Many of the early signs mimic seemingly normal behavior: trying something new, letting off steam, or coping with stress. But addiction is a medical condition that develops in predictable phases. Becoming familiar with them gives you the insight to spot when compulsive alcohol or substance use is turning into something more dangerous—whether for yourself, a loved one, or a friend—and opens the door to getting help sooner rather than later. Let’s take a closer look. 

1. Initiation

Also known as experimentation, this first stage is when a person tries alcohol or drugs for the first time. It might be a one-time event or occasional use sparked by curiosity, peer pressure, or as a way to relieve emotional or physical discomfort.

Signs to Look For:

• Trying substances in social settings.
• Expressing curiosity or excitement about the effects.
• No established pattern of use.

What’s Happening in the Brain

When substances are introduced, the brain releases surges of feel-good chemicals like dopamine and endorphins. This creates an early association between substances and pleasure. The prefrontal cortex, which is responsible for decision-making and impulse control, is still able to regulate behavior at this point. 

Why This Stage Matters

While it might seem harmless, this is where risk begins. Research indicates that “all addictive substances have powerful effects on the brain. These effects account for the euphoric or intensely pleasurable feelings that people experience during their initial use of alcohol or other substances, and these feelings motivate people to use those substances again and again, despite the risks for significant harm.”

2. Regular Use and Reinforcement

Substance use becomes more frequent. It might still seem under control, but it’s happening regularly enough to change behavior and thinking patterns.

Signs to Look For:

• Using substances as a way to unwind or cope with stress.
• Starting to prioritize use in certain routines or social situations.
• Increasing frequency of use, even if not in large quantities.

What’s Happening in the Brain

The reward system in the brain starts to dominate. As substances repeatedly flood the brain with dopamine, the ability to make rational decisions weakens. Over time, the prefrontal cortex begins to lose its regulatory control, and the brain starts to rely on substances to feel normal or cope.

Why This Stage Matters

This is where psychological dependence begins to develop. Individuals may not yet be physically addicted, but their behavior is being shaped by a growing need to feel good—or just feel okay—using substances. Triggers such as stress, social environments, unresolved adverse childhood experiences, or other trauma, reinforce the behavior.

3. Tolerance and Risky Use 

As the brain adapts to regular substance use, it starts requiring more to achieve the same effect. This is called tolerance. With it comes the risk of escalating from moderate use to risky behavior and potentially dangerous levels of consumption.

Signs to Look For:

• Needing more of the substance to feel the same effect
• Engaging in risky behaviors, like driving under the influence or using at work
• Increasing conflict in relationships or declining performance at work or school

What’s Happening in the Brain

With continued use, brain circuits involved in pleasure become less sensitive to dopamine. Substances are needed not just to feel good—but to feel anything at all. At the same time, emotional and stress-related centers of the brain become more reactive, increasing anxiety and dysphoria between uses.

Why This Stage Matters

This is where real danger begins. Risky use often leads to accidents, legal trouble, and irreversible damage to health or relationships. Importantly, this stage is a critical turning point for many people—either toward deeper dependence or toward seeking help.

4. Dependence

At this stage of addiction, substance use is no longer a choice—it’s a necessity. A person may experience serious physical withdrawal symptoms otherwise and feel incapable of coping with life without the substance.

Signs to Look For:

• Feeling unable to stop or cut back despite wanting to.
• Using substances daily or multiple times a day.
• Experiencing preliminary withdrawal symptoms such as anxiety, tremors, insomnia, and excessive sweating.  
• Continued use despite serious consequences.

What’s Happening in the Brain

At this stage, the brain is fully rewired to depend on the substance. The National Institute on Drug Abuse (NIDA) indicates that, “Now, the person needs to keep taking drugs to experience even a normal level of reward, which only makes the problem worse, like a vicious cycle. Also, the person will often need to take larger amounts of the drug to produce the familiar high—an effect known as tolerance.”

Additionally, “this is why a person who misuses drugs eventually feels flat, without motivation, lifeless, and/or depressed, and is unable to enjoy things that were previously pleasurable,” NIDA states. Executive function—responsible for self-control and decision-making—is severely compromised.

Why This Stage Matters

This is when substance use disorder or alcohol use disorder is fully developed. Without professional help, the risk of overdose, serious mental and physical health complications, and even death increases significantly. However, recovery is still possible—and seeking support is a vital first step.

What Can You Expect From Recovery Mountain?

It can be painful to admit that substance use is becoming a problem. But early action can prevent long-term harm. If you or a loved one is showing signs of progressing through these stages, reach out to Recovery Mountain in Tilton. We’re dedicated to helping individuals achieve long-term recovery in New Hampshire. Our board-certified medical professionals provide a range of addiction recovery services, including detoxification, substance and alcohol misuse treatment, and dual diagnosis support. To learn more about our approach, talk to a member of our admissions team today.