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Stages of Addiction in Adolescents
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In the last section, we discussed the four reasons teenagers are more prone to addiction. These reasons were, we live in an instant-gratification society, the amount of advertising for alcohol and other drugs has more than doubled in the last 15 years, television has produced a passive generation, and alcohol and other drugs are available in all communities.
in this section, we will discuss the four phases of addiction as a "feeling disease." These are, the user discovers substance-induced mood swings, the user seeks a mood swing, harmful dependence, and the user consumes more of the substance to feel ‘normal’.
Dr. Vernon Johnson describes addiction as a "feeling disease" that occurs in a four-phase progression.
Four Phases of the "Feeling Disease"
♦ Phase 1 - Learning Mood Swings
I find that the first of these phases is learning mood-swings. This phase occurs when the addict is first introduced to a potentially addictive substance. As they are introduced, the addict discovers that the drug has the power to produce a mood swing. As you are aware, these mood swings are usually experienced as positive, fun, and rewarding. There is not an emotional cost, pain, or unpleasant consequence associated with this early use.
Suzy, 16, was referred to me after her parents found her passed out on the stairs from alcohol use. When we discussed her first experience with alcohol, Suzy stated, "I found out that one drink made me feel good… but two or three made me feel even better! Every time I drank, I got that same good buzz… it always made me feel happy at first." Suzy discovered that drinking was reliable and quick, and that she could control the degree of her mood swings depending on how much she drank. As you are aware, the hallmark of this early stage is that when the high wears off, the future addict returns to normal feelings and normal living.
♦ Phase 2 - Seeking a Mood Swing
In my experience, the second phase of addiction is seeking a mood swing. In this stage, the user progresses from learning how to use alcohol or other drugs to forming a relationship with alcohol or other drugs. The teen user applies what he or she has learned to social situations.
Suzy told me, "I felt so happy when I was drinking, so I started drinking every time I went to a party. But I gave myself rules- I could only drink at parties on weekends, when I didn’t have school the next day. Sometimes the next day wasn’t so fun… I started getting hangovers. But they always went away in a few hours. And by the end of classes on Friday, I was tasting that first beer. My best friend would drive me to her house right after school. Her parents worked late, so we’d have a couple drinks before heading out to the parties."
As you can see, Suzy was describing the beginning of a regular drinking ritual.
Do you have a client who is going from the "learning a mood swing" stage to establishing a regular drinking ritual?
Although the teen user begins having negative consequences from their drug use at the second phase of forming a relationship with the addiction, they can and do return to normal living and feeling after the high wears off. As you know, many "social drinkers or drug users", misusers, or abusers remain in phase two. They are still capable of choosing and controlling their drug use.
♦ Phase 3 - Harmful Dependence
In addition to the learning and ritual stages, the third phase I have observed is harmful dependence, which signals the presence of the disease of chemical dependence. This is the middle phase of addiction. The addict begins to suffer losses in his or her life directly related to drug use. In this phase, behavior changes take place, and a delusional system develops.
As you are aware, behavior changes include a more intense preoccupation with the drug, growing rigidity of around rituals of using, increased physical tolerance, more creativity in getting and using the drug, and the repeated breaking of self-imposed rules.
Do you need to inform one of your teen clients that the delusional system is made up of psychological defenses, such as denial, rationalization, projection, and minimizing?
Are they aware that the delusional system is also comprised of memory distortions, such as repression, blackouts, and euphoric recall, that combine to prevent the addict from consciously experiencing the pain their drug use is causing. This pain is the result of the high emotional costs that using causes during this phase, such as remorse, guilt, shame, anger, hurt, anxiety, self-hatred, and eventually despair and suicidal thoughts.
Suzy stated, "Sometimes I wouldn’t remember the party from the night before. Or people would tell me I was wasted and puking my guts out, but I would remember having a great time. Sure, I started going to parties on weekdays too, but I would only have a couple beers. I was fine."
