What are the stages of drug and alcohol addiction?

Mental Health and Wellness
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The stages of addiction

Most people who wind up dependent on a substance start out by simply trying the substance, whether it be drugs or alcohol, in a social setting. From there, they dabble a bit more, taking the substance on a more regular basis. During these beginning phases, there typically are no red flags or noticeable consequences.

It isn’t until later on in the cycle of addiction, when a person starts misusing or abusing a substance, that life consequences begin to occur. Over time, people begin to crave the substance and may get irritable if they don’t take it. As addiction takes hold, those life consequences become increasingly serious, and in some cases, life-threatening.

As people progress from substance abuse to chemical dependence, denial often plays a role. As a result, it can be hard for people to connect the consequences they are experiencing in their lives to the drug or alcohol use. This denial allows them to progress further into the usage, and eventually, addiction, explains Jessica Molavi, the clinical manager of addiction specialty programs at Mirmont Treatment Center, part of Main Line Health. The sooner people can recognize they’re moving through the stages of alcohol or drug addiction, the earlier they can ask for help and intervene before things progress. But what are the stages of addiction? Keep reading to learn more.

Stage one: experimentation

The first stage of drug and alcohol addiction is experimentation. Experimentation involves voluntarily trying a substance, whether it be a drug or alcohol. This typically happens in a social setting where, for example, someone was peer pressured or influenced by their friends.

Molavi likens this stage to “testing the waters.” There is no consistency or any concerns related to frequency or tolerance at this point. “It’s just like a first introduction,” says Molavi.

Stage two: regular use

After experimentation comes regular, more frequent use of the substance. In this phase, there is no risky behavior or physical addiction. There also aren’t consequences or mood swings. People in this phase might identify as a social drinker, or someone who has a couple glasses of alcohol at night or on the weekends.

Over time, things can get progressively worse and move into the later stages of addiction, in which a person develops a chemical dependency. Other people may quickly learn that they don’t like the feelings or sensations alcohol or drugs cause, the risk factors associated with them, or the loss of control, and they can make a conscious decision to stop drinking or using the substance.

Stage three: misuse or abuse

When someone starts to use drugs or alcohol differently than they’re intended, they enter the phase of misuse or abuse. “They might start to take something more frequently than what’s recommended or a higher amount than what’s recommended,” says Molavi.

People who are misusing or abusing a substance can typically still function in everyday life and manage their daily responsibilities. There usually aren’t any severe consequences yet, but in this stage, people’s brain chemistry begins to shift. According to Molavi, people might start to experience some minor or isolated consequences as a result of the misuse, such as impacts on their relationships or choosing to drive under the influence.

People in this stage of drug or alcohol addiction may start to develop cravings to drink or use a drug more frequently than normal. “When they can’t follow through on that or when they can’t have the drink or the drug, they’ll have more irritability or an impact on their mood — frustration, agitation, maybe even some level of depression,” explains Molavi. At this point, people are starting to increase their dependency on the substance.

Some people may notice these behavioral changes and seek out treatment. There are various levels of treatment, explains Molavi, and not every program is geared toward people who are dependent on a substance. There are specialized programs for people who are misusing or using to help them intervene and avoid becoming fully dependent on the substance.

Stage four: dependency

The final stage of addiction is chemical dependency. In this stage, people have become physiologically dependent on the substance. “Progression has occurred and you’ve increased your frequency tolerance and amount,” Molavi said. During dependency, people will experience physical withdrawal if they don’t have the substance.

The more frequently a person takes a substance, the more the substance pushes the brain to release feel-good chemicals, and eventually, the brain starts to rely on the substance to feel that chemical release. “When the person stops the usage, the brain sends the body a message to go into severe withdrawal because it doesn’t have what it needs to physiologically function,” says Molavi.

Symptoms of withdrawal vary depending on the substance. With chemical dependency on opiates, people experiencing withdrawal commonly develop flu-like symptoms, nausea, muscle aches, increased anxiety and mood swings, and chills. Withdrawal from alcohol or benzodiazepines can be life-threatening. Some people have seizures as a result of abruptly stopping the medication or alcohol if they are chemically dependent. They might also develop psychiatric symptoms like hallucinations.

The pace and severity of these phases vary between people

The stages of addiction vary from person to person, depending on the person’s history and background, genetics, family history, and whether there are any underlying mental health issues or trauma. These phases also look different with each substance being used.

Someone with an undiagnosed depression disorder or chronic pain might find relief from a substance, like an opiate, and become physically dependent within a couple of weeks. That dependency can worsen over time and transform into addiction with high-risk behavior and problematic decision making. Individuals with a genetic or family component are twice as likely to be susceptible. “They may progress from misuse or abuse to addiction at a quicker pace than other people,” says Molavi.

If you notice that you are progressing through these phases, reach out to your primary care physician or look up local community resources, like 12-step meetings or support groups, for education, insight, and connection to other people who have varying stages of substance use and abuse. Molavi also recommends reaching out to a therapist or psychologist who has a background in substance use disorder.

Shame is a common barrier that prevents people from asking for help in the earlier stages of addiction. People might feel embarrassed or ashamed that they’re struggling with substance use and tell themselves they can handle it on their own.

“If you’re able to push that and ask for help when you’re starting to experience very early signs of abuse or consequences, you can really interrupt things before they get so progressive that you are in a severe situation with worse consequences,” Molavi said.

Mental and emotional well-being are integral to a healthy life. When people suffer with mental illness or drug and alcohol abuse, it significantly impacts all aspects of their lives and their loved ones.

Main Line Health offers behavioral health services, from group therapy and individual therapy to 12-step meetings for drug and alcohol addiction. It all begins with a phone call. Please call 1.888.CARE.898 (227.3898) to schedule a confidential appointment, or learn more about our services.

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