Curses, diseases, drugs, and poisons can all have effects on a character that continue long past the character's first exposure. This deterioration in physical or mental health is often represented by what is called a “progression track.” Diseases and poisons each have default progression tracks whose steps have specific rules consequences; drugs use the relevant poison track (for example, drugs that affect Wisdom use the Wisdom poison track). Some specific afflictions have their own unique progression tracks defined in their stat blocks. Curses generally do not use progression tracks—their effects continue until they're cured without progressing through stages.

Before an individual is subjected to an affliction, she is considered healthy in terms of the affliction's progression track, if any. When initially is targeted by an affliction, she must succeed at a saving throw to avoid its effects; if she fails, she is subject to the affliction. If the affliction has a progression track, she is no longer considered healthy with respect to that affliction and immediately gains the effects of the first step on its progression track. For diseases, this is the typically the latent state; at this step, the victim can pass the disease along to others if it's contagious, but generally suffers no ill effects from it herself. For poisons, the first step on the progression track is usually the weakened step. A truly deadly affliction might cause the victim to start further along a progression track than normal.

Diseases and poisons each have a listed frequency specifying how often a victim must attempt subsequent saving throws to prevent the affliction from progressing. Success could help the victim recover (see Curing an Affliction below); failure means that the victim moves one step further along its progression track, gaining the effects of the next step and keeping all previous effects. On a failed saving throw, if the victim was affected by a condition as a result of the affliction and that condition was removed (such as by remove condition), the victim regains any conditions from earlier steps along the affliction’s progression track (as well as conditions from the current step). A character using a drug must attempt a saving throw each time she uses that drug. Victims typically fail voluntarily, progressing along the drug's progression track in exchange for benefits, and withdrawal from the drug acts as a disease (see the stat block for Addiction).

Each progression track has an end state—a point at which the affliction has progressed as far as it can. Once an affliction has reached its end state, the victim keeps all current effects (but doesn't suffer further effects) and can no longer attempt saving throws to recover from the affliction (see below). By default, diseases, poisons, and drugs have an end state of dead, but some afflictions have less severe end states, while others might have no end state, allowing victims to continue attempting saves. Some afflictions cause the same effects as a condition (such as sickened). Effects that modify, prevent, or remove those conditions do not apply; only effects and immunities against the appropriate affliction apply.

Curses can be cured only by fulfilling the unique cure conditions listed in their individual stat blocks or through magic.

Usually, the spell remove affliction immediately cures a victim of an affliction (moving the victim of a disease, drug, or poison to a healthy state on its progression track). However, once a disease or poison has reached its end state, only the most powerful magic or technology (such as miracle or wish, or in the most extreme cases, reincarnate or a regeneration chamber) can remove its effects.

Curses

Curses are magical afflictions and usually have a single effect, though some curses use tracks like diseases and poisons do. Removing a curse requires either using remove affliction or fulfilling a special condition that varies by curse (and sometimes differs between individual applications of the same curse).