Understanding the stages of drug and alcohol 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 in the stage of abuse or misuse when a person will begin to have some minor consequences to their behavior. This can include frequent absence from work, poor decision making, increased fatigue and depression symptoms.

If you or a loved one are struggling with drug or alcohol addiction, it's essential to understand the stages of substance use disorder to better navigate the path to recovery. By recognizing the progression of addiction, you can take proactive steps towards seeking help and overcoming substance abuse.

Stage 1: Experimentation and social use

The first stage of substance abuse disorder is a crossroads of experimentation and social use.

"This stage often unfolds as individuals choose to try substances, typically influenced by social environments or the desire to connect with peers," explains Jessica Molavi, the clinical manager of specialty programs at Mirmont Treatment Center.

The act of experimenting may appear innocent at first, fueled by curiosity or a desire to belong. But it's at this juncture where the seeds of addiction can unknowingly be sown. The casual use within these settings can subtly shift, setting the stage for more frequent encounters with substances. Recognizing this early phase is pivotal, as it presents an opportunity to address behaviors and influences before they evolve into a deeper dependency.

Stage 2: Regular use and high-risk behavior

Transitioning into the second stage of substance use disorder marks a period where experimentation gives way to regular use, accompanied by a notable increase in high-risk behaviors. This evolution is characterized not just by the frequency of substance use, but also by the contexts in which it occurs.

"This can include an increase in consuming drugs or alcohol during moments of isolation and loneliness rather than at social gatherings," says Molavi. "During this phase, individuals often find themselves using substances as a misguided form of self-medication in an attempt to alleviate stress, emotional pain or social anxiety."

When people focus on the immediate pleasure of using substances rather than the potential consequences, their ability to control substance use weakens. Engaging in high-risk behaviors, such as driving under the influence or neglecting responsibilities, becomes more common, creating a precarious balance that jeopardizes not only their well-being but also that of those around them. The person begins to become more impulsive and their judgement may be impacted in a negative way.

Stage 3: Misuse or abuse

When someone starts to use substances more frequently than they're intended, they enter the phase of misuse or abuse. "A person in this stage might start to take something more frequently 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, the brain chemistry begins to shift. People might start to experience some minor or isolated consequences because of the misuse, such as impacts on their relationships or their job and family life.

People in this stage of substance use disorder may start to develop more intense cravings and urges 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, 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 4: Substance use disorder and dependency

The final stage of substance use disorder is chemical dependency. At this point, substance use is no longer a choice but a necessity for everyday functioning.

"Progression has occurred, and you've increased your frequency tolerance and amount. This can lead to loss of control and impaired thinking and judgement," 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 severe, intense 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 because of abruptly stopping the medication or alcohol if they are chemically dependent. They might also develop psychiatric symptoms like hallucinations.

The dangers of laced drugs

"Substances are increasingly being mixed with Fentanyl, posing a greater risk to users," says Molavi. "For instance, someone might unknowingly consume a mixture of substances when they believe they're using cocaine, only to find out during treatment that it contains more dangerous substances."

The opiate epidemic has taken a severe turn with the use of Xylazine or "tranq dope," a high-level sedative used as an animal tranquilizer. This is extremely dangerous and follows with severe medical concerns and high risk for overdose - this drug is not well reversed with the use of Narcan, a nasal spray that can treat overdose in an opioid emergency.

"There are also a variety of 'gas station' substances that create a similar feeling of euphoria to narcotic based drugs," says Molavi. "This can trick people into believing they're safe because they're sold in a store or a smoke shop, when in fact they're creating just as much risk for dependency."

All of that is to say, the substance use disorder trends are constantly changing, progressing and leading people into new dangerous avenues of abuse, misuse and dependency. It's very important to be aware and educate yourself as much as possible, and to reach out for help before things get worse.

Seeking help — the path to recovery

Embarking on the journey to recovery requires a lot of internal strength and courage and the decision to reach out for support, marking a pivotal step towards a healthier, substance-free life.

There are so many avenues for assistance, tailored to the unique needs of each individual. This may include engaging in therapy sessions that provide a safe space for exploration and healing, participating in support groups where shared experiences foster a sense of community or considering medication-assisted treatment to ease withdrawal symptoms and cravings.

"Rehabilitation programs also offer comprehensive care, focusing on both the psychological and physical facets of addiction. They also incorporate a trauma informed approach to assist the person in feeling safe and secure enough to address the underlying issues that drive the cycle of self sabotage and relapse," says Molavi. "It's important to remember that seeking help is a sign of strength, not weakness." By taking this step, individuals open the door to professional guidance and support, laying the foundation for a successful recovery process - just like one would for any other medical illness or condition.

Recovery and relapse prevention

Navigating the path of recovery is an ongoing endeavor, marked by both challenges and victories. The journey doesn't end upon leaving a treatment facility; it's a lifelong commitment to wellness and sobriety.

Relapse, while often a part of this journey, is not an indicator of defeat but a moment to learn and strengthen one's resolve. Working with a skilled behavioral health therapist on a relapse prevention plan is crucial to reduce risk and increase outcomes of success. This involves identifying triggers and warning signs, developing healthy coping mechanisms and establishing a supportive network of friends, family and possibly professionals who understand the journey you're on. Engaging in regular self-care practices, such as mindfulness, exercise and pursuing hobbies, can also play a significant role in maintaining balance and preventing relapse.

"Remember, each step forward, no matter how small, is a significant stride towards a life of sobriety," says Molavi. "Embrace the support available, trust the process, and know that each day offers a new opportunity to reinforce your commitment to recovery."

Next steps:

Schedule an intake at Mirmont Treatment Center
Breaking the cycle: Mirmont Treatment Center's Relapse Prevention Program
The connection between trauma and substance use