This is part three of the four-part series The Stages of Addiction. Read part two, The Middle Stages of Addiction: Substance Abuse
The late stages of addiction begin when addiction and dependence develop. Addiction and dependence are not the same thing. Addiction is characterized by compulsive drug or alcohol abuse despite the problems the abuse causes. Dependence is characterized by withdrawal symptoms that set in when you stop using a substance. Both are caused by brain changes resulting from chronic, heavy drug or alcohol abuse in the later stages of addiction.
In the later stages of addiction, drugs and alcohol change the activity of brain chemicals known as neurotransmitters. Different drugs act differently on the brain, but one thing they all have in common is that they produce a large dopamine rush.
Dopamine is a “feel-good” brain chemical that’s released when we engage in pleasurable activities like eating delicious food or having sex. It’s designed to keep us motivated to do these things, because in nature, these are the things that keep us alive and procreating.
The brain has natural thresholds for how much dopamine is released during these types of activities. But when we use drugs, the dopamine system is hijacked, and far more dopamine than is natural is released in the brain, leading to feelings of intense euphoria and well-being.
In the late stages of addiction, the learning center of the brain begins to associate drug or alcohol use with this intense pleasure. Eventually, the area of the brain that governs the planning and execution of tasks becomes involved. The ultimate result is intense cravings and drug-seeking behaviors that lead to compulsive use despite the fact that using is causing problems in your life.
These brain changes in the late stages of addiction lead to dysfunctional patterns of thinking and behaving, which further perpetuate the addiction.
Signs and symptoms of addiction include:
- Using more than you intended for longer periods than you intended
- Spending a lot of time seeking, using and recovering from drugs or alcohol
- Repeatedly neglecting duties at home, work or school
- Experiencing relationship problems with friends, family, classmates or co-workers due to your substance use, but using anyway
- Continuing to use drugs or alcohol despite experiencing physical or mental health problems related to your substance use
- Losing interest in activities you once enjoyed
- Experiencing intense cravings for drugs or alcohol
- Using drugs or alcohol in a way that puts you in hazardous situations
- Wanting to cut down or quit but finding that you’re unable to
Once an addiction develops, professional help is almost always needed to end it for the long-term.
Dependence is also the result of brain changes caused by heavy substance abuse in the late stages of addiction. As heavy drug and alcohol use changes neurotransmitter activity, the brain attempts to compensate.
For example, alcohol increases the activity of the relaxation neurotransmitter GABA while decreasing the excitability neurotransmitter glutamate. With heavy abuse, the brain begins to reduce the activity of GABA and increase the activity of glutamate in an attempt to normalize brain function. This results in tolerance, which occurs in the late stages of addiction and is the main indication that dependence is developing.
Tolerance means that you need increasingly larger doses of drugs or alcohol to get the desired effects. But as you increase the dose, the brain continues to compensate, and your tolerance continues to increase, leading again to larger doses. At some point, brain function may shift so that it now operates more comfortably when drugs or alcohol are present. Then, when you stop using, normal brain function rebounds, and this leads to physical withdrawal symptoms.