What Are The Stages Of Addiction? Mental Health, Substance Use, & Addiction Treatment

A person can become addicted to a substance (like alcohol) or a behavior (like gambling). Addictive behaviors can negatively impact a person's mental health, relationships, and overall well-being, and they tend to gradually escalate when there is no intervention. Here, we’ll explore addiction, its key stages, and some options for receiving support. 

What is addiction?

The American Psychological Association defines addiction as “a state of psychological and/or physical dependence on the use of drugs or other substances, such as alcohol, or on activities or behaviors.” The definition also notes that the term is often used as an equivalent for substance use disorder or substance dependence, and that it can be applied to “non-substance-related behavioral addictions, such as sex, exercise, and gambling.”

Defining use, misuse (formerly “substance abuse”), and dependence

Understanding different levels of substance use or potentially addictive behaviors can be important for understanding addiction and its possible stages. Below are a few key definitions:

• Substance use is when a person uses a potentially addictive substance, such as alcohol or drugs. “Use” could also refer to engaging in a potentially addictive behavior, like gambling. Use is not necessarily problematic, as some people can, for example, consume a glass of wine now and again without it becoming a problem.
• Substance misuse (formerly “substance abuse”), according to the American Psychological Association, is “a pattern of compulsive substance use marked by recurrent significant social, occupational, legal, or interpersonal adverse consequences.” Misuse may be a precursor to dependence/addiction.
• Substance dependence is “continued use of a substance despite significant substance-related problems.” It involves “a strong internal drive to continue use, tolerance to the effects of the substance, and withdrawal symptoms if use is suspended.” 

Note that some people may use the term dependence interchangeably with addiction, though a person with a dependence may or may not qualify as having a clinically diagnosable substance use disorder.

Regardless of what diagnosis a person may or may not qualify for, help is available for someone who is concerned about their relationship to certain substances or behaviors, and early intervention may lead to improved outcomes.

Symptoms of substance use disorder (formerly “addiction”) 

Substance use disorder, sometimes colloquially called “addiction,” is a diagnosable mental illness that involves a person having difficulty controlling their use of a substance like drugs or alcohol. Similar disorders, such as gambling disorder, involve the person having challenges controlling their participation in an addictive behavior. 

According to the American Psychiatric Association, substance use disorder and related disorders tend to involve four key types of symptoms:

1. Impaired control, or extreme difficulty controlling their behaviors related to the addiction
2. Social problems, which refers to how addiction symptoms can lead to social withdrawal or relationship issues
3. Dangerous use, or potentially putting oneself in risky situations in order to use 
4. Drug effects, or the need to ingest more and more of a substance (or gamble even more money, etc.) to feel the same effect

Substance use disorders are diagnosable illnesses, not matters of willpower. This type of chronic condition is considered treatable with professional support. 

Other types of addiction: Alcohol, gambling, and more 

While most people think of alcohol and drugs when they hear the word addiction, these are not the only things a person can become addicted to. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) also lists gambling disorder as a diagnosable, addiction-related condition. It tends to involve similar symptoms to substance use disorder but related to gambling behaviors instead of substances. 

There are also other addictions that could negatively affect a person’s life but that aren’t currently listed in the DSM as diagnosable disorders. Examples include:

• Sex addiction
• Pornography addiction
• Social media addiction
• Gaming addiction
• Shopping addiction
• Food addiction

How common is addiction today?

Addiction—whether to a substance or a behavior—is common today. Here are some statistics that reflect the prevalence of addiction in the U.S. today:

• Per the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2024, 48.4 million people aged 12 or older (16.8% of the population) had a substance use disorder (SUD) in the past year.
• Drug overdoses have killed over one million people in the United States alone since 1999.
• Individuals who try an illegal drug before age 15 are 6.5 times more likely to develop a substance use disorder than those who wait until age 21 or later.
• A 2023 study suggests that adults with any history of an adverse childhood experience (ACE), such as abuse, neglect, or witnessing violence, have a 4.3-fold higher likelihood of developing a substance use disorder.
• Between 2–7% of young people will develop a gambling disorder, and around 1% of adults will.

How addiction impacts mental health and other aspects of well-being

To varying degrees, addiction can negatively impact a person's mental health and well-being in many ways. First, substance use disorder is a mental illness that can cause various mental health symptoms as well as emotional distress. Also, 37% of people with a substance use disorder have a co-occurring mental illness. Research suggests that such individuals with a dual diagnosis are at a higher risk of “violence, reduced mental health-related quality of life, law enforcement encounters, homelessness, and incarceration.”

