The Cycle of Addiction



For many people who find themselves addicted to drugs or alcohol, the process happens very gradually. First, exposure to drugs often occurs in a social context, when people begin spending time with friends who drink or use drugs. Over time, that drug use will come to seem normal and demystified. The friends may offer to share their drugs, and with time, the offer may come to seem appealing.



How It Begins

The Substance Abuse and Mental Health Services Administration (SAMHSA) found in 2013 that, among Americans age 12 or older:

  • 6 million people tried alcohol for the first time (about 12,500 new initiates a day)
    • 84 percent of them were under age 21, and 59 percent were under age 18
  • 1 million people smoked cigarettes for the first time (about 5,700 new initiates a day)
    • 51 percent of new users were under age 18
  • 8 million people used an illegal drug for the first time (about 7,800 new initiates a day)
    • 54 percent of them were under the age of 18, and 58 percent were female
    • 70 percent reported that marijuana was the first drug they tried, and another 20 percent reported that their first drug was psychotherapeutic medication used non-medically

In some cases, this pattern of drug use may be a stable one, with the person only using when drugs are supplied by friends. Some people will take the next step, however, acquiring drugs or alcohol to begin using on their own.

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Research in the Journal of Studies on Alcohol and Drugs found that the reasons reported by adolescents for using alcohol and marijuana included:

  • Having a good time with friends
  • Fitting in with a social or peer group
  • Getting high
  • Wanting to experiment
  • Boredom
  • Relaxing
  • Getting away from problems
  • Coping with anger or frustration
  • Getting through the day
  • Feeling hooked
  • To increase the effects of other drugs
  • To decrease the effects of other drugs
  • To experience feelings of insight

The study also found that social, recreational, coping and drug-altering reasons for using alcohol at age 18 all predicted an increased likelihood of having symptoms of alcohol use disorder at age 35.

Most people who start drinking, however, don’t become alcoholics. SAMHSA reported that out of 137 million current drinkers in 2013, only 23 million drank excessively (as the Centers for Disease Control and Protection (CDC) define excessive drinking). The CDC also found that 90 percent of excessive drinkers were not alcoholics. Such drinking patterns might include binge drinking – drinking until blood alcohol concentration (BAC) reaches 0.08 percent or above, about four drinks for women or five drinks for men – infrequently.

Similarly, most people who use marijuana don’t become addicted – the National Institute on Drug Abuse (NIDA) reports that only about nine percent of people who try marijuana will develop marijuana dependence.

How It Progresses to Addiction

meth-addiction-in-tennesseeAt some point, however, certain people will see their infrequent drug use turn into habitual drug use. This might simply occur gradually over time, or it might happen in response to some form of stress like family conflict, losing a job, or the onset of a mental illness. Genetics also play a role in determining which people are more vulnerable to developing a drug habit.

Meanwhile, for other people, regular drug use is the point – they began taking drugs in the form of a prescribed medication for a legitimate medical condition. The Mayo Clinic found that seven in 10 Americans take prescription drugs, and of them, 13 percent take opiates, which can be highly addictive. Other addictive prescription drugs include stimulants, used to treat conditions like ADHD, and benzodiazepines, used to treat conditions like anxiety.

Although these drugs can treat medical conditions, they can be abused when taken outside of the prescribing doctor’s guidelines:

  • Using prescription drugs without a prescription or drugs that do not belong to you
  • Using prescription drugs in a dosage or at a frequency that exceeds the prescribed guidelines
  • Taking prescription drugs using a different method than recommended, such as crushing the tablets then injecting or snorting them
  • Using prescription drugs to for a different purpose than prescribed, such as to get high

SAMHSA found that in 2013, 6.5 million Americans aged 12 or older (2.5 percent) had used psychotherapeutic drugs for nonmedical purposes in the past month. They also found that in the past year, over two million people were dependent upon or abused prescription drugs.

Long-term use of prescription drugs can also cause changes in the brain. Although people who use prescription drugs according to their doctors’ orders are not addicts, they may still experience dependence upon the drug and, if they try to quit abruptly, withdrawal symptoms. These reflect a series of changes that the drugs have made to the brain.

