Stages of Addiction: When Experimentation Becomes an Addiction
What are the stages of addiction? Maybe you've been using a substance for a while and you're wondering if you're addicted. Perhaps you're watching a loved one use drugs or gamble and you're not sure if his use counts as an addiction. Whatever's going on, knowing more about how drug use and other habitual behaviors with addictive potential (e.g., shopping, gambling, sex, porn) can progress would be really helpful. For the sake of keeping things simple, for the rest of this post I'm just going to refer to any habit that may progress through these stages as "drug use" or "substance use," with the understanding that we're also talking about these other habitual behaviors too. Before we dive in, it's really important to note that drug use occurs on a continuum. That is, substance use ranges from the person who tried pot once as a teenager to the out-of-control alcoholic whose life is in chaos. We're often used to thinking about drug use in "either/or" terms. You're either an addict, or you're not. As we'll see, there's a little more to it than that. Here are some other things to keep in mind:
The stages of addiction are not linear; a person may be at one level on the continuum and stay there for most of their lives.
While some people do progress through these stages, many don't. That is, just because you occasionally use marijuana recreationally doesn't mean that you'll become a full-blown addict.
These levels can look a bit differently depending on whether we're talking about substance use or a behavioral habit or addiction like sex or pornography. I'll talk about this when it's appropriate throughout the post.
Experimentation
When a person tries a drug out of curiosity when it is available, she's experimenting with the drug. At this level, she will have had only a few exposures to the drug.
Social/Recreational
With social or recreational use, the individual uses the drug occasionally for certain purposes. The key characteristic at this level is that no pattern of regular use has been established. So, at this stage, someone may drink but only occasionally at social gatherings or holidays. Someone may go to Vegas and play a few hands of blackjack every now and again. Someone may watch porn very occasionally with their spouse as a part of their foreplay together in the context of a healthy, consensual sexual relationship.
Habituation
Habituation occurs when a clear pattern of use has been established but the use doesn't result in any problems. Whether it's having a glass or two of wine with dinner most days of the week, smoking a joint to relax at night, or snorting a half-gram of cocaine on while out with friends on weekends, habitual use involves regular use of a substance with no resultant problems. Let me say that again: At this stage, no problems come about from the individual's drug use. The individual is in full control of their habit. At no point have they lost any ability to reduce or stop their use. "Uh, hang on," you may be saying. "I'm still hanging on the paragraph before last. A glass or two of wine each day? A half-gram of coke on weekends?" Obviously, this is a controversial stage for a number of different reasons. For many people, any regular use of a substance means that the user is an addict. Moreover, as Patt Denning and Jeannie Little have stated, "[o]ther people allow that regular social use of alcohol may not be a problem but consider any use of illicit drugs to be addictive in nature" (p. 58).*
Use of Pornography and Engaging in Sexual Behaviors
At any stage, if one partner in a relationship engages in sexual behaviors without the full knowledge and consent of the other, including even intermittent use of pornography, it can create tremendous problems in the relationship. The non-consenting partner may feel betrayed and hurt; depending on the nature and extent of the behaviors in question, the partner can be significantly traumatized. Sexual behaviors, most commonly the use of pornography, are often pursued in secret and are therefore a breach of trust in relationships. For this reason, even if the other partner doesn't know about these behaviors yet, they're a problem. They breed secrecy and create distance between partners, making true intimacy impossible as one partner is always withholding a part of himself from the relationship.
So even though use of pornography may only be experimental, recreational, or habitual, non-consensual use of pornography can have devastating consequences for intimate relationships.
Abuse
Abuse means persistent use of a substance or engaging in sexual behaviors despite negative consequences. This level is also tricky, because there's no agreement among professionals about what constitutes negative consequences or harm when it comes to illicit substances and even pornography. For example, in line with the example above, some would consider cocaine a drug that is physically harmful enough that any use qualifies as abuse, especially in light of the possible legal consequences of possessing and using it. With regard to pornography, there is often much debate about how harmful pornography is; some argue that pornography can be addictive even after just a few exposures, while others have a different perspective. Sadly, these debates often do not address trauma, family history, genetic predisposition, and other factors that make an individual more vulnerable to substances or pornography; people with more of these vulnerabilities are more likely to develop harmful habits with substances, while others without them may not have a problem. Even here, the drug user is still in control of her habit. The individual is able to make choices about and control her use, the distinction in this stage being that now these choices result in harm.
Dependence (Addiction)
Dependence, or what we usually refer to as addiction as it's clinically defined, means that three factors are present:
Abuse (regular, persistent use despite negative consequences)
Compulsion (loss of control over use)
Relapse potential*
"Relapse potential" means that individuals who are considered dependent or addicted to a substance or behavior are likely to attempt to quit the now out-of-control habit but are very likely to return to it. This means that they've tried and failed to stop using at least once before.
Physiological Dependence
At this stage, the user's body has accommodated to continued use, so that the individual needs more of the drug to experience the same effect. This phenomena is known as tolerance, and it's not unique to substance use. With pornography and sexual addiction, the person will get bored with the behaviors he's used to and will seek out new and more exciting behaviors to experience the same effect. The same-ol' same-ol' just isn't giving his brain the same kick of dopamine it used to. So, he may start viewing more extreme forms of pornography or visit a prostitute for the first time.
Dependence and Pornography/Out-of-Control Sexual Behaviors
This is not to say, however, that a person is physiologically dependent upon problematic sex and pornography use in the same way that those addicted to substances are. The latter need their substance of choice so that their bodies continue to function normally; without it, they go through painful withdrawal as their cells learn to function without the substance. Sex and porn addicts do go through withdrawal, which is usually marked by:
irritability
depression
anxiety
difficulty sleeping
agitation
boredom
anger
emotional discomfort
These symptoms result because the person recovering from sex and pornography addiction is no longer able to self-soothe or cope with difficult feelings using the problematic behaviors they once used.
Persistent Addiction
This term is used to describe those who develop an addiction, fail to change it significantly, and experience significant deterioration as a result.* The pattern of use often brings about chaos in the user's life. People who have persistent addictions tend to be those with the most serious emotional, economic, or social difficulties. Almost always, there's a mental health disorder or issue (dual-diagnosis). They consistently relapse after treatment. *Denning, P. and Little, J. (2012). Practicing Harm Reduction Psychotherapy: An Alternative Approach to Addictions. Second edition. New York: Guilford.