Substance use disorders (SUDs) affected the lives of 20.2 million adults in the United States in 2014, accounting for over 6% of all Americans. In the same year, the group most affected by SUDs were people aged 18-25, accounting for 29.3% of the total amount of people affected by SUDs. An additional 1.24 million children aged 12-17 lived with a substance use disorder that year.

The question to consider is this: how do people go from abstaining from drugs and alcohol to developing an SUD? The truth is that there are many stages of addiction, each with their own signs and symptoms to monitor in yourself and others.

Stage 1: Initiation

Most people try drugs or alcohol for the first time before reaching adulthood. According to a survey by the Substance Abuse and Mental Health Services Administration, about 2.8 million people (age 12+) used an illegal drug or abused a legal drug for the first time in 2013. The same survey showed that 3.841 million people drank alcohol for the first time between the ages of 12 and 20.

The initiation stage generally happens during the teen years. Every day in 2013, approximately 4,220 people under the age of 18 used drugs or alcohol for the first time. Adolescents or teenagers try drugs or alcohol:

  • Out of curiosity.
  • Because their friends are doing it and they feel pressured into using as well.
  • The 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 matter 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 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, as most binge drinkers do so about four times per month, usually on weekends in social atmospheres. According to the National Institute on Alcohol Abuse and Alcoholism, you are at low risk for developing an alcohol use disorder if you:

  • Are a woman, have no more than three drinks per day, and no more than seven per week.
  • Are a man, have no more than four drinks per day, and no more than fourteen per week.

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 alone, too. You may miss school and work due to substance 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, and your relationships with others are, too. 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 does not meet the criteria for a substance use disorder.

Stage 5: Dependence

There are three steps to dependence:

  1. Tolerance, when you require more alcohol or more of your drug of choice to achieve the same ‘high.’
  2. Physical dependence, when going without drugs or alcohol elicits a withdrawal response. It is important to note, though, that physical tolerance can happen even when prescription drugs are taken as your doctor has instructed. But when drugs or alcohol are abused, or illegal drugs are used at a high level, physical tolerance becomes a problem.
  3. Psychological dependence, when you experience drug cravings, a high rate of substance use (using more frequently, using more of your substance of choice, 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

You know you’re living with a substance use disorder when you can meet the following criteria:

  • You ‘cannot face life’ with drugs or alcohol.
  • You cannot control your use.
  • You continue to use 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.

However, a substance abuse disorder is more than its symptoms. It is a chronic disease, meaning that it is slow to develop and of a long duration.

Substance use disorders are often-relapsing diseases, meaning that recovery will often entail setbacks. However, the relapse rates for SUDs are similar to those of other chronic conditions, including diabetes, hypertension, and asthma.

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 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. The longer you remain in rehab, the less likely you are to relapse, so take that into consideration when choosing a course of treatment.

There is also counseling available for you, your family, and friends to help with recovery, as well as support groups like AA, NA, Al-Anon, and Nar-Anon.

Knowing the stages of addiction is important: not to belittle you, but to help you understand your path to recovery. Enjoy the journey back to health.