The Stages of Addiction: How Casual Use Evolves into Dependence

Addiction is one of the greatest public health concerns facing the United States today. More than 21 million people are addicted to drugs and alcohol, and thousands of people die each year due to drug and alcohol-related overdoses. In fact, a startling 130 people die each day of opioid overdoses alone, never mind any other addictive substance. But these individuals are typically not those who have just begun using drugs or alcohol, rather they tend to be those who have struggled with the disease of addiction and the development of it. 

Like most diseases, it takes time for addiction to progress. Of course, there are cases where someone loses his or her life early on in his or her substance abuse or even during a period of experimentation, however it is much more common to see a progression occur over time. When someone experiments with drugs or alcohol, he or she is not planning on becoming an addict or an alcoholic, however in some instances, that is what occurs. That is because experimentation can lead to regular use, which can then lead to risky use, dependence, and the eventual development of addiction.

Stages of Addiction

What are the Stages of Addiction?

Each stage of addiction showcases what a person is going during that stage, but also highlights the potential of what can come next if the use continues. People of all ages abuse drugs and alcohol, but a vast majority of them are first exposed to addictive substances at an early age. That is because the most common ages to be introduced to drugs and/or alcohol occur in the teenage years. 

1. Initiation

The vast majority of children and adolescents are first exposed to drugs and alcohol at a very early age, especially if there is substance abuse occurring in the home. Typically, however, exposure and initiation are two separate things. 

Studies show that children and adolescents between ages 12-14 and 15-17 are at the highest risk for initiation of drug and alcohol use. Those same studies also report that those children and adolescents who are initiated into substance abuse at an early age are more likely to become addicted and/or dependent on drugs or alcohol in adulthood. Basically, the younger the initiation occurs, the more likely the child/adolescent will be to develop a substance use disorder. In 2012, the National Survey on Drug Use and Health (NSDUH) reported that out of those adults who used marijuana at age 14 or younger, 13.6% were diagnosed with illicit drug dependence or abuse. This percentage showed that marijuana use this early in life creates a risk potential for future dependence when in adulthood. 

Because of factors such as curiosity, peer pressure, and the underdevelopment of the prefrontal cortex in the brain (which helps with decision-making skills), children and adolescents this young are more inclined to try drugs and/or alcohol. 

2. Experimentation

Experimentation with drugs and alcohol can begin within childhood and adolescent years as well as in one’s adult years. Regardless of age, experimentation often begins for one reason or another. A person can feel inclined to experiment because they are feeling pressured to do so by their peers, are searching for a means to cope with pain, sadness, and other unsatisfactory emotions, or who are looking to achieve a goal (an example being abusing Adderall in an effort to stay awake to study longer). Most people do not think that just trying drugs or alcohol is going to lead to anything more and that they are in control of how they manage their use. Unfortunately, when experimentation turns into regular use, the risks of becoming out of control become more significant. 

3. Regular use 

Someone who is regularly using drugs or alcohol is incorporating it into their lives in some way or another. One person might regularly use alcohol each day while another person might regularly use drugs on the weekend. The definition of regular can vary in this way.

When regular use of drugs or alcohol is occurring, individuals are likely using to the point where other areas of their lives begin to suffer. Their use might interfere with their ability to get to work on time due to being hungover or prevent them from upholding responsibilities at home because of their preoccupation with ensuring the steady flow of their regular use. It is usually during this stage of addiction that minimal consequences like these occur as a result of regular substance use. As the use intensifies, the more severe the consequences can become. 

4. Problem/risky use

Use becomes problematic when it starts to really impact your everyday life, and potentially the lives of others. Examples of risky use would be driving while under the influence, having unsafe sex, and stealing in order to support your use. In these instances especially, you are not only risking your wellbeing, but also the wellbeing of others. During this stage, you still might feel as though you can control how much you use and when, but you may convince yourself that you are wanting to use each and every time you do so that your actions do not seem as permanent or irreversible. This is extremely common and can serve as a catalyst for the development of dependence. 

5. Dependence

Dependence refers to being physically unable to stop using drugs and/or alcohol without experiencing withdrawal symptoms. You do not become dependent to drugs and/or alcohol overnight, however it also does not take a long time for dependence to develop depending on which substance you are abusing. 

There are three steps to developing dependence:

1. Tolerance

Being tolerant of drugs or alcohol means that you need to increase the normal amount that you regularly use in order to achieve the desired effects. This is why most drug and alcohol users end up using way more than they began using in the first place, which also increases their risk of fatal overdose. 

2. Physical dependence

Physical dependence is occurring when you cannot end or limit your drug or alcohol intake without going into a state of withdrawal. Most addictive substances (even those that are prescribed by professionals) can cause dependence to develop even when taken as prescribed.

