People experiment with drugs for many different reasons. Many first try drugs out of curiosity, to have a good time, because friends are doing it, or in an effort to improve athletic performance or ease another problem, such as stress, anxiety, or depression. Use doesn’t automatically lead to abuse, and there is no specific level at which drug use moves from casual to problematic. It varies by individual. Drug abuse and addiction is less about the amount of substance consumed or the frequency, and more to do with the consequences of drug use. No matter how often or how little you’re consuming, if your drug use is causing problems in your life—at work, school, home, or in your relationships—you likely have a drug abuse or addiction problem.
Why do some drug users become addicted, while others don’t?
As with many other conditions and diseases, vulnerability to addiction differs from person to person. Your genes, mental health, family and social environment all play a role in addiction. Risk factors that increase your vulnerability include:
- Family history of addiction
- Abuse, neglect, or other traumatic experiences in childhood
- Mental disorders such as depression and anxiety
- Early use of drugs
- Method of administration—smoking or injecting a drug may increase its addictive potential
Drug abusers often try to conceal their symptoms and downplay their problem. If you’re worried that a friend or family member might be abusing drugs, look for the following warning signs:
Physical warning signs of drug abuse
- Bloodshot eyes, pupils larger or smaller than usual.
- Changes in appetite or sleep patterns. Sudden weight loss or weight gain.
- Deterioration of physical appearance, personal grooming habits.
- Unusual smells on breath, body, or clothing.
- Tremors, slurred speech, or impaired coordination.
Behavioral signs of drug abuse
- Drop in attendance and performance at work or school.
- Unexplained need for money or financial problems. May borrow or steal to get it.
- Engaging in secretive or suspicious behaviors.
- Sudden change in friends, favorite hangouts, and hobbies.
- Frequently getting into trouble (fights, accidents, illegal activities).
Psychological warning signs of drug abuse
- Unexplained change in personality or attitude.
- Sudden mood swings, irritability, or angry outbursts.
- Periods of unusual hyperactivity, agitation, or giddiness.
- Lack of motivation; appears lethargic or “spaced out.”
- Appears fearful, anxious, or paranoid, with no reason.
When a loved one has a drug problem
If you suspect that a friend or family member has a drug problem, here are a few things you can do:
- Speak up. Talk to the person about your concerns, and offer your help and support, without being judgmental. The earlier addiction is treated, the better. Don’t wait for your loved one to hit bottom! Be prepared for excuses and denial by listing specific examples of your loved one’s behavior that has you worried.
- Take care of yourself. Don’t get so caught up in someone else’s drug problem that you neglect your own needs. Make sure you have people you can talk to and lean on for support. And stay safe. Don’t put yourself in dangerous situations.
- Avoid self-blame. You can support a person with a substance abuse problem and encourage treatment, but you can’t force an addict to change. You can’t control your loved one’s decisions. Let the person accept responsibility for his or her actions, an essential step along the way to recovery for drug addiction.
But Don’t
- Attempt to punish, threaten, bribe, or preach.
- Try to be a martyr. Avoid emotional appeals that may only increase feelings of guilt and the compulsion to use drugs.
- Cover up or make excuses for the drug abuser, or shield them from the negative consequences of their behavior.
- Take over their responsibilities, leaving them with no sense of importance or dignity.
- Hide or throw out drugs.
- Argue with the person when they are high.
- Take drugs with the drug abuser.
- Feel guilty or responsible for another’s behavior.
Drug abuse and addiction, broadly, refers to the ingestion of a substance that has psychoactive effects by altering the balance of chemicals in the brain. Typically, people might associate the term ‘drug addiction’ with street drugs, such as heroin, cocaine, methamphetamine and marijuana. However, many more people are addicted to legal drugs such as alcohol, tobacco, and prescription medications.
Drug addiction, or more broadly, substance addiction, is a problem that goes back centuries in civilization. When someone is dependent on a substance, that means that they need the substance to function normally, and stopping taking it all of a sudden will cause withdrawal symptoms. Drug addiction on the other hand, means that someone compulsively uses the substance despite the negative or dangerous effects that result from it’s use. Most addicts are dependent on their substance, but not all dependent persons are addicted. As someone continues to use or abuse the substance, they can develop tolerance to the substance, meaning more and more of it is needed to achieve the same effect.
