Drug addiction: Substance use Disorder

Drug addiction, also called substance use disorder, is a disease that affects a person’s brain and behavior and leads to an inability to control the use of a legal or illegal drug or medication. Substances such as alcohol, marijuana, and nicotine also are considered drugs. When you’re addicted, you may continue using the drug despite the harm it causes.

Drug addiction can start with the experimental use of a recreational drug in social situations, and, for some people, the drug use becomes more frequent. For others, particularly with opioids, drug addiction begins with exposure to prescribed medications or receiving medications from a friend or relative who has been prescribed the medication.

The risk of addiction and how fast you become addicted varies by drug. Some drugs, such as opioid painkillers, have a higher risk and cause addiction more quickly than others.

As time passes, you may need larger doses of the drug to get high. Soon you may need the drug just to feel good. As your drug use increases, you may find that it’s increasingly difficult to go without the drug. Attempts to stop drug use may cause intense cravings and make you feel physically ill (withdrawal symptoms).

You may need help from your doctor, family, friends, support groups, or an organized treatment program to overcome your drug addiction and stay drug- free.

Understanding drug addiction

People from all walks of life can experience problems with their drug use, regardless of age, race, background, or the reason they started using drugs in the first place. Some people experiment with recreational drugs out of curiosity, to have a good time, because friends are doing it, or to ease problems such as stress, anxiety, or depression.

However, it's not just illegal drugs, such as cocaine or heroin, that can lead to abuse and addiction. Prescription medications such as painkillers, sleeping pills, and tranquilizers can cause similar problems. In fact, next to marijuana, prescription painkillers are the most abused drugs in the U.S. and more people die from overdosing powerful opioid painkillers each day than from traffic accidents and gun deaths combined. Addiction to opioid painkillers can be so powerful it has become the major risk factor for heroin abuse.

Symptoms of drug addiction

Drug addiction symptoms or behaviors include, among others:

Feeling that you have to use the drug regularly daily or even several times a day
Having intense urges for the drug that block out any other thoughts
Over time, needing more of the drug to get the same effect
Taking larger amounts of the drug over a longer period of time than you intended
Making certain that you maintain a supply of the drug
Spending money on the drug, even though you can’t afford it
Not meeting obligations and work responsibilities, or cutting back on social or recreational activities because of drug use
Continuing to use the drug, even though you know it’s causing problems in your life or causing you physical or psychological harm
Doing things to get the drug that you normally wouldn’t do, such as stealing
Driving or doing other risky activities when you’re under the influence of the drug
Spending a good deal of time getting the drug, using the drug or recovering from the effects of the drug
Failing in your attempts to stop using the drug
Experiencing withdrawal symptoms when you attempt to stop taking the drug

Recognizing unhealthy drug use in family members

Sometimes it’s difficult to distinguish normal teenage moodiness or angst from signs of drug use. Possible indications that your teenager or other family member is using drugs include:

Problems at school or work frequently missing school or work, a sudden disinterest in school activities or work, or a drop in grades or work performance
Physical health issues lack of energy and motivation, weight loss or gain, or red eyes
Neglected appearance lack of interest in clothing, grooming or looks
Changes in behavior exaggerated efforts to bar family members from entering his or her room or being secretive about where he or she goes with friends; or drastic changes in behavior and in relationships with family and friends
Money issues sudden requests for money without a reasonable explanation; or your discovery that money is missing or has been stolen or that items have disappeared from your home, indicating maybe they’re being sold to support drug use

Recognizing signs of drug use or intoxication

Signs and symptoms of drug use or intoxication may vary, depending on the type of drug. Below you’ll find several examples.

Marijuana, hashish and other cannabis-containing substances

People use cannabis by smoking, eating, or inhaling a vaporized form of the drug. Cannabis often precedes or is used along with other substances, such as alcohol or illegal drugs, and is often the first drug tried.

