Addiction to drugs, medications, and alcohol is prevalent in the United States and worldwide, despite the fact that such a wide prevalence of addiction is largely misunderstood. The general belief is that addiction to some substance happens easily, and it’s also easy to overcome it. Our society is still inclined to believe it’s enough to say or decide you want to quit, and the problem is solved. Addiction is more than that. Through this post, we are going to discuss six stages of addiction and help you to break the cycle.
What is Addiction?
The skewed perception of addiction and addictive behavior is the main factor behind the misunderstanding of this problem and its treatment.
Discussing the six stages of addiction would be impossible without defining addiction in the first place.
Addiction is often viewed as something people choose out of boredom or for some other reasons. The reality is different, and as a society, we need to get rid of that common belief.
The American Psychiatric Association defines addiction as a complex condition, a brain disease manifested by compulsive substance use despite harmful consequences. People with addiction have a strong urge to use a certain substance(s) to the point where it controls their life. Despite knowing the consequences and problems that substance can cause, people with addiction still use them.
That happens because men and women with addiction have distorted thinking, behavior, and body functions. The intense cravings for the drug are largely due to the changes in the brain’s wiring. These changes are also the reason why it’s not as easy to overcome addiction as most people think it is.
A study from the Frontiers in Integrative Neuroscience reports that it is still not entirely clear what neurophysiological processes are involved in the development and progression of addictive disorders. The same study focuses on drug addiction, which they define as chronic relapsing disorder comprised of three stages:
- Preoccupation / Anticipation
- Binge / Intoxication, and
- Withdrawal / Negative effect.
These stages feed into one another, thus becoming more intense over time and ultimately leading to the pathological state known as addiction.
Different drugs produce distinct patterns of addiction that engage different components of the addiction cycle. Each stage of addiction involves changes in critical neurotransmitters and neurocircuits. Further research is necessary to shed more light on how addiction really influences these changes. The more we know about the mechanisms of addiction, the easier it will get to treat these disorders.
While the above-mentioned study suggests there are three stages of developing an addiction, we are going to focus on six to illustrate just how complicated addiction is, but also to demonstrate successful treatment is possible.
A paper from the International Journal of Environmental Research and Public Health showed that addiction doesn’t happen overnight; it’s a process. The same research reveals that the addiction process may vary from one person to another. The course at which addiction develops may reflect individual differences prior to engaging in the addictive behavior. Many self-described addicts have reported feeling “different” from others long before developing their addictions. They felt uncomfortable, lonely, restless, and incomplete.
The American Society of Addiction Medicine explains that addiction is a treatable, chronic medical disease comprising of the complex interactions among brain circuits, the environment, genetics, and a person’s lived experiences.
As discussed above, addiction is a complicated condition that involves brain changes and other factors influencing a person’s health, wellbeing, and overall quality of life.
Prevalence of Addiction
Millions of people around the globe have an addiction to some substance, but it’s impossible not to wonder just how many individuals have that condition. The exact number of people with addiction is difficult to tell, particularly because many people strive to hide their problems as much as possible.
Only one in seven people with drug use disorder
receive the necessary treatment.
The World Drug Report 2019, released by the United Nations Office on Drug and Crime, states that about 35 million people worldwide suffer from drug use disorders. Unfortunately, only one in seven people with drug use disorders receive the necessary treatment. The same report estimates that the number of opioid users at 53 million, meaning it increased by 56% from previous estimates.
Keep in mind that the above-mentioned information is for drug use disorders only, not alcoholism and addiction to other substances.
Global statistics published in the Addiction journal revealed that about 4.9% of the world’s population (240 million people) suffers from alcohol use disorder. An estimated 22.5% of adults in the world (1 billion people) smoke tobacco products. Of unsanctioned psychoactive drugs, cannabis is the most prevalent at 3.5% globally.
