Does substance abuse just HAPPEN, or are there stages of addiction?

Most experts on Substance Abuse Disorders agree that problematic drug or alcohol use exists on a continuum. In other words, addictive disorders have distinct levels or stages, each with identifiable symptoms.

The bad news is that left unchecked, substance abuse almost invariably gets WORSE—often to the point of illness, permanent disability, or death.

But here’s the GOOD news – learning how to recognize the stages of addiction can point the way to positive solutions – timely intervention, effective treatment, and real healing.

Addiction Stage #1 – Abstinence

“Temperance is moderation in the things that are good and total abstinence from the things that are foul.”

~ Frances E. Willard, temperance reformer who influenced the passage of the 19th amendment

Abstinence is exactly what it sounds like – zero use of intoxicants.

In a perfect world, because so much is known about the health consequences of substance abuse, NO ONE would use alcohol or illicit drugs. Unfortunately, we DON’T live in a perfect world, because addictive substances are widely available:

• 72% of teens who drink get alcohol without having to pay for it.
• 27 of teens say they could get marijuana in an hour or less.
• More and more states are legalizing marijuana, with predictable results. For example, in Colorado, there are more pot dispensaries than there are 7-11s, Starbucks, and McDonald’s combined.
• Almost 92 MILLION Americans use prescription opioids.
• Only 6% of people who misuse prescription painkillers get them from a stranger or drug dealer. Most get them for free from a family member or friend.
• Over 3.5 MIILION US children are given prescription stimulants such as Adderall or Ritalin, and another 16 MILLION prescriptions are written for people between the ages of 20 and 39.
• 47% of high school seniors say that it is easy to obtain a stimulant for nonmedical/recreational use.
• 62% of college students have been offered a prescription stimulant for nonmedical use.
• Approximately 13.5 MILLION Americans take benzodiazepine tranquilizers.

Because of this ready availability, most people move on to Stage 2.

Addiction Stage #2 – Initiation and Experimentation

“Because their bodies have become sensitized to alcohol, once they have taken that first drink the tissues of the body cry out for more and more, until sufferers find that they cannot control the amount of alcohol consumed. One drink is too many, a hundred, not enough.”

~ John G. Cooney, Under the Weather – Coping with Alcohol Abuse and Alcoholism

There are many addictive drugs that are already legal in the United States—nicotine, alcohol, prescription opioids and benzodiazepines, and in many states, recreational marijuana.

Most Americans experiment with one or all of these substances, usually during adolescence or early adulthood. Currently:

• Every day, 3200 minors smoke their FIRST cigarette.
• Over 86% of US adults have tried alcohol.
• 1 in 8 US 8th-graders has used marijuana at least once.
• Each year, about 1.5 MILLION people misuse a prescription opioid for the first time.
• Roughly 1 out of 4 people who even TRIES heroin eventually becomes addicted.
• 31% of college students have misused a prescription stimulant.

Although it is true that simply TRYING alcohol or addictive drug does not definitely lead to addiction, it is also true that a person’s brain permanently changes after the very first time they drink or use drugs. This is because addictive substances affect the same regions of the brain that are associated with learning, memory, and motivation.

In other words, the artificial surge of pleasure-inducing neurotransmitters that is triggered by substance use “trains” the user’s brain that drinking/drug use is a GOOD thing.

Addiction Stage #3 – Regular Use

“Drugs age you after mental excitement. Lethargy then. Why? Reaction. A lifetime in a night. Gradually changes your character.”

~ James Joyce, Ulysses

The brain responds incredibly well to this training. This explains why some people feel a palatable NEED to use drugs and alcohol in order to have a good time—they are directed by their brain to keep chasing the pleasurable sensations. They aren’t dependent—YET—but they are well on their way.

This progression is borne out by statistics:

• Every day, 2100 teenage/young adult “occasional” smokers progress to daily smoking.
• More than 36 MILLION Americans smoke cigarettes.
• Over 56% of adults have used alcohol within the past month.
• 1 in 7 US 10th-graders has used marijuana within the past month.
• 40% of college students who abuse prescription stimulants do so during testing periods.

Addiction Stage #4 – Use Becomes Abuse

“The horribly ironic cosmic trick of drug addiction is that drugs are a lot of fun when you first start using them, but by the time the consequences manifest themselves, you’re no longer in a position to say, ‘Whoa, gotta stop that.’”

