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NIDA’s new three-stage addiction model

Posted on 04-05-16 in Addiction, Substance Abuse

NIDA’s new three-stage addiction model

According to the National Institute on Drug Abuse (NIDA) addiction is “a chronic, often relapsing brain disease that causes compulsive drug-seeking and use, despite harmful consequences to the addicted individual and to those around him or her.”

It’s a clear definition, as far as definitions go. But what’s unclear is what exactly addiction does. Sure, we know what addiction causes people to do – make a whole series of bad decisions that result in chronic sickness, financial ruin and even jail time or death – but the why of it is a little more complex than a simple definition.

NIDA’s researchers are attempting to change that with a new paper published in January 2016. The paper, which appeared in The New England Journal of Medicine, outlines a three-stage model of addiction that attempt to explain what happens in the brain during each stage of the disease.

Stage one: Binge and intoxication

Addictive drugs work by altering how the brain functions. Stimulants like methamphetamines and cocaine cause the brain to release massive amounts of the neurotransmitter dopamine, a chemical involved in the brain’s reward system. Other drugs, like heroin, work by imitating natural brain chemicals and interfering with how the brain communicates, allowing dopamine to stay in the system for far longer than it normally would. This excessive amount of dopamine causes the euphoric rush addicts chase.

It’s not just the drug that can be addictive: NIDA’s paper reports that environmental factors associated with drug use play a role in addiction as well. Places and people that a person associates with the pleasures of drug use can cause a dopamine release that in turn creates an urge to use – or even binge on – drugs.

As drug use continues, the body begins to adapt to the drug’s presence, leading to the second stage.

Stage two: Withdrawal and negative affect

NIDA reports the brain begins to adapt to the surges of dopamine drug use causes both by manufacturing lesser amounts of it, which is why addicts stop feeling a drug’s sense of euphoria after extended use. The brain also begins manufacturing more of the chemicals involved in its stress response system. This creates a stronger reaction to stress, causing the often intense discomfort that results when the addict no longer takes the drug.

This is known as withdrawal – eventually drug use becomes a way to escape from withdrawal, rather than to seek pleasure. It’s why many addicts report they continued to use drugs even when it stopped being fun.

Stage three: Preoccupation and anticipation

Dopamine also plays a role in the brain’s areas of higher function. As natural dopamine production is reduced, it affects a person’s self-control, mental flexibility and decision-making skills negatively. Addicts begin to lose their ability to resist certain urges and follow through on their actions. For example: An addict who sincerely wants to stop using drugs may be chemically unable to.

Other factors

According to NIDA, not everyone who uses drugs automatically becomes an addict. In addition to brain chemistry, there are three other factors NIDA identifies as factors of addiction:

  • Biology Studies have shown that genes, ethnicity and gender can play a role in addiction.
  • Environmental factors – Peer pressure, traumatic events and even upbringing influence both drug use and addiction.
  • Development – Adolescents tend to be at higher risk for addiction because their brains are still maturing.

The Sovereign Health Group is a leading provider of rehabilitation and mental health care. Our trained staff of experts can create effective, scientifically based treatment for addiction, and our dual diagnosis approach ensures that the underlying mental issues are treated as well. For more information, please contact our 24/7 helpline.

About the author

Brian Moore is a staff writer and graphic designer for the Sovereign Health Group. A 20-year veteran of the newspaper industry, he writes articles and creates graphics across Sovereign’s portfolio of marketing and content products. Brian enjoys music, bicycling and playing the tuba, which’s he’s done with varying degrees of success for over 25 years. For more information and other inquiries about this media, contact the author and designer at