In recent years, Monitoring the Future, the NIDA-funded annual survey of drug, alcohol, and tobacco use in 8th-, 10th-, and 12th-grade students, has shown persistently high rates of marijuana and nonmedical prescription drug use in our Nation’s teens. More information on the Monitoring the Future survey can be found at www.drugabuse.gov/related-topics/trends-statistics/monitoring-future.
Marijuana
Marijuana (cannabis) is the most commonly used illicit substance. This drug impairs short-term memory and learning, the ability to focus, and coordination. It also increases heart rate, can harm the lungs, and may increase the risk of psychosis in vulnerable people. Research suggests that when regular marijuana use begins in the teen years, addiction is more likely: 1 in 6 users, compared to 1 in 9 among adults. In addition, recent research suggests that heavy cannabis use that starts in the teen years is associated with declines in IQ scores in adulthood. More information on marijuana can be found at www.drugabuse.gov/drugs-abuse/marijuana.
Marijuana Research at NIDA
As part of its mandate to study drug use and addiction and other health effects of both legal and illegal drugs, NIDA funds a wide range of research on marijuana; its main psychoactive ingredient, delta- 9-tetrahydrocannabinol (THC); and chemicals related to THC (cannabinoids such as cannabidiol [CBD]). More information on marijuana research at NIDA can be found at www.drugabuse.gov/drugs-abuse/marijuana/marijuana-research-nida.
Medical Marijuana
Although many have called for the nationwide legalization of marijuana to treat medical conditions, the scientific evidence to date is not sufficient for the marijuana plant to gain U.S. Food and Drug Administration (FDA) approval, for two main reasons.
First, there have not been enough clinical trials showing that marijuana’s benefits outweigh its health risks. The FDA requires carefully conducted studies in large numbers of patients (hundreds to thousands) to accurately assess the benefits and risks of a potential medication.
Second, to be considered a legitimate medicine, a substance must have well-defined and measureable ingredients that are consistent from one unit to the next (such as a pill or injection). This consistency allows doctors to determine the dose and frequency. As the marijuana plant contains hundreds of chemical compounds that may have different effects and that vary from plant to plant, its use as a medicine is difficult to evaluate.
However, THC-based drugs to treat pain and nausea are already FDA approved and prescribed. Scientists continue to investigate the medicinal properties of cannabinoids—or the individual components of the marijuana plant (e.g., THC, CBD). The therapeutic potential lies in developing medications based upon cannabinoids that have therapeutic value but with limited-to-no risk for addiction, such as CBD. For more information, see our “Is Marijuana Medicine?” DrugFacts at www.drugabuse.gov/publications/drugfacts/marijuana-medicine.
Any of the 27 NIH Institutes could fund research in this area. To find out more about NIH-funded research into the therapeutic potential of cannabinoids, contact NIH at mylesr@mail.nih.gov. For more information on research that NIDA is supporting to explore this issue, go to www.drugabuse.gov/drugs-abuse/marijuana/nida-research-therapeutic-benefits-cannabis-cannabinoids.
K2/Spice
“K2” or “Spice” refers to a wide variety of herbal mixtures that produce experiences similar to marijuana. Of the illicit drugs most used by high school seniors, Spice is second only to marijuana. It is sometimes called “synthetic” marijuana, but this is a misperception. Labels on Spice products often claim that they contain “natural” psychoactive material taken from a variety of plants; however, chemical analyses show that their active ingredients are synthetic (or designer) cannabinoid compounds.
Poison Control Centers report a variety of K2/Spice symptoms, including rapid heart rate, vomiting, agitation, confusion, hallucinations, raised blood pressure and reduced blood supply to the heart, and, in a few cases, heart attacks. Because the chemicals used in Spice have a high addictive potential and no medical benefit, the Drug Enforcement Administration (DEA) has made it illegal to sell, buy, or possess the main chemicals in these drugs. More information can be found at www.drugabuse.gov/drugs-abuse/k2spice-synthetic-marijuana.
Prescription and Over-the-Counter Medications
Prescription medications and some over-the-counter medications are increasingly being abused (used in ways other than intended or without a prescription). This practice can lead to addiction, and in some cases, overdose. Among the most disturbing aspects of this emerging trend is its prevalence among teenagers and young adults, as well as the common misperception that because these are used medically or prescribed by physicians, they are safe even when not used as intended. Commonly abused classes of prescription drugs include opioid painkillers, stimulants, and depressants.
- Opioids are usually prescribed for pain relief. Commonly prescribed opioids include hydrocodone (e.g., Vicodin®), oxycodone (e.g., OxyContin®), morphine, fentanyl, and codeine. In the United States, more people now die from opioid painkiller overdoses than from heroin and cocaine combined.
- Stimulants: Methylphenidate (Ritalin®, Concerta®, Focalin®, and Metadate®) and amphetamines (Adderall®, Dexedrine®) are stimulants commonly prescribed for attention-deficit hyperactivity disorder (ADHD).
- Depressants are usually prescribed to promote sleep or to reduce anxiety. As measured by national surveys, depressants are often categorized as sedatives or tranquilizers. Sedatives primarily include barbiturates (e.g., phenobarbitol) but also include sleep medications such as Ambien® and Lunesta®. Tranquilizers primarily include benzodiazepines such as Valium® and Xanax®, but also include muscle relaxants and other anti-anxiety medications.
- “Syrup,” “Purple Drank,” “Sizzurp,” or “Lean” describes soda mixed with prescription-strength cough syrup containing codeine and promethazine—these cough syrups are available by prescription only. Users may also flavor the mixture with hard candies. Drinking this combination has become increasingly popular among some celebrities and youth in several areas of the country. Codeine is an opioid that can produce relaxation and euphoria when consumed in sufficient quantities. Promethazine is an antihistamine that also acts as a sedative. More information can be found at www.drugabuse.gov/drugs-abuse/emerging-trends.
Commonly abused over-the-counter drugs include cold medicines containing dextromethorphan (DMX), a cough suppressant. Products containing DMX can be sold as cough syrups, gel capsules, and pills (that can look like candies). They are frequently abused by young people, who refer to the practice as “robo-tripping” or “skittling.” Pseudoephedrine, a decongestant found in many over-the-counter cold medicines, is another over-the-counter medication that is used illicitly. Although not typically abused in itself, it is one ingredient used to produce methamphetamine. For more information about prescription drug abuse and related health consequences, go to www.drugabuse.gov/drugs-abuse/prescription-drugs-cold-medicines.
Other Commonly Used Addictive Drugs
Alcohol
Alcohol consumption can damage the brain and most body organs, including the heart, liver, and pancreas. It also increases the risk of some cancers, weakens the immune system, puts fetal development at risk, and causes deadly vehicle accidents. Areas of the brain that are especially vulnerable to alcohol-related damage are the cerebral cortex (largely responsible for our higher brain functions, including problem-solving and decisionmaking), the hippocampus (important for memory and learning), and the cerebellum (important for movement coordination).
More information can be found on the Web site of the National Institute on Alcohol Abuse and Alcoholism at www.niaaa.nih.gov.
Amphetamines/ Methamphetamine
Amphetamines, including methamphetamine, are powerful stimulants that can produce feelings of euphoria and alertness. Methamphetamine is a white, odorless, bitter-tasting crystalline powder that easily dissolves in water or alcohol and is taken orally, intra-nasally (snorting the powder), by needle injection, or by smoking. Methamphetamine’s effects are particularly long lasting and harmful to the brain. Amphetamines can cause high body temperature and can lead to serious heart problems and seizures.