Signs and symptoms of recent use can include:

A sense of euphoria or feeling “high”
A heightened sense of visual, auditory and taste perception
Increased blood pressure and heart rate
Red eyes
Dry mouth
Decreased coordination
Difficulty concentrating or remembering
Slowed reaction time
Anxiety or paranoid thinking
Cannabis odor on clothes or yellow fingertips
Exaggerated cravings for certain foods at unusual times

Long-term (chronic) use is often associated with:

Decreased mental sharpness
Poor performance at school or at work
Reduced number of friends and interests

K2, Spice and bath salts

Two groups of synthetic drugs synthetic cannabinoids and substituted or synthetic cathinones are illegal in most states. The effects of these drugs can be dangerous and unpredictable, as there is no quality control and some ingredients may not be known.

Synthetic cannabinoids, also called K2 or Spice, are sprayed on dried herbs and then smoked, but can be prepared as an herbal tea. Despite manufacturer claims, these are chemical compounds rather than “natural” or harmless products. These drugs can produce a “high” similar to marijuana and have become a popular but dangerous alternative.

Signs and symptoms of recent use can include:

A sense of euphoria or feeling “high”
Elevated mood
An altered sense of visual, auditory and taste perception
Extreme anxiety or agitation
Paranoia
Hallucinations
Heart rate and blood pressure increase or heart attack
Vomiting
Confusion

Substituted cathinones, also called “bath salts,” are mind-altering (psychoactive) substances similar to amphetamines such as ecstasy (MDMA) and cocaine. Packages are often labeled as other products to avoid detection.

Despite the name, these are not bath products such as Epsom salts. Substituted cathinones can be eaten, snorted, inhaled or injected and are highly addictive. These drugs can cause severe intoxication, which results in dangerous health effects or even death.

Signs and symptoms of recent use can include:

Euphoria
Improved sociability
Energy and agitation increased
Increased sex drive
Increased heart rate and blood pressure
Problems thinking clearly
Loss of muscle control
Paranoia
Panic attacks
Hallucinations
Delirium
Psychotic and violent behavior

Barbiturates, benzodiazepines and hypnotics

Barbiturates, benzodiazepines, and hypnotics are prescription central nervous system depressants. They’re often used and misused in search of a sense of relaxation or a desire to “switch off” or forget stress-related thoughts or feelings.

Barbiturates. Examples include phenobarbital and secobarbital (Seconal).
Benzodiazepines. Examples include sedatives, such as diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin) and chlordiazepoxide (Librium).
Hypnotics. Examples include prescription sleeping medications such as zolpidem (Ambien, Intermezzo, others) and zaleplon (Sonata).

Signs and symptoms of recent use can include:

Drowsiness
Slurred speech
Lack of coordination
Irritability or changes in mood
Problems concentrating or thinking clearly
Memory problems
Involuntary eye movements
Lack of inhibition
Slowed breathing and reduced blood pressure
Falls or accidents
Dizziness

Meth, cocaine and other stimulants

Stimulants include amphetamines, meth (methamphetamine), cocaine, methylphenidate (Ritalin, Concerta, others), and amphetamine-dextroamphetamine (Adderall, Adderall XR, others). They are often used and misused in search of a “high,” or to boost energy, to improve performance at work or school, or to lose weight or control appetite.

Signs and symptoms of recent use can include:

Feeling of exhilaration and excess confidence
Increased alertness
Increased energy and restlessness
Behavior changes or aggression
Rapid or rambling speech
Dilated pupils
Confusion, delusions and hallucinations
Irritability, anxiety or paranoia
Changes in heart rate, blood pressure and body temperature
Nausea or vomiting with weight loss
Impaired judgment
Nasal congestion and damage to the mucous membrane of the nose (if snorting drugs)
Mouth sores, gum disease and tooth decay from smoking drugs (“meth mouth”)
Insomnia
Depression as the drug wears off

Club drugs

Club drugs are commonly used at clubs, concerts, and parties. Examples include ecstasy or molly (MDMA), gamma-hydroxybutyric acid (GHB), flunitrazepam (Rohypnol a brand used outside the U.S. also called roofie), and ketamine. These drugs are not all in the same categories, but they share some similar effects and dangers, including long-term harmful effects.

Because GHB and flunitrazepam can cause sedation, muscle relaxation, confusion, and memory loss, the potential for sexual misconduct or sexual assault is associated with the use of these drugs.

