Most often, addiction does not happen all at once. Instead, it is a progression that takes place sometimes over years. This progression to addiction is a growing problem in American society, where illicit drug and marijuana use have been steadily rising in recent years (https://www.drugabuse.gov/publications/drugfacts/nationwide-trends). Of course not everyone who uses drugs will become addicted. But, according to USA Today nearly 1 in 7 Ameircans will struggle with substance addiction at some point in thier life. So, if addiction is such a problem, how exactly does it happen?
For Many people, the process of addiction starts before they ever ingest a substance. This is because many people have the risk factors that are associated with developing addiction. If you have these risk factors, it does not mean you are doomed. However, it does increase the chances that you will develop addiction at some point in your lifetime.
Risk Factors for Addiction:
- Availability of substances
- Stress levels
- Peer substance use
- Positive expectations about substance use
- Poor ability to cope with stress
- Genetic factors, including family history
- A history of other psychological disorders
- Early onset substance use
- History of physical or psychological abuse
The next phase in the process is intoxication. Often, intoxication means using a substance to excess. Generally, for people who develop addiction they do use substances heavily. However, we would like to point out that is is possible to get addicted to a substance if you use regularly even if you don’t use it excessively every time.
Intoxication is prevalent enough that the DSM-5 now has specific “intoxication” disorders (https://en.wikipedia.org/wiki/Substance_intoxication) related to each substance. Some examples are, alcohol intoxication disorder, cannabis intoxication disorder, and hallucinogen intoxication disorders.
When people use substances they are usually trying to get the desired effect of the substance. For some drugs this means getting the calming effect, while for other drugs it might mean getting the stimulating effect. Whatever it is, people are looking to achieve the desired effects of the drug. At this phase, you still would not say that someone is addicted. However, if they have risk factors for addiction and they are getting intoxicated someone is probably creeping closer to addiction.
After someone uses a substance regularly, they will probably start to develop tolerance to that substance. Tolerance is when you need increasing amounts of a substance in order to achieve the desired effect (https://www.drugabuse.gov/publications/teaching-packets/neurobiology-drug-addiction/section-iii-action-heroin-morphine/6-definition-tolerance). When you start drinking you might only need to have two drinks in order to feel a little drunk. However, as time goes on you will need more and more alcohol in order to become intoxicated. This is why people who use regularly usually need to increase the dose of whatever they are taking in order to get the intended effect.
Tolerance does not last forever. When you stop using a substance for a period of time your tolerance will go down. Little is known about how long exactly it takes for tolerance to go down for each drug. Still, at this stage people are not considered addicted. But, if you have developed tolerance to a substance you might be headed that way.
Substance withdrawal is when someone starts to have physical and psychological symptoms when a substance is leaving their body (https://psychcentral.com/disorders/alcohol-substance-dependence-symptoms/). You might have seen images in movies of heroin addicts who are vomiting or shaking as they try to come off the drug. What they are exhibiting are physical symptoms of withdrawal. In addition to these uncomfortable physical symptoms, people might experience psychological symptoms of withdrawal like anxiety or depression.
Here are some symptoms of withdrawal:
- Sweating and increased pulse rate
- Hand tremors
- Vomiting or Nausea
- Fatigue or drowsiness
- Depressed mood or irritability
- Difficulty concentrating
If someone is exhibiting signs of tolerance and withdrawal they have most likely developed dependence. Dependence is when someone becomes physically and psychologically reliant on the substance. If they don’t have the substance in their symptoms they will start to have those uncomfortable withdrawal symptoms. When they are using, they keep needing more to get the intended effect. When people are dependant on a substance they might also have intense cravings for it leading them to keep using.
At this phase, someone is most likely addicted. It depends a bit on how you define addiction, but at this point someone needs the substance in order to function normally.
Some people add in a stage beyond dependence that it specifically addiction. It takes dependance a step further. Addiction might be that not only will someone be using more and have negative consequences when they stop, they are using because it has become more pleasurable than all other activities.
Our brains give us little boosts of positive reinforcement when we do certain things. For example, we get a little rush of feel good hormones when we eat, have sex, or exercise. When someone is truly addicted to substances they are not able to get that pleasurable boost from anything other than drugs (http://learn.genetics.utah.edu/content/addiction/brainchange/). So, as a result they stop doing the things that used to feel good and instead seek out more and more substances to try to get that positive rush.
As we have explained, someone does not get all the way to this stage without going through some other things first. Addiction most likely begins with a predisposition based on some risk factors, next you have to actually use the substance, followed by tolerance for that substance, then dependance, until finally you land at addiction.
A Different Model
The model described above describes the process of addiction mostly from a biological perspective. However, there are other models of how people get addicted that have to do more with how they are using a substance, rather than what is happening in their body. In this model there are three stages:
- Substance use
- Substance misuse
- Substance abuse
Substance use is anytime someone uses alchol or drugs (http://study.com/academy/lesson/substance-use-abuse-and-dependence-definition-and-causes-of-substance-disorders.html). This is very similar to the intoxication phase listed in the previous model. Here, the progression to addiction starts with using substances.
Substance misuse is when substance use leads to social, psychological, or physical consequences. In this case, it might be that using substances leads someone’s friends to pull away or perhaps they become physically injured while using.
Substance abuse is the next phase. This is when someone cannot stop using despite wanting to. They have more negative consequences from use. Finally, the person might be using increasing amounts more frequently.
This model centers around how it looks when someone is using substances rather than what is going on biologically. However, there is overlap with the other model. Both include a progression from using substances in a way that might be ok to using them in a way that is detrimental. As you can see, addiction is a process.
Depending on the drug, the person, and the way they use addiction might happen in a matter of weeks or a matter of years. Regardless of how it happens, it has devastating consequences when it goes.