Changes in the Brain: Tolerance, Dependence and Withdrawal

The brain is a highly delicate network of billions of nerve cells, each of which can have as many as 10,000 connections to other cells. To communicate, nerve cells release chemicals called neurotransmitters, which bind to sites called receptors on other cells and cause changes inside of them, thus passing on the signal. Some drugs work by taking the place of these neurotransmitters – NIDA reports that certain drugs stimulate the receptors two to 10 times as powerfully as the neurotransmitters normally do. Other drugs force nerve cells to dump all their supplies of neurotransmitters, producing an initial spike of signals followed by a crash. Others still act on the transporters that normally recycle neurotransmitters, causing them to run in reverse and pump neurotransmitters out of the cell.

At first, this rush of excess neurotransmitters activating the downstream cells produces powerful effects, such as euphoria or a high. But over-stimulating the cells too often will cause them to take measures to protect themselves against toxic or excessive levels of neurotransmitters. They may reduce their number of receptors or otherwise desensitize their receptors to the effects of the signal.

This can produce an effect called tolerance, in which drug users need to take larger and larger amounts of their drug in order to experience the same high. If the desensitization continues, it can lead to dependence, wherein the baseline level of receptor stimulation gets too low for the person to feel well unless they have the boost from drugs.

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People who are dependent on drugs may experience withdrawal symptoms if they try to quit using all at once instead of tapering off gradually. Withdrawal symptoms usually resemble the mirror of the drug’s effects. This means that people withdrawing from stimulants may feel depressed and lethargic, while people withdrawing from depressants may experience anxiety or seizures. People who use their drug to self-medicate a mental illness like depression or anxiety may also see their condition recur in full force when they try to quit. Many people continue using drugs long past the point where they cease to be pleasurable simply to avoid the symptoms of withdrawal.

In addition to losing sensitivity to the particular type of neurotransmitter that is being overstimulated – such as dopamine, serotonin, endorphin or endocannabinoid – most drugs also have downstream effects on dopamine, the brain’s primary reward neurotransmitter, reports NIDA. Dopamine guides our ability to learn which behaviors to repeat, and when the dopamine system malfunctions, it leads to addiction.

It might be tempting to blame people who have become addicted to drugs for their behavior, but the truth is that addictive behavior is driven by very real malfunctions that have developed deep in the brain. According to NIDA, addiction involves brain regions that control judgment, decision-making, self-control, memory and learning. It’s just harder for addicted people to control drug-seeking behavior than it is for non-addicted people, something that can be hard to understand. The non-addicted brain has great difficulty imagining that it could become an addicted brain, or what that would be like. No person begins using drugs thinking that they will become an addict. Nonetheless, SAMHSA reports that in 2013, at least 21.6 million people experienced substance dependence or abuse.

Consequences of Drug Addiction and the Wakeup Call


Over time, people who are addicted to drugs may have a hard time getting the larger and larger quantities of drugs they need in order to stave off withdrawal and satisfy their addiction. They may also spend increasing amounts of time seeking drugs, using drugs, and recovering from the effects of drugs. These behaviors, coupled with the drug use itself, can lead to a wide range of life problems:

  • Making a scene at social functions while under the influence of drugs
  • Stopping important activities, such as valued hobbies, in order to use drugs
  • Being late to or missing school, work, events or other obligations because of drug use
  • Poor performance at school or work because of drug use, which may lead to job loss
  • Arguments or fights with family, friends, teachers or coworkers
  • Legal problems like getting a DUI or losing custody of children due to drug use
  • Taking physical risks while intoxicated, like driving a car or getting into physical fights
  • Injury from car collisions, falls, burns or other accidents sustained while under the influence of drugs
  • Medical problems from drug use, both mental (such as methamphetamine psychosis) and physical (such as liver damage from alcohol)
  • Overdose, which can be life-threatening

For many people, these problems can serve as a wakeup call that it’s time to change. Some people may make efforts to cut back, or try to quit entirely.


Getting Clean
Descent into Relapse

Such people are far from rare – the Partnership for Drug-Free Kids reports that 10 percent of American adults consider themselves to be in recovery from drug or alcohol problems.

According to research in Addiction on people who had experienced past alcohol dependence:

  • 25 percent were still dependent on alcohol in the past year
  • 3 percent were in partial remission
  • 8 percent were risky drinkers, but no longer had symptoms of alcohol dependence
  • 7 percent were low-risk drinkers without alcohol dependence
  • 2 percent were fully abstinent from alcohol

Quitting some drugs is easier than others – withdrawal from marijuana may just make someone irritable, while withdrawing from opiates is quite unpleasant and withdrawing from alcohol can be life-threatening. With detoxification treatment services, people can receive medication to reduce these symptoms and risks. They can also receive additional support to help ease the process of quitting drugs, like psychotherapy and a structured drug-free environment.