Regular methamphetamine use significantly changes how the brain functions. Noninvasive human brain imaging studies have shown alterations in the activity of the dopamine system that are associated with reduced motor skills and impaired verbal learning, which may account for many of the emotional and cognitive problems observed in regular methamphetamine users.
More information on methamphetamine can be found at www.drugabuse.gov/publications/drugfacts/methamphetamine.
Anabolic Steroids
Anabolic steroids refer to synthetic variants of the male sex hormone testosterone. The proper term for these compounds is anabolic-androgenic steroids (abbreviated AAS—“anabolic” referring to muscle building and “androgenic” referring to increased male sexual characteristics. Steroids can be prescribed for certain medical conditions; however, they are often abused to increase muscle mass and to improve athletic performance or physical appearance. Anabolic steroids are usually either taken orally or injected into the muscles, although some are applied to the skin as a cream or gel. Doses taken by abusers may be 10 to 100 times higher than doses prescribed to treat medical conditions.
Anabolic steroids work very differently from other addictive drugs, and they do not have the same acute effects on the brain. However, long-term steroid use can affect some of the same brain pathways and chemicals—including dopamine, serotonin, and opioid systems—that are affected by other drugs. They thereby may have a significant impact on mood and behavior.
Other serious consequences of steroid abuse can include heart disease, liver problems, stroke, infectious diseases, depression, and suicide. Less serious side effects include severe acne and changes in sex characteristics, like shrinking of the testicles in men and growth of facial hair in women. More information on steroids can be found at www.drugabuse.gov/drugs-abuse/steroids-anabolic.
Bath Salts
The term “bath salts” refers to an emerging family of drugs containing one or more synthetic chemicals related to cathinone, an amphetamine-like stimulant found naturally in the khat plant. Reports of severe intoxication and dangerous health effects associated with the use of bath salts have made these drugs a serious and growing public health and safety issue. Some users experience paranoia, agitation, hallucinatory delirium, and psychotic and violent behavior. Deaths have also been reported.
These synthetic cathinone products—marketed as “bath salts” to evade detection by authorities—should not be confused with products such as Epsom salts for bathing. Bath salts typically take the form of a white or brown crystalline powder and are sold in small plastic or foil packages labeled “not for human consumption.” More information can be found at www.drugabuse.gov/drugs-abuse/bath-salts-synthetic-cathinones.
Cocaine
Cocaine is a short-acting stimulant, which can lead users to “binge”—take the drug many times in a single session. Cocaine use can lead to severe medical consequences related to the heart and the respiratory, nervous, and digestive systems. Cocaine users can also experience severe paranoia, in which they lose touch with reality.
The powdered form of cocaine is either inhaled through the nose (snorted), where it is absorbed through the nasal tissue, or dissolved in water and injected into the bloodstream. Crack is a form of cocaine that has been processed to make a rock crystal (also called “freebase cocaine”) that can be smoked. The crystal is heated to produce vapors that are absorbed into the bloodstream through the lungs. (The term “crack” refers to the crackling sound produced by the rock as it is heated.)
More information can be found at www.drugabuse.gov/drugs-abuse/cocaine.
Hallucinogens
The effects of hallucinogens—perception-altering drugs—are highly variable and unreliable, producing different effects in different people at different times. This is mainly due to differences in the amounts and chemistries of active compounds within the drugs. Because of their unpredictable nature, the use of hallucinogens can be particularly dangerous. Examples of hallucinogens include:
- MDMA (Ecstasy, “Molly”) (3,4-methylenedioxymethamphetamine) produces both stimulant and mind-altering effects. It can increase body temperature, heart rate, blood pressure, and heart-wall stress. Ecstasy may also be toxic to nerve cells. It is taken orally, usually as a capsule or tablet. Its effects last approximately 3 to 6 hours, although it is not uncommon for users to take a second dose of the drug as the effects of the first dose begin to fade. Ecstasy is commonly taken in combination with alcohol and other drugs.
Molly—slang for “molecular”—refers to the pure crystalline powder form of ecstasy. Users may seek out Molly to avoid the adulterants or substitutes known to be commonly found in ecstasy, but those who purchase what they think is pure ecstasy may actually be exposing themselves to the same risks, since Molly often contains toxic additives. In fact, Molly is often nothing more than repackaged ecstasy.
More information can be found at www.drugabuse.gov/publications/drugfacts/mdma-ecstasy.
- LSD is one of the most potent hallucinogenic drugs. Its effects are unpredictable, and users may see vivid colors and images, hear sounds, and feel sensations that seem real but do not exist. Users also may have traumatic experiences and emotions that can last for many hours. Some short-term effects can include increased body temperature, heart rate, and blood pressure; sweating; loss of appetite; sleeplessness; dry mouth; and tremors.
- PCP (phencyclidine) was developed in the 1950s as an intravenous anesthetic. Its legitimate use has since been discontinued due to serious adverse effects.
- Psilocybin is obtained from certain types of mushrooms that are found in tropical and subtropical regions of South America, Mexico, and the United States. These mushrooms typically contain less than 0.5 percent psilocybin plus trace amounts of psilocin, another hallucinogenic substance. More information can be found at www.drugabuse.gov/publications/drugfacts/hallucinogens-lsd-peyote-psilocybin-pcp.
Heroin
Heroin is a powerful opioid drug that produces euphoria and feelings of relaxation. It slows respiration and can increase the risk of serious infectious diseases, especially when taken intravenously. Regular heroin use changes the functioning of the brain, causing tolerance and dependence. Other opioid drugs include morphine, OxyContin®, Vicodin®, and Percodan®, which have legitimate medical uses; however, using them in ways other than prescribed (or using them without a prescription) can result in the same harmful consequences as heroin use.
More information about heroin can be found at www.drugabuse.gov/drugs-abuse/heroin.
Inhalants
Inhalants are volatile substances found in many household products (such as oven cleaners, gasoline, spray paints, and other aerosols) that induce mind-altering effects. Inhalants are extremely toxic and can damage the heart, kidneys, lungs, and brain. Even a healthy person can suffer heart failure and death within minutes of a single session of the prolonged sniffing of an inhalant.
People tend to abuse different inhalant products at different ages. New younger users (ages 12–15) most commonly abuse glue, shoe polish, spray paints, gasoline, and lighter fluid. First-time older users (ages 16–17) most commonly abuse nitrous oxide, or “whippets.” Adults most commonly abuse a class of inhalants known as nitrites (such as amyl nitrites, or “poppers”).
More information on inhalants can be found at www.drugabuse.gov/drugs-abuse/inhalants.
Ketamine, Rohypnol, and GHB
Ketamine, Rohypnol®, and GHB have come to be known as “date rape” drugs because they can cause someone to lose their memory of an assault. Rohypnol® and GHB can easily be added to beverages and ingested unknowingly. Any of these drugs can also cause someone to lose consciousness. Ketamine and GHB are predominantly central nervous system (CNS) depressants, whereas Rohypnol® is a benzodiazepine. More information can be found at www.drugabuse.gov/drugs-abuse/club-drugs.
