Drug addiction; types, effects and control

Drug addiction, also called substance use disorder, is a dependence on a legal or illegal drug or medication. Keep in mind that alcohol and nicotine are legal substances, but are also considered drugs.

When you're addicted, you're not able to control your drug use and you may continue using the drug despite the harm it causes. Drug addiction can cause an intense craving for the drug. You may want to quit, but most people find they can't do it on their own.

Drug addiction can cause serious, long-term consequences, including problems with physical and mental health, relationships, employment, and the law.

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.

SYMPTOMS

Most drug addictions start with experimental use of a drug in social situations. For some people, the drug use becomes more frequent. The risk of addiction and how fast you become dependent varies by drug. Some drugs have a higher risk and cause dependency 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).

Drug addiction symptoms or behaviors include, among others:

• Feeling that you have to use the drug regularly — this can be daily or even several times a day
• Having intense urges for the drug
• Over time, needing more of the drug to get the same effect
• 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
• 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
• Focusing more and more time and energy on getting and using the drug
• Failing in your attempts to stop using the drug
• Experiencing withdrawal symptoms when you attempt to stop taking the drug

Recognizing drug abuse 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
• 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
• Spending money — 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 other 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
• Increased appetite
• Slowed reaction time
• Paranoid thinking

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

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

Synthetic cannabinoids and substituted cathinones

Two groups of synthetic drugs — synthetic cannabinoids and substituted 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
• Relaxation
• An altered sense of visual, auditory and taste perception
• Extreme anxiety or agitation
• Paranoia
• Hallucinations
• Increased heart rate and blood pressure
• Vomiting
• Confusion

Substituted cathinones, also called "bath salts," are psychoactive substances similar to amphetamines such as Ecstasy (MDMA) and cocaine. Despite the name, these are not bath products such as Epsom salts. Substituted cathinones can be eaten, inhaled or injected and are highly addictive. These drugs can cause severe intoxication that results in dangerous health effects or even death.

Signs and symptoms of recent use can include:

• Euphoria
• Increased sociability
• Increased energy and agitation
• Increased sex drive
• Increased heart rate and blood pressure
• Chest pain
• Paranoia
• Panic attacks
• Hallucinations
• Delirium
• Psychotic and violent behavior

Barbiturates and benzodiazepines

Barbiturates and benzodiazepines are prescription central nervous system depressants. They're often used and abused in search for a sense of relaxation or a desire to "switch off" or forget stress-related thoughts or feelings.

Phenobarbital, amobarbital (Amytal) and secobarbital (Seconal Sodium) are examples of barbiturates. Examples of benzodiazepines include sedatives, such as diazepam (Valium), alprazolam (Xanax, Niravam), lorazepam (Ativan), clonazepam (Klonopin) and chlordiazepoxide (Librium).

Signs and symptoms of recent use can include:

• Drowsiness
• Slurred speech
• Lack of coordination
• Euphoria or an exaggerated feeling of well-being
• Problems concentrating or thinking
• Memory problems
• Involuntary eye movements (nystagmus)
• Lack of inhibition
• Slowed breathing and reduced blood pressure
• Dizziness
• Depression

Meth, cocaine and other stimulants

Stimulants include amphetamines, meth (methamphetamine), cocaine and methylphenidate (Ritalin). They are often used and abused 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
• Delusions and hallucinations
• Irritability or changes in mood
• Changes in heart rate and blood pressure
• Nausea or vomiting with weight loss
• Impaired judgment
• Nasal congestion and damage to the mucous membrane of the nose (if snorting drugs)
• Insomnia
• Paranoia
• 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, or roofie) and ketamine. These drugs are not all in the same category, but they share some similar effects and dangers, including long-term harmful effects.

Because GHB and Rohypnol 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
• Reduced inhibitions
• Heightened or altered sense of sight, sound and taste
• Decreased coordination
• 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.

