The Stages of Addiction and Treatment 

The stages of addiction refer to the cycle of use leading to substance use disorder. These stages include initiation or experimentation, regular substance use, risky substance use, developing a dependence on substances, and eventually, substance use disorder. 

Addiction is a chronic brain disease that begins with initial drug use, also called experimentation, and progresses through several other stages, including regular use, risky use, tolerance, and dependence. Not everyone experiences addiction after initial experimentation, but many do. 
Risk factors that make a person more susceptible to substance use disorder include genetics, adverse childhood experiences, and the presence of an underlying mental health condition, for instance. [1] Disease progression may not be linear, and addiction recovery could also be a jagged trajectory.

What Is Addiction?

Addiction, also referred to as substance use disorder, is a chronic disease characterized by physical or psychological dependence on a substance such as alcohol or drugs. Addiction is a serious condition linked to many physical and mental health complications, both short-term and long-term. 

Types of Addiction

There are different types of addiction, depending on the type of substance used. It’s important to understand these different variations as different types of addiction may require different types of treatment. The distinct types of substance use disorder listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) include: [2]

• Alcohol use disorder
• Caffeine use disorder
• Cannabis use disorder
• Hallucinogen use disorder
• Inhalant use disorder
• Opioid use disorder
• Sedative, hypnotic, or anxiolytic disorder
• Stimulant use disorder
• Tobacco use disorder

Common Phases or Stages of Addiction

Initiation, Experimentation, or First Use

The initiation or experimentation stage of addiction begins the first time someone uses a substance illicitly or inappropriately. This initial use could be due to a new prescription, peer pressure, or even a cultural rite of passage. 

This first use might not immediately lead to an addiction, but in some cases, it can trigger the cycle of addiction to continue. [3] How a person responds during the initial experimentation phase depends on a variety of factors. 

Risk Factors for Developing a Substance Use Disorder

Some people are more vulnerable to developing an addiction or substance use disorder than others. Some of the risk factors for substance abuse and subsequent addiction include: [4]

• A pre-existing mental health condition
• Family history of substance abuse or dependency
• Adverse childhood experiences like abuse or neglect
• Easy access to the substance
• Prior substance abuse history

Regular Use/Misuse

This stage of addiction is often considered repeated use or misuse of a substance. [5] This stage varies for each individual, depending on their personal characteristics, the substance, and the specific circumstances. Examples include: 

• Being prescribed an addictive substance long-term
• Taking a prescription medication longer than prescribed
• Taking higher doses of a medication than prescribed
• Taking someone else’s prescription medication
• Drinking alcohol in excess or binge drinking
• Taking an illicit drug like heroin or cocaine

Risky Use

If left untreated, regular substance misuse progress to more risky use. This stage of addiction is marked by the acknowledgement that drug use is beginning to have negative consequences on a person’s life and a decision to continue using despite these adverse effects. Risky use may also include using a substance in places where they’re strictly prohibited (e.g., school or workplaces) or using the drug in a situation that puts the person or others at risk, such as driving under the influence. 

What Is Tolerance?

As a person continues to use a substance, their brains change in response to the repeated substance use. They may notice that over time, the dose of the drug that usually causes them to feel euphoric no longer has the same effect. They may start using more of the drug in an attempt to achieve the same high. As their brains and bodies continue to adjust to the higher doses, they may find themselves in a continual process of chasing the same high they first experienced. 

What About Dependence?

With prolonged use of higher and higher doses of an illicit substance, the body eventually becomes dependent on it to function normally. Dependence can be physical, meaning the body needs it to perform basic functions, or psychological. A psychological dependence represents a loss of control where a person becomes so emotionally or mentally attached to the drug that they can no longer limit their use.

A hallmark of physical dependence is withdrawal. While we often associate this with recreational drugs, it also occurs with common prescription medications. For example, abruptly stopping a steroidal anti-inflammatory can trigger severe prednisone withdrawal symptoms because the body has become physically dependent on the medication to replace its natural cortisol production.

When someone has developed a physical dependence on either an illicit drug or a legal prescription, the body may have a strong negative reaction if the substance is abruptly stopped or limited [6]. The type and severity of withdrawal symptoms can be severe and, in some cases, life-threatening. People with a physical dependence on alcohol or opioid drugs, for instance, require a medical detox under the direct supervision of a healthcare provider.

Identifying Symptoms of Substance Use Disorder

If you suspect you or a loved one has a substance disorder, it could be important to know the signs and symptoms. The American Psychological Association (APA) has outlined criteria for this disorder in its Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5): 

• Experiencing strong cravings for a substance
• Finding it challenging to control how much of the substance you use or for how long
• Spending a lot of time using the substance, acquiring the substance, or recovering from its effects
• Using the substance in hazardous situations
• Continuing to use the substance despite it interfering with work, school, or relationships
• Continuing to use the substance even though it’s exacerbating a physical or mental health condition
• Trying unsuccessfully to abstain from the substance or limit use
• Needing more and more of the substance to achieve similar effects (i.e., building tolerance)
• Experiencing withdrawal symptoms when not using the substance for a period of time

Just two or more of these symptoms indicate a mild substance use disorder, according to the APA. Generally, treatment in the early stages of addiction can be quicker and more effective than treatment for severe addiction. 

Explore Addiction Treatment Options

If you or a loved one is experiencing any of the stages of addiction, it could be important to reach out for help as soon as possible. Catching an addiction in its early stages may make it easier to treat, meaning the road to recovery may be shorter. A skilled, compassionate addiction counselor can help you evaluate your different treatment options and evidence-based interventions and develop an individualized treatment plan that targets your specific symptoms. 

Depending on your specific needs and preferences, your options for treatment may include inpatient and partial hospitalization treatment programs, intensive outpatient treatment, behavioral health services, and mental health counseling. Aftercare and relapse prevention support are also available.

Frequently Asked Questions About the Stages of Addiction