Substance use disorders (SUDs) affected the lives of 20.3 million adults in the United States in 2018, accounting for over 6% of all Americans. That same year, approximately 5.1 million young adults (ages 18 to 25) had a SUD. That’s 1 in 7 or about 15% of young adults. An estimated 916,000, or 3.7%, of adolescents (ages 12 to 17) had a SUD.
The question to consider is how do substance use disorders develop? The truth is that there are many stages of addiction, each with their own signs and symptoms to monitor in yourself and others.
Table of Contents
Stage 1: Initiation
According to a survey by the Substance Abuse and Mental Health Services Administration, about 3 million people (age 12+) used an illegal drug or abused a legal drug for the first time in 2018. The same survey showed that 4.9 million people drank alcohol for the first time.
The initiation stage generally happens during the teen years. In 2017, nearly 20% of teens (ages 12-20) reported drinking over the past month. Many adolescents or teenagers try drugs or alcohol for reasons like:
- Peer or social pressure
- Lack of development in the prefrontal cortex, which manages decision-making and controlling impulses
Once someone has tried alcohol or drugs, they may move along to experimentation or they may stop once their curiosity has been satisfied. This depends on a few factors, including:
- Availability of drugs and alcohol within the community
- Whether or not friends use drugs or alcohol
- Family environment, including physical or emotional abuse, mental illness, or alcohol or drug use in the house
- Mental health conditions like depression, anxiety, or ADHD
Stage 2: Experimentation
The experimentation stage begins when you start to use drugs or alcohol in specific situations, like teens in party atmospheres or adults in times of particular stress.
Substance use in this stage is a social behavior that you associate using with fun, ‘unwinding’, and a lack of consequences. You only think of substances every so often and there are no cravings. At this stage, substance use can be either controlled (i.e. you decide consciously to use with the risks in mind and you can stop if you want to) or impulsive (i.e. you use unpredictably and unexpected accidents or harm can come from substance use, but you do not use regularly, and you are not dependent).
Even if you consume a lot in a particular instance, the decision to use is made in the rational brain (i.e. you choose to use drugs or alcohol instead of being unconsciously ruled by an automatic response). You could even binge drink (i.e. a man having five or more drinks or a woman having four or more drinks within two hours) without straying outside of the experimentation stage.
Stage 3: Regular Use
At this point, substance use is more frequent for you. You may not use every day, but there may be a predictable pattern (using every weekend) or you may use under the same set of circumstances (when you’re stressed, bored, lonely, etc.).
At this stage, you still probably use drugs or alcohol with other people, but you may begin to use it alone too. You may miss school and work due to hangovers. There may be worries about losing your drug source since substance use has become tied to the idea of escaping negative emotions or situations.
Stage 4: Problem/Risky Use
As the name suggests, substance use at this point has begun to take a negative toll on your life. If you drive, you may do so under the influence. You may have gotten a DWI/DUI or had other negative legal consequences. Your performance at work or school may be suffering, along with your relationships with others. You may have changed your circle of friends and your behavior has almost certainly changed.
In short, risky or problem use threatens your safety and the safety of others but may not meet the criteria for a substance use disorder.
Stage 5: Dependence
There are three steps to dependence:
- Tolerance describes the effect that happens when you start to require more of a substance to achieve the same “high.”
- Physical dependence has been achieved when going without drugs or alcohol elicits a withdrawal response. It is important to note that physical tolerance can happen even when prescription drugs are taken as your doctor has instructed.
- Psychological dependence describes the state where you experience drug cravings, a high rate of substance use (using more, using more frequently or both), and using again after attempting to quit. This can also be known as “‘chemical dependency.”
These stages are cumulative. For example, you can have a tolerance for a substance without being physically dependent and be physically dependent without being psychologically dependent, but you cannot be psychologically dependent without being physically dependent and having developed a tolerance.
Stage 6: A Substance Use Disorder
A substance use disorder (SUD) is diagnosed when you meet a specific set of criteria. Substance use disorders can be mild, moderate, or severe depending on the number of criteria met. The assessment will include criteria like:
- You “cannot face life” with drugs or alcohol.
- You cannot control your use.
- You continue to use a substance despite the harm that comes to your health and life.
- You lie about your use, especially about how much you are using.
- You avoid friends and family.
- You have given up activities you used to enjoy.
- You cannot recognize the problems with your behavior or with your relationships with others.
A substance abuse disorder is more than its symptoms. It is a chronic disease, meaning that it is slow to develop and of long duration. Substance use disorders are often relapsing, meaning that recovery will often entail setbacks. Relapse rates for substance use disorders are similar to relapse rates for other chronic diseases like asthma and hypertension.
SUDs affect the memory, motivation, learning, movement, emotion, judgment, and reward-related circuitry in the brain. This happens because chronic substance use floods the brain with dopamine, first teaching you to use more of the substance that produced such a pleasurable effect, then keeping your brain from producing enough dopamine on its own. You then have to continue to use the substance in order to feel happy or even normal.
Stage 7: Treatment
There are ways to treat SUDs, though, so you can regain control over your life, health, and wellbeing. After an initial detox period, behavioral therapy combined with medication is often the best course of treatment. A high-quality addiction treatment program can help you identify and heal the root cause of your addiction and teach you coping skills that will help prevent relapse.
There is also counseling available for you, your family, and friends to help with recovery after leaving treatment, as well as support groups like AA, NA, Al-Anon, and Nar-Anon. These groups and types of therapy help support long-term recovery.
Understanding the stages of addiction is important to help you understand how substance use can evolve into something that harms your relationships, sense of self, and overall health. If you or someone you love is on the path of addiction, The Recovery Village can help. Our compassionate intake coordinators can answer your questions and help you understand treatment options that can work well for your specific situation.
Substance Abuse and Mental Health Services Administration. “Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health.” August 2019. Accessed June 3, 2020.
NIDA. “Drugs, Brains, and Behavior: The Science of Addiction.” Treatment and Recovery, May 29, 2020 Accessed June 22, 2020.
Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.