The Five Stages of Addiction
Addiction is a plague that affects individuals and society in an adverse manner. It is a very costly illness that has worldwide prevalence (www.aipc.net.au/articles/?p=209). If addiction is an illness wherein a person’s drives are operating improperly, then the stages of addiction are the signposts that indicate just how far down the road to addiction the drives have taken the person. Many authorities in the field of addiction recognise four or five major stages. We’ll review each of these stages below.
Stage One: Experimentation
Also called “partying” or “chipping” in the context of drug and alcohol addictions, this first stage is where use of the substance or performance of the behaviour is voluntary, and there are no apparent negative consequences. The first time a person looks through a pornographic magazine, or a teenager goes to a party and has some drinks and some pills in order to fit in, that is experimentation. Similarly, the first time a person goes to a casino and spends a few hours at the tables or the pokies, they are just toying with gambling, trying it out.
The impetus to explore the substance or behaviour may have arisen in order to deal with an unmet need. An example of this could be an older woman who loses her husband and purchases a bottle of wine to drink with dinner because she no longer has her life companion to share dinner with. The substance or behaviour often seems to help assuage the feeling of loss, emptiness, or lack of esteem which created the original interest in the experimentation. Because it seems to help, the person is drawn to using the substance or performing the behaviour again, ushering in the second stage.
Stage Two: Regular use (with alcohol and drugs, this is also called the “misuse” stage)
Here people are not truly addicted, and some may remain at this stage for months or even years, possibly never becoming an addict. Generally this is the time when the negative consequences of doing the substance/behaviour begin to make themselves known. For instance, a person regularly using alcohol may get stopped on the way home for driving while intoxicated, and have his licence suspended for six months. A food addict has established her favourite binge foods and looks forward to the Friday night binge. She will “need” the binge all the more after being told that her cholesterol and blood pressure are dangerously high.
Because many people at this stage stop using the substance (or doing the behaviour) while the negative consequences are happening, they feel entitled to claim that they are in control and not addicted. An example here could be the man who has been visiting pornographic or online dating sites. His wife finds out about them and is shocked and hurt. He promises not to ever visit the sites again: a promise he keeps until the fuss dies down, whereupon he finds himself drawn back to the sites again.
This is usually the time when regular use begins to evolve into risky use: the porno-site-visitor, for instance, decides that he needs to personally meet one of the beautiful “babes” he is seeing on the sites.
Stage Three: Risky use (also called “abuse”)
The point at which an individual crosses the line from “regular” use to “risky” use or “abuse” can be difficult to determine and varies in each case. What is common here is that the social, legal, financial, and/or health consequences of engaging with the substance/behaviour are escalating, and the person continues with the behaviour despite the toll it is taking in his or her life. An example is the gambler who begins to gamble away the money in the family cheque account because other funds have been exhausted. Even though his wife notices and confronts him about the missing funds, he still returns to the casino. A drug addict at this point needs to borrow or steal in order to fund the habit. Some people pass quickly from this stage to dependence.
Stage Four: Dependence
This stage is sometimes combined with Stage Five, Addiction, but it is useful to separate the two, because many people at Stage Four appear to be quite functional, although the underlying reality is that work, personal, and social obligations are not being met. The dependent person may still be employed, and appear to have friendships and primary relationships, at least at the earlier part of this stage, as they may mostly confine the times for doing the substance/behaviour to leisure hours. Looking more closely, however, one finds that the person is struggling to keep it all together. The friendships may be with other heavy drinkers, for example, and revolve around drinking activities.
Underneath a veneer of family harmony there may be increasing tension in the home relationships as the addict’s focus and interest narrow to the substance or behaviour only (for example, the alcoholic is only interested in the bottle). As the person becomes drawn more and more into the world of the addiction, he or she begins to disappear for periods with no explanation. Family members and loved ones are reluctant to confront the person, because increased moodiness on the part of the addict means that other members of the household must “walk on eggshells” in order to keep the peace, and possibly avoid violence. By modifying their own actions in this way, family members are enabling even more of the addictive behaviour.
Clearly, the façade of functionality can only be kept up for so long. The reality is that the person is probably already addicted, and the manipulation, justification, and defensiveness will only increase as the addict attempts to keep up this new way of life.
Stage Five: Addiction
The last stage of persistent abuse of substances or compulsive repetition of harmful behaviours is addiction. As we defined above, addiction means that the person no longer has a choice, and is engaging with the substance/behaviour under compulsion generated by changed brain circuitry dictating that certain substances or behaviours are “rewarding”, and must be undertaken at all costs. Out of control and often not even enjoying a “high” as much as needing to avoid withdrawal, the addict engenders repeated negative consequences in the form of mental, emotional, or physical harm from his or her actions. Those consequences include the loss of health, job and financial security, and relationship, and – often – the gaining of a criminal record.
Addiction is a progressive, chronic, and sometimes fatal disease. As the Intercept Interventions site states, “If left untreated, it can only lead to jails, institutions, death, and dereliction, in no specific order” (Intercept Interventions, 2012; Martin et al, 2007; Drug Rehab Advice Center, n.d.).
This article is an extract of the Mental Health Social Support Specialty “Aiding Addicts”. For more information on MHSS, visit www.mhss.net.au.
- Drug and Alcohol Rehab Asia (DARA). (2011). Alcoholism in Australia. Drug and Alcohol Rehab Asia. Retrieved on 1 May, 2012, from: http://alcoholrehab.com/alcohol-rehab/alcoholism-in-australia/Drug Rehab Advice Center. (Undated). Stages of Addiction. Drug Rehab Advice Center: Drug Addiction Rehab United States and Canada. Retrieved on 3 May, 2012 from: http://www.drugrehabadvice.org/stagesofaddiction.html
- Intercept Interventions (2012) Stages of Addiction. Intercept Interventions. Retrieved on 3 May, 2012 from http://www.interceptinterventions.com/stages-of-addiction
- Martin, P.R., Weinberg, B.A., & Bealer, B.K. (2007). Healing addiction: An integrated pharmacopsychosocial approach to treatment. Hoboken, New Jersey: John Wiley & Sons, Inc.