The Stages of Addiction: Understanding the Cycle and How to Break It

Every addiction begins with the initial use of a substance. The reasons for using the substance for the first time can vary and may include curiosity, peer pressure, a need to be socially accepted, or just being in a place where the substance is available to you when you’re feeling vulnerable. For some people, especially those prescribed opioids, their addiction starts with a medication to manage a legitimate medical condition, and develops into a problem entirely of its own. 

Young people are at higher risk of alcohol or drug addiction.[3] The adolescent brain is still developing, so it’s more vulnerable to the neurological effects caused by the use of an addictive substance. 

Many people who try a substance for the first time will not go on to develop an addiction. Genetics, mental health history, trauma, age when the substance was first used, and the environment where the substance was used will all influence the chances of progressing to the next stage.[4]

After the first use of the substance, some people may go on to a pattern of regular or experimental use. At this stage, a person may use intentionally and feel in control of their usage, whether it’s in social situations, to relieve stress, to deal with past emotional trauma, or to boost focus or mood. The sense of control a person has is what makes this stage deceptive. While intentional usage is happening, brain chemistry is changing.[5] 

Repeated exposure to the addictive substance will gradually alter the brain’s reward systems to the point where the baseline of what feels “normal” or good begins to shift.

As a person continues to use the substance, the level and frequency of use may continue to increase to the point where their usage exceeds what is intended, they start using in risky situations, or their usage becomes their primary resource for coping with stress, anxiety, or emotional pain. Tolerance soon develops, and the user will need to use larger and more frequent doses to achieve the same effect the substance used to have.[6]

At this stage, the signs of an addiction will become more obvious. Missed responsibilities, changing relationships, and an increasing obsession to obtain and use the substance become more and more apparent. This is also where the symptoms of associated co-occurring mental health disorders will begin to present themselves or be aggravated.[7] Anxiety, depression, and other mental health conditions can both fuel escalating use and be worsened by it.

Physical and psychological dependence occur when one’s brain adapts so fully to using a substance that it struggles to function without it.[8] In the dependence stage, symptoms of withdrawal may occur when the person stops using, ranging from uncomfortable to dangerous, depending on the substance used. Withdrawal symptoms from opioids, alcohol, and benzodiazepines can lead to life-threatening consequences and usually require a medically supervised detox to quit.

Dependency doesn’t always mean addiction; however, they commonly occur together. A person who is dependent on a substance has a physical condition that makes it extremely difficult to stop without assistance from professionals.

Addiction is clinically defined as a moderate to severe substance use disorder, and at this stage, use becomes compulsive.[9] The person will continue to use a substance despite significant negative repercussions regarding health, relationships, financial status, and overall well-being. The brain’s reward system has become permanently altered, so finding pleasure from anything other than the drug will be extremely difficult.

When a person attempts to stop using drugs or alcohol at this stage, it is common for them to relapse, not because they don’t have willpower, but because of these changes in the brain. At this stage of the addiction cycle, there is no way for an addicted person to overcome addiction without professional intervention.

Relapse is also part of the addiction cycle and does not signify a failure or reason to give up on recovery. 

According to the National Institute on Drug Abuse, 40 to 60% of people will relapse when they try to quit using a substance.[10] Relapse can happen at any time, during addiction treatment or long after, and can be triggered by stress, exposure to cues that are associated with past substance use, emotional pain, or any kind of disruption in aftercare or support after recovery. 

It is imperative to view a relapse as a stage of the addiction cycle rather than a moral failure, as viewing it as a failure impacts how people react when they experience a relapse. Relapse is only a signal that treatment or aftercare needs to be adjusted, not given up on.