During this stage of addiction, friends and family members become enablers. They react to the addict’s behavior in ways that keep him or her from experiencing pain. Suzy’s best friend, Allie, would clean Suzy up when she vomited from drinking too much, and helped Suzy constructs lies to tell her parents about how she had spent the weekend.
As you are aware, the addict in this phase is out of touch with reality in two ways. Their delusional system prevents them from recognizing and acknowledging what is happening, and the enablers support this process.
♦ Phase 4 - Drinking or Using to Feel "Normal"
The fourth phase is drinking or using to feel normal, or what the addict remembers as normal. As you are aware, deterioration occurs in all phases of the addict’s life. The emotional pain becomes overwhelming, and any relief found through the drug is temporary. Often thoughts of suicide, or suicide attempts, occur.
Suzy stated, "my grades started slipping, and most of my friends started avoiding me. I hurt, all the time, and I kept drinking more to try to get back that happy feeling. It didn’t work so good most of the time. I blacked out a lot. I started thinking, maybe I should just get out of everything, you know?"
♦ "How My Problem Served Me" Technique
To help Suzy understand why the ‘good buzz’ mood swing she described led to her relationship with alcohol, I asked her to work through the "How my problem served me" exercise. As you know, the point of an exercise such as this is to get the addict to see how their addiction to alcohol or other drugs has protected them from painful feelings.
First, I asked Suzy to list the ways her alcohol use had served her. I asked her to make a second list of which painful feelings the alcohol had replaced. Suzy stated "I was always tense at parties. A couple of drinks made me relax. When I was scared to approach a boy I liked, alcohol gave me the courage to go up to him. And if he rejected me, I didn’t feel so bad. Most of all though, it made boring weekends or slow parties seem like a blast."
In this section, we have discussed the four phases of addiction as a "feeling disease". These are, the user discovers substance-induced mood swings, the user seeks a mood swing, harmful dependence, and using to feel ‘normal’.
In the next section, we will discuss the seven ways in which chemical dependence in teenagers differs from chemical dependence in adults. These reasons are polydrug use is higher among teens, the reasons teenagers use drugs are more internal, levels of use are harder to determine in teenagers, addiction happens more quickly in teenagers, emotional arrestment takes place earlier in teenagers, the delusional system in teenagers is more complicated, and teenagers have more "built in" enablers than adults.
Peer-Reviewed Journal Article References:
Bekman, N. M., Anderson, K. G., Trim, R. S., Metrik, J., Diulio, A. R., Myers, M. G., & Brown, S. A. (2011). Thinking and drinking: Alcohol-related cognitions across stages of adolescent alcohol involvement. Psychology of Addictive Behaviors, 25(3), 415–425.
Brick, L. A., Redding, C. A., Paiva, A. L., & Velicer, W. F. (2017). Intervention effects on stage transitions for adolescent smoking and alcohol use acquisition. Psychology of Addictive Behaviors, 31(5), 614–624.
Heaton, L. L. (2018). Racial/ethnic differences of justice-involved youth in substance-related problems and services received. American Journal of Orthopsychiatry, 88(3), 363–375.
Hong, J. S., Voisin, D. R., Cho, S., Smith, D. C., & Resko, S. M. (2018). Peer victimization and substance use among African American adolescents and emerging adults on Chicago’s Southside. American Journal of Orthopsychiatry, 88(4), 431–440.
Howard, A. L., Kennedy, T. M., Mitchell, J. T., Sibley, M. H., Hinshaw, S. P., Arnold, L. E., Roy, A., Stehli, A., Swanson, J. M., & Molina, B. S. G. (2020). Early substance use in the pathway from childhood attention-deficit/hyperactivity disorder (ADHD) to young adult substance use: Evidence of statistical mediation and substance specificity. Psychology of Addictive Behaviors, 34(2), 281–292.
Lloyd-Richardson, E. E., Papandonatos, G., Kazura, A., Stanton, C., & Niaura, R. (2002). Differentiating stages of smoking intensity among adolescents: Stage-specific psychological and social influences. Journal of Consulting and Clinical Psychology, 70(4), 998–1009.
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