It’s fairly common for people to associate the stages of addiction with dire consequences, such as imprisonment, homelessness and fatal overdose.
The truth is, an estimated 24.6 million Americans, many of them seemingly healthy and productive, struggle with substance abuse on a day-to-day basis, reports the National Institute on Drug Abuse (NIDA).
Attention grabbing headlines like, “130 people a day die from opioid overdoses related to prescription painkillers, fentanyl and heroin,” are important for people to hear.
But they can 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.
Most healthcare experts agree there are five stages of addiction.
What is Addiction?
NIDA defines addiction as a chronic, relapsing disease of the brain, that is characterized by compulsively seeking drugs or alcohol despite the negative impact the behavior has on the individual’s health, their relationships at home, work and in the community at large.
The disease of addiction, according to NIDA, “is considered both a complex brain disorder and a mental illness.”
Prolonged dependency to alcohol and drugs actually changes the brain’s chemistry and can make it impossible for a person to stop their self-destructive behavior without treatment.
It’s vital to emphasize that addiction doesn’t necessarily happen instantly. Developing the disease is most often a gradual process that victims may not recognize until it’s too late.
Knowing the stages of addiction can help a person, their loved ones and friends call attention to problematic, habit-forming behaviors before a person’s life spins out of control.
What Are The 5 Stages of Addiction?
While some say there are four stages of addiction, most healthcare professionals agree there are actually five stages of addiction as outlined below.
1. The First Stage of Addiction – First Use (Experimentation or Prescription)
As the name implies, the first stage of addiction is characterized by someone using drugs, alcohol, or even a medication prescribed by their doctor for the very first time.
It may be a young person using drugs or alcohol to fit in with peers, or “partying” in college, but in this phase the individual learns how the substance makes them feel. This stage is usually free of any negative consequences for the person.
The first stage of addiction is an important one that deserves some explanation because too often it is classified only as experimentation, and this isn’t necessarily true for everyone.
For some people who become addicted to a substance, their first use might in fact be while experimenting with friends, often at a young age, such as trying alcohol or marijuana in high school. They like the way it makes them feel and they decide to continue. This is a very common scenario, but it is not the only one.
Other people encounter their first use of a drug after they receive a prescription by a doctor. This can be a prescribed opioid for pain management after surgery or an injury, and it is intended to be a short-term remedy for an ailment.
For those receiving a prescribed medication from a doctor, they are not doing it to experiment with drugs, and it is considered medically necessary for their health.
They usually perceive it to be safe because a doctor prescribed it. What they might not know is they can become dependent on it if they take it in a way not prescribed.
It’s unfortunate that many people consider those addicted to drugs to be at fault because they chose to take them by experimenting and becoming hooked. This is not the case for a large part of the population who became addicted from using a prescription medication.
2. The Second Stage of Addiction – Continued or Regular Use
The second stage of addiction is continued use that begins when an individual is already familiar with the way alcohol or drugs make them feel and are more comfortable in their ability to handle it. They either enjoy the feeling they get from using it, or need the medication to continue its effects on their health.
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 that their consumption has increased in this phase because they are often using addictive substances in social settings, with the approval of other people.
Here, the consequences of using drugs and alcohol are starting to develop, such as poor performance at school or work, or feeling hung over because it takes the body longer to metabolize the drugs or alcohol and return to normal.
3. The Third Stage of Addiction – Tolerance
The third stage of addiction is tolerance, and it’s one of the biggest warning signs that a person is progressing toward addiction.
As a person continues to use drugs or alcohol, they build up a tolerance and need to consume more of the substance to feel the effects because their body and brain have adjusted to regular or continued use.
Someone who builds a tolerance to prescription painkillers, for instance, will notice that the meds as prescribed are not improving their pain, so they must increase the dosage or take them more frequently. Every person is different and some build a tolerance sooner than others.
Very often, individuals are taking greater and greater risks in this stage, like driving while under the influence or ignoring the warnings of friends and family, because abusing drugs and alcohol has become a normal thing for them.
4. The Fourth Stage of Addiction – Dependence
The fourth stage of addiction is dependence, and this occurs when the brain and body have become so accustomed to the effects of continuously taking drugs or alcohol that a person will become sick, go into withdrawals, or be unable to function or feel “normal” on a daily basis without them.
To counteract these negative effects, a person may find themselves drinking alcohol in the morning to get rid of “the shakes” or consuming several painkillers at a time to manage the pain and flu-like symptoms of opioid withdrawal.
Related: What are the Signs of Alcoholism?
Things have taken a serious turn in the dependence stage because an individual will have to start structuring their life around how they can use alcohol or drugs, often to the detriment of their relationships at school, work, or home, as well as the increasingly negative effects to their health.
5. The Final Stage – Addiction
In the final stage, addiction, a person is often overwhelmed by physical cravings for drugs and alcohol and is unable to stop using them without help, despite no longer enjoying it, even in the face of extreme life consequences.
Many people who develop a substance use addiction suffer from denial and the inability to recognize that their life is in total chaos as a result of their drug and alcohol abuse.
Because addiction affects each individual differently, some people are able to manage sobriety on their own for a period of 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 help.