Getting clean is easier than staying clean. For a time, recovering addicts may be able to abstain from drug use or keep their use under control. However, any number of circumstances can tip the scales and begin the slide into relapse:

  • Using small amounts of drugs or alcohol, thinking that this use won’t get out of control
  • Meeting old friends or returning to places associated with drinking or drug use
  • Social situations that encourage drug or alcohol use, like bars, parties, or concerts
  • Encouragement from friends to drink, such as during a toast
  • Accidentally using drugs or alcohol, such as unknowingly drinking rum in punch
  • Times of year that are associated with increased drinking or substance use, like St. Patrick’s Day, April 20th, Halloween, Christmas and New Year’s Eve
  • Sources of stress arising, such as loss of a job, a breakup or divorce, financial difficulties, or legal problems
  • Worsening of mental or physical illness, such as continuing chronic pain from an injury or depression increasing during the winter
  • Using a prescription drug again for initially medical reasons

Relapse is common, especially without treatment – NIDA reports that about 40 to 60 percent of people experiencing addiction will relapse. This is a rate similar to other diseases that require chronic management, like high blood pressure, diabetes and asthma. SAMHSA found that even with treatment, relapse rates remain high – 60 percent of people admitted for substance abuse treatment had received treatment at least once before, and 13 percent had been in treatment five times or more.

As NIDA outlines, for many people, addiction is a chronic illness that requires ongoing management. People living with addiction should expect to cycle many times through relapse and remission in the process of recovery. This is a normal part of the healing process, and no reason to be ashamed.

The reason for these high relapse rates is that quitting simply isn’t enough. For months or years after drug use ends, NIDA reports, situations related to substance use can still trigger powerful cravings in recovering addicts. The brain can recover over time and eventually loses its sensitivity to drugs, NIDA found, but the process is slow and the person is at risk for a long period of time. With even a low level of drug or alcohol exposure, the addictive pathways formed in the brain can be reawakened, triggering old habits and returning the person to substance abuse.

Breaking the Cycle: Getting Treatment

doctor-treatmentResearch in JAMA suggests that many drug treatment options treat substance abuse like an acute condition, such as a broken bone, to be treated a single time, and that this approach is not conducive to long-term recovery. Rather, like other chronic illnesses, even once someone has reached recovery, regular monitoring and care can help maintain this improvement. Medication, ongoing behavioral therapy, and attendance at self-help groups or support groups can all help maintain recovery.

  • Medication. For people who are addicted to opiates, maintenance therapy on buprenorphine (Subutex/Suboxone) or methadone may be helpful. Both offer safe alternatives to addictive and dangerous opiates like heroin or many prescription opiate drugs – in particular, buprenorphine, which has a plateauing effect that makes overdose difficult. Naltrexone is useful for treating both alcohol and opiate dependence, blocking the drugs from causing pleasurable effects. Meanwhile, bupropion (Wellbutrin/Zyban) can reduce cravings for tobacco and methamphetamine. People with co-occurring mental illnesses that are driving drug use may also benefit from the right psychiatric medication.
  • Psychotherapy. Various therapies are useful for treating drug addiction. Motivational Interviewing can help people find their real motivations for beating addiction. Contingency management, also known as motivation incentives, offers a system of prizes or vouchers in exchange for passing drug tests or attending therapy. Cognitive Behavioral Therapy helps people identify the circumstances and stressors that trigger their drug use and learn new, drug-free ways of thinking about and reacting to these triggers. Cognitive Behavioral Therapy is also effective for treating a range of mental illnesses that may be co-occurring.
  • Support groups. Both 12-Step programs and other support groups offer a social support network of peers who also understand the unique trials of addiction. People who attend such groups can share their stories, hear the stories of other addicted people, find mentors, and receive guidance. Such groups are usually not supervised by a therapist.

Call our toll-free number to speak with an admissions coordinator at The Oaks at La Paloma. We understand how gripping addiction can be and want to help you get free from it once and for all. Take the next step and learn more about how our evidence-based treatment programs can help.