Signs and symptoms of use of club drugs can include:

Hallucinations
Paranoia
Dilated pupils
Chills and sweating
Involuntary shaking (tremors)
Behavior changes
Muscle cramping and teeth clenching
Muscle relaxation, poor coordination or problems moving
Reduced inhibitions
Heightened or altered sense of sight, sound and taste
Poor judgment
Memory problems or loss of memory
Reduced consciousness
Increased or decreased heart rate and blood pressure

Hallucinogens

Use of hallucinogens can produce different signs and symptoms, depending on the drug. The most common hallucinogens are lysergic acid diethylamide (LSD) and phencyclidine (PCP).

LSD use may cause:

Hallucinations
Greatly reduced perception of reality, for example, interpreting input from one of your senses as another, such as hearing colors
Impulsive behavior
Rapid shifts in emotions
Permanent mental changes in perception
Rapid heart rate and high blood pressure
Tremors
Flashbacks, a re-experience of the hallucinations even years later

PCP use may cause:

A feeling of being separated from your body and surroundings
Hallucinations
Problems with coordination and movement
Aggressive, possibly violent behavior
Involuntary eye movements
Lack of pain sensation
Increase in blood pressure and heart rate
Problems with thinking and memory
Problems speaking
Impaired judgment
Intolerance to loud noise
Sometimes seizures or coma

Inhalants

Signs and symptoms of inhalant use vary, depending on the substance. Some commonly inhaled substances include glue, paint thinners, correction fluid, felt tip marker fluid, gasoline, cleaning fluids, and household aerosol products. Due to the toxic nature of these substances, users may develop brain damage or sudden death.

Signs and symptoms of use can include:

Possessing an inhalant substance without a reasonable explanation
Brief euphoria or intoxication
Decreased inhibition
Combativeness or belligerence
Dizziness
Nausea or vomiting
Involuntary eye movements
Appearing intoxicated with slurred speech, slow movements and poor coordination
Irregular heartbeats
Tremors
Lingering odor of inhalant material
Rash around the nose and mouth

Opioid painkillers

Opioids are narcotic, painkilling drugs produced from opium or made synthetically. This class of drugs includes, among others, heroin, morphine, codeine, methadone, and oxycodone.

Sometimes called the “opioid epidemic,” addiction to opioid prescription pain medications has reached an alarming rate across the United States. Some people who’ve been using opioids over a long period of time may need physician- prescribed temporary or long-term drug substitution during treatment.

Signs and symptoms of narcotic use and dependence can include:

Reduced sense of pain
Agitation, drowsiness or sedation
Slurred speech
Problems with attention and memory
Constricted pupils
Lack of awareness or inattention to surrounding people and things
Problems with coordination
Depression
Confusion
Constipation
Runny nose or nose sores (if snorting drugs)
Needle marks (if injecting drugs)

Warning signs of prescription drug addiction

In recent years, prescription drug abuse has become an escalating problem, most commonly involving opioid painkillers, anti-anxiety medications, sedatives, and stimulants. Many people start taking these drugs to cope with a specific medical problemtaking painkillers following injury or surgery, for example. However, over time, increased doses are needed to achieve the same level of pain relief and some users can become physically dependent, experiencing withdrawal symptoms if they try to quit.

One of the earliest warning signs of a developing problem is going through the medication at a faster-than-expected rate. In other cases, people start abusing medication not prescribed for them in order to experience a high, relieve tension, increase alertness, or improve concentration.

To avoid developing problems with a prescription medication, it's important to take it only as directed, use the lowest dose for the shortest period possible, and to talk to your doctor about other methods of treating the problem. Being aware of any signs of dependency can help identify prescription drug problems at an early stage and help to prevent them progressing into an addiction.

How drug abuse and addiction develops

There's a fine line between regular drug use and drug abuse and addiction. Very few drug abusers or addicts are able to recognize when they've crossed that line. While frequency or the amount of drugs consumed do not necessarily constitute drug abuse or addiction, they can often be indicators of drug- related problems.

If the drug fulfills a valuable need, you may find yourself increasingly relying on it. You may take illegal drugs to calm or energize yourself or make you more confident. You may start abusing prescription drugs to relieve pain, cope with panic attacks, or improve concentration at school or work. If you are using drugs to fill a void in your life, you're more at risk of crossing the line from casual drug use to drug abuse and addiction. To maintain a healthy balance in your life, you need to have positive experiences and feel good about your life without any drug use.

