Stages of Substance Abuse

A Consumer's Guide to Alcohol and Drug Addiction Treatment

Substance use can be addressed and treated at any stage. Despite popular myths, people do not need to “hit bottom” before they can benefit from help.

Stages of substance use include experimentation, regular use, risky use, dependence, and addiction.  

The first stage, experimentation, is the voluntary use of alcohol or other drugs. 
Quite frequently, the person experimenting is trying to erase another problem.  An
older person may start drinking to cope with depression after losing a spouse.  A
teenager, angry about his parents’ divorce, could start smoking marijuana or huffing
inhalants. Experimentation may even include a husband taking his wife’s prescription
painkillers to cope with a back problem.  The substance seems solve the problem.  So the person takes more, and moves from experimentation to regular use, the next stage.

Some people stay in the regular use stage indefinitely. They will not develop a problem, and stop by themselves.  Others start using substances in a manner that is
risky or hazardous to themselves or to others.  Risky behaviors include: smoking
marijuana and driving; binge drinking (consuming more than the recommended
amount of alcohol at one occasion); and unexplained violence, to one’s self or
another.

When and how the transition from regular to risky use happens differs for every individual. So, what constitutes “risky behavior” by another person can be difficult
to gauge. Just the same, if someone’s behavior concerns you, say so. People can
pass quickly from risky use to dependence.

Stage Four:  Dependence

Characteristics of dependence include: Repeated use of alcohol or other drugs that leads to failure to fulfill major responsibilities related to work, family, school or other
roles. Or, repeatedly drinking or using drugs in situations that are physically
hazardous, such as driving while intoxicated or using heavy machinery when
intoxicated. Or repeated legal problems. Or any combination of these.

Many dependent people are able to work, maintain family relationships and
friendships, and limit their use of alcohol or other drugs to certain time periods, such
as evenings or weekends.

Stage Five:  Addiction

The last phase of the spectrum of substance use problems is addiction. Addiction is a medical condition involving serious psychological and physical changes from
repeated heavy use of alcohol, other drugs, or both.

• Symptoms include uncontrollable alcohol or other drug craving, seeking, and
  use, that persists even in the face of negative consequences. 
  
• Addiction is a progressive illness. If left untreated, it gets worse.  It is also
  chronic, or long-standing (versus acute, or short-term). 
  
• Addiction is a treatable illness. Recovery rates for people who go through
  treatment are very similar to those who get treatment for other chronic
  diseases such as diabetes and asthma. There are a number of treatment
  methods and community resources, including outpatient or residential
  treatment programs and twelve-step groups  These approaches can be
  customized to fit the needs of the individual and family. 

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This information is courtesy of: 
Join Together, a project of Boston University School of Public Health

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