What is substance abuse disorder (drug addiction)?
Substance abuse disorder, or drug addiction, can be defined as a progressive disease that causes people to lose control of the use of some substance despite worsening consequences of that use. Substance use disorder can be life-threatening.
Addictions are not problems of willpower or morality. Addiction is a powerful and complex disease. People who have an addiction to drugs cannot simply quit, even if they want to. The drugs change the brain in a way that makes quitting physically and mentally difficult. Treating addiction often requires lifelong care and therapy.
What are drugs of abuse?
Drugs that are commonly misused include:
- Club drugs, like GHB, ketamine, MDMA (ecstasy/molly), flunitrazepam (Rohypnol®).
- Stimulants, such as cocaine (including crack) and methamphetamine (meth).
- Hallucinogens, including ayahuasca, D-lysergic acid diethylamide (LSD), peyote (mescaline), phencyclidine (PCP) and DMT.
- Inhalants, including solvents, aerosol sprays, gases and nitrites (poppers).
- Opioid pain killers such as heroin, fentanyl, oxycodone, hydrocodone, codeine and morphine.
- Prescription drugs and cold medicines.
- Sedatives, hypnotics and anxiolytics (anti-anxiety medications).
- Steroids (anabolic).
- Synthetic cannabinoids (K2 or Spice).
- Synthetic cathinones (bath salts).
- Tobacco/nicotine and electronic cigarettes (e-cigarettes or vaping).
While these drugs are very different from each other, they all strongly activate the addiction center of the brain. That is what makes these substances habit-forming, while others are not.
Why do people with substance use disorder need more and more drugs over time?
People feel intoxicated after using drugs of abuse. Over time, the brain is changed by drugs of abuse. The brain becomes desensitized to the drug of abuse so that more of the drug must be used to produce the same effect.
As the person consumes more, drugs start to take over the person’s life. One may stop enjoying other aspects of life. For many people, social, family and work obligations fall to the side. The person with SUD starts to feel like something’s wrong if he or she isn’t under the influence of the substance. They may become consumed with the need to recapture that original feeling.
Who is at risk for substance use disorder?
Anyone can develop a substance use disorder. No one thing can predict whether a person may develop an addiction. You may be more prone to drug use due to:
- Biology: The person’s genetic makeup, gender, ethnicity and mental health issues may raise his or her risk for developing an addiction. About two-thirds of people in addiction treatment are men. Particular ethnicities are at higher risk for substance abuse disorder. This is true for Native Americans.
- Environment: Surroundings can affect the likelihood of developing substance use disorder. For example, stress, peer pressure, physical or sexual abuse and early exposure to drugs can raise the risk.
- Age: Teenagers who start taking drugs are especially at risk. The parts of the brain that control judgment, decisions and self-control are not fully developed. Teens are more likely to engage in risky behaviors. In a developing brain, drugs can cause changes that make addiction more likely.
How common is substance use disorder?
Substance use disorder and alcohol use disorder are the leading causes of preventable illness and early death. Research has shown that about 1 in 9 Americans uses illicit drugs (about 11% of the population). The most commonly misused drugs are marijuana and prescription medications.
How might substance use disorder affect me?
Drugs affect the brain, especially the “reward center” of the brain.
Humans are biologically motivated to seek rewards. Often, these rewards come from healthy behaviors. When you spend time with a loved one or eat a delicious meal, your body releases a chemical called dopamine, which makes you feel pleasure. It becomes a cycle: You seek out these experiences because they reward you with good feelings.
Drugs of abuse send massive surges of dopamine through the brain, too. But instead of feeling motivated to do the things you need to survive (eat, work, spend time with loved ones), such massive dopamine levels can lead to damaging changes that change thoughts, feelings and behavior. That can create an unhealthy drive to seek pleasure from the drug and less from more healthy pleasurable experiences. The cycle revolves around seeking and consuming drugs to get that pleasurable feeling.
Addiction to drugs changes the brain over time. It affects how the brain works and even the brain’s structure. That’s why healthcare providers consider substance use disorder a brain disease.
The first use of a drug is a choice. But addiction can develop, creating a very dangerous condition. Drugs affect your decision-making ability, including the decision to stop drug use.
You may be aware there’s a problem but unable to stop. With addiction, stopping drug use can be physically uncomfortable. It can make you sick and even become life-threatening.
Symptoms and Causes
Why do people take drugs?
People may begin using drugs for several reasons. They may:
- Enjoy the pleasurable experience.
- Want to change or blunt their unpleasant feelings.
- Want to improve their performance at work, school or athletics.
- Be curious or give in to peer pressure.
What are symptoms of substance use disorder?
Symptoms of drug addiction include:
- Bloodshot eyes and looking tired.
- Changes in appetite, usually eating less.
- Changes in physical appearance, such as having a poor complexion or looking ungroomed.
- Craving drugs.
- Difficulty completing tasks at work, school or home.
- Engaging in risky behaviors, despite knowing negative consequences (such as driving while impaired or having unprotected sex).