Signs and symptoms of use can include:

• Possessing an inhalant substance without a reasonable explanation
• Brief euphoria or intoxication
• Decreased inhibition
• 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

Narcotic 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. 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:

• Euphoria or feeling "high"
• Reduced sense of pain
• 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
• Sweaty, clammy skin
• Constipation
• Runny nose or nose sores (if snorting drugs)
• Needle marks (if injecting drugs)

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 provider, 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
• 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 in the phone book or on the Internet.

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

• May have overdosed
• Shows changes in consciousness
• Has trouble breathing
• Has 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 they have a problem 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 a 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

Like many mental health disorders, several factors may contribute to development of drug addiction and dependence. 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. However, 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 problems, you're at greater risk of developing a drug addiction.
• Being male. Men are more likely to have problems with drugs than women are. However, progression of addictive disorders is known to be faster in females.
• Having another 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 dependent on drugs.
• Peer pressure. Peer pressure is a strong factor in starting to use and abuse 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.
• Anxiety, depression and loneliness. Using drugs can become a way of coping with these painful psychological feelings and can make these problems even worse.
• Taking a highly addictive drug. Some drugs, such as stimulants, cocaine or painkillers, may result in faster development of addiction than other drugs. However, 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 Rohypnol may cause sedation, confusion and memory loss. These so-called "date rape drugs" are easy to give someone without his or her knowledge or consent and 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. If you're addicted to a drug, you're more likely to drive or do other dangerous activities while under the influence.
• Suicide. People who are addicted to drugs commit suicide more often than people who aren't addicted.
• Family problems. Behavioral changes may cause marital or family strife and custody issues.
• Work issues. Drug use and dependence 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. These are very common for drug users and can stem from buying or possessing illegal drugs, stealing to support your drug addiction, driving while under the influence of drugs or alcohol, or disputes over child custody.
• Financial problems. Spending money to support your drug use takes away money from your other needs, could put you into debt, and can lead to illegal or unethical behaviors.

PREPARING FOR YOUR APPOINTMENT

It may help to get an independent perspective from someone you trust and who knows you well. You can start by discussing your substance use with your primary doctor, or ask for a referral to a specialist in drug addiction, such as a licensed alcohol and drug counselor, or a psychiatrist or psychologist. Take a relative or friend along.

What you can do

To prepare for your appointment:

• Be honest about your drug use. When you have a drug-use problem, it can be easy to downplay or underestimate how much you use and your level of dependence. To get an accurate idea of which treatment may help, be honest with your doctor or other mental health provider.
• Make a list of all medications, vitamins or other supplements that you're taking and the dosages. Tell the doctor about any legal or illegal drugs you're using.
• Prepare questions to ask your doctor.

Basic questions to ask your doctor include:

• What's the best approach to my drug problem?
• Should I see a psychiatrist or other mental health provider?
• Will I need to go to the hospital or spend time as an inpatient or outpatient at a recovery clinic?
• Are there any brochures or other printed material that I can have? What websites do you recommend?
• What are the alternatives to the primary approach that you're suggesting?

Don't hesitate to ask questions anytime during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask:

• What drugs do you use?
• When did your drug use first start?
• How often do you use drugs?
• When you take a drug, how much do you use?
• Do you ever feel that you might have a problem with drugs?
• Have you tried to quit on your own? What happened when you did?
• If you tried to quit, did you have withdrawal symptoms?
• Have any family members criticized your drug use?
• Are you ready to get the treatment needed for your drug problem?

TESTS AND DIAGNOSIS

Diagnosing drug addiction (also called substance use disorder) requires a thorough evaluation and often includes an assessment by a psychiatrist, a psychologist, or a licensed alcohol and drug counselor. Blood, urine or other lab tests are used to assess drug use, but they're not a diagnostic test for addiction. These tests may be used for monitoring treatment and recovery.

For diagnosis of a substance use disorder, most mental health professionals use criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to diagnose mental conditions. This manual is also used by insurance companies to reimburse for treatment.

DSM-5 criteria for substance use disorder include a behavior pattern of drug use that causes significant problems and distress, regardless of what drug is used.

