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Stages of Substance Use

Oct 30, 2016 11:45AM ● Published by MED Magazine

By Chris Sandvig




Often parents will ask about the signs and symptoms of alcohol and drug use in their children. Substance abuse counselors will explore nine critical life areas to assess the progression of the client’s substance use. These critical life areas include Physical, Psychological, Family, Education, Social, Employment, Financial, Spiritual and Legal.



The more substance use-related problems the individual has in any of these nine areas, the farther their substance use has progressed. Parents should look for any significant changes in behavior by their child. This may include falling grades, a change in friends, dropping out of extracurricular activities, disappearance of money or valuables, withdrawal from family, lying, escalation of conflicts at home and a change in appearance or hygiene.



Typically, experts refer to four stages of substance use.  These include Experimentation, Regular Use, Risky Use/Abuse, and Addiction.



During the Experimentation stage of substance use, teens are voluntarily using chemicals without experiencing any negative issues in any of the nine critical life areas. Often during this stage the individual has little to no desire to continue the use of that particular drug. At this time the teen is just using the drug to have “fun” and has control of his/her use.


During the Regular Use stage, teens typically are still able to stop their chemical use on their own. The substance use greatly increases during this stage. The teen starts to engage in risky behaviors such as fighting or driving under the influence. They also may demonstrate symptoms of depression, anxiety or anger.



During the Risky Use/ Abuse stage, the teen is continuing to use substances despite multiple consequences within the nine critical life areas. Their chemical use has started to become their primary focus in their life. This is the stage where many teens start to see their legal issues increase. Parents may see an escalation in problems in the home environment. The teen may start to crave drugs/alcohol, experience some minor withdrawal symptoms and changes in mood when they are not using the drug.



During the Addiction stage, the teen experiences physical dependence of the drug, including an increase in withdrawal symptoms and cravings for the drug. The problems related to their substance use will continue to spread through the nine critical life areas. The teen will be more likely to go against their own value system during this stage. The risks of accidental death or injury, suicide and incarceration greatly increase during this stage.



While a parent can seek help for their teen at any point during these stages of substance use, the earlier a parent recognizes the warning signs and seeks help for their teen the better the chances of the teen discontinuing their substance use. Prevention and Education classes may be sufficient for teens in the Experimentation and Regular Use stages, whereas outpatient or inpatient substance abuse treatment may be required for teens in the Risky Use/Abuse and Addiction stages of substance use.



Experts in adolescent substance problems have identified a common progression of alcohol- and drug-related behaviors that moves from bad to worse. While it is not a foregone conclusion that everyone who experiments with drugs will progress to the worst stages of involvement, a child can incur a lot of damage before parents or others notice that something is wrong.


Secretive adolescent behavior and skillful lying, combined with parental denial may delay identification of the problem. While paranoia and daily inquisitions around the breakfast table are counterproductive, wise parents will keep their eyes and ears open and promptly take action if they see any signs that a problem may be developing.



Stage one: Experimentation

●  Use is occasional, sporadic, often unplanned — weekends, summer nights, unsupervised parties.
●  Use is precipitated by peer pressure, curiosity, thrill-seeking, desire to look and feel grown-up.
●  Gateway drugs are usually used — cigarettes, alcohol, marijuana, possibly inhalants.
●  A drug high is easier to experience because tolerance has not been developed.



Parents may notice:

●   Tobacco or alcohol on the breath or intoxicated behavior.
●   Little change in normal behavior between episodes of drug use.



Stage two: More regular drug use

●  Alcohol and other drugs are used not only on weekends but also on weekdays, and not only with friends but when alone.
●  Quantities of alcohol and drugs increase as tolerance develops; hangovers become more common.
●  Blackouts — periods of time in which drugs or alcohol prevent normal memories from forming — may occur. "What happened last night?" becomes a frequent question.
●  More time and attention are focused on when the next drug experience will occur.
●  Fellow drinkers/drug users become preferred companions.



Parents may notice:

●  A son or daughter will be out of the house later at night, overnight or all weekend.
●  Unexplained school absences and deteriorating school performance.
●  Outside activities such as sports are dropped.
●  Decreased contact with friends who don't use drugs.
●  Disappearance of money or other valuables.
●  Withdrawal from the family, and an increasingly sullen and hostile attitude.
●  The user is caught in one or many lies.



Stage three: Waist deep in the mire of addiction

●  Alcohol and drugs become the primary focus of attention.
●  Becoming high is a daily event.
●  A willingness to try more dangerous drugs or combinations of drugs.
●  More money is spent each week on drugs. Theft or dealing may become part of drug-seeking behavior.
●  Increasing social isolation and loss of contact with non-drug-using friends. More drug use in isolation, rather than at parties or with other users.



Parents may notice the behaviors listed earlier, plus:

●  Escalation of conflicts at home.
●  Loss of nearly all control of the adolescent.
●  Possible discovery of a stash of drugs at home.
●  Arrest(s) for possession of and/or dealing drugs or for driving while intoxicated.



Stage four: Drowning in addiction

●  Constant state of intoxication. Being high or stoned is routine, even at school or a job (if the user even bothers to attend).
●  Blackouts increase in frequency.
●  Physical appearance deteriorates, with noticeable weight loss, infection, and overall poor self-care.
●  Injectable drugs may be part of the user's routine.
●  Involvement in casual sexual relationships, at times in exchange for drugs.
●  User will likely be involved with theft, dealing and other criminal activity.
●  Guilt, self-hatred and thoughts of suicide increase.



Parents are likely to deal with:

●  Complete loss of control of adolescent's behavior and escalation of conflict, possibly to the point of violence.
●  Ongoing denial by the user that drugs are a problem.
●  Increasing problems with the law and time spent with police, attorneys, hearings, court officials, etc.
●  Other siblings negatively affected because the family is preoccupied or overwhelmed by consequences of the drug user's behavior.



This descent into drug hell is a nightmare that no parent envisions while rocking a newborn baby or escorting an eager 5-year-old to kindergarten. But it can happen in any neighborhood, any church, any family, even when parents have provided a stable and loving home environment. In fact, it is often in such homes that a drug problem goes undetected until it's reached an advanced and dangerous stage. This can't be happening; not in my house! But if it does, parental guilt, anger and depression can undermine the responses necessary to restore order.




Chris Sandvig, a commissioned minister, has been working with at risk youth since 1995, and is
  currently employed at Volunteers of America, Dakotas as a Licensed Addictions Counselor

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