The Addiction Cycle: How addiction develops
Addiction to drugs and alcohol doesn’t happen all at once. Rather the path to addiction takes several steps that alone may seem innocuous at first. Though the severity of addiction and time it takes to become addicted varies according to the individual and the substance used, addiction always begins with just one use. From there, it can easily slip into habitual and problematic use.
While a single use, or even habitual use, doesn’t necessarily mean a chronic addiction will develop, sometimes circumstances create the perfect conditions to breed addiction. Once it’s started, the cycle of addiction can persist for years, leading to periods of treatment and sobriety and then relapse. Once it’s begun, addiction is much harder to break, which underscores the importance of identifying and understanding the different stages in the addiction cycle.
The first stage of the addiction cycle is the initial use. Not all uses of drugs and alcohol are problematic or likely to result in addiction. For example, sharing a beer with friends on the weekend or taking a prescription painkiller after a major surgery. Whether that first use turns into a problematic habit depends on the individual and the circumstances. Certain risk factors influence whether first use of a substance can spiral, including:
- Mental health issues such as depression or anxiety that substances are used to cope with
- A genetic predisposition to addiction
- Abuse or neglect
- Unstable or unsafe home environment
- Peer group pressure to use substances
Even if first use appears harmless, it’s the first step toward progressing deeper into the cycle of addiction.
Substance abuse begins when a person starts to abuse a substance repeatedly despite the harm it causes. For instance, a person may binge drink every weekend despite having uncomfortable hangovers, or a person may begin to take higher doses of a prescription against doctors’ recommendations.
On the other hand, illicit substances like cocaine or methamphetamine only require one use for the purpose of getting high to constitute abuse. The difference is that there is no medically or socially acceptable use for these “hard” drugs other than to experience a euphoric high.
For many individuals, problematic use of legal substances or use of illicit substances occurs as a way to self-medicate for mental health problems. For example, someone who suffers from social anxiety may do drugs or drink excessively to relieve the discomfort caused by their emotional distress in social situations.
Tolerance marks a dangerous shift in the course of addiction that drastically increases the likelihood of addiction developing. While abuse represents a behavioral shift, tolerance is a physiological change that is much harder to undo. Tolerance occurs when a person has been taking a substance for a long period of time and becomes physically adjusted to the dose, meaning that the same dose no longer has the same effect.
In turn, individuals may increase the amount of substances used or the frequency of use in order to recreate the high they used to experience at lower doses. This is an ongoing and vicious cycle, because it leads to gradual increase in use every time tolerance to a higher dose is developed.
In the brain, tolerance represents a change in functioning and chemical makeup. This could lead to damage to neural receptors or a change in how much of a certain neurotransmitter is produced naturally on a long-term basis. This change precedes physical dependence.
The mind and body are exceptionally adaptable. The same adaptability that promotes the development of tolerance also leads to physical dependence. Over time, the body adjusts to having the substance and can no longer function properly without it. This is the same way that a person becomes dependent on a necessary medication that alleviates symptoms like chronic pain or diabetes.
However, the kind of dependence that characterizes addiction is dysfunctional and causes more harm than it does benefits. Dependence makes it difficult for a person to quit using a substance because reducing or eliminating the substance use causes uncomfortable or even dangerous withdrawal symptoms that may include headaches, vomiting, fever, or digestive problems. To avoid these symptoms, individuals will continue using the substance.
Addiction typically occurs when tolerance and dependence have developed. Addiction is diagnosed as substance use disorder by medical and mental health professionals according to the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5). Signs and symptoms used to diagnose addiction include:
- Uncontrolled use of a substance, such as taking more of a substance than intended
- Being unable to cut back on use despite wanting to
- Continuing substance use despite the social or interpersonal problems it may cause
- Increased time spent obtaining, using, or recovering from substance use
- Reducing time spent on hobbies or other enjoyable activities due to substance use
- Experiencing intense cravings for the substance
- Continuing to use the substance despite its detrimental effects on health or mental health conditions
- Engaging in risky or dangerous behavior when using drugs (like driving drunk or sharing needles)
- Continuing substance use despite it interfering with home or professional duties
- Tolerance as described above
- Dependence as described above
The severity of addiction is determined by the number of diagnostic symptoms exhibited. Someone experiencing more than six symptoms would be diagnosed as having severe substance abuse disorder.
Since addiction is chronic, there is a potential for relapse even after getting clean and sober. According to the National Institute on Drug Abuse, relapse rates are between 40-60%. Though this seems high, it’s actually lower compared to relapse rates for other chronic illnesses like hypertension and asthma.
This is why addiction treatment often focuses on relapse-prevention strategies that can be employed by individuals long after treatment is complete. These strategies may include stress management or having a sober sponsor who you can turn to if you have strong cravings. Though relapse is common in the addiction cycle, it’s possible to break the cycle and regain control over substance abuse. Ongoing treatment can help.
Breaking the addiction cycle
An important component of breaking the addiction cycle involves recognizing the stages as soon as possible. Addiction therapy employs a host of interventions including individual therapy, group therapy, stress management, wellness and nutrition that work together to promote healthier living and to mitigate risk factors that can lead to addiction.
Treatment is designed to give individuals the tools they need to manage their condition at various stages so they can maintain abstinence from substance use in the long run. Continued engagement in addiction prevention and treatment such as Alcoholics Anonymous peer groups can reduce the risk of relapse.