The Stages of Addiction
The use of alcohol and other drugs is a topic that has been studied by many experts over many, many decades in an effort to identify the stages of addiction. Over the years, some clear patterns have emerged and while the individual’s level of use and the dysfunction experienced as a result of addiction varies, the general progression toward addiction has been identified. What is generally agreed upon to day is that there are four stages of addiction to alcohol and other drugs starting with experimentation, then leading to social/regular use, problem/risky use, and finally, dependence.
Stage 1: Experimentation
Experimentation is the first stop in our journey to discover the stages of addiction. Defined as the use of alcohol or illicit/mood-altering drugs at any time for experimentation. We’ve all heard stories about how parents counsel teens not to mess around with alcohol or drinks even once because it might lead to addiction. We laughed it off when we were teenagers because we knew everything. Turns out, they were right. Experimentation may not appear to be risky, but even a single episode of experimentation can result in substantial harm to self or to others. Examples of potentially harmful experimentation include using any alcohol or other drugs during pregnancy, which could result in harm to the fetus; experimental use of alcohol or drugs while driving, which could result in serious harm to the user as well as others; children may be injured when left unsupervised while a parent is intoxicated. Ultimately though, the biggest risk is that experimental use often serves as a gateway to additional use (as it often does), patterns of alcohol/ drug abuse may develop. With inhibitions reduced because of the influence of alcohol, users are more open to trying harder substances. In fact, many of our patients in recovery talk about this. [contact-form-7 id=”27″ title=”Contact form 1″]
Stage 2: Social Drug Use
Social drug use is the use of any drug or combination of drugs in social situations, or for social reasons. If such social use causes any harm, physical or otherwise, to the user or others, it is also considered abuse. Social use of alcohol or other drugs usually leads to further and elevated use and is the a turning point in the stages of addiction. It is at this level that users can either walk away or succumb to hardcore addiction. Family members who observes this behavior will often be met with resistance if they attempt to intervene. The user may be adamant that he has things under control.
Stage 3: Binging
Social use often progresses to binge use. It is at this point that addiction becomes a critical threat. Users in this category are often under the illusion that they can quit at any time. This is among the more dangerous stages of addiction. Binge Drinking Binge drinking is heavy use of alcohol periodically. A weekend binge for a bachelor party may seem harmless on its own, but when combined with many other weekend excuses for partying, the evidence points to addiction. Binging can result in harm to the physical health of self and others, and negative behavioral consequences, which may result in bodily harm to self or others. For example, harm may be caused by heavy periodic use of alcohol or other drugs while pregnant, driving while intoxicated, or either neglecting or inflicting violence on self and others while under the influence. What defines binging? The National Household Survey On Drug Abuse (NHSDA) defines binge alcohol use as drinking five or more drinks on the same occasion at least one day in the past thirty days. Substance Abuse The characteristic feature of substance abuse is the presence of dysfunction related to the person’s use of alcohol or other drugs. HHS (U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration [HHS/SAMHSA], 1994) describes substance abuse as “the use of a psychoactive drug to such an extent that its effects seriously interfere with health or occupational and social functioning.” Substance abuse may or may not involve physiologic dependence or tolerance. For example, use of substances in weekend binge patterns may not involve physiologic dependence; however, it may have adverse affects on a person’s and possibly others’ lives. Relationships become more complicated, bad decisions while under the influence create problems after each binge episode and addicts start to change their behavior. At this point, the addict starts to focus more and more on opportunities to use, making whatever excuse necessary to get that opportunity. This is the on-set of addiction and without immediate intervention, the consequences will get even more dire. Attempts to intervene at this point can be frought with resistance but at this point, action is critical. [cta id=’269′]
Stage 4: Full on Addiction
Once addiction has set in, the addict becomes a different person. Friends will observe changes in the body, mind, and behavior, usually within a few weeks or months. Addicts spend most of their time planning for their next opportunity to use. They will start to hang out with new people, they will become more secretive about their activities and they will seem reckless in their spending and in how they handle relationships with loved ones. As a result of this disease, addicted people are unable to control their use of substances despite the negative consequences that occur as a result. Addiction may be a chronic, relapsing disorder and as the disease process progresses, recovery becomes increasingly difficult. Chemical dependency occurs most frequently in those who have a family history of the disease. Chemical dependency may cause death if the person does not completely abstain from using alcohol and other mood-altering drugs (HHS/SAMHSA, 1996a). The DSM-IV distinguishes dependence from abuse primarily by the presence of more abuse symptoms (three or more rather than at least one), and the possible presence of tolerance (needing more of the substance for the same intoxicating effect) or withdrawal (physical symptoms that occur when the substance is not used). The American Society of Addiction Medicine (ASAM) describes drug dependence as having two possible components:
Psychological dependence centers on the user’s need of a drug to reach a level of functioning or feeling of well-being. Due to the subjective nature of this term, it is not very useful in making a diagnosis. Physical dependence, however, refers to the issues of physiologic dependence, establishment of tolerance, and evidence of an abstinence syndrome or withdrawal upon cessation of alcohol or other drug use. Tolerance, dependence, and withdrawal develop differently depending on the particular substance (HHS/SAMHSA, 1994). [contact-form-7 id=”27″ title=”Contact form 1″]