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The 5 Stages of Addiction

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Medically Reviewed By: Diana Vo, LMFT

November 22, 2023

Table of Contents

46 million U.S. adults reported a diagnosable addiction in 2021, yet few actively pursued treatment. The onset of addiction unfolds gradually, progressing through distinct addiction stages before evolving into a full-blown substance use disorder – the clinical term for addiction.

While the specific substances may differ, the stages of addiction to opioids closely parallel levels of addiction to alcohol, prescription medications, and other illicit narcotics. Read on to learn more about the following issues:

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  • How many stages of addiction are there?
  • What are the stages of substance abuse?
  • What is the first stage in the cycle of addiction?
  • How to connect with addiction treatment in California.

What Are the Stages of Addiction?

Addiction is a chronic and relapsing disease, then, but it doesn’t always follow a linear path. The road from the first use of drink or drugs to full-blown addiction tends to follow stages of change in addiction. These are commonly recognized as the following 5 stages of addiction:

  1. Initial use and experimentation
  2. Regular substance use
  3. Substance abuse
  4. Dependence
  5. Addiction

Stage 1: Initial use and experimentation

What is the first stage of addiction, then? The first stage of addiction is far removed from substance use disorder. Initial use of alcohol and drugs often takes place as early as adolescence. It is commonplace for teens to experiment with substances, and in most cases, the relationship with substances progresses no further. For others, though, initial use of substances and experimentation with drink and drugs can be the first step of a gradual transition to a diagnosable substance use disorder.

The risk for addiction at this early stage largely depends on the age of the person and the substance they are taking. Drinking alcohol as a teen might be illegal, and it may also be proven dangerous, but it is also not uncommon for young adults to consume alcohol with friends. Contrast this with a 12-year-old experimenting with opioid painkillers. This child has a stronger chance of initiating drug dependence than a teen experimenting with alcohol.

The motivation for substance use also plays a role in determining the overall level of danger at this initial stage of addiction. People of all ages routinely use small amounts of alcohol or drugs as a social lubricant. When someone relies upon any addictive substance to self-medicate mental health conditions or stress, on the other hand, this is likely to trigger a more powerful desire to continue using substances than when someone simply looking to have fun at a bar or party. This motivation can bring about more regular substance use – the second stage of addiction.

Increasingly, people are first exposed to addictive substances in the form of prescription medications. Over the past two decades, the aggressive prescribing of opioids to manage persistent pain means that millions of people each year find themselves experiencing a powerful opioid for the first time. If opioids are taken long-term, tolerance builds so that more of the substance is required to achieve the same effect.

 Regardless of how the initial use of substance occurs, and whether it was through legal or illicit means, there are only two outcomes: either the person stops using substances completely, or they start to use drink or drugs more regularly.

friend talking to another friend representing Stages of drug addiction

Stage 2: Regular substance use

For those who go on to use alcohol or drugs regularly, patterns of use develop. Some people limit substance use to the weekends, others to the evenings, and others only when spending time with friends. The more dangerous type of regular substance use is when people use drink or drugs alone, and especially when self-medicating the symptoms of other conditions like depression or anxiety.

With prescription drugs, some people may continue to use these medications purely through legitimate need, while others may feel driven to continue using prescribed drugs for their euphoric effects.

Many people find they can continue using substances without ever developing any notable problems, remaining in the second phase of addiction.

More often, though, tolerance starts building after someone continues using drink or drugs for a prolonged spell. The speed and level of tolerance varies from person to person, and also depending on the substance in question. Tolerance is one of the early warning signs of addiction. This phenomenon occurs when the brain and body have already adjusted to the continuing presence of the substance, and it now requires more of the substance to achieve the same effects. For those who are prescribed painkillers, tolerance can be detected when the normal dose no longer effectively dulls the pain. Tolerance to alcohol causes people to drink more to feel intoxicated, even though BAC (blood alcohol concentration) levels remain constant.

Stage 3: Substance abuse

Most people abusing substances find that their personal relationships start deteriorating. Trouble at home and work is commonplace, and legal problems may also ensue.

It is not only those who use drink or drugs daily who can reach this troubling stage of addiction. What characterizes substance abuse is that alcohol or drugs become a pillar in life assuming more priority than any other obligations, personal or professional, even with an awareness of adverse outcomes.

