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This topic is about drug
abuse and dependence in adults. For information about drug abuse in teens or
children, see the topic
Teen Alcohol and Drug Abuse.
Drug abuse is using drugs in a way that harms you or that leads you to harm
others. You can abuse illegal drugs, prescription drugs, or
When you abuse
drugs, you are not always able to meet work, home, or school duties. You may be
late to work. You may use drugs in dangerous situations, such as when driving
or operating machines. Or drugs may cause problems in your
Drug abuse can lead to drug dependence, where you
addicted to a drug. The drug controls your life. Any
of the following can happen:
Drug dependence is a disease. It's not a weakness or a
lack of willpower. It's your choice to begin using a drug. But as you use it
more, your brain begins to change. This change can lead to a craving to use the
drug, and this can influence how you act.
Drugs that are
Behaviors that may be signs of a drug problem include:
Having these signs doesn't always mean a person is using
drugs. The behavior could be because of work or school stress, or it could be a
depression or another medical problem. But behavior
changes like these are common in people who abuse drugs.
signs of drug abuse and dependence include:
Drug problems may
be diagnosed at a routine doctor visit or when you see your doctor for a health
or social problem linked to drug use, such as anxiety,
depression, or family conflict. If a partner or friend
thinks you have a drug problem, he or she may urge you to see your
Your doctor will ask questions about your symptoms and
past health. He or she will do a physical exam and sometimes a mental
medicine, therapy, and support groups.
The first step in treatment is to quit using drugs. You may need medical care to manage withdrawal symptoms when you first quit. Some people call this detoxification, or detox.
After you stop using drugs, you focus on staying drug-free. Most people receive
some type of therapy, such as group counseling. You also may need medicine to
help you stay drug-free.
When you have stopped using drugs, you
have taken the first step toward
recovery. To gain full recovery, you need to take
steps to improve other areas of your life, such as learning to deal with your
work, family, and living situation in healthy ways. This makes it easier to
If you feel that you have a drug problem, get help. You can visit a
doctor or go to a self-help group. The earlier you get help, the easier your
recovery will be for you and your family.
Helping someone who has a
drug problem is hard. If you are
"covering" for the person, you need to stop. For
example, don't make excuses for the person when he or she misses work.
You may be able to help by talking to the person about what his or her
drug use does to you and others. Talk to the person in private, when he or she
isn't using drugs or alcohol and when you are both calm. If the person agrees
to get help, call for an appointment right away. Don't wait.
Learning about drug abuse and dependence:
Most of the time,
drug abuse starts with casual use. People don't use drugs because they want to be
addicted. Drugs can make
you feel good for a while. They may make you feel energetic, self-confident,
and powerful. You may take a drug to reduce
anxiety or to help you forget a problem.
changes your brain and how it works. If you continue to use drugs,
you may develop strong cravings for them, and it may get harder to say "no" to further use. At the same time, you may begin to lose interest in
activities you always enjoyed. This is because you may feel that they are not
as enjoyable as using drugs. You may then become dependent.
Not everyone who uses drugs abuses them or becomes dependent. Other
things that influence whether this happens include your
genes, family, friends, and life situations. For more information, see
What Happens and What Increases Your Risk.
When drug use,
dependence occur, you are more likely to have changes
in your behavior than to have physical symptoms.
These signs don't always mean a person is using drugs.
The behavior could be because of work or school stress, or it could be a sign
depression or another medical problem. But behavior
changes like these are common in people who abuse drugs.
think you or a loved one might have a drug problem, use this short quiz to
check your drug use:
Drug abuse in older adults may go unnoticed, since the signs may be similar to those of
aging. Older adults often take more medicines, such as sleep medicines and
painkillers, that can lead to dependence.
When you are dependent on a
drug and you stop using it, you may have physical symptoms known as
withdrawal. These symptoms differ for each drug. They can include feeling sick to your stomach,
vomiting, having belly pain, sweats, nervousness and shaking, and
You may not feel that using drugs is a
problem. Maybe you feel that you are a casual user because you use drugs only
now and then. You may feel that you can stop using drugs at any time.
But drug use quickly can become a habit, and for many people it may lead
addiction. You may begin to use drugs without thinking
about how drugs can harm you and those you care about.
Drugs can cause you to have
health problems, such as:
Drugs also can lead to problems with thinking and
remembering. They can affect judgment, decision-making, emotions, and learning.
Different drugs harm your body in different
ways. Drugs that can cause harm include:
You are more likely to have unsafe sex when on drugs, and you may get
sexually transmitted infections (STIs).
pregnant, drugs can pass into your uterus and
harm your baby.