3. Psychological dependence

Psychological dependence happens when you feel the intense, uncontrollable need to keep using. You likely feel that you cannot function without using, making it extremely difficult (if not impossible) for you to quit.

While much of the disease of addiction does not feel scientific, the process of developing dependence is. You cannot have a physical dependence on a drug or alcohol without first being tolerant to it. Likewise, you cannot be psychologically dependent without being physically dependent first. 

Substance use disorder

Once you have developed a dependence on drugs or alcohol, it is only a matter of time until you reach the final stage of addiction, which is a full-blown substance use disorder. The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) has eleven different criteria that define a substance use disorder:

  1. Taking drugs or alcohol in greater amounts or for longer than intended
  2. Wanting to cut back or stop using altogether but not being able to
  3. Spending an excessive amount f time getting, using, or recovering from the use of drugs and/or alcohol
  4. Experiencing cravings to keep using
  5. Neglecting responsibilities at work, home, or school because of substance use
  6. Continuing to use despite when it causes issues in relationships
  7. Withdrawing from social, occupational, or recreational activities because of substance abuse
  8. Continuing to abuse drugs and/or alcohol even when it puts you or others in danger
  9. Continuing to use when you know that you have an issue that can be made worse by your use
  10. Needing more drugs and/or alcohol in order to get high
  11. Developing withdrawal symptoms that can only be remedied by using again 

It is imperative to obtain professional treatment at any stage of addiction, but most important when a substance use disorder has formed. That is because this is the final stage of addiction and it often results in overdose, accidents caused by being under the influence, or harm to others.

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What are the Stage Models of Addiction?

The Jellinek Curve is a stage model of addiction that focuses on the progression of the disease of addiction and how cyclical it is, especially when untreated. There are five stages of this model:

Stage 1 – Pre-alcoholic

You are drinking or using to feel better about yourself, to manage painful emotions, to forget something, or to avoid anxiety. 

Stage 2 – Early alcoholic

You are experiencing blackouts related to drinking or using drugs and are also becoming deceitful and dishonest about your use. During stage 2, you are also using to excess as well as thinking about your use to excess.

Stage 3 – Middle alcoholic

Your drug and/or alcohol use is noticeable to those around you and you are beginning to slack on major responsibilities at work, home, or school. You experience physical effects related to your use.

Stage 4 – Late alcoholic

Your drinking and/or drug use has taken over all aspects of your life and you are willing to compromise your wellbeing to keep using. If you attempt to stop using or drinking, you can experience severe withdrawal symptoms — some of which may be deadly depending on what you are using.

Stage 5 – Recovery

You are ready to get help, which can include a combination of detox, therapy, and maintenance. 

Valliant’s Model

Developed by Dr. George E. Valliant, this model of addiction was initially used to describe the progression of alcoholism. Today it is used to address addiction as a whole and is broken down into three stages:

Stage 1 – Asymptomatic use

You are drinking or using drugs in social settings or other events where it is common to drink. You usually do not have trouble controlling your drinking or drug use but on occasion use more than intended. 

Stage 2 – Abuse

You are drinking or using drugs to help manage problems in your life, such as stress produced by work or a relationship, a mental illness like anxiety or depression, or to manage upsetting emotions surrounding specific life circumstances. At this time, the abuse of drugs and/or alcohol for these purposes causes negative effects within their lives that continue to fuel the substance abuse.

Stage 3 – The dependent person

You have developed an addiction as evidenced by four symptoms:

  1. Tolerance to the drug of choice and/or alcohol
  2. Presence of withdrawal symptoms when unable to use drugs and/or alcohol
  3. Inability to control substance abuse 
  4. Significant impairment in life

Volkow, Koob and McLellan’s Model 

Nora D. Volkow, MD, George F. Koob, PhD., and Thomas McLellan, PhD. are all addiction researchers who developed an addiction model that focuses on a distinction between substance use disorders and addiction. They state that addiction is the most severe form of a substance use disorder rather than it being a term that is interchangeable with substance use disorder. 

This model is described in three stages:

1. Binge and intoxication

You binge drink/use and become intoxicated due to cravings triggering your use. This is because your brain craves the dopamine release that occurs when you use.

2. Withdrawal and negative affect

Your brain starts to struggle to experience pleasure or gratification because of your substance abuse, causing a negative effect that makes you more sensitive to withdrawal and other challenging physical or emotional situations.

3. Preoccupation and anticipation

You experience this stage when you are in the thick of a severe substance use disorder and are physically dependent on drugs or alcohol. At this time, you become fixated on everything that goes into your substance abuse. 

Each model, while different in their approaches, helps to provide a general understanding of how addiction does not just occur overnight, rather it develops through a series of stages. 

Do You Need Help?

If you are struggling with addiction, reach out and ask for help. You do not need to try to go through this alone. Contact us right now to get the help that you need to stop using and begin living a happy, sober life. 

The Addiction Blog