Drug abuse may start as a way to socially connect. People often try drugs for the first time in social situations with friends and acquaintances. A strong desire to fit in to the group can make it feel like doing the drugs with them is the only option.

Additional reason for drug addiction

Problems can sometimes sneak up on you, as your drug use gradually increases over time. Smoking a joint with friends over the weekend, or taking ecstasy at a rave, or painkillers when your back aches, for example, can change from using drugs a couple of days a week to using them every day. Gradually, getting and using the drug becomes more and more important to you.

As drug abuse takes hold, you may miss or frequently be late for work or school, your job performance may progressively deteriorate, and you may start to neglect social or family responsibilities. Your ability to stop using is eventually compromised. What began as a voluntary choice has turned into a physical and psychological need.

Eventually drug abuse can consume your life, stopping social and intellectual development. This only reinforces feelings of isolation.

With the right treatment and support, you can counteract the disruptive effects of drug use and regain control of your life. The first obstacle is to recognize and admit you have a problem, or listen to loved ones who are often better able to see the negative effects drug use is having on your life.

When to see a doctor

If your drug use is out of control or causing problems, get help. The sooner you seek help, the greater your chances for a long-term recovery. Talk with your primary doctor or see a mental health professional, such as a doctor who specializes in addiction medicine or addiction psychiatry, or a licensed alcohol and drug counselor.

Make an appointment to see a doctor if:

You can’t stop using a drug
You continue using the drug despite the harm it causes
Your drug use has led to unsafe behavior, such as sharing needles or unprotected sex
You think you may be having withdrawal symptoms after stopping drug use

If you’re not ready to approach a doctor, help lines or hotlines may be a good place to learn about treatment. You can find these lines listed on the internet or in the phone book.

When to seek emergency help

Seek emergency help if you or someone you know has taken a drug and:

May have overdosed
Shows changes in consciousness
trouble breathing
seizures or convulsions
Has signs of a possible heart attack, such as chest pain or pressure
Has any other troublesome physical or psychological reaction to use of the drug

Staging an intervention

People struggling with addiction usually deny that their drug use is problematic and are reluctant to seek treatment. An intervention presents a loved one with a structured opportunity to make changes before things get even worse and can motivate someone to seek or accept help.

An intervention should be carefully planned and may be done by family and friends in consultation with a doctor or professional such as a licensed alcohol and drug counselor, or directed by an intervention professional. It involves family and friends and sometimes co-workers, clergy or others who care about the person struggling with addiction.

During the intervention, these people gather together to have a direct, heart- to-heart conversation with the person about the consequences of addiction and ask him or her to accept treatment.

Causes of drug addiction

Like many mental health disorders, several factors may contribute to development of drug addiction. The main factors are:

Environment. Environmental factors, including your family’s beliefs and attitudes and exposure to a peer group that encourages drug use, seem to play a role in initial drug use.
Genetics. Once you’ve started using a drug, the development into addiction may be influenced by inherited (genetic) traits, which may delay or speed up the disease progression.

Changes in the brain

Physical addiction appears to occur when repeated use of a drug changes the way your brain feels pleasure. The addicting drug causes physical changes to some nerve cells (neurons) in your brain. Neurons use chemicals called neurotransmitters to communicate. These changes can remain long after you stop using the drug.

Risk factors

People of any age, sex or economic status can become addicted to a drug. Certain factors can affect the likelihood and speed of developing an addiction:

Family history of addiction. Drug addiction is more common in some families and likely involves genetic predisposition. If you have a blood relative, such as a parent or sibling, with alcohol or drug addiction, you’re at greater risk of developing a drug addiction.
Mental health disorder. If you have a mental health disorder such as depression, attention-deficit/hyperactivity disorder (ADHD) or post-traumatic stress disorder, you’re more likely to become addicted to drugs. Using drugs can become a way of coping with painful feelings, such as anxiety, depression and loneliness, and can make these problems even worse.
Peer pressure. Peer pressure is a strong factor in starting to use and misuse drugs, particularly for young people.
Lack of family involvement. Difficult family situations or lack of a bond with your parents or siblings may increase the risk of addiction, as can a lack of parental supervision.
Early use. Using drugs at an early age can cause changes in the developing brain and increase the likelihood of progressing to drug addiction.
Taking a highly addictive drug. Some drugs, such as stimulants, cocaine or opioid painkillers, may result in faster development of addiction than other drugs. Smoking or injecting drugs can increase the potential for addiction. Taking drugs considered less addicting so-called “light drugs” can start you on a pathway of drug use and addiction.

