Each person’s journey from addiction to recovery is unique. There are a number of models explaining the stages of addiction, initially largely from the perspective of alcohol use disorder. In this article, I present a model which outlines stages as a way of thinking about the addictions cycle. I briefly outline brain science that explains one of the stages. Then I highlight typical treatments that may be used to help people recover.
It’s important to note that most people do not go through this cycle in a linear way. Many cycle back to early stages for various reasons and then continue anew. Here are stages that a person may go through:
Initial Use/Irregular Involvement
A person has random or infrequent experimental or recreational use of alcohol or drugs. The motivation to use is either pleasure seeking, pain management or escape from everyday life.There is little or no evidence of problems caused by use.
Regular Involvement and Abuse
The person uses alcohol or drugs regularly, with some pattern (e.g. daily, weekly, monthly)
Minor or isolated problems may be caused by use but they may grow worse. They are actively seeking involvement with the substance. The motivation is typically a way to cope with some emotional or cognitive deficiency, some form of stress or as an escape from life’s problems.
Regular involvement gradually grows into abuse. The person is continuing to use alcohol or drugs to maintain the euphoric feeling it creates, as a way to manage pain or escape from their reality. This abuse occurs on a regular basis, but in a way that gives them more harm than relief.
For example, someone who is prescribed Oxycodone for a legitimate leg injury increases the dose beyond the limits of the prescription, without a doctor’s approval. They are now chasing the original feeling of a high, but needing to take higher and higher doses to reach that. This now becomes the person’s daily routine and alters their lifestyle correspondingly.
Harmful Involvement
Using drugs or alcohol now causes problems in one or more areas of their life, potentially affecting family members and even friends, as well as coworkers.
Dependent Involvement, Addiction and Tolerance
Use is continued despite problems it causes in life. There are failed attempts to cut down or quit. Much time is spent using or thinking about using. Strong urges to use are experienced. Dependence on alcohol or drugs is developed.
Some people continue their substance abuse despite clear indications of its negative consequences and dysfunctional impact. These may include:
- Ruptured family relations
- Alienation from friends
- Negative implications at work
- Financial problems
- Physical health problems
- Mental health issues
Some begin to realize these impacts although many do not. The development of physical dependence usually makes the issues associated with substance abuse worse, reinforcing the cycle of addiction or Substance Use Disorder.
The person has uncomfortable feelings when abstaining. More of the substance is needed to get the same high. This is called tolerance. Neurological changes take place as the brain’s tolerance to the alcohol or drug adapts. Addictive substances trigger an outsized response when they reach the brain. Instead of a simple, pleasurable surge of dopamine, such as when eating, many drugs cause dopamine to flood the reward pathway, ten times more than a natural reward [1].
The brain remembers this surge and associates it with the addictive substance. But with chronic abuse, the brain’s circuits adapt and become less sensitive to dopamine. The desire for the pleasurable sensation increases, but the addict builds tolerance and needs more of the substance to achieve the high they crave.
Gradually the brain no longer produces the levels of dopamine it once did naturally. Addictive drugs circumvent the natural process of satiating dopamine levels and stop their firing, and continue to directly increase dopamine levels as a reward associated with the drug.
So ordinary healthful rewards, lose their motivational power. And the reward and motivational systems become reoriented through conditioning to focus on the more potent release of dopamine produced by the drug and its cues. In fact over time, drug consumption triggers much smaller increases in dopamine levels in the presence of addiction than in its absence. This diminished release of dopamine renders the brain’s reward system much less sensitive to stimulation by both drug-related and non-drug-related rewards (such as normal enjoyment of life).
The person may choose to increase the frequency of use and the quantity as they seek the initial euphoric dopamine release they are craving. And this becomes a reinforcing cycle leading deeper into addiction.
Gradually the person’s tolerance to the increased dose and frequency leads them to repeatedly increase these. This creates a cycle of tolerance for heavy alcohol and drug abuse. This may also lead drug users to seek out harder drugs such as fentanyl. Brain changes continue with the loss of chemical receptors, leaving the person feeling depressed, yet craving, when not using.
As the person’s life is more severely impacted by addiction, they may realize and accept they have a problem with alcohol or drugs. Typical symptoms of this stage involve:
- Increase in consumption of substances
- Significantly increased tolerance
- Experiencing painful unsuccessful withdrawal
- Continuing to abuse substances when it affects their family and friends
- Continuing to abuse substances despite significant health issues
- Using becomes the centerpiece of their life
The continued growing use of alcohol or drugs interferes with the person’s health and normal functioning. Many people do not feel they have a problem controlling their use, despite clear evidence to the contrary, whether it be at home, at work or in the community. However their use results in negative consequences which they often rationalize and deny. They are out of control with their addiction.
Transitional Abstinence
Often following some adverse consequences, the person chooses to quit using alcohol or drugs after harmful dependent involvement. The person struggles with how this feels but doesn’t have a clear plan or support to abstain successfully. They may still crave the substance.
Stabilized Abstinence/Recovery
Either on their own, which is usually extremely difficult to do, or following successful treatment, the person abstains from alcohol and other drugs after harmful or dependent involvement. The person feels good about this and is able to sustain their abstinence, often by attending support groups.
Relapse
Relapse is the last stage in the cycle of addiction. This may occur if the person tries to get sober on their own, but gives in to the cravings and resumes consuming substances. Or, it may occur if the person sought treatment for their alcohol and drug abuse and was successful in getting sober, but was unable to stay that way. This is not uncommon and it often takes several attempts to achieve lasting sobriety. Typically the person returns to the dependence stage, which then presents all the obstacles of getting sober again.
Treatment Recovery
Treatment for addiction typically involves detox, followed by therapy, often in a residential treatment setting. Detox is done under medical supervision and may involve the use of medications to assist with the withdrawal process.
Therapy following detox is a critical factor for success. It may include:
- Cognitive Behavioral Therapy assists people to learn to identify harmful thinking patterns, reframe negative thought patterns and assist in setting positive goals.
- Dialectical Behavior Therapy is a cognitive-behavioral approach to healing dysfunctional patterns of behavior and emotional dysregulation by providing psychotherapy, group skills training, mindfulness, therapy sessions and phone support.
- Psychotherapy helps people suffering from addiction understand the impact of their addiction on their life and those around them and helps them develop healthy coping strategies to heal from addiction.
Restorations Is Here For You
Located in Anaheim, California, Restorations Health Care can help you or a loved one overcome their addictions issues. Our mission is all about saving lives. We offer detox and inpatient treatment programs that help people get back on their feet. Our dedicated team of trained addiction professionals and counselors provides individualized addiction treatment programs for recovery.
Sources.
[1] Nora D. Volkow, M.D., George F. Koob, Ph.D., and A. Thomas McLellan, Ph.D. 2016. Neurobiologic Advances from the Brain Disease Model of Addiction. N Engl J Med 2016;374:363-371
Lacey graduated from Brand University with a MA in Psychology, Marriage & Family Therapy. Lacey is a skilled clinician, supervisor, and administrator with extensive therapy experience. She is responsible for providing clinical leadership and policy direction for our program and maintains accepted standards of medical practice throughout the facility.