Nicotine
Nicotine is an addictive stimulant found in cigarettes and other forms of tobacco. Tobacco smoke increases a user’s risk of cancer, emphysema, bronchial disorders, and cardiovascular disease. Smoking rates have decreased in the United States in recent years, yet the mortality rate associated with tobacco addiction is still staggering, with more than 480,000 premature deaths in the United States each year—about 1 in every 5 deaths.5 Tobacco use killed approximately 100 million people during the 20th century and, if current smoking trends continue, the cumulative death toll for this century is projected to reach 1 billion.8 More information can be found at www.drugabuse.gov/drugs-abuse/tobacco-addiction-nicotine.
Resources
Where to Find Nationwide Trends and Statistics
Major sources of data on the extent of drug use in the United States include the following:
Monitoring the Future (MTF)
The MTF survey measures drug, alcohol, and cigarette use and related attitudes among 8th-, 10th-, and 12th-grade students nationwide. Survey participants report their drug use behaviors across three time periods: lifetime, past year, and past month. The annual survey is funded by NIDA and is conducted by the University of Michigan. Results from the survey are released late each fall. For the latest survey results, go to www.drugabuse.gov/DrugPages/MTF.html.
National Drug Early Warning System (NDEWS)
NDEWS will monitor emerging trends to help health experts respond quickly to potential outbreaks of illicit drug use and to identify increased use of designer synthetic compounds. The system will scan social media and Web platforms to identify new trends as well as use conventional national- and local-level data resources that are utilized by the Community Epidemiology Work Group (CEWG). Development of this project started August 2014. The system is expected to launch in 2015 as an enhancement (and eventual replacement) of the current system – the CEWG. Until then, project updates can be found on the CEWG Web site: www.drugabuse.gov/about-nida/organization/workgroups-interest-groups-consortia/community-epidemiology-work-group-cewg.
National Survey on Drug Use and Health (NSDUH)
The Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) NSDUH (formerly called the National Household Survey on Drug Abuse) is the primary source of information on the prevalence, patterns, and consequences of alcohol, tobacco, and illicit drug use in the general U.S. civilian non-institutionalized population, ages 12 and older. Survey information can be found at www.oas.samhsa.gov/nsduh.htm.
Drug Abuse Warning Network (DAWN)
The DAWN report, also prepared by SAMHSA, provides information about the impact of drug use on hospital emergency departments in the United States. It reports the number of visits to the emergency department that were related directly to the use of an illegal drug or the nonmedical use of a legal drug, as well as drug-related deaths investigated by medical examiners and coroners. DAWN is not a measure of the prevalence of use but instead offers information complementary to the prevalence data found in the NSDUH. Survey information can be found at www.samhsa.gov/data/DAWN.aspx.
Treatment Episode Data Set (TEDS)
The TEDS system includes records for approximately 1.5 million substance abuse treatment admissions annually. While TEDS does not represent all substance abuse treatment activities, it comprises a significant proportion of all admissions to substance abuse treatment programs and includes those admissions that rely on public funds. Data are reported by sex, age, and race/ethnicity for each of 15 substance abuse categories. TEDS is maintained by SAMHSA’s Office of Applied Studies, and can be found at www.oas.samhsa.gov/ dasis.htm#teds2.
Youth Risk Behavior Survey (YRBS)
The YRBS, part of the Centers for Disease Control and Prevention’s (CDC’s) Youth Risk Behavior Surveillance System (YRBSS), is a school-based survey that collects data from students in grades 9–12. The survey includes questions on a wide variety of health-related risk behaviors, including substance use. More information is available at www.cdc.gov/ HealthyYouth/yrbs/index.htm.
CDC’s Home & Recreational Safety: Drug Overdose Data
CDC consolidates information from their Wide-ranging OnLine Data for Epidemiologic Research (WONDER) database, which tracks underlying cause of death, and SAMHSA’s DAWN data to provide information on U.S. drug overdose deaths. More information is available at www.cdc.gov/homeandrecreationalsafety/overdose/index.html.
NIDA Resources
A wealth of material regarding various aspects of drug use and addiction is available, free of charge, from NIDA.
NIDA Web Site
Through its online and mobile presence, NIDA strives to communicate its research findings to the wide-ranging audiences it serves, which include students, parents, teachers, researchers, scientists, prevention and treatment practitioners, health care professionals, policymakers, constituent groups, children and teens, underserved populations, and the general public.
Most of NIDA’s publications are available on NIDA’s Web site: www.drugabuse.gov. The site’s responsive design allows users to access the information on handheld devices, including smart phones and tablets, and some resources can be ordered free in hard copy.
Other NIDA Sites:
- For low literacy users: www.easyread.drugabuse.gov
- For teens and people who work with teens: www.teens.drugabuse.gov
- Information for young adults on the link between HIV/AIDS and drugs: www.hiv.drugabuse.gov
- NIDA’s intramural research program: www.irp.drugabuse.gov
NIDA’s New Media Accounts:
- Twitter: @NIDAnews
- Facebook:RSS feed: www.drugabuse.gov/nidanews.xml
- General audience: www.facebook.com/NIDANIH
- For teens and their teachers and parents: www.facebook.com/NIDA.Drug.Facts.Week
- YouTube: www.youtube.com/user/NIDANIH
- Flickr: www.flickr.com/photos/nida-nih/collections/
- LinkedIn: www.linkedin.com/company/the-national-institute-on-drug-abuse-nida
NIDA images are in the public domain and may be used, linked, or reproduced without further permission from NIDA. However, credit should be given to NIDA, unless otherwise instructed to give credit to the photographer or other source.
Other Government Web Sites for Health and Science Information
National Institutes of Health (NIH) (www.nih.gov)
NIH is the steward of medical and behavioral research for the Nation. Its mission is to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to extend health, lengthen life, and reduce illness and disability. NIH is part of the U.S. Department of Health and Human Services (HHS). The NIH site links to sites for its 27 Institutes and Centers.
RePORTER (www.projectreporter.nih.gov/reporter.cfm)
RePORTER includes information on research projects funded by the NIH as well as CDC, the Agency for Healthcare Research and Quality, the Health Resources and Services Administration, SAMHSA, and the U.S. Department of Veterans Affairs. RePORTER also includes links to publications and patents citing support from these projects.
Project results can be filtered according to specific parameters, such as Principal Investigator, Fiscal Year, keyword, etc.
Note: when doing a “Text Search” to filter by certain keywords, you will have to read the description of each study to determine if that research is actually focusing on your keyword of interest. In some cases, the term may be merely mentioned in the grant application but is not the topic of the study.
National Library of Medicine (NLM)
(www.nlm.nih.gov)
NLM is the world’s largest library dealing with a single scientific/professional topic. It cares for nearly 19 million holdings (including books, journals, reports, manuscripts, and audiovisual items) and sponsors MedlinePlus, a source of up-to-date, quality health care information from NLM and NIH.
ClinicalTrials.gov
(www.clinicaltrials.gov)
ClinicalTrials.gov lists publicly and privately supported clinical studies of human participants conducted around the world. ClinicalTrials.gov does not contain all the clinical studies conducted in the United States because not all studies (for example, observational studies and trials that do not study a drug, biologic, or device) are required by law to be registered. The Web site is maintained by NLM.
Healthfinder
(www.healthfinder.gov)
Healthfinder is a Government Web site providing resources on a wide range of health topics, selected from approximately 1,400 Government and non-profit organizations.
Office on Women’s Health (OWH)
(www.womenshealth.gov)
OWH provides up-to-date and commercial-free health information on topics that range from reproductive health to healthy aging. The site provides easy-to-understand health information, daily announcements, links to thousands of free health publications and Web sites, and statistics on women’s health.