~ Anthony Kiedis of the Red Hot Chili Peppers, Scar Tissue

There is a fine line between substance use and substance abuse. What started out as experimentation became a regular habit (use), but when that use begins to result in negative consequences or changes in behavior, then that person is now on a steep, slippery slope to full-blown addiction.

Examples of substance use that has progressed to abuse include:

• 6% of high school seniors use marijuana daily.
• 1 out of every 6 US adults binge-drinks four times a month.
• On these occasions, they consume around 8 drinks.
• 80% of heroin addicts began by misusing prescription opioids.
• Even merely using benzodiazepines “as needed” can lead to misuse
• 90% of college students who misuse stimulants are heavy drinkers.
• They also are at much greater risk for polydrug abuse:
  • 80% smoke marijuana.
  • 45% misuse prescription painkillers.
  • 29% use cocaine.
  • 25% misuse prescription tranquilizers.

Behaviors fueled by substance abuse might include:

• Engaging in risky behaviors – binge-drinking, driving while impaired, unsafe sex, violence, etc.
• Abusing other substances
• Minimizing drinking/drug consumption.
• Drinking/drugging in secret.
• Obtaining fraudulent prescriptions – faking symptoms, doctor shopping, claiming prescriptions were “lost”, buying drugs on the Internet, taking other people’s medications, etc.
• Moving from occasional or even regular use to daily or near-constant intoxication.

Naturally, these behaviors invariably lead to negative consequences:

• Criminal charges – DUIs, public intoxication charges, property damage, manslaughter, etc.
• Violence – assaults, domestic violence, child abuse
• Rape and sexual assault – both as victim and perpetrator
• Relationship difficulties – arguments, breakups, separation, divorce
• School/work problems – absences, poor performance, reprimands, suspension, expulsion/termination
• Health issues – injury, illness, disease, overdose

Addiction Stage #5—Dependence and Addiction

“Even when I took the drugs I realized that this just wasn’t fun anymore. The drugs had become a part of my routine. Something to wake me up. Something to help me sleep. Something to calm my nerves. There was a time when I was able to wake up, go to sleep, and have fun without a pill or a line to help me function. These days it felt like I might have a nervous breakdown if I didn’t have them.”

~ Cherie Currie, the Runaways

Substance use triggers a massive surge of dopamine, a neurotransmitter associated with pleasure, motivation, and learning. An addict’s brain physically and chemically changes – they LEARN to associate extreme PLEASURE with drug/alcohol use. This MOTIVATES them to compulsively use.

Over time and with chronic abuse, the brain stops producing dopamine naturally. The addict becomes incapable of feeling ANY pleasure – or even feeling normal – unless they are using/drinking

Once, they used alcohol and drugs to feel good. Now, they want to keep from feeling bad.

Addiction – properly called Substance Abuse Disorder – is a medical condition with identifiable symptoms. Per the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), an SUD diagnosis is probable when three or more symptoms present:

• Tolerance – needing ever-increasing amounts to achieve the same effects.
• Loss of Control – the inability to choose how often/ how much is consumed.
• Failed Attempts to Cut Back/Quit – Alone or after previous stints in rehab.
• Disproportionate Time Spent Thinking about, Acquiring, Using, or Recovering from Using—Preoccupation with the substance interferes with other areas of their life.
• Abandonment of Other Responsibilities/Interests – Increasing isolation/social withdrawal, skipping family/work obligations, loss of interest in hobbies or pastimes.
• Continued Usage Despite Negative Consequences –AFTER substance use creates undeniable problems, an addict will KEEP drinking/drugging.
• Withdrawal – Within hours after the last use, addicts suffer painfully uncomfortable – or even dangerous – psychological/physical symptoms of withdrawal.

Addiction is an Insidious Disease

“Addiction comes into our lives posing as a friend and then slowly grows into a monster that can destroy us.”

~ Terence T. Gorski, Straight Talk about Addiction

No one ever intends to become dependent or addicted to alcohol or drugs, but that is precisely the point. Addiction is such an insidious disease that experimentation, recreational “fun”, or even mere incautious use of prescription medications sets the user on a slippery slope that can easily lead to a place where no one wants to be.

The best way to prevent that from happening is to never gamble with alcohol or drugs in the first place.

But if you are already past Stage 1 and you are finding that your substance use is progressing and becoming a problem, then the surest and safest way to arrest that progress is with professional help that specifically addresses how the disease manifests in you as an individual.