The cause of drug addiction is not known, however the interplay between a person’s genes, environment, upbringing, and mental health all play a role in whether someone becomes addicted to a substance. People who have mental health problems and who are under emotional stress, or suffering with depression or anxiety are at greater risk for drug addiction, as are people who have family histories of addiction. The National Institutes of health notes that the people who are most likely to abuse or become addicted to drugs include people who:
- Have depression, bipolar disorder, anxiety disorders, and schizophrenia
- Have easy access to drugs
- Have low self-esteem, or problems with relationships
- Live a stressful lifestyle, economic or emotional
- Live in a culture where there is a high social acceptance of drug use
Commonly abused substances include:
- Opiates and narcotics are powerful painkillers that cause drowsiness (sedation) and sometimes feelings of euphoria. These include heroin, opium, codeine, meperidine (Demerol), hydromorphone (Dilaudid), and oxycodone (Oxycontin).
- Central nervous system (CNS) stimulants include amphetamines, cocaine, dextroamphetamine, methamphetamine, andmethylphenidate (Ritalin). These drugs have a stimulating effect, and people can start needing higher amounts of these drugs to feel the same effect (tolerance).
- Central nervous system depressants include alcohol, barbiturates (amobarbital, pentobarbital, secobarbital), benzodiazepines (Valium, Ativan, Xanax), chloral hydrate, and paraldehyde. These substances produce a sedative and anxiety-reducing effect, which can lead to dependence.
- Hallucinogens include LSD, mescaline, psilocybin (“mushrooms”), and phencyclidine (PCP or “angel dust”). They can cause people to see things that aren’t there (hallucinations) and can lead to psychological dependence.
- Tetrahydrocannabinol (THC) is the active ingredient found in marijuana (cannabis) and hashish.
Marijuana Use
The 2009 National Survey on Drug Use and Health reported that 16.7 million Americans aged 12 or older used marijuana at least once in the month prior to being surveyed, and it is the most used illegal drug in the United States. It is cultivated from the buds and flowers of the plant Cannabis sativa, and is most commonly smoked as a cigarette or in a pipe to achieve the short-term psychoactive effects of euphoria, altered consciousness, and many others.
Short term physiological effects include increased heart-rate, dry mouth, red eyes, and muscle relaxation. Negatively, marijuana use can cause distorted perceptions, impaired coordination, difficulty with thinking and problem solving, and problems with learning and memory.
Long-term marijuana users who are trying to quit report withdrawal symptoms including irritability, sleeplessness, decreased appetite, anxiety, and drug craving. Long term health risks of marijuana use include the same respiratory problems as tobacco smokers, such as daily cough and phlegm production, more frequent acute chest illness, and a heightened risk of lung infections. Several studies have confirmed a correlation between long term use and anxiety, psychosis, and depression.
Social problems from marijuana abuse include increase mental health issues, and deficits in cognitive abilities, social life, and career status. Marijuana use for medicinal purposes has been the subject of much study and debate, as the active ingredients in marijuana have therapeutic potential for relieving pain, controlling nausea, stimulating appetite, and decreasing ocular pressure. Many states have medical marijuana programs where patients can access legal marijuana with a doctor’s prescription.
Painkillers
It is estimated that approximately 1 million people in the United States suffer from heroin addiction, and another 1.4 million abuse prescription painkillers such as vicodin, oxycontin, and fentanyl. Opiates, derived from morphine, have been used as painkillers for centuries.
In the presence of chronic pain, users can become quickly addicted to them, as consistent use causes the body to stop making it’s own natural painkillers, called endorphins. When an addict tries to stop using , the resulting withdrawal sickness causes vomiting, insomnia, digestive problems, anxiety, depression, and body aches; and often causes the addict to use again, to alleviate the withdrawal sickness. Overdose can cause respiratory depression and death.
Treatment is achieved with inpatient rehabilitation if possible, along with medications that can help alleviate withdrawal symptoms, such as methadone, Suboxone, Revia, and Subutex. Twelve step addiction recovery (Narcotics Anonymous) is also helpful for maintaining sobriety.
Addiction is common in people with mental health problems. According to reports published in the Journal of the American Medical Association:
- Roughly 50 percent of individuals with severe mental disorders are affected by substance abuse.
- 37 percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness.
- Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs.
Many drug-addicted individuals also have other mental disorders. Because drug abuse and addiction—both of which are mental disorders—often co-occur with other mental illnesses, patients presenting with one condition should be assessed for the other(s). And when these problems co-occur, treatment should address both (or all), including the use of medications as appropriate.
Warning Signs of Commonly Abused Drugs
- Marijuana: Glassy, red eyes; loud talking, inappropriate laughter followed by sleepiness; loss of interest, motivation; weight gain or loss.
- Depressants (including Xanax, Valium, GHB): Contracted pupils; drunk-like; difficulty concentrating; clumsiness; poor judgment; slurred speech; sleepiness.