Drug use also can lead to problems with
your partner, family, or friends. You and
your family may feel that you have turned against each other. You may be angry at
them, and they may be angry at you. You may do poorly at work or in school, or
you may even quit. You also can have legal problems, like being arrested for
driving while on drugs or for using or selling drugs.
Not everyone who uses a
drug develops a drug problem. Certain things make
dependence more likely. These are called risk factors.
Call 911 or other emergency services right away if you or someone else:
Call your doctor if:
who can diagnose, prescribe medicine for, and treat
drug abuse problems include:
Counseling usually is part of treatment. This can be done
Watchful waiting is a
wait-and-see approach. If you get better on your own, you won't need treatment.
If you get worse, you and your doctor will decide what to do next.
Watchful waiting is not a good choice for drug abuse and dependence. If
you have a drug problem, or if you believe that your health or other areas of
your life are being affected by drugs, you need to take steps to stop using
dependence may be diagnosed during a routine doctor
visit or when you see your doctor for a health or other problem linked to drug
use, such as
depression, or family conflict. If your partner or a
friend suspects a drug problem, he or she may urge you to see your
If you think you or a loved one might have a drug problem,
use this short quiz to check for drug use:
Your doctor will ask you questions about your symptoms and
past health and will do a
physical exam. If your doctor thinks you have a drug
problem, he or she may ask about
current and past drug use. He or she also may ask if it's okay to give you a test to check for drug use,
such as a urine or blood test.
Your doctor may ask to give you
tests to look for health problems related to drug abuse. These may include
hepatitis C, or
If you and your doctor agree that
you have a drug problem, your doctor probably will refer you to a specialist in
drug abuse or dependence.
People who use
drugs also may have mental health problems. These include
anxiety disorders, or
post-traumatic stress disorder (PTSD). If your doctor
thinks this may be true for you, he or she may do a
mental health assessment.
If you use
drugs and have a mental health problem, it's called a
dual diagnosis. If you
treat only one problem, treatment may not work well. When you treat both
problems, you have a better chance of a full
recovery and less chance of using drugs again.
drug abuse or
dependence usually includes group therapy, one or more
counseling, and drug education. A
12-step program is often part of treatment and
continues afterward as part of your
Treatment doesn't just deal
with drugs. It helps you take control of your life so you don't have to depend on drugs. You'll learn
good reasons to quit drugs. Staying drug-free is a lifelong
process that takes commitment and effort.
You might start with your family doctor, or your doctor may recommend that you
enter a treatment facility. A friend could bring you to a self-help group, such
as Narcotics Anonymous, or you might walk into a clinic that deals with drug
You may have a treatment team to help you. This team may include
social workers, nurses, and a case manager. A case
manager helps plan and manage your treatment.
You may be asked
questions about your drug use, health problems, work, and living situation. Be
open and honest to get the best treatment possible. Your team may
write a plan, which includes your treatment goals and ways to reach
those goals. This helps you stay on track.
Your doctor may decide you need
medical care to manage withdrawal symptoms when you first quit using drugs. This is sometimes called detoxification, or detox.
People who are dependent on
drugs often have to go to a hospital or treatment facility. Detox usually is
done under the care of a doctor, because withdrawal can be
dangerous without medical care. A doctor may prescribe medicines to help with withdrawal symptoms.
Treatment for a drug problem usually
involves one or more types of therapy.
Treatment usually includes going to a support group, such
as going to Narcotics Anonymous (NA) meetings. Your family members might also
want to attend a support group such as Nar-Anon.
You may take medicines to help you quit
or to help you overcome
withdrawal symptoms. Medicines often are used for
opiate drugs like heroin or certain painkillers.
Medicines that can help you include methadone (such as Dolophine) or Naltrexone (such as ReVia).
Treatment programs can be
outpatient, inpatient, or residential. They offer similar therapies. Your
treatment team can help you decide which type of program is best for you.
Some treatment programs give rewards, called vouchers,
when you stay off drugs. The rewards may get bigger when you go for a long time
Many programs give regular drug tests while you go
through treatment. Knowing that you will be tested can make you more likely to
resist your cravings.
