Holder, Lennox, and Blose (1992) "the economic benefits of alchoholism treatment" (might have the title wrong.. fact check please? The ramp effect is (my wording) the more a user/abuser uses a given chemical substance, the higher their tolerance, requiring more of the substance for a given effect, and exacerbating any addictive or other adverse health effects, and causing a rapid deterioration in the patient at a certain point. term "Ramp effect" may have originated earlier, anecdotally, but this is the earliest reference I am aware of in medical literature. referred to by Holder, Lennox, and Blose as the "pre-intervention ramp effect"