Loved-ones of a person so suffers from addiction are often mystified by how chemical dependency snuck up on their spouse, or parent, or child. They say things like, " ...the drinking hasn't always been so bad", or "he drank for years and it's just been in the last few months that it got out of control", or "she used to be the life of the party, now she sneaks around hiding booze and drinking all the time" or "my son experimented with drugs like all his friends, why did they move on with their lives and and he's out on the streets?" ... and so on.
The answer lies in the fact that the disease of addiction doesn't always explode full-blown into a person's life, but has four progressive stages.
If left untreated, the final stage ends in death - addiction is a fatal disease.
Each stage is characterised by the predominant motivation to drink or use, and by what a person hopes their relationship with alcohol or other drugs will bring them.
The name of each stage comes from this motivation:
Stage 1: Pleasure
Stage 2: Relief (from discomforts)
Stage 3: Maintenance (to feel normal)
Stage 4: Escape (to oblivion)
When a person enters the first of these four stages, they have made the transition from a casual (pre-dependent) relationship with alcohol or other drugs to a committed, pathological relationship.
Nothing illustrates this better than a real-life example. The other day I read an article about Todd Fedoruk, a professional hockey player, and his life in addiction. His story tells us what it's like to live through each of the four stages:
Stage 1: the predominant motive is PLEASURE
Virtually every human being enjoys a pleasant mood. That's the motivation behind even the most causal relationship with alcohol or other drugs. Generally, that's why people drink.
But some people experience pleasure that is so rewarding and intense that the casual relationship becomes committed - and pathological. It is the beginning of their illness, and even when the motive is pleasure, there are negative consequences. Here's what Todd Fedoruk experienced:
He remembers being 14 or 15 years old, hanging with a group of older teens when he got drunk for the first time. A shy kid, he was suddenly the center of attention. His social fears and anxieties evaporated one sip at a time. His idea of an alcoholic was some bum under a bridge with a brown bag in his hands, not a blossoming star with his eyes on the NHL.
“What booze did for me at that age, I fell in love with it instantly,” he said. “What I felt that night stayed with me forever. I had found a new friend. And it was alcohol.”
He could have used a more pious sidekick. His drinking increased and he spent a night in jail at 19 because of a bar fight directly related to his alcohol consumption.
Stage 2: the predominant motive is RELIEF from discomforts.
When we hear someone talk about self-medicating, they're usually referring to this stage. That doesn't mean that they are no longer motivated by pleasure - but relief has become the predominant motive to use.
He moved on to harder partying and later nights. His drinking morphed from casual fun to an addiction. That didn’t prevent him from getting drafted. The Flyers made him a seventh-round pick in the 1997 draft.
What drinking did was halt his promotion to the NHL. He was out of control at 20 when the Flyers gave him an ultimatum: Get help or he’d be sent packing.
He did what he could to salvage his career and got clean. He checked into treatment for alcohol and chemical dependency. He was admitted for a 28-day stay, but was let out after only 17 days.
He always felt like he didn’t fit in and was socially awkward around people. In treatment, he found answers and ways to cope that didn’t involve hitting the bottle.
Stage 3: the predominant motive is MAINTENANCE of normalcy
This stage means that a person must maintain a certain level of alcohol or other drugs in their system - just to function in their everyday lives. There's also the fear that if they didn't, the withdrawal could be not only uncomfortable, but life-threatening.
…..One as a brawling hockey player who upheld a code of conduct, one as a devoted family man, and one as a relapsed drug addict who secretly prowled the streets for his next big score. There was no trigger point, no defining incident that sent his life spiralling back out of control. He simply says he lost focus on the big picture of how to maintain his sobriety.
He wanted to be the life of the party.
“I was loud, somewhat obnoxious,” he said. “It was always, let’s go, let’s keep it going. It was 6 a.m. and I was looking for people to wake up and keep going.”
Stage 4: the predominant motive is ESCAPE to oblivion.
This is also called the terminal stage. A person may not be consciously suicidal, but everybody around them knows they just want the pain to end:
“I wanted that oblivion. That’s what I craved, that escape,” he said. “With being sober, everything is real. You’ve got to deal with (stuff).”
“I didn't want to drive anywhere because I was loaded,” he said. “I couldn't stay in the house because I was paranoid. ...
“I knew everything was coming to an end. I didn't care about hockey anymore. I didn't care about my family. I was struck with this feeling of, how the hell did I get back here after everything I've been though? How the hell did I get back in this position again?”
Another way to understand the four stages is like this:
Stage One: Use and Live
Stage Two: Live to Use
Stage Three: Use to Live
Stage Four: Use to Die
You can read the full story: http://www.globeandmail.com/ NHL enforcer Todd Fedoruk opens up about drug abuse, September 9, 2011
For more information about the stages of addiction: The Essentials of Chemical Dependency, Robert M. and Mary McAuliffe (2007)
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