Office of Adolescent Health (OAH)
(www.hhs.gov/ash/oah/)
OAH is dedicated to improving the health and well-being of America’s adolescents, especially those who are most vulnerable.
Source: NIDA, NIH, HHS
The Science of Drug Abuse and Addiction: The Basics
What is drug addiction?
Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain; they change its structure and how it works. These brain changes can be long lasting and can lead to many harmful, often self-destructive, behaviors.
Why study drug abuse and addiction?
Abuse of and addiction to alcohol, nicotine, and illicit and prescription drugs cost Americans more than $700 billion a year in increased health care costs, crime, and lost productivity. Every year, illicit and prescription drugs and alcohol contribute to the death of more than 90,000 Americans, while tobacco is linked to an estimated 480,000 deaths per year. (Hereafter, unless otherwise specified, drugs refers to all of these substances.)
How are drug disorders categorized?
NIDA continues to use the term “addiction” to describe compulsive drug seeking despite negative consequences. However, “addiction” is not considered a specific diagnosis in the fifth edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—a diagnostic manual used by clinicians that contains descriptions and symptoms of all mental disorders classified by the American Psychiatric Association (APA).
In 2013, APA updated the DSM, replacing the categories of substance abuse and substance dependence with a single category: substance use disorder. The symptoms associated with a substance use disorder fall into four major groupings: impaired control, social impairment, risky use, and pharmacological criteria (i.e., tolerance and withdrawal).
The new DSM describes a problematic pattern of use of an intoxicating substance leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:
- The substance is often taken in larger amounts or over a longer period than was intended.
- There is a persistent desire or unsuccessful effort to cut down or control use of the substance.
- A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
- Craving, or a strong desire or urge to use the substance.
- Recurrent use of the substance resulting in a failure to fulfill major role obligations at work, school, or home.
- Continued use of the substance despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use.
- Important social, occupational, or recreational activities are given up or reduced because of use of the substance.
- Recurrent use of the substance in situations in which it is physically hazardous.
- Use of the substance is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
- Tolerance, as defined by either of the following:
- A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
- A markedly diminished effect with continued use of the same amount of the substance.
- Withdrawal, as manifested by either of the following:
- The characteristic withdrawal syndrome for that substance (as specified in the DSM- 5 for each substance).
- The substance (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.
Please Note: Current national surveys of drug use have not yet been modified to reflect the new DSM-5 criteria of substance use disorders and therefore still report substance abuse and dependence separately.
How does NIDA use the terms drug abuse and addiction?
People use substances for a variety of reasons. It becomes drug abuse when people use illegal drugs or use legal drugs inappropriately. This includes the repeated use of drugs to produce pleasure, alleviate stress, and/or alter or avoid reality. It also includes using prescription drugs in ways other than prescribed or using someone else’s prescription. Addiction occurs when a person cannot control the impulse to use drugs even when there are negative consequences—the defining characteristic of addiction. These behavioral changes are also accompanied by changes in brain functioning, especially in the brain’s natural inhibition and reward centers. NIDA’s use of the term addiction corresponds roughly to the DSM definition of substance use disorder. The DSM does not use the term addiction.
What is the difference between physical dependence, dependence, and addiction?
Physical dependence is not equivalent to dependence or addiction, and may occur with the regular (daily or almost daily) use of any substance, legal or illegal, even when taken as prescribed. It occurs because the body naturally adapts to regular exposure to a substance (e.g., caffeine or a prescription drug). When that substance is taken away, symptoms can emerge while the body re-adjusts to the loss of the substance. Physical dependence can lead to craving the drug to relieve the withdrawal symptoms. Drug dependence and addiction refer to substance use disorders, which may include physical dependence but must also meet additional criteria.
How do drugs work in the brain to produce pleasure?
Nearly all addictive drugs directly or indirectly target the brain’s reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, cognition, motivation, and feelings of pleasure. The overstimulation of this system, which rewards our natural behaviors, produces the euphoric effects sought by people who use drugs and teaches them to repeat the behavior.
Is drug abuse a voluntary behavior?
The initial decision to take drugs is mostly voluntary. However, when addiction takes over, a person’s ability to exert self-control can become seriously impaired. Brain-imaging studies from people addicted to drugs show physical changes in areas of the brain that are critical for judgment, decisionmaking, learning, memory, and behavior control. Scientists believe that these changes alter the way the brain works and may help explain the compulsive and destructive behaviors of an addicted person.
Can addiction be treated successfully?
Yes. Addiction is a treatable, chronic disease that can be managed successfully. Research shows that combining behavioral therapy with medications, where available, is the best way to ensure success for most patients. Treatment approaches must be tailored to address each patient’s drug use patterns and drug-related medical, psychiatric, and social problems.
Does relapse to drug use mean treatment has failed?
No. The chronic nature of addiction means that relapsing to drug use is not only possible but also likely. Relapse rates are similar to those for other well-characterized chronic medical illnesses such as diabetes, hypertension, and asthma, which also have both physiological and behavioral components. Treatment of chronic diseases involves changing deeply imbedded behaviors. For the addicted patient, lapses back to drug use indicate that treatment needs to be reinstated or adjusted, or that alternate treatment is needed.
How many people die from drug use?
The Centers for Disease Control and Prevention (CDC) report that there were more than 40,000 unintentional drug overdose deaths in the United States in 2011, a 118-percent increase since 1999. More than 22,000 people die every year from prescription drug abuse,6 more than heroin and cocaine combined.7
Relapse rates for drug-addicted patients are compared with those suffering from diabetes, hypertension, and asthma. Relapse is common and similar across these illnesses (as is adherence to medication). Thus, drug addiction should be treated like any other chronic illness, with relapse serving as a trigger for renewed intervention. Source: McLellan et al., JAMA, 284:1689-1695, 2000.
Most Commonly Used Addictive Drugs
In recent years, Monitoring the Future, the NIDA-funded annual survey of drug, alcohol, and tobacco use in 8th-, 10th-, and 12th-grade students, has shown persistently high rates of marijuana and nonmedical prescription drug use in our Nation’s teens. More information on the Monitoring the Future survey can be found at www.drugabuse.gov/related-topics/trends-statistics/monitoring-future.
Marijuana
Marijuana (cannabis) is the most commonly used illicit substance. This drug impairs short-term memory and learning, the ability to focus, and coordination. It also increases heart rate, can harm the lungs, and may increase the risk of psychosis in vulnerable people. Research suggests that when regular marijuana use begins in the teen years, addiction is more likely: 1 in 6 users, compared to 1 in 9 among adults. In addition, recent research suggests that heavy cannabis use that starts in the teen years is associated with declines in IQ scores in adulthood. More information on marijuana can be found at www.drugabuse.gov/drugs-abuse/marijuana.
Marijuana Research at NIDA
As part of its mandate to study drug use and addiction and other health effects of both legal and illegal drugs, NIDA funds a wide range of research on marijuana; its main psychoactive ingredient, delta- 9-tetrahydrocannabinol (THC); and chemicals related to THC (cannabinoids such as cannabidiol [CBD]). More information on marijuana research at NIDA can be found at www.drugabuse.gov/drugs-abuse/marijuana/marijuana-research-nida.
Medical Marijuana
Although many have called for the nationwide legalization of marijuana to treat medical conditions, the scientific evidence to date is not sufficient for the marijuana plant to gain U.S. Food and Drug Administration (FDA) approval, for two main reasons.
