According to the National Institute on Drug Abuse (NIDA), addiction is defined as a chronic, relapsing disorder. It is characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain. It is considered both a complex brain disorder and a mental illness.

People with an addiction or Substance Use Disorder (SUD) are often those who initially used prescription or illicit drugs to cope with some form of mental or physical discomfort.

Stage 1: Experimentation/First or Initial Use/First Exposure

Unfortunately, prescription medications rank among the most addictive drugs in the world.

Sometimes, a person’s first exposure to an addictive substance is in taking something to relieve physical or mental discomfort. Opiods for physical relief might be obtained via direct prescription or “borrowing” a pill from a friend or family member. Unless it is chronic, persistent pain is present to promote continual use. This scenario is unlikely to cause the body to develop cravings.

Prescription drug usage for the purpose of mental health has a greater propensity to be habit-forming. While it can be done safely under medical supervision, the real danger comes when a drug is taken in manner or from a source that it is not prescribed. Peer pressure is an example of this scenario.

While at this stage a person still has decision-making capability, their actions may be dictated not by need of the drug, but need of social acceptance.

Stage 2: Habit/Regular Use

The defining characteristic of stage two is that a pattern for use has been established. Whether due to a specific motivation or particular setting, the drug now has an identifiable, repetitive purpose.

A motivation example may be to escape boredom, relieve stress, or boost mood to keep unwanted feelings suppressed. A setting-based pattern might be to relieve anxiety in certain recurring social situations or to heighten a social experience.

This stage often where polysubstance abuse, or mixing of drugs with other drugs or alcohol, can occur. These habits often form what later become “triggers.” Triggers can include locations, situations, & people that the brain begins to associate with a craving for that drug. This is also the point where new habits may be formed. The person might start to consume drugs or alcohol alone, removing the social element.

Unlike a later stage of dependence, the user still has significant control & election over their consumption of the drug.

Stage 3: Tolerance & Risky Use

As drug & alcohol users progress to the next stage of addiction, their habitual use leads the body to build up a tolerance for the drug, requiring more of the substance to get the same effect. The body has stopped producing the brain stimulating chemicals naturally, requiring the person to engage in increasingly risky behaviour to achieve the same level & frequency of feeling secure.

Getting the next “fix” begins to interfere with regular life & observers can begin to recognize telltale signs of addictive behaviours. These may include:

• Borrowing or stealing money
• Neglecting responsibilities such as work or family
• Attempting to hide their drinking/drug usage
• Hiding drugs in easily accessible places (e.g. mint tins)
• Changing peer groups
• Visiting multiple doctors or rapidly changing doctors (if using a prescription drug)
• Losing interest in old hobbies

A person may start to feel that situations which were moderately uncomfortable before are now intolerable while sober. Arriving at work high, drunk or hungover or getting a DUI is a high probability. Users often find themselves surprised at their own actions. They may justify uncharacteristic behaviours as lifestyle changes & financial difficulties begin to take a toll on relationships.

Stage 4: Dependence

The fourth stage of addiction is usually made up of a combination of physical dependence & psychological dependence.

Physical dependence is synonymous with chemical dependency. This is where a person needs a substance to avoid the effects of withdrawal. At this stage, they experience cravings for the drug & have begun to lose the ability to make decisions about drug intake. A prescription drug patient may over-medicate, perceiving moderate pain as severe.

Psychological dependence is more common with prescription drug addiction & alcohol as the user becomes convinced that they need them to function normally.

Problem focused coping or emotion focused coping are common contributors to this type of dependence. The individual first takes the drug or drinks for “trying times,” then extends consumption to instances when it’s not actually necessary.

Stage 5: SUD/Addiction

In the final stage of addiction, the intake of drugs or alcohol ceases to be a conscious choice. Often at this stage the user has attempted–maybe more than once–to attain sobriety by their own strength & will with no success. Not realizing when they had passed the point of dependence, the need to use overrides concern for themselves and/or loved ones.

The Substance Use Disorder (SUD) stage is recognizable by continued use despite significant consequences such as homelessness, loss of job, expulsion or dropping out of school, etc. Other behaviours include compulsive lying, agitation with any threat to lifestyle, & neglecting basic hygiene or skipping meals. Without help, there is a high probability this stage will result in criminal activity, incarceration, overdose, & even death.

There is hope, however. If you recognize any of these five stages in your life or that of a loved one, it’s not too late to find help & make a lasting life change. It is possible to live a life of sobriety even after continued use of some of the most addictive drugs. The earlier stage addiction is addressed, the higher the likelihood for full recovery.