Stages of Drug Dependency

September 25, 2017 The Noffs Team Comments

The causes of drug dependency have been subject to numerous theories, and for much of the last century researchers, medical professionals and those working in drug treatment have focused on one in particular. The ‘chemical hooks’ theory of drug dependence argues that there are chemicals in illicit substances that make them naturally addictive, that have an immediate, powerful effect on the body, setting off cravings and making the individual physically need more of the drug. If that were the case though, surely everyone who tried certain substances would be hooked on them.

The reality is, despite the fact that a significant percentage of the world’s population use drugs, a much smaller percentage could actually be classified as drug-dependent.

Regardless, there have been numerous attempts to portray dependency as a likely outcome of drug experimentation. The Gateway Hypothesis, for example, was widely publicised last century as a well-regarded theory, but it is an overly simplistic predictor of harmful drug use that is rarely used these days as a credible explanation for drug dependency. In order to identify how an individual becomes dependent on drugs, it is important to consider the psychosocial factors that can influence a spiral into problematic substance use.

Transition to harmful use

Drug dependency progresses in a series of stages, from occasional recreational use, to impulsive use, to habitual compulsive use [1]. The reward-driven receptors of the brain are enhanced by the drug, particularly the release of dopamine. While this explanation would appear to indicate that the risks for dependence are largely chemical, the strength of reward-driven brain receptors in individuals are largely influenced by social and environmental factors.

Spooner and Hetherington [2] look at the risk factors for developing problematic drug use, and see them as manifesting socially and environmentally during early childhood development.

They use the example of an elevated risk of tobacco and alcohol dependence in people from a lower socioeconomic status (SES) within a context of social marginalisation and lack of access to adequate resources, implying that people use drugs as a stress relief, and become dependent as part of that relief. Poverty alone, however, cannot account for an individual’s progression into harmful drug use.

The influence of social conditions in early development on a person’s risk for harmful substance use may be explained by the theory that strong social attachments and familiar, predictable environments during early development can increase the brain’s resilience when faced with stress [3] and that initial stages of dependency are characterised by psychosocial stress that results from early experiences in an unstable environment with a lack of secure social attachments.

The way in which harmful substance use is perceived has important practical implications for how individuals are treated [4]. Part of understanding how drug dependency works and why people become dependent involves looking at the attractiveness of drugs – specifically the feelings of pleasure derived from them – particularly for individuals using them as a coping mechanism.

Initiation into drug use often begins in adolescence, with curiosity and rebelliousness frequently cited as the reasons for experimenting with a drug. Whilst adolescent drug use isn’t usually a precursor to problematic use, negative social conditions experienced during early childhood can increase the likelihood of the individual developing a dependence on drugs as a method of coping and escape [5], as well as fostering a sense of belonging and acceptance for those who feel isolated or marginalised.


Recovery - in the context of drug dependency – is a relatively vague term, and reaching consensus on an accepted definition has proven difficult [6]. There has been growing agreement, however, that there are many paths to recovery and it is different for each individual [7], and as a whole it involves individuals having access to opportunities to make a change in many areas of their lives, not just their drug use [8 ALSO 9]. This can include health, relationships, housing, employment, and community participation. Indeed, this study [10] surveyed several groups of individuals ranging from those using illicit drugs to those in treatment, and found that all groups emphasised that, for them, recovery involved more than just making changes to their substance use, but also in all areas of their lives.

Despite the apparent cycle of relapse and the nature of drug dependency as a long-term problem, many people do recover, and a significant amount of them manage to do so without any formal treatment [11]. Numerous studies have shown that a high proportion of people with a drug dependency manage to stop using in their thirties, in what is known as the maturation thesis, in which they ‘mature out’ of drug use and it becomes a phase in their lives [12]. This is not the case for all individuals however, and the maturation thesis is only one of a number of ways people recover.

How does the process to recovery often begin? Frykholm (1985) [CITED HERE: 13] identified the first stage in the process as burgeoning feelings of ambivalence towards drug use, where the individual begins to feel the negative effects of their use. These can include deteriorating health, isolation from friends and family, risk of prison, and/or the financial difficulties that come with maintaining their habit. The individual may begin to make attempts to stop, which often are likely to end in relapse.  Upon having access to treatment however, the individual’s attempts to detox may last longer.

Harm reduction is an extremely important part of the overall recovery process, particularly for those individuals who might have come to the realisation that they would like to address their drug dependence but have little idea how to go about doing so. It prioritises an individual’s wellbeing, whilst providing them with opportunities to seek further help. Beyond that, successful recovery involves helping the individual change their outlook on life, with a focus on resilience, potential and hope.

Given the feelings of marginalisation, hopelessness and social isolation that often accompany drug dependency, hope, guidance and relationships are three crucial factors to a person ceasing to be drug-dependent [14].

The strengths perspective model of psychotherapy [15], is a pragmatic, positive approach focusing on an individual’s capabilities and resilience, thereby fostering in them a sense of hope and increased self-determination. The idea is that drug dependency is fuelled by a sense of despair, helplessness and a perceived lack of options, and eliminating these negative feelings by reminding the individual of their value and potential is an important step forward in the recovery process.

A practical example of this and the way it assisted individuals in recovering was discussed by David Peters of ARAFMI NSW [16], in which he referred to a program for residents of a boarding house in Sydney. These residents had a range of complex issues involving harmful drug use, mental health, and housing and financial issues. These issues had led them to exist in a state of marginalisation and social isolation. A number of community programs were offered to them, with the aim of providing an open, non-judgemental atmosphere and fostering a sense of community and belonging. At the beginning of program participation, there was a high rate of intoxication amongst participants, at almost 50%, though this reduced significantly to almost nil as the program continued, and participants reported making friendships, feeling part of a team and a “sense of responsibility” for their duties.

Most participants recalled they decided to join the community programs out of a desire for social interaction and to feel part of a community, and as these feelings existed, so did a sense of inclusion and hope, to the point where their drug use became less relevant and important to them. Whilst the above is one example of assisting individuals through particular stages of the recovery process and in no way accounts for how all individuals may overcome drug dependency, research on risk factors for harmful drug use does suggest that the social support networks, inclusion and feelings of belonging could act as factors assisting recovery or preventing a transition to harmful use in the first place [17].

As crucial as it is to build individuals up and help them realise their value and potential, one study [18] found that, from the perspective of recovering individuals, another important part of the recovery process was not to deny the negative feelings that exist, and instead acknowledge that they will resurface during recovery and develop strategies of coping with and managing them. Participants also acknowledged that focusing too much on confidence and self-belief could increase the chances of relapse, and that it was important to be realistic about the process and retain a small amount of self-doubt.


Drug dependency is a complex, multifaceted health issue, and theories such as chemical hooks and the Gateway Hypothesis provide an overly simplistic explanation for transitioning into harmful use, one that does not account for the acute mental health issues and trauma found to be experienced by many in this demographic.

The roots for transitioning into harmful drug use are often sown early in life, and theories that do not acknowledge this often influence reactive policy (including criminalisation) that has little effect on preventing an individual’s initial transition into harmful use.

Based on evidence presented, we know that recovery is not a one-size-fits-all approach. It is a unique journey for each individual and, as such, requires a comprehensive, holistic strategy that addresses the underlying issues an individual may be dealing with by using drugs.  























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