Complications

Drug use can have significant and damaging short-term and long-term effects. Taking some drugs can be particularly risky, especially if you take high doses or combine them with other drugs or alcohol. Here are some examples.

Methamphetamine, opiates and cocaine are highly addictive and cause multiple short-term and long-term health consequences, including psychotic behavior, seizures or death due to overdose.
GHB and flunitrazepam may cause sedation, confusion and memory loss. These so-called “date rape drugs” are known to impair the ability to resist unwanted contact and recollection of the event. At high doses, they can cause seizures, coma and death. The danger increases when these drugs are taken with alcohol.
Ecstasy or molly (MDMA) can cause dehydration, electrolyte imbalance and complications that can include seizures. Long-term, MDMA can damage the brain.
One particular danger of club drugs is that the liquid, pill or powder forms of these drugs available on the street often contain unknown substances that can be harmful, including other illegally manufactured or pharmaceutical drugs.
Due to the toxic nature of inhalants, users may develop brain damage of different levels of severity.

Other life-changing complications

Dependence on drugs can create a number of dangerous and damaging complications, including:

Getting a communicable disease. People who are addicted to a drug are more likely to get an infectious disease, such as HIV, either through unsafe sex or by sharing needles.
Other health problems. Drug addiction can lead to a range of both short-term and long-term mental and physical health problems. These depend on what drug is taken.
Accidents. People who are addicted to drugs are more likely to drive or do other dangerous activities while under the influence.
Suicide. People who are addicted to drugs die by suicide more often than people who aren’t addicted.
Family problems. Behavioral changes may cause marital or family conflict and custody issues.
Work issues. Drug use can cause declining performance at work, absenteeism and eventual loss of employment.
Problems at school. Drug use can negatively affect academic performance and motivation to excel in school.
Legal issues. Legal problems are common for drug users and can stem from buying or possessing illegal drugs, stealing to support the drug addiction, driving while under the influence of drugs or alcohol, or disputes over child custody.
Financial problems. Spending money to support drug use takes away money from other needs, could lead to debt, and can lead to illegal or unethical behaviors.

Prevention

The best way to prevent an addiction to a drug is not to take the drug at all. If your doctor prescribes a drug with the potential for addiction, use care when taking the drug and follow the instructions provided by your doctor.

Doctors should prescribe these medications at safe doses and amounts and monitor their use so that you’re not given too great a dose or for too long a time. If you feel you need to take more than the prescribed dose of a medication, talk to your doctor.

Preventing drug misuse in children and teenagers

Take these steps to help prevent drug misuse in your children and teenagers:

Communicate. Talk to your children about the risks of drug use and misuse.
Listen. Be a good listener when your children talk about peer pressure, and be supportive of their efforts to resist it.
Set a good example. Don’t misuse alcohol or addictive drugs. Children of parents who misuse drugs are at greater risk of drug addiction.
Strengthen the bond. Work on your relationship with your children. A strong, stable bond between you and your child will reduce your child’s risk of using or misusing drugs.

Preventing a relapse

Once you’ve been addicted to a drug, you’re at high risk of falling back into a pattern of addiction. If you do start using the drug, it’s likely you’ll lose control over its use again even if you’ve had treatment and you haven’t used the drug for some time.

Stick with your treatment plan. Monitor your cravings. It may seem like you’ve recovered and you don’t need to keep taking steps to stay drug-free. But your chances of staying drug-free will be much higher if you continue seeing your therapist or counselor, going to support group meetings and taking prescribed medication.
Avoid high-risk situations. Don’t go back to the neighborhood where you used to get your drugs. And stay away from your old drug crowd.
Get help immediately if you use the drug again. If you start using the drug again, talk to your doctor, your mental health professional or someone else who can help you right away.