When it comes to the United States, a nationwide survey on a sample of 265 million individuals 12 years of age and older discovered that approximately 17% of the population (44 million people) reported use of an illegal drug, non-medical use of the prescribed drug, or heavy alcohol use during the prior year. Almost 3% of the population, or 7.8 million people, initiated some form of substance use in the prior year, and 8% or 21.4 million people met diagnostic criteria for substance use disorder.
In fact, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health also revealed that over 20.8 million people have substance use disorders, but only one in ten receives treatment.
What we can learn from these figures is that the prevalence of addiction is high worldwide, thus confirming the severity of addictive behaviors. These reports intensify the need for encouraging people with addiction to get much-needed treatment.
What Are The Stages of Addiction?
Addiction doesn’t occur overnight; it’s not something that develops instantly. The addiction disorder develops gradually through different stages that may occur at the same time. The process through which addiction forms may differ from one person to another.
Various factors play a role, including the substance used, genetic predisposition, the amount used, among others. For illicit substances, even one use can be considered as abuse, while alcohol, for example, requires heavy or binge drinking to be considered as abuse. The rate at which a person becomes tolerant of the substance also plays a role in progress from one stage to another.
Even though people may experience stages of addiction differently, we can identify six of them:
- Initial use
Below, we are going to discuss each stage of addiction more thoroughly.
Stage 1: Initial Use
Everything has the beginning, and so does the addiction. Initial use is a catapult for all the ensuing stages. The question is why adolescents and adults decide to use drugs, alcohol, and other addictive substances in the first place.
A study from the Psychology of Addictive Behaviors found that among adolescents, the most prominent reason behind initial drug/alcohol use was positive/negative reinforcement. They either started using alcohol/drugs to enhance a positive state (positive reinforcement) or to cope with a negative state (negative reinforcement).
Subjects who reported substance use due to negative reinforcement turned out to have a more severe problem than their counterparts. This tells us that, at least among adolescents, the initial use of drugs or alcohol is a sort of escape from reality. Many adolescents consider these substances as a mechanism that helps them tackle negative situations in their lives. Adults are similar; they tend to start using substances to deal with traumas and other negative experiences.
For many people, the initial use of a certain substance comes in the form of experimentation. They want to try and experience it, especially adolescents who are also susceptible to peer pressure. Adolescents may also try alcohol or drugs out of boredom and grow to like the effects they experience.
Other reasons behind the initial use of a substance include:
- Low self-esteem
- Co-occurring mental health disorders, and
Not every initial use will result in addiction
Some people are more prone to developing an addiction than others. This subject requires further research in order to shed more light on the susceptibility of some people to develop an addiction. A common misconception is that certain groups of people are more inclined to display addictive behaviors, but this problem can affect anyone.
Below, you can see the most significant risk factors that increase a person’s likelihood of developing an addiction:
- Genetics – according to the National Institute on Drug Abuse, up to half of the risk of addiction to nicotine, alcohol, and other substances is based on genetics. You are more likely to develop an addiction if you have family members who’ve experienced it.
- Environment – environmental factors also raise the risk of addiction. For instance, young people who experience neglect or abuse from parents may use drugs or alcohol to cope with their emotions. This leads us to the above study, which showed that people initiate substance use to overcome negative reinforcements. Peer pressure also belongs to this risk factor. The availability of a certain substance in a social group also increases the risk of initial use and addiction.
- Dual diagnoses – this means a person has both an addictive disorder and another mental health condition. The risk of addiction increases in the presence of underlying mental health issues. Other medical problems may also lead to addiction, especially if a person takes prescription pills for pain, anxiety, etc.
- Early use – the age at which the initial use starts is a big risk factor for addiction. One survey found that young adults between the age of 18 and 24 were most likely to have alcohol use disorder and drug addictions. This happens because substance use at a younger age can impact brain development.
- Drug of choice – some substances such as cocaine, heroin, and methamphetamines are more addictive than others, such as alcohol and marijuana. Therefore, a person who takes those substances is at a higher risk of addiction after the initial use.
