It is important, especially when teens are involved, to address the issue of substance abuse early before it grows into a much more significant problem. In this article, we will discuss each stage with an example of potential effects it has on a teenager.
“My daughter, Carly, has been in and out of drug treatment facilities since she was thirteen. Every time she goes away, I have a routine: I go through her room and search for drugs she may have left behind,” wrote Dina Kucera in her memoir, Everything I Never Wanted to Be: A Memoir of Alcoholism and Addiction, Faith and Family, Hope and Humor. “We have a laugh these days because Carly says, ‘So you were looking for drugs I might have left behind? I’m a drug addict, Mother. We don’t leave drugs behind, especially if we’re going into treatment. We do all the drugs. We don’t save drugs back for later. If I have drugs, I do them. All of them. If I had my way, we would stop for more drugs on the way to rehab, and I would do them in the parking lot of the treatment center.’”
The DSM-IV defines substance abuse is “a maladaptive pattern of substance use leading to clinically significant impairment or distress,” as manifested by a variety of possible symptoms of impairment (American Psychiatric Association, 1994). A variety of sources profess that addiction tends to go through four key steps or stages before potentially ending up in a full blown, out of control, addiction.
The Four Stages of Addiction to Drugs and Alcohol
The use of alcohol and other drugs is a multifaceted phenomenon, varying with the individual’s level of use and the dysfunction experienced as a result of that use. In brief, the four stages of addiction to alcohol and other drugs are 1) experimentation, 2) social/regular use, 3) problem/risky use, and finally, 4) dependence.
Stage 1: Drug Experimentation
Drug experimentation is defined as the use of alcohol or illicit/mood-altering drugs at any time for experimentation. While in and of itself experimentation may not appear to be abusive, even a single episode of experimentation can result in substantial harm to self or to others.
Examples of potentially harmful experimentation include using any alcohol or other drugs during pregnancy, which could result in harm to the fetus; or experimental use of alcohol or drugs while driving, which could result in serious harm to the user as well as others. If experimental use continues or serves as a gateway to additional use (as it often does), patterns of alcohol/ drug abuse may develop.
Many parents find their teenage children participating in underage drinking, smoking cigarettes, marijuana, or even abusing prescription or over-the-counter drugs. Some teens experiment, and their use stops there. For others, this can be the first step in a lifelong struggle with substance abuse. Many people who become addicted started drinking and using drugs as early as 12 years old. Early use is one of the risk factors for addiction.
Stage 2: Social Drug Use, Regular Use
Social drug use is the use of any drug or combination of drugs in social situations, or for social reasons. If such social use causes any harm, physical or otherwise, to the user or others, it is also considered abuse. Social use of alcohol or other drugs often leads to further and elevated use. Alternatively, those with strong tendencies to isolate themselves socially may move from experimentation to regular use in the absence of social situations.
Parents may begin to notice their teens develop a regular pattern of underage drinking or drug abuse. At this stage, they are still able to stop this pattern. Some risky behavior may begin to occur in this stage such as binge drinking, driving under the influence, or becoming preoccupied with drugs. A teen can also begin to show defiance, depression, or anxiety.
Stage 3: Problem Use, Risky Use
Examples of problem use or risky use of drugs and/or alcohol include binge drinking and drug abuse.
Binge drinking is heavy use of alcohol periodically. The National Household Survey on Drug Abuse (NHSDA) defines binge alcohol use as drinking five or more drinks on the same occasion at least one day in the past 30 days. This can result in harm to the physical health of self and others, and negative behavioral consequences, which may result in bodily harm to self or others. For example, harm may be caused by heavy periodic use of alcohol or other drugs while pregnant, driving while intoxicated, or either neglecting or inflicting violence on self and others while under the influence.
The problem/risky use stage is when parents typically find evidence of a teen’s persistent substance abuse. Relationships with family and friends are impacted. Negative consequences at school and work and possible legal problems may emerge. Despite the consequences of the teen’s risky behavior, the substance abuse continues.
What distinguishes substance abuse from risky substance use? The characteristic feature of substance abuse is the presence of dysfunction related to the person’s use of alcohol or other drugs. The U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration [HHS/SAMHSA], 1994) describes substance abuse as “the use of a psychoactive drug to such an extent that its effects seriously interfere with health or occupational and social functioning.”
Substance abuse may or may not involve physiologic dependence or tolerance. For example, use of substances in weekend binge patterns may not involve physiologic dependence. However, it may have adverse effects on a person’s and possibly others’ lives.
Stage 4: Addiction, Chemical Dependency
For some people, continued use or abuse of alcohol or other drugs becomes addiction: a disease in which the substances have caused changes in body, mind, and behavior. As a result of this disease, addicted people are unable to control their use of substances despite the negative consequences that occur as a result.
Addiction may be a chronic, relapsing disorder, and as the disease process progresses, recovery becomes increasingly difficult. Chemical dependency occurs most frequently in those who have a family history of the disease. Chemical dependency may cause death if the person does not completely abstain from using alcohol and other mood-altering drugs (HHS/SAMHSA, 1996a).
The DSM-IV distinguishes dependence from abuse primarily by the presence of more abuse symptoms (three or more rather than at least one), and the possible presence of tolerance (needing more of the substance for the same intoxicating effect) or withdrawal (physical symptoms that occur when the substance is not used).
The American Society of Addiction Medicine (ASAM) describes drug dependence as having two possible components:
Psychological dependence, which centers on the user’s need of a drug to reach a level of functioning or feeling of well-being. Due to the subjective nature of this term, it is not very useful in making a diagnosis.
Physical dependence, which refers to the issues of physiologic dependence, establishment of tolerance, and evidence of an abstinence syndrome or withdrawal upon cessation of alcohol or other drug use. Tolerance, dependence, and withdrawal develop differently depending on the particular substance (HHS/SAMHSA, 1994).
A teen’s drug or alcohol abuse may progress to addiction— a chronic, often relapsing, but treatable brain disease. A characteristic of addiction is cravings that tell a person’s brain that continued use is critical for their survival. Cravings are what drive the dependent person to continue to use, despite the damage that it creates in their life and to the lives of those around them.
The Stages of Addiction are Not One-Size-Fits All
Not every individual goes through stages of addiction. For some teens it may be the first drink that creates the chemical dependency, while for others it may take years of chronic abuse before it becomes a physical dependency. One can be become addicted to the point of the dependency being more important than life itself without him or her even realizing it’s gotten that far. Denial and immediate gratification have at times no enemies.
The key is understanding the stages of chemical dependency is variable to the individual. A client sitting in front of you is not a theory but a real, live person with lifelong behavioral cues for coping (for example, a family background in substance use and possible psychological issues).
Photo courtesy of Cassandra Jowett on flickr