From experimentation to dependency: How substance use can escalate over time

Nobody sets out to develop a problem with alcohol. For many, it begins as experimentation—a drink at a party, a way to unwind after work, or a social ritual that feels normal and harmless. Over time, what starts as occasional can shift into something more habitual. Understanding how substance use can escalate, which often happens gradually and without obvious warning signs, is an important step in recognizing risk and reducing harm.

For many people in the United States, their first encounter with alcohol happens before they’re legally allowed to drink. Underage drinking remains a significant public health concern, with millions of adolescents and young adults reporting risky use. According to 2024 data from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), an estimated 2.9 million people between the ages of 12 and 20 reported binge drinking in the month prior to taking the National Survey on Drug Use and Health, while 576,000 reported heavy alcohol use during that same period. The US Centers for Disease Control and Prevention (CDC) reports that there are numerous negative consequences to underage drinking, including:

• Lower grades and more school absences
• Slower brain development and stunted growth
• Sexually transmitted infections and unplanned pregnancy
• Drinking and driving which can lead to serious injury or death
• Going on to misuse prescription drugs and illegal drugs
• Violence, ranging from suicide and sexual violence up to murder

According to the CDC, people who start drinking early on in life “have a higher risk of using alcohol excessively or developing alcohol use disorder later in life.”

The NIAAA describes alcohol use disorder as a spectrum disorder characterized by an inability to stop or control alcohol use despite negative social, occupational, or health consequences. As a spectrum disorder, it can be mild, moderate, or severe. That said, most times, alcohol use disorder doesn’t happen overnight. Instead, it develops gradually. The Hazelden Betty Ford Foundation, an addiction treatment and advocacy foundation, describes five stages of alcoholism:

• Pre-alcoholic: During this stage, someone might drink to decompress, cope with stress, or to feel more at ease in social situations. This is the stage where dependency starts to creep in.
• Early alcoholic: Someone in the early alcoholic stage might think about drinking often and start hiding or lying about the amounts they drink. At this stage, they might feel defensive or ashamed but unsure how to stop.
• Middle alcoholic: This is where alcohol starts interfering with family, work, and daily life. Someone in this stage will experience mood, behavior, and even appearance changes. They often feel stuck.
• Late alcoholic: This is the most severe stage of alcoholism. Someone in the late alcoholic stage will deal with health issues, find their relationships struggling, and suffer from withdrawal symptoms if they don’t drink. Even at this stage, there is hope for recovery.
• Recovery: Recovery begins with a decision to try. From detoxing to building new relationships and finding support, people struggling with alcohol use disorder can learn to live without alcohol.

Anyone can be at risk for alcohol use disorder, regardless of their age or background. According to the Hazelden Betty Ford Foundation, people with a family history of addiction, people who started drinking underage, people with mental health conditions such as anxiety, depression, or PTSD, and people who have experienced trauma or ongoing stress are at a higher risk for developing alcoholism. Understanding these risk factors can help at-risk individuals make informed choices and seek early support.

Alcohol Awareness Month is an opportunity to raise awareness and notice patterns, risk factors, and moments where support could make a difference. Because alcohol use disorder develops over time, awareness can be a powerful form of prevention. Checking in with yourself or someone you care about, recognizing early warning signs, and reaching out for help can all reduce harm. Small practical steps can engage, support, and open the door to change. No matter where someone falls on the spectrum of alcohol use, support is available, recovery is possible, and it’s never too early or too late to take that first step.

If you’re struggling with alcohol use disorder or substance use disorder, Mass General Brigham Health Plan is here to support you. Depending on your plan’s benefits, you can find behavioral health support through Optum or Lyra. If you’re interested in peer support, we can also connect you with recovery coaches who have been where you are.

For more information or to refer yourself or someone you know to a recovery coach, email us at HealthPlanYourCareCircle@mgb.org or call our Clinical Support Coordinator at 866-456-4059.