Four Stages of Addiction: Understanding Cycles, Stages, and Levels of Addiction

What you will learn

• Addiction is a complex condition that has several risk factors.
• Multiple stages of addiction demonstrate how addiction develops from first use to substance use disorder.
• Not everyone who tries a substance will develop an addiction, though reaching certain stages can increase the risk of becoming addicted.
• Comprehensive addiction treatment can be effective in overcoming addiction, especially if it happens at earlier stages.

Addiction is a complex and multifaceted chronic disease that impacts people of all backgrounds. While some people have social, genetic, and environmental factors that make them more prone to developing an addiction with just a few uses, others may take longer to become addicted.[1]

Researchers have identified different stages and levels of addiction that comprise the cycle. While there’s some variation, you can understand how addiction develops by examining how these stages and levels are defined.

The Stages of Addiction

The number of stages of addiction varies across addiction medicine, but there are similarities between the stages and the general progression of addiction.

Three Stages of Addiction

According to the surgeon general, addiction is described as a repeating cycle with three stages that are associated with different brain regions. The three-stage model includes:

• Stage 1 – Binge/intoxication: This is the stage when you consume an intoxicating substance and experience rewarding effects, such as euphoria. In this stage, the substance impacts the brain’s reward system, reinforcing its use and encouraging repeated use.
• Stage 2 – Withdrawal/negative effect: This is when you experience negative emotions without the substance. This stage sets up future binge and intoxication due to withdrawal symptoms and negative emotions related to missing the substance.
• Stage 3 – Preoccupation/anticipation: This is the stage when you seek substances again after abstaining from them. In some cases, the period of abstinence may be short, even as little as a few hours. These are commonly known as cravings.[2]

These three stages are linked to each other and involve different changes in the brain. It’s possible to complete the cycle over a few weeks or months or even to progress through it multiple times in one day. However, over time, the addiction cycle intensifies.

Four Stages of Addiction

Some schools of thought define the cycle of addiction with four stages:

• Stage 1 – Experimentation: This is the first stage and involves the voluntary use of drugs without negative effects. This may be to have fun or cope with a problem. Experimentation can happen without any desire to continue using the drug.
• Stage 2- Regular use: This stage is when casual use transitions to regular use. While this can still occur without dependence or addiction, the risk for a substance use disorder (addiction) is much higher with regular use. There are other risks as well, including driving under the influence, violence, or worsening mental health.
• Stage 3 – Risky use or abuse: The line between regular use and abuse is thin, but it’s defined as continuing to use a substance without regard for negative social, legal, or health consequences. The warning signs of addiction may appear during this stage.
• Stage 4 – Drug dependence and addiction: Physical dependence is when the body becomes used to the presence of a drug and needs it to function properly. This isn’t addiction on its own, but it can be part of it. At this stage, the need to continue using the substance overpowers any concerns for responsibilities, interpersonal relationships, health, finances, or legal issues.[3]

Six Stages of Addiction

Some schools of thought break down the stages of addiction into more stages with more nuance between them. These include:

• Stage 1- Initial use: This is the stage when you first try a substance, whether through a prescription or experimentation with illicit drugs.
• Stage 2- Abuse: The next stage of addiction is substance abuse, which is the point when you begin using a substance repeatedly. This could be moving from casual use to regular use, misusing a prescription for a controlled substance, or losing control over your use of a legal substance, such as drinking excessively.
• Stage 3 – Tolerance: When you use a legal or illicit substance over time, it can cause changes in the brain that result in tolerance. You no longer experience the same effects at the same dose, so you may increase the dosage or frequency of use to get results. This cycle continues, developing into heavy substance use.
• Stage 4 – Dependence: At this stage, the body or brain has become dependent on having the substance to function properly. You may not be able to experience pleasure in any way without the drug.
• Stage 5 – Addiction: Addiction, or a substance use disorder, is a chronic mental health disorder that has specific criteria, but it’s generally defined as compulsive, uncontrollable use of a substance despite consequences.
• Stage 6 – Relapse: The potential for relapse is a hallmark of any chronic condition. With addiction, relapse is when you quit using a substance initially, then lose control and relapse to drug use.

Four Levels of Addiction

Along with the stages, some schools of thought characterize the addiction cycle with levels. There are similarities between the stages and levels of addiction, which are defined as:

• Level 1 – Trying the substance: Like the first stages, level 1 is trying a substance for the first time, which doesn’t necessarily develop into abuse or addiction.
• Level 2 – Regular use and abuse: Regular use and abuse is when the first time develops into more chronic use, though it’s not necessarily dependence or addiction. This does increase the risk of developing an addiction, however.
• Level 3 – Dependence and tolerance: Building a tolerance to a drug and needing higher doses to get the same effect. This builds dependence quickly, causing withdrawal when the substance is stopped. This isn’t an addiction on its own, but it can be part of one.
• Level 4 – Substance use disorder: Substance use disorder is characterized by a compulsive pattern of substance use despite significant negative consequences in life, work, school, health, or interpersonal relationships.

Seeking Help for Abuse and Addiction

Some people use substances casually and never develop an addiction. Others have environmental, genetic, or individual factors that make them more prone to developing an addiction through experimentation and risky use.

Once addiction starts, however, it’s more difficult to interrupt the cycle. People may try to quit using a substance multiple times before succeeding, or they may not realize they have an addiction at all. However, professional addiction treatment with a comprehensive, individualized care plan can make a huge difference.

Substance abuse treatment plans are tailored to individual needs, substance use history, mental and physical health history, specific challenges, and more. There are many treatment settings and therapies to provide a full continuum of care, including medical detox, inpatient or residential treatment, outpatient treatment, and aftercare. Therapies vary but often include a combination of cognitive and behavioral therapies, group therapy, and individual and group counseling to gain the tools to manage chronic substance use.

Interrupt the Cycle of Addiction

The addiction cycle can develop over days, months, or even years. It’s never too early to get help. The sooner you seek treatment for abuse or addiction, the more likely you are to overcome your addiction and commit to a healthier lifestyle.

Amanda is a prolific medical content writer specializing in eating disorders and addiction treatment. She graduated Magna Cum Laude from Purdue University with a B.S. in Social Work. Read more