Drug Use Continuum:

Stages of Substance Use

What are the stages of substance use? The following Drug Use Continuum are Stages of Use and are not necessarily a progression showing what will happen, but more of a snapshot as to where the person is at now. Substance users may move back and forth along the continuum with their use being more harmful at times and less harmful at other times. Although for some people it may be a progression, and one that happens fairly quickly.

Two questions to keep in mind:

How serious has the substance using behavior gotten or what is the worst that their use has been?
How long has their substance use been at a serious level? (For a few weeks, for a few months, for a few years, for many years...)

Using the stages as a therapeutic or assessment tool
This "therapeutic tool" or information sheet also works well with the Assessment Bell Curve. The Stages of Use Continuum can help a person decide where they are at, and the Assessment Bell Curve can help a person decide how much help they need. Most research confirms the general belief that if you have hit a point with any drug that you could be considered addicted - then abstinence should remain your goal with regard to that drug – and perhaps other drugs too (due to a phenomenon called cross-addiction).

Five types of Substance Use

1. No Use: The person does not use any mood altering substances. This is either by choice due to never having the chance to use, having a belief or value against using, or having a previously bad experience with drugs or alcohol and deciding that this is not a good thing, for the person to be doing (perhaps ever again).
2. Experimental Use - Novel (new) Experience: The person tries the drug once or twice to experience the effects. The decision to continue using the drug or not depends upon the person's subjective experience. This may include: their first experience with alcohol or other drugs, and they may use because they are curious, their friends are using, or it is available to them. People at this stage usually have a low tolerance to the drug or alcohol and may have recently experienced their first time of being drunk or high. Often young teens get pressured to try alcohol or drugs without even realizing that they are being persuaded to do so. Just being around others who are using, and having the "pressure to want to fit in" can be enough to make some teens try something that they might not otherwise do. Misinformation about how good the drug will make you feel or at least not telling people about the negative consequences is a big part of getting others to try alcohol or drugs for the first time. How many people do you think would choose to smoke cigarettes the first time, if they knew they would be addicted to them later in life?
3. Social Use - Adds to Life - becomes Misuse: The person uses the drug occasionally, and can readily control the use of the drug. Their Major Life Areas not affected. No emotional pain results from the drug use. The drug use patterns, and reactions and consequences of drug use are known and predictable. The person does not use the drug when negative consequences are likely, and there is little or no occurrence of hangover, blackouts, no occurrence of seizures, D.T.'s shakes or other withdrawal symptoms. The person is not worried about the use of the drug. During this stage the person's tolerance to the drug or alcohol begins to increase, and they may develop a pattern of using such as every weekend, or every day after school. The reason for the social gatherings (friends getting together) starts to revolve around the substance use. At this point the person has begun to experience a few negative consequences from using such as a hangover, or missing an appointment, school or work, and tries to set a few self-imposed rules for using such as only using on weekends, only using at certain times, or only using a certain amount.
4. Harmfully Involved - Becomes Life - Compulsive use: The person uses the drug regularly and frequently, uses more of the drug over a longer period of time, makes attempts to control use of the drug but has difficulty doing so, some Major Life Areas are affected, drug use continues despite the appearance of negative drug use patterns and consequences, emotional pain starts to result from the use of the drug, experiences withdrawal symptoms, tolerance begins to increase, minimizes or rationalizes drug use, may deny drug is causing problems, begins to make promises to self and others about quitting or cutting down). The person is beginning to feel that they have less control over their substance use. Their use is now clearly abuse, as they are using more that they intend to use, more frequently than they planned, and are still using despite the problems that their use has caused. They have begun to build up a significant amount of tolerance to the drug and need to use significant amounts to "feel anything." The user has acquired drug paraphernalia such as a crack pipe, meth bong, needles, or even keeps a stash available or a supply of alcohol "handy." They have created rituals for using and obtaining their drug, and starts the day anticipating and planning for substance use. They become more careful about hiding their use from people who may disapprove.
5. Dependent - Takes over Life: The person (uses the drug very regularly and very frequently, feels they have lost control over the use of the drug, most Major Life Areas are affected, drug use patterns and consequences are unknown and unpredictable, strong emotional pain results from continued use of the drug, frequent negative effects of drug use and clear signs of withdrawal when drug use is stopped, very worried about the use of the drug and experiences a sense of helplessness, tolerance either increases or decreases dramatically, minimizes the quantity of drug actually used, has difficulty admitting the full extent of the problems the drug use has caused, tries to quit or seriously cut down but relapses often, tries to change pattern of drug use, becomes continually pre-occupied with thinking about the drug, needs to have a supply always available to prevent panic feelings). The person has broken off contact with family and friends that objected to their substance use. They may still be working or going to school, but are finding it extremely hard to use and "maintain a normal life." If they remain apart of their family system, their use has affected the family in significant ways such that other family members have become enablers, or have made serious attempts to get the person to stop using. There is a lot of tension and stress with non-substance using family and friends. They have built up significant tolerance to the point where they need to drink or use drugs just to "feel normal." Any decrease in use results in significant withdrawal symptoms. They can no longer predict how much they will use or the outcome once they begin using. The user may experience marked periods of binge using and crashing and this pattern of use becomes like a roller-coaster. Their thinking has become a constant obsession with planning for their continues substance use and all of their daily activities seem to revolve around getting or using drugs, and ensuring a sufficient supply. They slowly become more careless about hiding their substance use, as they have lost most of their non-using support systems. They have lost their home, job, relationships, and are now living a subsistence existence. All of their major life areas have been negatively affected. The person spends more and more time by them self and using by them self. They have tried repeatedly to stop or control their use, and may have even attended several treatment programs. Their mental and emotional state has diminished to the point where they may have thought about or attempted suicide. The person needs help and may not even have the "strength" to ask for it anymore as they may feel like a failure from not being able to quit on their own.