You may have a substance use disorder if at least two of these issues occur within a 12-month period:

• You often take larger amounts of the drug over a longer period of time than you intended
• You want to cut down or quit, but haven't been successful
• You spend a good deal of time getting the drug, using the drug or recovering from the effects of the drug
• You have intense urges for the drug that block out any other thoughts
• You aren't meeting obligations and responsibilities because of your substance use
• You keep using the drug, even though you know it's causing problems in your life
• You give up or cut back important social, occupational or recreational activities because of your substance use
• You use the substance in situations that may be unsafe, such as when driving or operating machinery
• You use the substance even though you know it's causing you physical or psychological harm
• You develop tolerance, which means that the drug has less and less effect on you and you need more of the drug to get the same effect
• You have physical or psychological withdrawal symptoms when you stop taking the drug, or you take the drug (or a similar drug) to avoid withdrawal symptoms

TREATMENTS AND DRUGS

The treatment options explained below can help you overcome an addiction and stay drug-free.

Chemical dependence treatment programs

Treatment programs usually offer:

• Individual, group or family therapy sessions
• A focus on understanding the nature of addiction and preventing relapse
• Levels of care and settings that vary depending on your needs, such as outpatient, residential and inpatient programs

Detoxification

The goal of detoxification, also called "detox" or withdrawal therapy, is to enable you to stop taking the addicting drug as quickly and safely as possible. For some people, it may be safe to undergo withdrawal therapy on an outpatient basis. Others may need admission to a hospital or a residential treatment center.

Withdrawal from different categories of drugs — such as depressants, stimulants or opioids — produces different side effects and requires different approaches. Detoxification may involve gradually reducing the dose of the drug or temporarily substituting other substances, such as methadone, buprenorphine, or a combination of buprenorphine and naloxone.

Counseling

As part of a drug treatment program, counseling — also called talk therapy or psychotherapy — can be done by a psychologist, psychiatrist, or licensed alcohol and drug counselor with an individual, family or group. The therapist or counselor can:

• Help you develop ways to cope with your drug cravings
• Suggest strategies to avoid drugs and prevent relapse
• Offer suggestions on how to deal with a relapse if it occurs
• Talk about issues regarding your job, legal problems, and relationships with family and friends
• Include family members to help them develop better communication skills and be supportive

Self-help groups

Many, though not all, self-help support groups use the 12-step model first developed by Alcoholics Anonymous. Self-help groups, such as Narcotics Anonymous, help people who are addicted to drugs.

The self-help support group message is that addiction is a chronic disorder with a danger of relapse. Self-help support groups can decrease the sense of shame and isolation that can lead to relapse.

Your therapist or counselor can help you locate a self-help group. You may also find support groups in your community or on the Internet.

LIFESTYLE AND HOME REMEDIES

The best way to prevent an addiction to an illegal drug is not to take the drug at all.

Use care when taking an addictive prescription drug. Doctors prescribe these medications at safe doses 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 abuse in children and teenagers

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

• Communicate. Talk to your children about the risks of drug use and abuse.
• 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 abuse alcohol or addictive drugs. Children of parents who abuse 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 abusing 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 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 provider or someone else who can help you right away.

COPING AND SUPPORT

Overcoming an addiction and staying drug-free require a persistent effort. Learning new coping skills and knowing where to find help are essential. Taking these actions can help:

• See a therapist. Pay attention to your mental health. Drug addiction is linked to a number of problems that may be helped with counseling, including other underlying mental health concerns or marriage or family problems. Seeing a therapist or psychiatrist may help you regain your peace of mind and mend your relationships.
• Seek treatment for other mental health disorders. People with other mental health problems, such as depression, are more likely to become addicted to drugs. Seek immediate treatment from a qualified mental health professional if you have any signs or symptoms of mental illness.
• Join a support group. Support groups, such as Narcotics Anonymous or Alcoholics Anonymous, can be very effective in coping with addiction. Compassion, understanding and shared experiences can help you break your addiction and stay drug-free.