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Stages of Change

According to the National Institute on Drug Abuse (NIDA), an estimated 24.6 million Americans struggle with substance abuse on a day-to-day basis. Many of them are seemingly healthy and productive. Most healthcare experts agree there are five stages of addiction.

It’s vital to emphasize that addiction doesn’t necessarily happen instantly. Instead, developing the disease is most often a gradual process that victims may not recognize.

Knowing the stages can help a person and others call attention to their related behaviors.

1. Initial Use

A young person may use drugs or alcohol to fit in with peers or party in college. In this phase, the individual learns how the substance makes them feel. It is usually free of any negative consequences.

For people who eventually become addicted, their first use might be experimenting with friends, often at a young age—for example, trying alcohol or marijuana in high school. They like the way it makes them feel, and they decide to use it again.

Other people encounter their first use of a drug after they receive a prescription from a doctor. For example, first-time use can be a prescribed opioid for pain management.

Those receiving a prescribed medication from a doctor are not doing it to experiment. Instead, it is considered medically necessary for their health.

They usually perceive it to be safe because a doctor prescribed it. They might not know that they can become dependent on it even if they take it in a way prescribed.

Unfortunately, many people consider those addicted to drugs at fault because they chose to take them by experimenting and becoming hooked.

2. Regular Use

The second stage is regular use that begins when an individual is already familiar with the way alcohol or drugs make them feel. They are more comfortable in their ability to handle it. They either enjoy the feeling they get from using it.

For a person taking prescription meds, continued use might be under a doctor’s orders, or it may be out of a need for the feeling the prescription gives them.

People might also fail to see their consumption has increased in this phase because they often use them in social settings with other people’s approval.

Here, the consequences of using drugs and alcohol are starting to develop. Things such as poor performance at school or work or feeling hungover. Recovery takes the body longer to metabolize the drugs or alcohol and return to normal.

3. Tolerance

The third is tolerance. It is one of the most significant warning signs a person is progressing toward addiction.

As a person continues to use drugs or alcohol, most will gradually build up a tolerance. That means they need to consume more of the substance to feel the effects because their bodies and brains have adjusted to it.

Someone who builds up a tolerance to prescription painkillers, for instance, will notice that the prescribed meds no longer decrease the pain. In that case, they must increase the dosage or take them more frequently. Every person is different. Some build a tolerance faster than others.

Individuals are often taking greater and greater risks now and, for example, driving while under the influence. Some are ignoring the warnings of friends and family because abusing drugs and alcohol has become routine.

4. Dependence

Dependence occurs when the brain and body have become accustomed to the effects of regularly taking drugs or alcohol. As a result, a person will become sick, go into withdrawals, or be unable to function or feel normal without ingesting them.

To counteract these adverse effects, a person may find themselves drinking alcohol in the morning to get rid of the shakes. Or they may consume more painkillers at one time to manage the discomfort and flu-like symptoms of opioid withdrawal.

Things have now taken a severe turn because individuals will have to start structuring their lives around using them.

5. Addiction

Now a person is often overwhelmed by physical cravings for drugs and alcohol. Most are unable to stop without help. This despite no longer enjoying it anymore and in the face of severe life consequences.

Many people who develop a substance use addiction suffer from denial. Denial is the inability to recognize that their life is in chaos due to their substance abuse.

NIDA defines addiction as “a chronic, relapsing disease of the brain. It is characterized by compulsively seeking drugs or alcohol despite the behavior’s negative impact on the individual’s health, relationships, work, and community. The disease of addiction, according to NIDA, “is considered a complex brain disorder and mental illness.”

Prolonged dependency changes the brain’s chemistry. This fact can make it virtually impossible for a person to stop their self-destructive behavior without treatment.

It’s common for people to associate it with dire consequences, such as imprisonment, homelessness, and fatal overdose.

Attention-grabbing headlines often serve as a distraction from the fact that addiction is a progressive disease that doesn’t necessarily take hold of a person all at once.

  • It affects each individual differently.

Some people can manage sobriety on their own for some time. But because addiction is a chronic, relapsing disease, they can rarely remain “clean” or achieve a healthy recovery without the help of treatment programs that offer compassion, support, and professional service.

The cycle of addiction is the closed-loop of obsessive behavior when someone has any substance or behavioral dependency. Once a user becomes dependent on any substance or behavior, they are trapped.

The 3 C’s of addiction:

  • compulsive use
  • cutting down
  • continued use despite consequences

Addicts get trapped in a closed loop of using or behaving again and again with no way out:

  • An addict is at the mercy of their disease.
  • They are powerless to escape.
  • There is no way out.

Addictive behavior drives using, which leads to withdrawal, creating the pains of craving. Cravings are a mental obsession to relieve the compulsion. It is an endless wheel an addict cannot escape without help.

Five stages of the cycle of addiction;

  • Bingeing
  • Gratification
  • Withdrawal
  • Craving
  • Relief seeking

The DSM defines a substance use disorder as “…all drug use in excess have in common direct activation of the brain reward system, which is involved in the reinforcement of behaviors and the production of memories.”

Dependence is the underlying condition of the closed cycle triggering a continuous, compulsive behavior of using over and over again.


Bingeing is defined as the overindulgence in some repetitive action. It includes alcohol, drugs, sex, food, gambling, or compulsive behavior of any kind.


Reaching satiation brings gratification. It is the apex where the cycle of addiction turns downward.


Withdrawal is the physical and psychological effect of stopping abusing drugs. The body commences purifying itself, which causes side effects. Detox causes the desire for relief of the resultant discomfort. These symptoms can include:

  • anxiety
  • fatigue
  • sweating
  • vomiting
  • depression
  • seizures
  • hallucinations

These and other withdrawal symptoms cause the subsequent desire for relief. Without medical intervention, a person is faced with a craving to get relief. Faced with no other option, they choose self-medicating themselves by using again.


Craving is the inevitable result of experiencing withdrawal. The body and the are suffering the consequences of breaking the insidious cycle of addiction. An addict now becomes obsessed with relief that can only come from using again.

Relief Seeking Behavior

Without medical supervision, the user suffers the pain and discomfort of withdrawal or using the substance again. For example, when someone is prescribed opioids for pain. Faced with a no-win situation, the user seeks immediate relief from the discomfort. Therefore the user seeks out relief in whatever ways available such as drinking alcohol or using the drug of choice or another substitute, as quickly as possible.