- Inability to reduce or control drug use.
- Issues with money.
- Weight loss.
Diagnosis and Tests
How is substance use disorder diagnosed?
The first step to diagnosing a drug addiction is recognizing the problem and wanting help. This initial step may start with an intervention from friends or loved ones. Once someone decides to seek help for addiction, the next steps include:
- Complete exam by a healthcare provider.
- Individualized treatment, either inpatient or outpatient.
Management and Treatment
What are treatments for drug addiction?
Several therapies exist for treating substance use disorder. Even for a severe disorder, treatment can help. Often, you’ll receive a combination of these therapies:
- Detoxification: You stop taking drugs, allowing the drugs to leave the body. You may need healthcare supervision to detox safely.
- Medication-assisted therapies: During detox, medicine can help control cravings and relieve withdrawal symptoms.
- Behavioral therapies: Cognitive behavioral therapy or other psychotherapy (talk therapy) can help deal with addiction’s cause. Therapy also helps build self-esteem and teaches healthy coping mechanisms.
What medications are available to help with substance use disorder?
Medication may be part of your treatment plan. Your care team figures out the best medications for you. Medication-assisted treatments are available for:
- Opioids: Methadone, buprenorphine and naltrexone are FDA-approved for the treatment of Opiate Use Disorder.
- Alcohol: Three FDA-approved drugs include naltrexone, acamprosate and disulfiram (Antabuse®).
- Tobacco: A nicotine patch, spray, gum or lozenge can help. Or your doctor might prescribe bupropion (Wellbutrin®) or varenicline (Chantix®).
Is treatment for drug addiction inpatient or outpatient?
Both inpatient and outpatient treatment plans are available, depending on your needs. Treatment typically involves group therapy sessions that occur weekly for three months to a year.
Inpatient therapy can include:
- Therapeutic communities or sober houses, which are tightly controlled, drug-free environments.
Self-help groups such as Alcoholics Anonymous and Narcotics Anonymous can help you on the path to recovery. Self-help groups are also available for family members, including Al-Anon and Nar-Anon Family Groups. Participation in 12-step based recovery work has been proven to improve outcomes.
Is there a cure for substance use disorder?
There is no cure for drug addiction. People can manage and treat addiction. But there is always a risk that the addiction will return. Managing substance use disorder is a lifelong job.
Can I prevent substance use disorder?
Yes. Preventing drug addiction starts with education. Education in schools, communities and families helps prevent misusing a substance for the first time. Other ways to prevent substance use disorder:
- Don’t try illegal drugs, even one time.
- Follow instructions for prescription medications. Don't ever take more than instructed. Opioid addiction, for instance, can start after just five days.
- Dispose of unused prescriptions promptly to reduce risks of misuse by others.
Are there conditions that raise the risk for substance use disorder?
Many people have both a mental health condition and a substance use disorder. Sometimes, mental illness is there before the addiction happens. Other times, the addiction triggers or worsens a mental health disorder. When both conditions are treated properly, the chances for recovery improve.
Outlook / Prognosis
What is the outlook for people with substance use disorder?
Addiction is a lifelong disease. But people can recover from addiction and lead full lives. Getting help is essential to recovery. Different tools work for different people, but ongoing therapy and self-help groups such as Narcotics Anonymous help many.
Are there long-term effects of addiction?
If you continue to misuse drugs, brain structures and functions can change. Substance use disorder alters how you:
- Deal with stress.
- Make judgments and decisions.
- Store memories.
Can addiction come back?
Substance use disorder is a “relapsing disease.” People who are in recovery from this disease have a higher chance of using drugs again. Recurrence can happen even years after you last took drugs.
Because of the possibility of relapse, you need ongoing treatment. Your healthcare provider should review your treatment plan with you and change it based on your changing needs. If you have a problem with prescription drugs, including opioids, inform your healthcare providers. They can help you find other options to manage pain.
Is drug addiction fatal?
Substance use disorder can kill. If left untreated, you could die from overdose or engaging in dangerous behavior under the influence of drugs. Treatment can help people recover from addiction and prevent serious consequences.
How can I best take care of myself?
Avoiding drugs is the best way to take care of yourself. Once you experiment with substance use, it becomes harder to quit. If you think you have substance use disorder and want to stop, talk to a healthcare provider who can guide you on next steps.
What else should I ask my healthcare provider?
If you or a loved one is experiencing substance use disorder, ask your healthcare provider:
- How can I stop taking drugs?
- What is the best treatment plan for me?
- How long will the withdrawal symptoms last?
- How long does therapy take?
- What can I do to prevent a relapse?
- What community resources can help me during my recovery?
A note from Cleveland Clinic
Substance abuse, or substance use disorder, is a brain disease. Drugs affect your brain, including your decision-making ability. These changes make it hard to stop taking drugs, even if you want to. If you or a loved one has a substance use disorder, talk to a healthcare provider. A trained provider can help guide you to the treatment you need. Usually, a combination of medication and ongoing therapy helps people recover from addiction and get back to their lives.