People with drug problems
often have other problems. They may need other
treatments, or other resources may be available to help them with the drug
Your doctor may prescribe medicine during
detoxification to ease
withdrawal symptoms or during treatment to help you
move away from
dependence. These medicines are mainly used for
heroin or other
Medicines that can help
drug abuse or
dependence means finding a way to stay drug-free while
changing your attitudes and behaviors. In recovery, you work to restore
relationships with your family and friends and with people at your job or
Recovery isn't a cure. It is a lifelong
process. There are
10 principles of recovery10 principles of recovery(What is a PDF document?) that can help you reach your goals and learn new things to
To help stay
drug-free after treatment, you can find things to do, such as
sports or volunteer work. Stay away from friends or family members who use
drugs. Learn how to say
"no" to alcohol and drugs.
An important part of recovery is being
sure you have support. You can:
Stopping drug use is very hard.
It's normal to have setbacks, even years later. Very few people succeed the
first time they try. A lapse or
relapse is likely.
A lapse or relapse doesn't mean that you or your treatment has
failed. It may mean that you just slipped up. You also may need more treatment,
another type of treatment, or more time in support groups such as Narcotics
It's smart to
plan for a relapse before it happens. Your doctor, family, and friends can
help you do this.
Part of recovery is finding
your way back to a healthy lifestyle.
If someone you care about has had a drug problem, you know how hard it
can be. You know how living or dealing with someone who has a drug problem can
change and even destroy your life. But family members and friends can play an important role in helping a loved one recover from drug use and addiction.
hard to get someone who uses drugs into treatment if he or she doesn't want it.
You may be able to
help the person get treatment by:
After the choice for treatment
has been made:
probably will feel relief and happiness when the person decides to get help.
But treatment and recovery mean changes in your life too. Your emotions may
become more complicated. You may:
These feelings are common. You've been through a bad
period of your life, and what happened isn't easy to forget. Nor is it easy to
forgive the person. Keep in mind that recovery is the road to a better life
and that you can help your loved one get there.
Find your own
support. Nar-Anon and similar programs are for people with family members or
friends who have drug problems. They help you recover from the effects of being
around someone who was addicted. You also may try
The American Council for Drug Education provides current scientific
research, prevention materials, and programs on tobacco, alcohol, and illegal
drugs and their effects. It offers programs and services for teens and provides
information to parents, employers, educators, health professionals, policy
makers, and the media.
LifeRing is a network of support groups for people with
alcohol or drug problems. Support groups meet about an hour each week. LifeRing
is abstinence-based, like Alcoholics Anonymous (AA) or Narcotics Anonymous
(NA), but does not rely on a "higher power" concept for recovery.
Nar-Anon is an organization dedicated to helping family and friends
of people suffering from drug addiction to cope with addiction. Support group
meetings are available in most communities at various times. Contact Nar-Anon
or check your local phone book for meeting dates and times.
Narcotics Anonymous is an international, community-based support
group that serves people recovering from drug addiction with more than 31,000
weekly meetings in over 100 countries worldwide. NA provides an environment in
which people recovering from drug addiction can help one another stop using
drugs and find a new way to live. Meetings are available in most communities at
various times. Contact NA or check your local phone book for meeting dates and
This organization provides information for the public on
drugs. It contains information about how certain drugs affect the brain.
SAMHSA provides information on substance abuse prevention and
treatment. Its website is the gateway to the Center for Substance Abuse
Prevention (www.samhsa.gov/prevention) and the Center for Substance Abuse
Cloninger RC (2008). Genetics of substance abuse. In M Galanter, HD Kleber, eds., Textbook of Substance Abuse Treatment, 4th ed., pp. 17–27. Washington, DC: American Psychiatric Publishing.
Substance Abuse and Mental Health Services Administration, Office of Applied Studies (2010). Results From the 2009 National Survey on Drug Use and Health: Volume I. Summary of National Findings (NSDUH Series H-38A, HHS Publication No. SMA 10-4586FINDINGS). Available online: http://store.samhsa.gov/product/Results-from-the-2009-National-Survey-on-Drug-Use-and-Health/SMA10-4586FINDINGS.
National Institute on Drug Abuse (2010). Drugs, Brains, and Behavior: The Science of Addiction (NIH Publication No. 10-5605). Available online: http://www.nida.nih.gov/scienceofaddiction/sciofaddiction.pdf.
Other Works Consulted
Department of Veterans Affairs, Department of Defense (2009). Clinical Practice Guideline: Management of Substance Use Disorders (SUD). Available online: http://www.healthquality.va.gov/Substance_Use_Disorder_SUD.asp.
Strain EC, Anthony JC (2009). Introduction and overview section of Substance-related disorders. In BJ Sadock et al., eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 1237–1268. Philadelphia: Lippincott Williams and Wilkins.
January 5, 2012
Adam Husney, MD - Family Medicine & Peter Monti, PhD - Alcohol and Addiction
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