- Method of use – generally, substances that are smoked and injected into the body are more addictive than those you swallow. When drugs are smoked or injected, they go straight to the brain or bloodstream, but the ones you swallow need to go through the liver, which breaks them down.
- Metabolism – how a person absorbs and processes compounds determines the effect of a substance on the body. Changes in metabolism influence the duration of the effects of alcohol and certain drugs. Not every person has the same metabolism, so these variations also influence your risk of developing an addiction.
Stage 2: Abuse
Initial use, for many people, progresses into the next stage of substance abuse. The World Health Organization defines substance abuse as harmful or hazardous use of psychoactive substances, including illicit drugs and alcohol.
The substance abuse term is used to refer to different behaviors, actually. One research reports that substance abuse may refer to the use that contradicts medical advice (if prescription medications are involved and not taken as prescribed). The term abuse is also used to refer to illegal use of the substance.
In a nutshell, the second stage of the addiction cycle, i.e., substance abuse, refers to the excessive use of a substance in a way that is harmful to self, society, or both. The definition includes both psychological and physical dependence.
At this point, many people are unaware they have a problem. A patient with a prescription for painkillers may decide to take a higher dosage to eliminate the pain. A higher dose turns out to be effective, and they do it frequently. In a patient’s mind, nothing is wrong, but technically they’ve entered the substance abuse cycle.
Other examples of substance abuse include occasional use of cocaine and regular binge drinking. When it comes to cocaine, a person may believe that using the drug from time to time isn’t a big deal, and nothing will happen, but the reality is different, and that behavior shows signs of substance abuse.
Stage 3: Tolerance
The terms tolerance, addiction, and dependence are used interchangeably, although they are different and represent different stages of the addiction cycle.
After substance abuse comes tolerance to that substance, which only deepens the roots of addiction, tolerance is defined as a person’s diminished response to a substance that is a result of repeated use. People can develop tolerance to prescription medications and illicit drugs.
Tolerance can be acute, chronic, and learned. Acute or short-term tolerance occurs due to repeated exposure to a drug over a relatively short period of time.
Chronic, or long-term, tolerance develops when a person’s body adapts to constant exposure to a drug over weeks or months.
On the other hand, learned tolerance might stem from frequent exposure to certain drugs or other substances. A good example of learned tolerance is alcohol abuse that lasts for months or years without appearing intoxicated to others.
A common misconception about tolerance is that it only develops when a person uses alcohol or drugs for a longer period of time. But tolerance can develop within hours or days. This depends on the type of the substance but also other factors such as metabolism.
Tolerance means the current dose of a drug (or the amount of alcohol) is not enough for a person to achieve the pleasurable effects. Then, they try to increase it, but this only leads to tolerance to that new dose, and the cycle continues.
In tolerance, the brain changes its response to the drug, and higher doses are necessary to overcome this problem.
Stage 4: Dependence
When a person develops tolerance, they increase the dosage to which they also become tolerant eventually. Tolerance leads to dependence.
Dependence is defined as a physical condition wherein the body has adapted to the presence of the drug and develops withdrawal symptoms when a person stops taking it. Like other stages of addiction, dependence is also misunderstood. It’s often mistaken for substance abuse or identified with tolerance and addiction.
Drug dependence is not the same as substance abuse because it consists of clearly measurable periods of tolerance and withdrawal. On the other hand, substance abuse sets the occasion with tolerance and withdrawal.
Dependence doesn’t necessarily occur due to illicit and addictive drugs all the time. Non-addictive drugs can also produce dependence in some patients, but they’re not the subject of this post.
When drinking too much alcohol or using drugs, the body and brain become dependent on having that specific substance to function. That’s why you experience some withdrawal signs when you don’t take that drug or drink alcohol for a few hours. Withdrawal symptoms can be uncomfortable and also occur during medical detox programs in Dallas-Fort Worth, the first stage of recovery. That’s why detox should be performed in a supervised setting.
