What is Escalation?

Addicts new to recovery often face a whole world of new terminology. Sometimes when they enter treatment or start attending 12-step meetings, it seems as if the people around them are speaking an entirely different language. One of the new terms that many addicts are confronted with is “escalation.” Escalation is common to all types of addiction – alcoholism, drug addiction, gambling addiction, compulsive shopping, sex addiction, etc. It is caused by an increasing tolerance to the mood altering effects of the addict’s drug/behavior or choice. (There is a very specific neurophysiological process to the development of both tolerance and escalation, but that is not the subject of this blog.) Suffice it to say that addicts, over time, nearly always find themselves doing more of their drug/behavior of choice, and/or turning to more intense substances/experiences to achieve and maintain the neurochemical “high” that they seek.

Consider, for instance, drug addiction. The simple fact is relatively few people shoot heroin right out of the gate. More often, drug addicts begin by using something relatively innocuous. Usually they start by smoking cigarettes, drinking a few beers, or misusing a prescription medication. As time passes, however, their usage escalates. Tobacco cigarettes become marijuana cigarettes, and before the user knows it he’s smoking pot around the clock. Or maybe the girl who occasionally took one of Grandma’s Xanax as a way to mellow out is now stealing Oxycontin (a powerful synthetic opiate) and popping them by the handful. Eventually even that level of use – 24/7 pot smoking or multiple Oxycontin tablets – does not get (or keep) the user high.

So what then?

At some point these users are likely to discover “harder” drugs like crystal meth, cocaine, and heroin, and they use these substances to get the high they used to achieve with much softer substances. Initially they may sprinkle a little bit of cocaine or crystal meth into a joint, or mix a tiny bit of heroin into the pills they’ve learned to crush and snort (for faster, more powerful effect). Before they know it, and usually without ever making a conscious decision to do so, they are cooking and injecting their new drug of choice.

The same basic pattern is apparent with behavioral addicts. Sex addicts, for instance, don’t start out with sexual acting out patterns that ruin their relationships, careers, and lives. Instead, they begin with something relatively “normal” such as viewing and masturbating to online porn. For most people, this is a relatively innocuous adult activity – a little bit like drinking a beer or taking a hit off a joint. However, for individuals predisposed to impulsive, compulsive, and/or addictive behaviors, what begins as harmless fun can, over time, become an all-consuming activity. These people may spend twenty to thirty hours per week (or even more) looking at and masturbating to erotic images and videos. Often they find themselves getting turned on by increasingly more intense or bizarre imagery. Before they know it, they are masturbating to things that didn’t interest them or possibly even disgusted them when they started out. And for some, images and videos are not enough. They start in with webcam sex, virtual sex games, and compulsive in-person encounters – some of which may be dangerous or even illegal.

Simply put, every addiction escalates over time, regardless of whether it is a substance or a behavioral dependence. As a result, addicts neglect important people (spouses, kids, friends), responsibilities (work, school, bills), and life-affirming interests (exercise, hobbies, creativity) to spend hours, sometimes even days “escaping” from life via their addiction. Eventually, the only thing that matters is the high, and an addict will do whatever it takes – no matter the cost – to achieve and maintain that neurochemical rush.

Stopping this destructive cycle nearly always requires outside intervention, such as the counseling services provided by Promises in California or The Ranch in Tennessee. Inpatient treatment followed by ongoing outpatient individual and group therapy, along with appropriate 12-step meetings, is the most common path to lasting sobriety. Unfortunately, addicts rarely seek treatment on their own. More often than not they are forced into seeking help by their families, employers, or the legal system. Sadly, most addicts, when they do finally become willing seek help, end up wishing they’d asked for and accepted assistance long before they actually did.