- Stimulants (including amphetamines, cocaine, crystal meth): Dilated pupils; hyperactivity; euphoria; irritability; anxiety; excessive talking followed by depression or excessive sleeping at odd times; may go long periods of time without eating or sleeping; weight loss; dry mouth and nose.
- Inhalants (glues, aerosols, vapors): Watery eyes; impaired vision, memory and thought; secretions from the nose or rashes around the nose and mouth; headaches and nausea; appearance of intoxication; drowsiness; poor muscle control; changes in appetite; anxiety; irritability; lots of cans/aerosols in the trash.
- Hallucinogens (LSD, PCP): Dilated pupils; bizarre and irrational behavior including paranoia, aggression, hallucinations; mood swings; detachment from people; absorption with self or other objects, slurred speech; confusion.
- Heroin: Contracted pupils; no response of pupils to light; needle marks; sleeping at unusual times; sweating; vomiting; coughing, sniffling; twitching; loss of appetite.
Medication
Treatment medications, such as methadone, buprenorphine, and naltrexone, are available for individuals addicted to opioids, while nicotine preparations (patches, gum, lozenges, and nasal spray) and the medications varenicline and bupropion are available for individuals addicted to tobacco. Disulfiram, acamprosate, naltrexone, and topiramate are medications used for treating alcohol dependence, which commonly co-occurs with other drug addictions. In fact, most people with severe addiction are polydrug users and require treatment for all substances abused. Even combined alcohol and tobacco use has proven amenable to concurrent treatment for both substances.
Psychoactive medications, such as antidepressants, antianxiety agents, mood stabilizers, and antipsychotic medications, may be critical for treatment success when patients have co-occurring mental disorders, such as depression, anxiety disorders (including post-traumatic stress disorder), bipolar disorder, or schizophrenia.
Because they work on different aspects of addiction, combinations of behavioral therapies and medications (when available) generally appear to be more effective than either approach used alone.
Therapies
Behavioral therapies can help motivate people to participate in drug treatment; offer strategies for coping with drug cravings; teach ways to avoid drugs and prevent relapse; and help individuals deal with relapse if it occurs. Behavioral therapies can also help people improve communication, relationship, and parenting skills, as well as family dynamics.
Many treatment programs employ both individual and group therapies. Group therapy can provide social reinforcement and help enforce behavioral contingencies that promote abstinence and a non-drug-using lifestyle. Some of the more established behavioral treatments, such as contingency management and cognitive-behavioral therapy, are also being adapted for group settings to improve efficiency and cost-effectiveness. However, particularly in adolescents, there can also be a danger of iatrogenic, or inadvertent, effects of group treatment; thus, trained counselors should be aware and monitor for such effects.
Because they work on different aspects of addiction, combinations of behavioral therapies and medications (when available) generally appear to be more effective than either approach used alone.
No one should be expected to treat addiction on their own. There are lots of resources that can help:
- Visit a Narcotics Anonymous meeting in your area.
- Recognizing that you have a problem is the first step on the road to recovery, one that takes tremendous courage and strength.
- Facing your addiction without minimizing the problem or making excuses can feel frightening and overwhelming, but recovery is within reach.
- If you’re ready to make a change and willing to seek help, you can overcome your addiction and build a satisfying, drug-free life for yourself.
Support is essential to addiction recovery
Don’t try to go it alone; it’s all too easy to get discouraged and rationalize “just one more” hit or pill. Whether you choose to go to rehab, rely on self-help programs, get therapy, or take a self-directed treatment approach, support is essential. Recovering from drug addiction is much easier when you have people you can lean on for encouragement, comfort, and guidance.
Symptoms of addiction to drugs or other substances may be subtle or overt:
- You’ve built up a drug tolerance. You need to use more of the drug to experience the same effects you used to attain with smaller amounts.
- You take drugs to avoid or relieve withdrawal symptoms. If you go too long without drugs, you experience symptoms such as nausea, restlessness, insomnia, depression, sweating, shaking, and anxiety.
- You’ve lost control over your drug use. You often do drugs or use more than you planned, even though you told yourself you wouldn’t. You may want to stop using, but you feel powerless.
- Your life revolves around drug use. You spend a lot of time using and thinking about drugs, figuring out how to get them, and recovering from the drug’s effects.
- You’ve abandoned activities you used to enjoy, such as hobbies, sports, and socializing, because of your drug use.
- You continue to use drugs, despite knowing it’s hurting you. It’s causing major problems in your life—blackouts, infections, mood swings, depression, paranoia—but you use anyway.