Problems

This final model is not rooted in any particular scientific theory or research. Rather it is a pop culture understanding of the phases of addiction that comes up frequently in AA meetings. It is more of an observation about many people’s experiences than it is a stage model. However, it can be a helpful way of conceptualizing the stages of addiction.

In the first stage substance use is fun and carefree. In the second stage use is still fun but someone might start to experience some negative consequences. You might think of someone who is starting to have hangovers or get in trouble with family as a result of using. In the final stage substance use is almost entirely problematic. At this stage someone might be in trouble with the law or have serious physical, social, or economic consequences as a result of use. 

Moving Forward

It is helpful to have an understanding of the different stages of addiction so that you can identify problematic substance use in yourself or loved ones. All of these models help us understand how addiction plays out for someone who does become addicted. It is important to remember that there are numerous places you can reach out for help both for yourself and others.

 
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