Apr 06, 2008
You may be hooked emotionally and psychologically. You may have a physical dependence, too. If you have a drug addiction — whether to a legal or illegal drug — you have intense cravings for it. You want to use the drug again and again. When you stop taking it, you may have unpleasant physical reactions.
While not everyone who uses drugs becomes addicted, many people do. Drug addiction involves compulsively seeking to use a substance, regardless of the potentially negative social, psychological and physical consequences. Certain drugs, such as narcotics and cocaine, are more likely to cause physical dependence than are other drugs.
Breaking a drug addiction is difficult, but not impossible. Support from your doctor, family, friends and others who have a drug addiction, as well as inpatient or outpatient drug addiction treatment, may help you beat your drug dependence.
Signs and symptoms
The range of drugs to which you can become addicted is wide. The drugs include:
• Cannabis compounds. These compounds are found in marijuana and hashish.
• Central nervous system depressants. Barbiturates and benzodiazepines are examples of central nervous system depressants. Phenobarbital, amobarbital (Amytal) and secobarbital (Seconal) are examples of barbiturates. Benzodiazepines include tranquilizers such as diazepam (Valium), alprazolam (Xanax), oxazepam (Serax), lorazepam (Ativan), clonazepam (Klonopin) and chlordiazepoxide (Librium).
• Central nervous system stimulants. This class of drugs includes amphetamines, methamphetamine, cocaine and methylphenidate (Ritalin).
• Designer drugs. Synthetic compounds, such as Ecstasy, which has both amphetamine-like and hallucinogenic effects, are included in this category.
• Hallucinogens. LSD, phencyclidine (PCP) and ketamine (special K) are examples of hallucinogens.
• Inhalants. Glue, paint, solvents and nitrous oxide can all be used as inhalant drugs.
• Opioids. Opioids are narcotic, painkilling drugs produced naturally from opium or made synthetically. This class of drugs includes heroin, morphine, codeine, methadone and oxycodone (Oxycontin).
General signs and symptoms
Addiction to any drug may include these general characteristics:
• Feeling that you need the drug regularly and, in some cases, many times a day
• Making certain that you maintain a supply of the drug
• Failing repeatedly in your attempts to stop using the drug
• Doing things to obtain the drug that you normally wouldn't do, such as stealing
• Feeling that you need the drug to deal with your problems
• Driving or doing other activities that place you and others at risk of physical harm when you're under the influence of the drug
The particular signs and symptoms of drug use and dependence vary depending on the type of drug.
Cannabis compounds: Signs and symptoms
• A sense of relaxation and happiness
• A heightened sense of visual, auditory and taste perception
• Poor memory
• Increased blood pressure and heart rate
• Red eyes
• Decreased coordination
• Difficulty concentrating
• Increased appetite
• Slowed reaction time
• Paranoid thinking
Central nervous system depressants: Signs and symptoms
• Slurred speech
• Lack of coordination
• Memory impairment
• Slowed breathing and decreased blood pressure
Central nervous system stimulants: Signs and symptoms
• Decreased appetite
• Rapid speech
• Depression as the drug wears off
• Nasal congestion and damage to the mucous membrane of the nose in users who snort drugs
• Weight loss
• Increased heart rate, blood pressure and temperature
Designer drugs: Signs and symptoms
Signs and symptoms of using designer drugs vary depending on the drug. You might be able to tell that a family member or a friend is using or abusing a drug based on the physical and behavioral signs and symptoms associated with the drug. Ecstasy produces a mild hallucinogenic effect and a feeling of euphoria. It also causes an increased heart rate, overheating, high blood pressure, kidney and liver toxicity, and memory problems.
Hallucinogens: Signs and symptoms
Use of hallucinogens produces different signs and symptoms depending on the drug. The most common hallucinogens are LSD, PCP and ketamine, a so-called "club drug."
Signs and symptoms of LSD use include:
• Greatly impaired perception of reality, for example, interpreting input from one of your senses as another, such as hearing colors
• Permanent mental changes in perception
• Rapid heart rate
• High blood pressure
• Flashbacks, a re-experience of the hallucinations — even years later
Signs and symptoms of PCP use include:
• Loss of appetite
• Aggressive, possibly violent behavior
Signs and symptoms of ketamine use include:
• Increased heart rate
• Nausea and vomiting
• Impaired motor function
• Loss of memory
Inhalants: Signs and symptoms
The signs and symptoms of inhalant use vary depending on what substance is inhaled. Some commonly inhaled substances include glue, paint thinners, correction fluid, felt tip marker fluid, gasoline, cleaning fluids and household aerosol products. When inhaled, these products can cause brief intoxication and a decreased feeling of inhibition. Long-term use may cause seizures and damage to the brain, liver and kidneys. Inhalant use can also cause death.