Those who abuse substances to self-medicate typically encounter more profound difficulties during this phase of addiction. They may find that drink or drugs no longer effectively manage their symptoms, prompting increased consumption. At the same time, the chance of engaging in risky behaviors increases, while the risk of developing physical dependence accelerates. To further inflame the issue, the original symptoms may start getting worse, while new symptoms may also manifest.

If you find yourself abusing substances, detox and recovery will be much smoother if you take action before dependence sets in – addiction is a progressive condition that often gets worse when untreated.

Stage 4: Dependence

The fourth stage of addiction is physical dependence. If you are dependent on a substance, you may feel physically ill in its absence. This can lead to intensely unpleasant withdrawal symptoms. Unsupervised withdrawal from alcohol or opioids can be life-threatening.

Biological reasons underpin dependence. On a chemical level, the brain is now accustomed to the substance, struggling to function without it. Dependence also presents physically in the form of withdrawal symptoms when abstinent. These adverse effects of dependence normally subside when the person is able to consume the substance in question.

If you are dependent on drink or drugs, you will not feel normal when sober, and you will need the substance to function. At this stage of addiction, the disorder is exerting a physical and psychological pull.

Stage 5: Addiction

In its fifth and final stage, addiction leaves people unable to stop using drink or drugs, even when no longer enjoying it, and even when their behaviors are causing dramatic problems in all areas of life. This characterizes addiction: it leads to a compulsive desire to use the substance, in the face of clearly harmful consequences.

Addiction (substance use disorder) is diagnosed based on the criteria outlined in DSM-5-TR (the fifth revised edition of the Diagnostic and Statistical Manual of Mental Disorders. This stage of addiction sees drink or drug use moving beyond the recreational. Some people in this phase of full-blown addiction may find they can abstain for periods of time, but they cannot maintain sobriety without assistance.

Oftentimes, the person remains in denial regarding both the existence and extent of their addiction, as well as the consequences triggered by substance abuse. Their judgment is flawed, and their perspective is skewed by their addiction. At this stage of addiction, their lives are at risk by the continued use, and if they are unable to stop, they will suffer severe health consequences.

While addiction is a chronic and incurable condition, almost all substance use disorders respond favorably to evidence-based treatment. What does that involve?

therapy appointment representing 5 stages of addiction

How Are the Stages of Addiction Treated?

Addressing the stages of addiction involves a comprehensive approach tailored to individual needs. Treatment may incorporate the following components:

  • Intervention: Early intervention is crucial. Identifying signs of addiction and addressing them promptly can prevent its progression to more severe stages.
  • Detoxification: In cases of physical dependence, a supervised detoxification process helps manage withdrawal symptoms safely.
  • Therapeutic interventions: Counseling and therapy, such as CBT (cognitive behavioral therapy) or MET (motivational enhancement therapy), play a pivotal role in addressing psychological aspects of addiction.
  • MAT (medication-assisted treatment): Some people may benefit from medications to reduce cravings and support recovery. This approach is often employed in opioid or alcohol addiction.
  • Support groups: Participation in support groups like AA, NA, or SMART Recovery provides a sense of community and encouragement for those battling any stage of addiction.
  • Aftercare planning: Developing a robust aftercare plan ensures ongoing support post-treatment, reducing the risk of relapse.

Understanding and addressing the stages of addiction with these interventions can contribute significantly to successful recovery. Reach out to Renaissance Recovery today to begin your recovery right away.

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Get Treatment for Every Stage of Addiction at Renaissance Recovery

If you need help addressing substance use issues, we can help you at Renaissance Recovery, regardless of the severity of your addiction. We specialize in treating all types of addictions at our beachside Orange County treatment facility.

We offer a variety of outpatient programs at different levels of intensity, allowing you to choose the structure and support you need to engage with evidence-based addiction treatment. The outpatient nature of therapy allows you to fulfill your personal and professional commitments without compromising your mental health.

All treatment programs at Renaissance deliver personalized and blended treatment that may include any or all of the following:

  • Holistic therapies
  • Individual counseling
  • Family therapy
  • Group therapy
  • Psychotherapies
  • MAT (medication-assisted treatment)
  • Aftercare and support

Call 866.330.9449 and get immediate help fighting addiction in California.



At Renaissance Recovery our goal is to provide evidence-based treatment to as many individuals as possible. Give us a call today to verify your insurance coverage or to learn more about paying for addiction treatment.

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Joseph Gilmore has been in the addiction industry for three years with experience working for facilities all across the country. Connect with Joe on LinkedIn.

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