Stage 5 : Addiction
Addiction is a term that most people use to refer to any kind of activity that involves the use of drugs and alcohol. We’ve covered the definition of addiction above in this post. Addiction is compulsive substance use that occurs despite personal harm or negative consequences. It’s considered a chronic disease that involves impaired control and craving.
An affected person experiences different symptoms of addiction, but the presence of this stage of the addictive behavior is also observed by other people.
If you’re addicted to alcohol, prescription medications, or illicit drugs, you may notice the following symptoms:
- Strong urge to use the substance regularly, even several times a day
- Being unable to stop using the substance
- Needing more to get the same effect
- Spending money on drugs or alcohol even though you can’t afford it
- Failing to meet obligations and work responsibilities due to drug use
- Continuing to use the substance even though you’re aware it’s causing problems to your health, life, and relationships
- Engaging in risky behaviors such as stealing to obtain the drug
- Spending a lot of time on getting and using the drug or recovering from use
Sometimes it can be difficult to recognize signs of addiction in others, but common symptoms you can notice include:
- Problems at work such as lack of interest and decreased productivity
- Weight loss or weight gain
- Lack of energy or motivation
- Red eyes
- Neglected appearance
- Behavioral changes
- Money problems
Stage 6: Relapse
Relapse is a recurrence of past activity. In this case, relapse means a patient starts using the drug or alcohol again at some point in the recovery process. This is an important stage of addiction, but its significance is overlooked. Many people consider relapse as the end of the road like they (or the loved one) will never be able to achieve full recovery again. That’s not entirely correct.
Relapse can be part of the recovery process, but nowadays, treatments are created in a way to decrease the risk of experiencing them.
That’s why starting the recovery in an addiction treatment center is crucial. One study found that compared to subjects who got help for alcoholism, those who didn’t were more likely to relapse. This only shows why it’s so important to get professional help for the addiction problem.
Why do people relapse?
Various factors play a role in the risk of relapse, including:
- Spending time in the environment or with people who use that specific substance
- Being exposed to situations that act as a trigger for substance use as a coping strategy
- Pre-existing emotional or mental health problems
- Underlying physical health condition
Many studies have found that relapse rates within the first twelve weeks after the completion of intensive inpatient programs are about 50%. The relapse episodes may last from four to twelve weeks and can cost tens of thousands of dollars. For that reason, it’s crucial to make the right choice, get professional help, and join a facility with a team of experts who know how to help you prevent or overcome your relapse.
How to Break The Cycle
We can easily consider the six stages of addiction as a wheel that keeps turning and turning on the road. Each stage feeds into the next one, and the cycle continues.
Since addiction is misunderstood, it’s easy to assume breaking the wheel equals mission impossible. Not true!
Sure, addiction is a serious problem, but it also happens to be treatable.
You can overcome addiction to alcohol, prescription drugs, and illicit drugs. But in order to achieve that, you need to get professional help at an inpatient alcohol rehab in Texas, for instance.
Professional help involves finding the drug or alcohol abuse treatment center where you will start the detox and move to other stages of the recovery process. Inpatient and outpatient treatment programs are available to men and women with addiction. The substance abuse rehab program includes therapy sessions where you get to learn all the mechanisms to adopt in order to start a healthier and happier life. Relapse prevention is a major aspect of addiction treatment.
In this post, we focused on six stages of addiction to show how complicated this condition is, but also to demonstrate that professional help at long-term detox centers for alcoholism and guidance is crucial. Addiction isn’t a final state, but an obstacle you need to cross for a healthier life. Addiction treatment is challenging but rewarding, and it enriches your life.
John Eckelbarger is a Business Development Representative for Stonegate Center. With a BSA in Chemistry from the University of Texas at Austin, he has an interest in the neurobiology of addiction as well as the pharmacology of drugs. He hopes to bolster Stonegate Center’s status at the forefront of addiction medicine through bold, innovative content creation. He is currently pursuing his MBA in Finance from Texas Christian University.