Watching someone you care about struggle with addiction is incredibly painful. It’s often hard to understand why they can’t just stop using, especially when they’ve promised to do so, or when they seem to ignore the negative consequences. Unfortunately, there are many myths about addiction, but decades of research indicate that it’s a complex, multi-stage process that affects the brain in deep and lasting ways.
4 Stages of Addiction
Here’s a closer look at the four stages of addiction.
1. Initiation: Start of the Journey
Also referred to as experimentation, this is when someone first starts using a substance, whether out of curiosity, peer pressure, or to cope with stress, anxiety, or pain. During this stage, a person might not think of themselves as having alcohol use disorder (AUD) or substance use disorder (SUD)—they might just be trying different things or using occasionally.
What Happens in the Brain
The National Institute on Drug Abuse (NIDA) explains that when someone uses a substance, their brain experiences “surges of chemical signaling compounds including the body’s natural opioids (endorphins) and other neurotransmitters in parts of the basal ganglia (the reward circuit).” Over time, the brain starts to associate the substance with this positive feeling.
However, in this early stage, the brain’s prefrontal cortex—which helps with decision-making and controlling impulses—is still able to make rational choices. This means that, while the brain is beginning to enjoy the effects of the substance, it hasn’t yet lost control over behavior.
Why It’s Risky
Even though initiation might seem harmless, it’s during this stage that habits start to form. “When some drugs are taken, they can cause surges of these neurotransmitters much greater than the smaller bursts naturally produced in association with healthy rewards like eating, hearing or playing music, creative pursuits, or social interaction,” NIDA states. So a person’s brain begins to link alcohol or drugs with greater feelings of pleasure over other activities, and this creates a foundation for more frequent use.
2. Reinforcement: Pull of Reward
In the second stage, behavior becomes more frequent. An individual starts using alcohol or drugs more often, driven by the brain’s increasing desire for more pleasurable feelings—and possibly as a way to cope with stress and emotions, or just to feel “normal.”
What Happens in the Brain
The brain’s reward system is more deeply involved, and the prefrontal cortex loses some of its power to stop impulsive decisions. This means the person’s ability to control usage weakens, especially if they start to choose substances over dealing with certain feelings, including stress, trauma, and other issues.
The National Institute on Alcohol Abuse and Alcoholism notes that “research shows that over time, drinking to cope with stress—while it may provide temporary relief from emotional discomfort—tends to enhance negative emotional states between bouts of alcohol consumption. These changes can motivate further drinking and cause an individual to become stuck in an unhealthy cycle of alcohol consumption.”
These and other cues, known as triggers, make an individual more likely to reach for alcohol or drugs, even when they know it’s not a good idea.
Why It’s Risky
At this point, the person is reinforcing the habit. The brain has begun to prioritize the substance over other rewards. This stage can lead to more frequent use and the beginning of negative consequences, like relationship issues or trouble at work or school.
3. Tolerance: Needing More
Now, an individual needs larger or more frequent amounts of the substance to achieve the same effects because their brain is starting to adapt.
What Happens in the Brain
Yale Medicine points out that “with chronic use of a substance, over time the brain’s circuits adapt and become less sensitive to dopamine. Achieving that pleasurable sensation becomes increasingly important, but at the same time, you build tolerance and need more and more of that substance to generate the level of high you crave.”
This change to relying more on drugs or alcohol to feel good makes it harder to experience joy from anything else.
Why It’s Risky
As tolerance builds, the person may start using larger amounts, which increases the risk of overdose or severe physical damage. Tolerance also encourages the cycle to continue. If they have other risk factors, such as adverse childhood experiences, a family history of AUD or SUD, or mental and emotional health disorders, there’s a greater chance they’ll develop dependency.
4. Dependence: Loss of Control
Now, addiction is no longer a choice. A person is so dependent on the effects of substances that they experience withdrawal symptoms when they try to stop. These range from mild, such as irritability and fatigue, to severe, including seizures and delirium.
What Happens in the Brain
The reward system no longer functions the way it did before. The brain has rewired itself to expect the substance to feel “normal.” The amygdala, which processes emotions and stress, is often overactive, leading to heightened feelings of anxiety or depression. An individual may feel as though they can’t cope with life without substances.
Why It’s Risky
With the onset of AUD or SUD, someone might try to quit but are physically and psychologically unable to. This is when addiction can be life-threatening due to risks like overdose, accidents, or worsening health problems. The brain’s adaptations make it very difficult to break free from the cycle without professional help.
The Evidenced-Based Treatment Approach at Fair Oaks
If you’re concerned about a loved one, it’s essential to approach the situation with compassion, not judgment. Fair Oaks Recovery Center in Sacramento, California is a licensed Chemical Dependency Recovery Hospital, issued by the California Department of Public Health to addiction rehabilitation and dual diagnosis treatment facilities. Our board-certified professionals help provide a clear understanding of addiction as a chronic health condition that might not be fully curable but is treatable. The goal is to manage it with evidence-based and holistic approaches to build a healthier, substance-free life. Contact our admissions team to learn more.