First, there have not been enough clinical trials showing that marijuana’s benefits outweigh its health risks. The FDA requires carefully conducted studies in large numbers of patients (hundreds to thousands) to accurately assess the benefits and risks of a potential medication.
Second, to be considered a legitimate medicine, a substance must have well-defined and measureable ingredients that are consistent from one unit to the next (such as a pill or injection). This consistency allows doctors to determine the dose and frequency. As the marijuana plant contains hundreds of chemical compounds that may have different effects and that vary from plant to plant, its use as a medicine is difficult to evaluate.
However, THC-based drugs to treat pain and nausea are already FDA approved and prescribed. Scientists continue to investigate the medicinal properties of cannabinoids—or the individual components of the marijuana plant (e.g., THC, CBD). The therapeutic potential lies in developing medications based upon cannabinoids that have therapeutic value but with limited-to-no risk for addiction, such as CBD. For more information, see our “Is Marijuana Medicine?” DrugFacts at www.drugabuse.gov/publications/drugfacts/marijuana-medicine.
Any of the 27 NIH Institutes could fund research in this area. To find out more about NIH-funded research into the therapeutic potential of cannabinoids, contact NIH at mylesr@mail.nih.gov. For more information on research that NIDA is supporting to explore this issue, go to www.drugabuse.gov/drugs-abuse/marijuana/nida-research-therapeutic-benefits-cannabis-cannabinoids.
K2/Spice
“K2” or “Spice” refers to a wide variety of herbal mixtures that produce experiences similar to marijuana. Of the illicit drugs most used by high school seniors, Spice is second only to marijuana. It is sometimes called “synthetic” marijuana, but this is a misperception. Labels on Spice products often claim that they contain “natural” psychoactive material taken from a variety of plants; however, chemical analyses show that their active ingredients are synthetic (or designer) cannabinoid compounds.
Poison Control Centers report a variety of K2/Spice symptoms, including rapid heart rate, vomiting, agitation, confusion, hallucinations, raised blood pressure and reduced blood supply to the heart, and, in a few cases, heart attacks. Because the chemicals used in Spice have a high addictive potential and no medical benefit, the Drug Enforcement Administration (DEA) has made it illegal to sell, buy, or possess the main chemicals in these drugs. More information can be found at www.drugabuse.gov/drugs-abuse/k2spice-synthetic-marijuana.
Prescription and Over-the-Counter Medications
Prescription medications and some over-the-counter medications are increasingly being abused (used in ways other than intended or without a prescription). This practice can lead to addiction, and in some cases, overdose. Among the most disturbing aspects of this emerging trend is its prevalence among teenagers and young adults, as well as the common misperception that because these are used medically or prescribed by physicians, they are safe even when not used as intended. Commonly abused classes of prescription drugs include opioid painkillers, stimulants, and depressants.
- Opioids are usually prescribed for pain relief. Commonly prescribed opioids include hydrocodone (e.g., Vicodin®), oxycodone (e.g., OxyContin®), morphine, fentanyl, and codeine. In the United States, more people now die from opioid painkiller overdoses than from heroin and cocaine combined.
- Stimulants: Methylphenidate (Ritalin®, Concerta®, Focalin®, and Metadate®) and amphetamines (Adderall®, Dexedrine®) are stimulants commonly prescribed for attention-deficit hyperactivity disorder (ADHD).
- Depressants are usually prescribed to promote sleep or to reduce anxiety. As measured by national surveys, depressants are often categorized as sedatives or tranquilizers. Sedatives primarily include barbiturates (e.g., phenobarbitol) but also include sleep medications such as Ambien® and Lunesta®. Tranquilizers primarily include benzodiazepines such as Valium® and Xanax®, but also include muscle relaxants and other anti-anxiety medications.
- “Syrup,” “Purple Drank,” “Sizzurp,” or “Lean” describes soda mixed with prescription-strength cough syrup containing codeine and promethazine—these cough syrups are available by prescription only. Users may also flavor the mixture with hard candies. Drinking this combination has become increasingly popular among some celebrities and youth in several areas of the country. Codeine is an opioid that can produce relaxation and euphoria when consumed in sufficient quantities. Promethazine is an antihistamine that also acts as a sedative. More information can be found at www.drugabuse.gov/drugs-abuse/emerging-trends.
Commonly abused over-the-counter drugs include cold medicines containing dextromethorphan (DMX), a cough suppressant. Products containing DMX can be sold as cough syrups, gel capsules, and pills (that can look like candies). They are frequently abused by young people, who refer to the practice as “robo-tripping” or “skittling.” Pseudoephedrine, a decongestant found in many over-the-counter cold medicines, is another over-the-counter medication that is used illicitly. Although not typically abused in itself, it is one ingredient used to produce methamphetamine. For more information about prescription drug abuse and related health consequences, go to www.drugabuse.gov/drugs-abuse/prescription-drugs-cold-medicines.
Media Guide
Other Commonly Used Addictive Drugs
Alcohol
Alcohol consumption can damage the brain and most body organs, including the heart, liver, and pancreas. It also increases the risk of some cancers, weakens the immune system, puts fetal development at risk, and causes deadly vehicle accidents. Areas of the brain that are especially vulnerable to alcohol-related damage are the cerebral cortex (largely responsible for our higher brain functions, including problem-solving and decisionmaking), the hippocampus (important for memory and learning), and the cerebellum (important for movement coordination).
More information can be found on the Web site of the National Institute on Alcohol Abuse and Alcoholism at www.niaaa.nih.gov.
Amphetamines/ Methamphetamine
Amphetamines, including methamphetamine, are powerful stimulants that can produce feelings of euphoria and alertness. Methamphetamine is a white, odorless, bitter-tasting crystalline powder that easily dissolves in water or alcohol and is taken orally, intra-nasally (snorting the powder), by needle injection, or by smoking. Methamphetamine’s effects are particularly long lasting and harmful to the brain. Amphetamines can cause high body temperature and can lead to serious heart problems and seizures.
Regular methamphetamine use significantly changes how the brain functions. Noninvasive human brain imaging studies have shown alterations in the activity of the dopamine system that are associated with reduced motor skills and impaired verbal learning, which may account for many of the emotional and cognitive problems observed in regular methamphetamine users.
More information on methamphetamine can be found at www.drugabuse.gov/publications/drugfacts/methamphetamine.
Anabolic Steroids
Anabolic steroids refer to synthetic variants of the male sex hormone testosterone. The proper term for these compounds is anabolic-androgenic steroids (abbreviated AAS—“anabolic” referring to muscle building and “androgenic” referring to increased male sexual characteristics. Steroids can be prescribed for certain medical conditions; however, they are often abused to increase muscle mass and to improve athletic performance or physical appearance. Anabolic steroids are usually either taken orally or injected into the muscles, although some are applied to the skin as a cream or gel. Doses taken by abusers may be 10 to 100 times higher than doses prescribed to treat medical conditions.
Anabolic steroids work very differently from other addictive drugs, and they do not have the same acute effects on the brain. However, long-term steroid use can affect some of the same brain pathways and chemicals—including dopamine, serotonin, and opioid systems—that are affected by other drugs. They thereby may have a significant impact on mood and behavior.
Other serious consequences of steroid abuse can include heart disease, liver problems, stroke, infectious diseases, depression, and suicide. Less serious side effects include severe acne and changes in sex characteristics, like shrinking of the testicles in men and growth of facial hair in women. More information on steroids can be found at www.drugabuse.gov/drugs-abuse/steroids-anabolic.
