5 Stages of the Addiction Cycle

What Is the Addiction Cycle?

The addiction cycle describes the process every addict experiences, from initial use and abuse to addiction and relapse.

Despite the common belief that there are only casual users and full-blown addicts, addiction is a brain disease that occurs in stages. Each stage of addiction involves complex interactions between brain circuits and behaviors.

While slight variations of the addiction cycle exist, they all follow a similar format. By understanding these stages of addiction, loved ones can better identify signs of addiction and stop the cycle.

What Are the 5 Stages in the Addiction Cycle?

The stages of the addiction cycle are based on research from the Substance Abuse and Mental Health Services Administration (SAMSHA), which identified the areas of the brain where these stages occur.

The stages of the addiction cycle are:

1. Initial Use
2. Abuse
3. Tolerance and Dependence
4. Addiction
5. Relapse

These stages of addiction don’t have a set timeline, and the entire cycle may occur over a short period of time or take months or even years to develop, depending on any higher risk factors or existing mental health disorders they face.

Additionally, not everyone experiences Stage 5: Relapse. However, we’ve included it, as relapse can be a typical part of the overall addiction and recovery process.

Addiction Stage 1: Initial Use

The first stage of addiction includes a person’s first time using a substance.

A person’s introduction to drugs and alcohol comes in many forms. For example, initial use could start as prescription medications from a doctor or through peer pressure.

This first use of drugs or alcohol might be all it takes to form an addiction due to the rush of dopamine to certain neurotransmitters in the brain. The individual may continue chasing that rush or high after the drug’s initial use (e.g., using opioids or even drinking alcohol).

However, whether an individual immediately continues through the cycle of addiction depends on many factors like genetics, upbringing, co-occurring physical or mental illness, and social and economic status.

Addiction Stage 2: Abuse

In this next stage of addiction, the individual begins to use the substance repeatedly to feel the positive effects, cope with existing issues, or escape reality.

Addiction truly begins during this stage. Addicts often experience significant changes in their lifestyle and personality to cater to drug or alcohol abuse.

Common signs of the abuse stage of addiction include:

• Being unable to control your substance use
• Constantly thinking about the next time you will use the substance
• Focusing on getting the substance, regardless of the negative consequences
• Abandoning hobbies and activities
• Performing poorly at school or work
• Unexplained financial problems
• Continuing to use the substance despite the adverse effects

Addiction Stage 3: Tolerance and Dependence

At the third stage of the addiction cycle, regular use causes tolerance and physical or psychological dependence on the abused substance.

Tolerance occurs when the brain or body of an addict has changed in response to the substance, requiring higher amounts to achieve the same effect.

Alcohol or drug dependence is when an addict’s body needs the substance to function normally and avoid withdrawal symptoms.

If an individual requires higher doses of the substance or begins experiencing withdrawal if they aren’t using the drug, they are likely in the third stage of the addiction cycle.

Common signs of the tolerance and physical dependence stage of addiction include:

• Requiring higher amounts of a substance to feel the same effect
• Being unable to go without the substance for a short amount of time
• Having intense cravings for the substance
• Experiencing withdrawal symptoms like muscle cramps, fevers, nausea, vomiting, or psychological disturbances

Addiction Stage 4: Addiction

The fourth addiction stage differs from the abuse stage because the person typically realizes they have a substance problem at this point. Their addictive behaviors become so severe that they cannot function without their substance of choice.

At this stage, the addict’s health, financial status, and social life have been severely affected by their addiction.

Common signs of the addiction stage include:

• Using more of the substance despite the harm using it causes
• Having cravings that are impossible to ignore
• Being unable to stop or worrying about stopping your substance abuse
• Spending all of your time using drugs or alcohol
• Going through withdrawals
• Continuing to use despite the health or relationship problems the substance use causes
• Using the substance to the point of blackouts, overdoses, or other medical emergencies
• Using the substance in inappropriate or dangerous areas

Addiction Stage 5: Relapse

In this final stage of addiction, the individual attempts to stop using the substance but experience intense withdrawals. These withdrawals may be so extreme you’re willing to do anything to obtain the substance.

The relapse stage holds most addicts back from achieving full recovery. The National Institute on Drug Abuse (NIDA) reports relapse rates for addiction are around 40–60%. That’s why we include it in these stages of addiction. It should also be noted that relapse can occur before treatment, as many

Relapse is defined to have occurred regardless of whether the addict attempted to stop the drug themselves before seeking treatment or enrolling in a treatment center.

Unfortunately, most people living with addiction experience relapse at least once. But relapse does not equal failure; with the right addiction treatment programs, individuals can break this cycle of addiction.

Treatment During the Addiction Cycle

Substance abuse treatment can begin no matter what stage of addiction you’re currently experiencing. However, the sooner treatment begins, the less intensive the treatment will need to be, and the less harm will be done to your health and relationships.

For individuals in the first two stages of initial use and abuse, outpatient treatment and behavioral health counseling may be all that’s needed to get back on track. Later stages, like stages 3 and 4, may require more involved treatment.

If you’re using certain substances known for dangerous withdrawal symptoms like benzodiazepines or alcohol, medical detox may be required if you’re experiencing tolerance or dependence.

Ask your healthcare professional what option is ideal for the stage of addiction you’re currently in.

Finding Treatment and Breaking the Cycle of Addiction

If you or someone you know shows these signs of addiction or has tried and failed to quit using drugs or alcohol, there is still hope.

Treatment centers are ready to help, no matter your addiction stage.

Visit SAMHSA’s online treatment locator or call (800) 662-4357 to learn about local treatment centers and find the best treatment option for your alcohol or drug addiction.