Understanding Addiction

I Have Nothing

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Last night, I was talking to a friend from CBS.  When I hung up the phone, I logged onto Facebook and his status update said, “RIP Whitney Houston.”

I commented, “What??!!”

I felt immediate disbelief.  It’s a joke.  It’s a mistake.  Seconds later, a filled news feed confirmed the sad news: Whitney Houston, the musical icon, one of the most successful female performers of all time, dead at 48.

At 3:55 p.m. yesterday, Whitney Houston was found dead at The Beverly Hills Hilton Hotel.  Unbelievable.  The voice of an Angel gone.  We can’t bring Whitney Houston back or anyone else who lost their gifts to substance abuse, but we can seek first to understand how it happens, recognize symptoms and think about better ways to either help prevent or treat it. You don’t have to be a celebrity to be familiar with downward spiral of addiction.

Ironically, Whitney Houston sang the song, “The Greatest Love of All,” but it may very well be that she never achieved this greatest love for herself. She is quoted as having said:

“The biggest devil is me.  I’m either my best friend or worst enemy.” ~Whitney Houston

This is common for people battling any type of addiction, albeit drugs, alcohol, gambling, sex, food or any other behavior which has negative consequences.  The reason Cognitive Behavioral Therapy works is because it gets to the bottom of why the individual lacks self-love, which can often be at the root of any addiction.

Once that is established, the individual can be provided with healthy tools to begin achieving a greater self-image from the inside out.  This takes time and a willingness to release a lot of toxic inner garbage that may have accumulated over the years.   It’s the long-term and healthy approach.  My feeling is some people want a quick-fix and pay for prescription medication without ever taking the time to get to the cause or root of their problem. The drugs mask their pain and then they get addicted to the drugs, so the vicious circle begins.  Let’s take a closer look at addiction.

According to Psychology Today, addiction is a condition that results when a person ingests a substance (alcohol, cocaine, nicotine) or engages in an activity (gambling) that can be pleasurable but the continued use of which becomes compulsive and interferes with ordinary life responsibilities, such as work or relationships, even health. Users may not be aware that their behavior is out of control and causing problems for themselves and others.

The word addiction is used in several different ways. One definition describes physical addiction. This is a biological state in which the body adapts to the presence of a drug so that drug no longer has the same effect; this is known as tolerance. Because of tolerance, there is a biological reaction when the drug is withdrawn. Another form of physical addiction is the phenomenon of overreaction by the brain to drugs (or to cues associated with the drugs). An alcoholic walking into a bar, for instance, will feel an extra pull to have a drink because of these cues.

However, most addictive behavior is not related to either physical tolerance or exposure to cues. People compulsively use drugs, or gamble or shop, nearly always in reaction to being emotionally stressed, whether or not they have a physical addiction. Since these psychologically based addictions are not based on drug or brain effects, they can account for why people frequently switch addictive actions from one drug to a completely different kind of drug, or even to a non-drug behavior. The focus of the addiction isn’t what matters; it’s the need to take action under certain kinds of stress. To treat this kind of addiction requires understanding of how it works psychologically.

No matter which kind of addiction is meant, it is important to recognize that its cause is not a search for pleasure, and addiction has nothing to do with one’s morality or strength of character. Experts debate whether addiction is a “disease” or a true mental illness, whether drug dependence and addiction mean the same thing, and many other aspects of addiction. Such debates are not likely to be resolved soon. But the lack of resolution does not preclude effective treatment.

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Legalizing these addictions isn’t the answer.

What happens when the drug is a prescribed one?  TMZ reported no drugs or alcohol were found in Whitney’s hotel room, but prescription bottles were found there.  The following are statistics on prescription drug abuse from Drug Free World.  It’s disturbing to see how young people are (12-17) when first becoming addicted.