Addiction can also affect social relationships, which can impact mental health. For example, a person with an addiction may self-isolate out of shame, miss family obligations due to addiction symptoms, or negatively impact shared finances due to a drug addiction, gambling addiction, or alcohol addiction. It may also be harder for a person who loses their social relationships due to addiction to receive professional support for their symptoms. Plus, many people living with addiction experience stigma and discrimination related to their condition, which can be isolating, exacerbate symptoms, and delay treatment. 

People experiencing challenges related to drug or alcohol misuse (formerly “drug abuse” or “alcohol abuse”) can also be at an increased risk of various physical health complications, including accidents and injuries as well as illnesses. For example, alcohol use—especially at high levels—can increase a person’s risk of heart attack, liver disease, many types of cancer, and other conditions. 

What are the stages of addiction to alcohol or another substance or behavior?

The stages of addiction to alcohol, another substance, or a specific behavior can take different forms depending on many factors. For example, a person experiencing prescription drug misuse and a person experiencing gambling may have significantly different experiences. That said, some patterns may be common. 

According to American Addiction Centers, the escalating stages of addiction can be defined as:

1. Initial use (or experimentation)
2. Misuse
3. Tolerance
4. Dependence
5. Addiction
6. Relapse

Whatever stages of addiction a person is in, the steps tend to be gradual and progressive, though the speed of addiction can depend on the substance. Addictions may take some time to develop, which is why early intervention can be important. 

How people may experience the stages of addiction differently 

The addictive behavior or substance can have a significant effect on how a person experiences the stages of addiction. The severity of their symptoms, such as frequency or intensity of use, could also affect the stages a person goes through or how quickly they move through them. Each person's experience could be different, but addiction is a serious matter regardless. It's recommended that a person experiencing signs of any type of addiction reach out for professional support as soon as possible. 

How are addiction, withdrawal symptoms, and related concerns treated?

Since each person’s experience with addiction can be different, the most effective treatment is generally the one that’s tailored to the individual's needs. That said, addiction treatment usually involves a few core components:

• Mental health care from a therapist, counselor, or psychiatrist, which can help the person address emotional pain that may be contributing to or resulting from addictive behaviors
• Medical care for those who have developed physical health complications or who may be at risk of serious withdrawal symptoms, which could require inpatient care 
• Social support, such as support groups, group therapy, and emotional and practical support from loved ones 

Seeking therapy as part of addiction treatment

Some form of talk therapy is usually a core component of addiction treatment. A therapist, particularly one who is trained in addiction treatment, can help a person uncover any underlying experiences, negative feelings, or symptoms that may be contributing to addictive behaviors. This may involve processing past trauma, learning healthier coping mechanisms, and receiving treatment for any co-occurring mental health conditions.

There are many different types of talk therapy that may benefit a person experiencing addiction. Cognitive behavioral therapy, motivational interviewing, and acceptance and commitment therapy are just a few examples. 

Exploring online mental health therapy

In some cases, a person experiencing an addiction may need to seek immediate in-person treatment, whether at a hospital or a rehabilitation facility. In other cases, or in earlier stages of addiction, meeting with a therapist online or in person may be the core of an individual's treatment plan. When appropriate, online therapy can be a more convenient way for some people showing signs of addiction to receive mental health support. It could also complement other types of in-person care.

Online therapy can allow a person to receive mental health support from a licensed therapist or counselor remotely, from the comfort of home or anywhere else they have an internet connection. With online therapy, a person can meet with their provider via phone, video, or live chat. Plus, online therapy is often more affordable than in-person therapy without insurance coverage.

Withdrawal symptoms and other factors: When addiction treatment may need to be in person

Withdrawal symptoms from certain substances, like alcohol and drugs, can be serious and life-threatening. Individuals who are addicted to substances, especially those experiencing severe substance use disorders, may need to seek in-person medical care and treatment programs before undertaking the detox process.

What the research says about online therapy 

There's a growing body of research which suggests that online therapy can be an effective form of mental health treatment, with findings often indicating similar outcomes for in-person treatment compared to virtual treatment. In addition, research from 2023 suggests that telehealth “is a promising approach for the treatment of substance use disorders,” though keep in mind that online treatment might not be appropriate for severe substance use disorder.

Takeaway

The stages of addiction can be categorized as initial use/experimentation, misuse, tolerance, dependence, addiction, and relapse. A person can be addicted to substances, alcohol, or certain behaviors like gambling. Treatment for addiction is available and lasting recovery is possible, usually involving therapy, medical care, and/or social support.