Decades of research have provided a better understanding of how addiction occurs and is maintained, which is encompassed in this widely recognized three-stage model.
STAGE 1: Binge/Intoxication After consuming an intoxicating substance, a person experiences its pleasurable effects, which activates the reward circuitry in the brain located in the basal ganglia. Within this group of brain structures, two sub-regions are particularly important in addiction:
- Nucleus accumbens is involved in motivation and the experience of reward. The pleasurable effects of the intoxicating substance reinforce its use and increase the likelihood of addiction developing. During the use of the substance, the brain’s dopamine and opioid systems are affected:
- Dopamine is activated by all addictive substances, but particularly by stimulants such as amphetamines, nicotine or cocaine.
- The brain’s opioid system includes both naturally occurring opioid molecules such as endorphins as well as opioid receptors that play a key role in activating the rewarding effect of substances like opioids and alcohol.
- Dorsal striatum is involved in forming habits and other routine behaviors. Changes in this part of the brain activated by substance use are strengthened as a person’s addiction progresses, thereby contributing to compulsive use of the addictive substance.
STAGE 2: Withdrawal/Negative Affect Here, an individual experiences a negative emotional state—and possible symptoms of physical illness such as nausea or vomiting—when use of the substance has ended.
In this stage, functioning of the brain’s reward system becomes impaired and stress hormones are activated in the extended amygdala. Therefore, continued substance use becomes appealing because of the desire to end uncomfortable emotions and physical symptoms.
STAGE 3: Preoccupation/Anticipation Also known as “craving,” in this stage, a person seeks substances again after a period of abstinence. The brain’s prefrontal cortex, which controls executive functioning (organizing thoughts, prioritizing tasks, making decisions, regulating emotions and impulses, etc.), is heavily involved in this stage. Without adequate executive functioning, a person has more difficulty with reasoning, thinking ahead about consequences and resisting urges to use a substance when cravings arise.
These three stages—which can occur multiple times each day or cycle during weeks or months—reinforce each other, strengthening an individual’s addiction. The good news? A much better understanding of addiction, based upon years of research, informs us of best practices (such as those set forth by the American Society for Addiction Medicine) for providing effective addiction treatment.
First Step Recovery follows best practices for providing quality addiction treatment. If you need help, contact us today!