Opioids: Signs and symptoms
• Reduced sense of pain
• Slowed breathing
• Needle marks (if injecting drugs)
Recognizing drug abuse in teenagers
Possible indications that your teenager is using drugs include:
• School performance. Your child suddenly shows an active dislike of school and looks for excuses to stay home. Contact your school officials to see if your child's attendance record matches what you know about his or her absent days. A student who experiences a drop in performance, possibly failing courses or receiving only minimally passing grades, may be using drugs.
• Physical health. Listlessness and apathy may indicate your child is using certain drugs.
• Appearance. How they look is extremely important to adolescents. A sudden lack of interest in clothing, grooming or looks may be a warning sign of drug use.
• Personal behavior. Teenagers enjoy privacy, but exaggerated efforts to bar family members from entering their rooms or knowing where they go with their friends might indicate drug use. Also, drastic changes in behavior and in relationships with family and friends may signal drug use.
• Money. Sudden requests for money without a reasonable explanation for its use may be a sign of drug use. You may also discover money stolen from previously safe places at home. Items may disappear from your home because they're being sold to support a drug habit.
Drug use or abuse crosses the line into drug addiction when you feel you have to have the drug, and you increase the amount of the drug you take. Various factors, such as your personality, your genetic makeup and peer pressure, affect your likelihood of becoming addicted to a drug. In addition, some drugs, such as heroin and cocaine, more quickly produce a physical addiction than other drugs do for many people.
Physical addiction appears to occur when repeated use of a drug alters reward pathways in your brain. The addicting drug causes physical changes to some nerve cells (neurons) in your brain.
Neurons use chemicals called neurotransmitters to communicate. Neurons release neurotransmitters into the gaps (synapses) between nerve cells; neurotransmitters are received by receptors on other neurons and on their own cell bodies. The changes that occur in this communication process vary with the type of drug to which you're addicted, though researchers have discovered that addictive drugs, such as cocaine and morphine, affect some areas of the brain in the same manner. If further research confirms findings such as this, it would be possible to develop more effective medications to combat addiction to more than one drug.
Here are some of the ways specific drugs may contribute to addiction:
• Cannabis compounds. The main active agent in cannabis compounds, delta-9-tetrahydrocannabinol (THC), affects the neurotransmitter communication process. Some people perceive the effects of THC as enjoyable, and this sensation reinforces use of the drug. For others, THC causes uncomfortable feelings or anxiety, which doesn't reinforce use of the drug.
• Central nervous system depressants. Benzodiazepines and barbiturates produce long-term cellular changes partly by enhancing the actions of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). Released into the synapses, GABA binds to receptors and ultimately lowers cell excitability, which slows down brain activity.
• Central nervous system stimulants. These drugs raise the levels of dopamine and serotonin in the synapses. Brain cells release dopamine as part of the reward system through which you learn to seek stimuli, such as food and sex. Serotonin is a chemical in the brain that regulates mood. Stimulants block the reabsorption of dopamine after its release and can physically alter the sensitivities of some dopamine and serotonin receptors.
• Opioids. These drugs affect the nerve cells of the reward pathways in your brain in ways similar to that of stimulants, producing positive reinforcement for the use of these drugs. There are opioid receptors in the brain, spinal cord and gastrointestinal tract.
These factors increase the likelihood of your having an addiction to a legal or an illegal drug:
• Personality. If you have another psychological problem, such as depression, attention-deficit/hyperactivity disorder and post-traumatic stress disorder, you're more likely to become dependent on drugs. Children who exhibit aggression, a lack of self-control and a difficult temperament may be at greater risk of drug addiction.
• Social environment. Particularly for young people, peer pressure is a strong factor in starting to use and abuse drugs. A lack of attachment with your parents 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.
• Genetics. Drug addiction is more common in some families and likely involves the effects of many genes. If you have family members with alcohol or drug problems, you're at greater risk of developing a drug addiction.
• Type of drug. Some drugs, such as heroin and cocaine, more quickly result in physical addiction than do others.
When to seek medical advice
Addiction is a chronic relapsing disorder, meaning you tend to fall back into old addictive behaviors, including drug use, even after treatment. The sooner you seek help, the greater your chances are for a long-term recovery. If you're initially reluctant to approach a doctor, help lines or hot lines may be a good place to start to learn about treatment. You can find these lines listed in the phone book or on the Internet.
Because denial is often a characteristic of addiction, many people who are addicted to or who abuse drugs won't seek medical treatment on their own. Family members, friends or co-workers may need to persuade the user to undergo screening for drug addiction. Breaking a drug addiction may involve counseling, an outpatient treatment program or residential treatment.
Screening and diagnosis
Diagnosing a drug addiction often starts at the family doctor level, often after one family member has raised concerns about another family member's behavior. Your doctor may ask questions about the frequency of drug use, whether any family member has criticized your drug use or whether you've ever felt you might have a problem.
A definitive diagnosis of drug addiction usually occurs after an evaluation by a psychiatrist, psychologist or a specialized addiction counselor. Blood tests often aren't able to result in a diagnosis of a drug addiction, but these tests can help a doctor detect the presence of a drug when its use has been denied.
Aside from the physical and psychological problems it causes, dependence on drugs can create a number of other disruptions in your life:
• Family. Behavioral changes may cause marital or family strife.