Bath Salts
The term “bath salts” refers to an emerging family of drugs containing one or more synthetic chemicals related to cathinone, an amphetamine-like stimulant found naturally in the khat plant. Reports of severe intoxication and dangerous health effects associated with the use of bath salts have made these drugs a serious and growing public health and safety issue. Some users experience paranoia, agitation, hallucinatory delirium, and psychotic and violent behavior. Deaths have also been reported.
These synthetic cathinone products—marketed as “bath salts” to evade detection by authorities—should not be confused with products such as Epsom salts for bathing. Bath salts typically take the form of a white or brown crystalline powder and are sold in small plastic or foil packages labeled “not for human consumption.” More information can be found at www.drugabuse.gov/drugs-abuse/bath-salts-synthetic-cathinones.
Cocaine
Cocaine is a short-acting stimulant, which can lead users to “binge”—take the drug many times in a single session. Cocaine use can lead to severe medical consequences related to the heart and the respiratory, nervous, and digestive systems. Cocaine users can also experience severe paranoia, in which they lose touch with reality.
The powdered form of cocaine is either inhaled through the nose (snorted), where it is absorbed through the nasal tissue, or dissolved in water and injected into the bloodstream. Crack is a form of cocaine that has been processed to make a rock crystal (also called “freebase cocaine”) that can be smoked. The crystal is heated to produce vapors that are absorbed into the bloodstream through the lungs. (The term “crack” refers to the crackling sound produced by the rock as it is heated.)
More information can be found at www.drugabuse.gov/drugs-abuse/cocaine.
Hallucinogens
The effects of hallucinogens—perception-altering drugs—are highly variable and unreliable, producing different effects in different people at different times. This is mainly due to differences in the amounts and chemistries of active compounds within the drugs. Because of their unpredictable nature, the use of hallucinogens can be particularly dangerous. Examples of hallucinogens include:
- MDMA (Ecstasy, “Molly”) (3,4-methylenedioxymethamphetamine) produces both stimulant and mind-altering effects. It can increase body temperature, heart rate, blood pressure, and heart-wall stress. Ecstasy may also be toxic to nerve cells. It is taken orally, usually as a capsule or tablet. Its effects last approximately 3 to 6 hours, although it is not uncommon for users to take a second dose of the drug as the effects of the first dose begin to fade. Ecstasy is commonly taken in combination with alcohol and other drugs.
Molly—slang for “molecular”—refers to the pure crystalline powder form of ecstasy. Users may seek out Molly to avoid the adulterants or substitutes known to be commonly found in ecstasy, but those who purchase what they think is pure ecstasy may actually be exposing themselves to the same risks, since Molly often contains toxic additives. In fact, Molly is often nothing more than repackaged ecstasy.
More information can be found at www.drugabuse.gov/publications/drugfacts/mdma-ecstasy.
- LSD is one of the most potent hallucinogenic drugs. Its effects are unpredictable, and users may see vivid colors and images, hear sounds, and feel sensations that seem real but do not exist. Users also may have traumatic experiences and emotions that can last for many hours. Some short-term effects can include increased body temperature, heart rate, and blood pressure; sweating; loss of appetite; sleeplessness; dry mouth; and tremors.
- PCP (phencyclidine) was developed in the 1950s as an intravenous anesthetic. Its legitimate use has since been discontinued due to serious adverse effects.
- Psilocybin is obtained from certain types of mushrooms that are found in tropical and subtropical regions of South America, Mexico, and the United States. These mushrooms typically contain less than 0.5 percent psilocybin plus trace amounts of psilocin, another hallucinogenic substance. More information can be found at www.drugabuse.gov/publications/drugfacts/hallucinogens-lsd-peyote-psilocybin-pcp.
Heroin
Heroin is a powerful opioid drug that produces euphoria and feelings of relaxation. It slows respiration and can increase the risk of serious infectious diseases, especially when taken intravenously. Regular heroin use changes the functioning of the brain, causing tolerance and dependence. Other opioid drugs include morphine, OxyContin®, Vicodin®, and Percodan®, which have legitimate medical uses; however, using them in ways other than prescribed (or using them without a prescription) can result in the same harmful consequences as heroin use.
More information about heroin can be found at www.drugabuse.gov/drugs-abuse/heroin.
Inhalants
Inhalants are volatile substances found in many household products (such as oven cleaners, gasoline, spray paints, and other aerosols) that induce mind-altering effects. Inhalants are extremely toxic and can damage the heart, kidneys, lungs, and brain. Even a healthy person can suffer heart failure and death within minutes of a single session of the prolonged sniffing of an inhalant.
People tend to abuse different inhalant products at different ages. New younger users (ages 12–15) most commonly abuse glue, shoe polish, spray paints, gasoline, and lighter fluid. First-time older users (ages 16–17) most commonly abuse nitrous oxide, or “whippets.” Adults most commonly abuse a class of inhalants known as nitrites (such as amyl nitrites, or “poppers”).
More information on inhalants can be found at www.drugabuse.gov/drugs-abuse/inhalants.
Ketamine, Rohypnol, and GHB
Ketamine, Rohypnol®, and GHB have come to be known as “date rape” drugs because they can cause someone to lose their memory of an assault. Rohypnol® and GHB can easily be added to beverages and ingested unknowingly. Any of these drugs can also cause someone to lose consciousness. Ketamine and GHB are predominantly central nervous system (CNS) depressants, whereas Rohypnol® is a benzodiazepine. More information can be found at www.drugabuse.gov/drugs-abuse/club-drugs.
Nicotine
Nicotine is an addictive stimulant found in cigarettes and other forms of tobacco. Tobacco smoke increases a user’s risk of cancer, emphysema, bronchial disorders, and cardiovascular disease. Smoking rates have decreased in the United States in recent years, yet the mortality rate associated with tobacco addiction is still staggering, with more than 480,000 premature deaths in the United States each year—about 1 in every 5 deaths.5 Tobacco use killed approximately 100 million people during the 20th century and, if current smoking trends continue, the cumulative death toll for this century is projected to reach 1 billion.8 More information can be found at www.drugabuse.gov/drugs-abuse/tobacco-addiction-nicotine.
Resources
Where to Find Nationwide Trends and Statistics
Major sources of data on the extent of drug use in the United States include the following:
Monitoring the Future (MTF)
The MTF survey measures drug, alcohol, and cigarette use and related attitudes among 8th-, 10th-, and 12th-grade students nationwide. Survey participants report their drug use behaviors across three time periods: lifetime, past year, and past month. The annual survey is funded by NIDA and is conducted by the University of Michigan. Results from the survey are released late each fall. For the latest survey results, go to www.drugabuse.gov/DrugPages/MTF.html.
National Drug Early Warning System (NDEWS)
NDEWS will monitor emerging trends to help health experts respond quickly to potential outbreaks of illicit drug use and to identify increased use of designer synthetic compounds. The system will scan social media and Web platforms to identify new trends as well as use conventional national- and local-level data resources that are utilized by the Community Epidemiology Work Group (CEWG). Development of this project started August 2014. The system is expected to launch in 2015 as an enhancement (and eventual replacement) of the current system – the CEWG. Until then, project updates can be found on the CEWG Web site: www.drugabuse.gov/about-nida/organization/workgroups-interest-groups-consortia/community-epidemiology-work-group-cewg.