• Work. Work performance may decline, and you may be absent from work more often.
• Social. You may lose or alienate longtime friends.
• School. Academic performance and motivation to excel in school may suffer.
• Legal. Stealing to support your drug addiction and driving while impaired are just two of the possible legal problems drug addiction can cause.
• Financial. Spending money to support your habit takes away money from your other needs, could put you into debt and could lead you into behaviors that are contrary to your values.
• Health. Drug use and addiction has many physical consequences that vary depending on which drug you use. Using drugs may make you more likely to participate in other unsafe behaviors, such as sharing needles or having unprotected sex, which can increase your chances of contracting HIV or hepatitis. People who are addicted to drugs are also at a higher risk of overdosing because addicts need more and more of the drug to achieve the same feeling.
Treatment typically involves steps to help you withdraw from using the drug, followed by counseling and attending self-help groups to help you resist using the addictive drug again.
The goal of withdrawal therapy (detoxification) is for you to stop taking the addicting drug as quickly and safely as possible. Detoxification may involve gradually reducing the dose of the drug or temporarily substituting other substances, such as methadone, that have less severe side effects. For some people, it may be safe to undergo withdrawal therapy on an outpatient basis; others may require placement in a hospital or a residential treatment center.
Withdrawal from different categories of drugs produces different side effects and requires different approaches.
• Central nervous system depressants. Minor side effects of withdrawal may include restlessness, anxiety, sleep problems and sweating. More serious signs and symptoms also could include hallucinations, whole-body tremors, seizures, and increased blood pressure, heart rate and body temperature. The most serious stage of withdrawal may include delirium, which is potentially life-threatening. Withdrawal therapy may involve gradually scaling back the amount of the drug.
• Central nervous system stimulants. Side effects of withdrawal typically include depression, fatigue, anxiety and intense cravings. In some cases, signs and symptoms may include suicidal thoughts and suicide attempts, paranoia and impaired contact with reality (acute psychosis). Treatment during withdrawal is usually limited to emotional support from your family, friends and doctor. Your doctor may recommend medications to treat paranoid psychosis or depression.
• Opioids. Side effects of withdrawal of opioids, such as heroin, morphine, oxycodone or codeine, can range from relatively minor to severe. On the minor end, they may include runny nose, sweating, yawning, feeling anxiety and craving the drug. Severe reactions can include sleeplessness, depression, dilated pupils, rapid pulse, rapid breathing, high blood pressure, abdominal cramps, tremors, bone and muscle pain, vomiting, and diarrhea. Doctors may substitute a synthetic opiate, such as methadone, to reduce the craving for heroin and to gently ease people away from heroin. The most recently approved medication to ease withdrawal from opiates is buprenorphine (Suboxone, Subutex). Buprenorphine is a milder opioid that was approved in the United States to manage cravings in individuals who decide to stop using stronger opiates. This drug is the first narcotic medication used for the treatment of addiction that may be prescribed in a doctor's office rather than a treatment center.
After detoxification, therapies such as counseling, addiction treatment programs and self-help group meetings can help you stay sober.
• Counseling. Individual or family counseling with a psychologist, psychiatrist or addiction counselor may help you resist the temptation to resume using addicting drugs. Behavior therapies can help you develop ways to cope with your drug cravings, suggest strategies to avoid drugs and prevent relapse, and offer suggestions on how to deal with a relapse if it occurs. Counseling also can involve talking about your job, legal problems and relationships with family and friends. Counseling with family members can help them to develop better communication skills and to be more supportive.
• Treatment programs. Treatment programs generally include educational and therapy sessions focused on establishing sobriety and preventing relapse. This may be accomplished in individual, group or family sessions. These programs are available in various settings from outpatient to residential and inpatient programs.
• Self-help groups. Many, though not all, of these groups tend to use the 12-step model first developed by Alcoholics Anonymous. Self-help groups, such as Narcotics Anonymous, exist for people addicted to drugs, such as cocaine, sedatives and narcotics. The message is that addiction is a chronic disorder with a danger of relapse and that ongoing maintenance treatment — which may include medications, counseling and attending self-help group meetings — is necessary to prevent a relapse. Your doctor or counselor can help you locate a self-help group. You also can find listings for self-help groups in the phone book, at the library and on the Internet.
The best way to prevent an addiction to an illegal drug is not to take the drug at all. Your doctor may prescribe narcotics to relieve pain, benzodiazepines to relieve anxiety or insomnia, or barbiturates to relieve nervousness or irritation. 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.
Parents can take the following steps to help prevent drug dependency in their children:
• 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.
Along with counseling and attending self-help groups, talk with your doctor or counselor about other ways you can boost your chances of staying drug-free. Following are some suggestions:
• Give yourself time. For most people, it takes about three months before significant improvement occurs, so don't give up on your treatment program too soon.
• Promptly seek treatment for other mental health disorders. Since people with other mental health problems, such as depression, are twice as 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.
• 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 crow