National Survey on Drug Use and Health (NSDUH)
The Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) NSDUH (formerly called the National Household Survey on Drug Abuse) is the primary source of information on the prevalence, patterns, and consequences of alcohol, tobacco, and illicit drug use in the general U.S. civilian non-institutionalized population, ages 12 and older. Survey information can be found at www.oas.samhsa.gov/nsduh.htm.
Drug Abuse Warning Network (DAWN)
The DAWN report, also prepared by SAMHSA, provides information about the impact of drug use on hospital emergency departments in the United States. It reports the number of visits to the emergency department that were related directly to the use of an illegal drug or the nonmedical use of a legal drug, as well as drug-related deaths investigated by medical examiners and coroners. DAWN is not a measure of the prevalence of use but instead offers information complementary to the prevalence data found in the NSDUH. Survey information can be found at www.samhsa.gov/data/DAWN.aspx.
Treatment Episode Data Set (TEDS)
The TEDS system includes records for approximately 1.5 million substance abuse treatment admissions annually. While TEDS does not represent all substance abuse treatment activities, it comprises a significant proportion of all admissions to substance abuse treatment programs and includes those admissions that rely on public funds. Data are reported by sex, age, and race/ethnicity for each of 15 substance abuse categories. TEDS is maintained by SAMHSA’s Office of Applied Studies, and can be found at www.oas.samhsa.gov/ dasis.htm#teds2.
Youth Risk Behavior Survey (YRBS)
The YRBS, part of the Centers for Disease Control and Prevention’s (CDC’s) Youth Risk Behavior Surveillance System (YRBSS), is a school-based survey that collects data from students in grades 9–12. The survey includes questions on a wide variety of health-related risk behaviors, including substance use. More information is available at www.cdc.gov/ HealthyYouth/yrbs/index.htm.
CDC’s Home & Recreational Safety: Drug Overdose Data
CDC consolidates information from their Wide-ranging OnLine Data for Epidemiologic Research (WONDER) database, which tracks underlying cause of death, and SAMHSA’s DAWN data to provide information on U.S. drug overdose deaths. More information is available at www.cdc.gov/homeandrecreationalsafety/overdose/index.html.
NIDA Resources
A wealth of material regarding various aspects of drug use and addiction is available, free of charge, from NIDA.
NIDA Web Site
Through its online and mobile presence, NIDA strives to communicate its research findings to the wide-ranging audiences it serves, which include students, parents, teachers, researchers, scientists, prevention and treatment practitioners, health care professionals, policymakers, constituent groups, children and teens, underserved populations, and the general public.
Most of NIDA’s publications are available on NIDA’s Web site: www.drugabuse.gov. The site’s responsive design allows users to access the information on handheld devices, including smart phones and tablets, and some resources can be ordered free in hard copy.
Other NIDA Sites:
- For low literacy users: www.easyread.drugabuse.gov
- For teens and people who work with teens: www.teens.drugabuse.gov
- Information for young adults on the link between HIV/AIDS and drugs: www.hiv.drugabuse.gov
- NIDA’s intramural research program: www.irp.drugabuse.gov
NIDA’s New Media Accounts:
- Twitter: @NIDAnews
- Facebook:RSS feed: www.drugabuse.gov/nidanews.xml
- General audience: www.facebook.com/NIDANIH
- For teens and their teachers and parents: www.facebook.com/NIDA.Drug.Facts.Week
- YouTube: www.youtube.com/user/NIDANIH
- Flickr: www.flickr.com/photos/nida-nih/collections/
- LinkedIn: www.linkedin.com/company/the-national-institute-on-drug-abuse-nida
NIDA images are in the public domain and may be used, linked, or reproduced without further permission from NIDA. However, credit should be given to NIDA, unless otherwise instructed to give credit to the photographer or other source.
Other Government Web Sites for Health and Science Information
National Institutes of Health (NIH) (www.nih.gov)
NIH is the steward of medical and behavioral research for the Nation. Its mission is to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to extend health, lengthen life, and reduce illness and disability. NIH is part of the U.S. Department of Health and Human Services (HHS). The NIH site links to sites for its 27 Institutes and Centers.
RePORTER (www.projectreporter.nih.gov/reporter.cfm)
RePORTER includes information on research projects funded by the NIH as well as CDC, the Agency for Healthcare Research and Quality, the Health Resources and Services Administration, SAMHSA, and the U.S. Department of Veterans Affairs. RePORTER also includes links to publications and patents citing support from these projects.
Project results can be filtered according to specific parameters, such as Principal Investigator, Fiscal Year, keyword, etc.
Note: when doing a “Text Search” to filter by certain keywords, you will have to read the description of each study to determine if that research is actually focusing on your keyword of interest. In some cases, the term may be merely mentioned in the grant application but is not the topic of the study.
National Library of Medicine (NLM)
(www.nlm.nih.gov)
NLM is the world’s largest library dealing with a single scientific/professional topic. It cares for nearly 19 million holdings (including books, journals, reports, manuscripts, and audiovisual items) and sponsors MedlinePlus, a source of up-to-date, quality health care information from NLM and NIH.
ClinicalTrials.gov
(www.clinicaltrials.gov)
ClinicalTrials.gov lists publicly and privately supported clinical studies of human participants conducted around the world. ClinicalTrials.gov does not contain all the clinical studies conducted in the United States because not all studies (for example, observational studies and trials that do not study a drug, biologic, or device) are required by law to be registered. The Web site is maintained by NLM.
Healthfinder
(www.healthfinder.gov)
Healthfinder is a Government Web site providing resources on a wide range of health topics, selected from approximately 1,400 Government and non-profit organizations.
Office on Women’s Health (OWH)
(www.womenshealth.gov)
OWH provides up-to-date and commercial-free health information on topics that range from reproductive health to healthy aging. The site provides easy-to-understand health information, daily announcements, links to thousands of free health publications and Web sites, and statistics on women’s health.
Office of Adolescent Health (OAH)
(www.hhs.gov/ash/oah/)
OAH is dedicated to improving the health and well-being of America’s adolescents, especially those who are most vulnerable.
Source: NIDA, NIH, HHS
Heroin and Opiate Addiction
In 2009, 605,000 Americans age 12 and older had abused heroin at least once in the year prior to being surveyed. Source: National Survey on Drug Use and Health (Substance Abuse and Mental Health Administration web site). The NIDA-funded 2010 Monitoring the Future Study showed that 0.8% of 8th graders, 0.8% of 10th graders, and 0.9% of 12th graders had abused heroin at least once in the year prior to being surveyed. Source: Monitoring the Future (University of Michigan web site.)
Heroin is a highly addictive drug that is processed from morphine and usually appears as a white or brown powder or as a black, sticky substance. It is injected, snorted, or smoked.
Short-term effects of heroin include a surge of euphoria and clouded thinking followed by alternately wakeful and drowsy states. Heroin depresses breathing, and therefore, overdose can be fatal. Users who inject the drug risk infectious diseases such as HIV/AIDS and hepatitis.
Nobody wants to be in pain
As human beings, there are many different kinds of pain: physical pain like aches and burns; and then there is emotional pain like heartache, painful memories, guilt, sadness, insecurity and anxiety. Most any living creature has a very instinctual drive to not hurt or to avoid pain, but it might be said that humans are subjected to many more types of pain than any other known organism.
One of the many less-than-healthy ways that some of us choose to try to remove pain and gain pleasure is by taking alcohol and other drugs. Historically, heroin and other opioids have appeared to many people as a viable means, or even as the only route, to do that very natural thing that all living organisms try to do: avoid pain and feel good.
What is heroin and how does it work?
Heroin and other opioids, like prescription pain-killers, have a very addictive quality to them due largely to how when consumed, they mimic the brain’s natural processes for seeking pleasure. Opioids access and alter the very components that are involved in producing pleasure and removing pain, i.e. the brain’s pleasure center and opioid receptors, dopamine and endorphins. This very rewarding process also affects an individual’s cognitive process – how we think and feel about pain and pleasure, adding a complicated layer to the risk of addiction.
Heroin and other opioids can be injected, smoked, used as a suppository or swallowed. They are central nervous system depressants and have several short-term effects such as: euphoria, sedation, reduction of pain and anxiety, breathing complications and nausea. In addition, there are risky physical effects associated with opiate and heroin addiction and these include: HIV/ AIDS, hepatitis, skin infections, or bacterial or viral infections, collapsed veins, lung infections and death from overdose.
Who gets addicted to heroin and why?
Can you imagine having a magical button that you could push and all of your body’s aches and pains would go away in a matter of seconds? What if your pain was suddenly replaced with a euphoric feeling? What if that same button could take away every insecurity, worry, painful memory and sadness in your life? Sounds too good to be true, right? Well, it is, because the consequences of opioid addiction are often unimaginably scary. Although, the truth is, that for many people who are struggling and even for those who are just young and confused or dealing with self-exploration, the allure of this kind of freedom, this type of reward, this access to so much pleasure, is very, very powerful.
Heroin isn’t just for bikers and homeless people anymore. Anyone can become addicted to heroin: from troubled youth in single parent families to cheerleaders and football players from affluent families; from people with mental health issues to lawyers and judges. In fact, more and more “well-adjusted” young people are becoming addicted to heroin every day. Just as there are as many paths to recovery as there are people, so are there as many reasons why a person becomes addicted to heroin.
Statistically, most people, especially youth, are introduced to heroin and other opioids in the form of prescription pain-killers such as Oxycontin, Vicodin, Percocet, Hydrocodone, Oxycodone and Fentanyl; drugs which when viewed at a molecular level are virtually identical to heroin (heroin was actually invented by the pharmaceutical company, Bayer). Many people are prescribed these medications appropriately for the purpose of relieving physical pain. This is not the only way, however, for an individual to acquire a prescribed opioid. Currently, acquiring prescription opioids is considered an easy task due to the overabundance of prescription pills in our medicine cabinets and society at large.
What this overabundance of prescription pills has done is to take the needle, and thus the stigma, out of opioid addiction and opened it up an entirely new audience to its dangers. Pills come from well-intended family and friends, they are sold to us or shared with us by our peers as a means of relaxing. For a number of people who use opioids, as prescribed or not, addiction is a marked risk and they may form maladaptive and dangerous behaviors, poor emotional and psychological patterns and unhealthy relationships with the drug. As prescription opioids become harder for them to obtain, heroin becomes more and more appealing in terms of cost and effect. Further, as many find out, the lifestyle that heroin addiction brings can be one wrought with danger and despair.
What does it mean to be addicted?
Chronic heroin and other opioid use results, in effect, in the body producing more and more opioid-receptors to meet the needs of the flood of opioids in the system. At the same time the body now believes that it no longer needs to produce its own pleasure-giving and pain-reducing chemicals. This is the point at which we say a person is physically dependent on the drug. The body can no longer function at its normal level without the drug. This dependence leads to painful and often frightening withdrawals when the drug is removed and the body begins the process of figuring out how to live without the extra opioids it has become accustomed to.
Withdrawals: Around 10 hours after a heroin-dependent person has last used heroin they begin to feel anxious or agitated, their eyes begin to tear-up and they begin yawning a lot. They also begin sweating and getting feverish, start to have stomach cramps and diarrhea, begin to have muscle cramps and spasms and experience chills. This gamut of physical and emotional pain and discomfort tends to peak at around three days but can be prolonged for nearly ten days. Many people addicted to heroin describe experiencing their “bones aching” and a feeling that they want to “crawl out of their skin”. The fear of this experience is felt by many who are addicted to be the reason that they get “stuck” in the addiction as they have convinced their mind and body on some level that to not have heroin is akin to dying.
How do I know if I have a problem and what sort of help do I need?
*This is in no way intended as a substitute for professional or medical advice!
If you are worried about your heroin or pill-form opioid use you may already qualify, clinically-speaking, for “opioid abuse”. Any behavior is technically “abusive” if it interferes in your life in any way and yet you continue with it. This could mean that the substance or any behavior that is related to its use leads to fighting with your family or friends, giving up or interfering with things that you previously enjoyed, spending too much money, feelings of guilt, feelings of being out of control, legal issues or many other things. “Abuse” is continuing a behavior despite negative consequences. Only you can decide if a substance or behavior is a problem in your life; it has to come from you, otherwise, change will be superficial and short-lived.
If you are experiencing: physical withdrawals, tolerance to the substance, an inability to cut-down or control your use, spending large amounts of time in activities related to the substance, interference with important things in your life or continued use of the substance despite severe physical or psychological consequences, this is a strong indicator of dependency. This means you may want to consider more immediate professional help and possibly medically assisted detox.
Also remember that, although you may feel like it, very few people actually die from opioid withdrawal (with the exception of Methadone).
There are various treatments and treatment combinations that may be effective for opioid abuse and dependence and these include, but are not limited to, talk therapy (e.g. Cognitive Behavioral Therapy, Motivational Interviewing and therapies which include contingency management), support groups (such as SMART Recovery), medically assisted treatment or replacement therapy (Methadone or Suboxone) and antagonist therapy (such as Vivitrol).
Above all, it is most important that you take action. Reach out. Let someone know that you want to talk. Please, know that you are not alone in this.
*Please remember that if you have not used heroin or other opioids before or have been off of them for a while due to being in jail or rehab, you are especially susceptible to overdose and, potentially, death.
How can SMART Recovery help me stop my heroin (opioid) problem?
SMART Recovery provides its members with tools and support that they can use to help themselves recover from addictions – be it alcohol, or other drugs or negative behaviors. SMART Recovery's 4-Point Program® is designed to help you overcome your substance abuse problems and quit by:
<> 1. Building & Maintaining Motivation – Identify and keep up with your reasons for positive change. Why do you want to change - what will keep you focused on that goal?
2. Coping with Urges – Dealing with urges and cravings is part of recovery. SMART has tools designed to help our members cope with urges and cravings.
3. Managing Thoughts, Feelings and Behaviors – We frequently turn to using drugs either to escape from or to avoid addressing problems. SMART Recovery participants learn problem-solving skills to help them manage challenges along the way.
4. Living a Balanced Life – Addiction can put your life out of balance – you may find yourself opting to engage in your addiction rather than going to work or to school. You may find that things you once enjoyed aren’t fun anymore. SMART helps participants build skills to balance both short and long-term goals, pleasures and needs that have become out of balance.
Where do I go from here?
Getting started with SMART Recovery is easy! If you would like to get started right away, you can join our online support group where you can read, share and learn from our worldwide community of members at any time of the day or night.
You can also find a local SMART Recovery meeting, or, if we don’t have any meetings in your area yet, you can join us at one of our online meetings.
If you’d like to have printed study material, we suggest the SMART Recovery Handbook.