When I think of someone being a drug addict, I think of them getting drugs in some seedy alleyway.  Today, it’s a fancy doctor’s office.  As a society, I believe we need to start taking a look at the source. We need to ask the right questions.  Who is prescribing the medications, why and to whom?  The answers are: Doctors, Money, People with Money.  It’s far easier to blame the victim.   But it’s the person prescribing the medication who is aware of the addicting nature of the medications. Parents need to be aware of what is being prescribed for their children.

Everyone needs to be aware that often there is a natural remedy when you are being prescribed a medication.  Celebrities are an easy target for prescriptions.  I have seen some status updates say that a drug addict (referring to Whitney Houston) isn’t getting any sympathy from them.  Sympathy isn’t required, but the ability to empathize is needed if we are to prevent others (celebrity or not) from the same fate.  Can we save a person once addiction has them in their grip?  When I use the word “save” –I’m talking about doing so BEFORE addiction has taken a hold of them.  I’ll talk about AFTER later.

I’ve never acquired a taste for alcohol and the only drug I’ve ever taken is  low dosage baby aspirin, but I’ve also never experienced physical pain, except for a few falls. Even then, my body went into shock and naturally protected me.  I recall the physician prescribing pain medication for me when I dislocated an elbow on a fall, but I only needed them the first few days, tossing the rest. Prescribed painkillers are the top drug addiction, more abused than so-called street drugs. I find this crazy, but it’s true.

Educating parents, patients and physicians is a start. Prevention is ideal, but for those already in the grip of addiction –it’s a daily challenge.  So far, the best known help for that is Cognitive Behavioral Therapy combined with low-dosage (non addicting) medication and healthy lifestyle changes.  There are known natural highs that release the same chemicals that these drugs release. The person also needs to surround themselves with healthy people.  Someone with a drinking problem doesn’t want to be hanging out with barflies.

The abuse of prescription drugs has skyrocketed across the nation, and especially in Texas where, according to the Drug Policy Alliance, accidental overdoses from 1999 to 2007 increased 150%.

Here are some more startling statistics, which aren’t new.

INTERNATIONAL STATISTICS

Every day in the US, 2,500 youth (12 to 17) abuse a prescription pain reliever for the first time.Prescription drug abuse, while most prevalent in the US, is a problem in many areas around the world including Europe, Southern Africa and South Asia. In the US alone, more than 15 million people abuse prescription drugs, more than the combined number who reported abusing cocaine, hallucinogens, inhalants and heroin.

In 2006 in the United States, 2.6 million people abused prescription drugs for the first time.

A 2007 survey in the US found that 3.3% of 12- to 17-year-olds and 6% of 17- to 25-year-olds had abused prescription drugs in the past month.

Prescription drug abuse causes the largest percentage of deaths from drug overdosing. Of the 22,400 drug overdose deaths in the US in 2005, opioid painkillers were the most commonly found drug, accounting for 38.2% of these deaths.

In 2005, 4.4 million teenagers (aged 12 to 17) in the US admitted to taking prescription painkillers, and 2.3 million took a prescription stimulant such as Ritalin. 2.2 million abused over-the-counter drugs such as cough syrup. The average age for first-time users is now 13 to 14.

CAUSE OF DEATHS

Prescription
Drugs
Street Drugs
Combined:
39%
45% (Amphetamine
+ Heroin
+ Methamphetamine
+ Cocaine)

Depressants, opioids and antidepressants are responsible for more overdose deaths (45%) than cocaine, heroin, methamphetamine and amphetamines (39%) combined. In the United States, the most deaths used to take place in inner cities in African-American neighborhoods, but they have now been overtaken by white rural communities. The same trend can be seen in the rates of hospitalization for substance abuse and emergency hospitalization for overdoses. Of the 1.4 million drug-related emergency room admissions in 2005, 598,542 were associated with abuse of pharmaceuticals alone or with other drugs.

By survey, almost 50% of teens believe that prescription drugs are much safer than illegal street drugs—60% to 70% say that home medicine cabinets are their source of drugs.

According to the National Center on Addiction and Substance Abuse at Columbia University, teens who abuse prescription drugs are twice as likely to use alcohol, five times more likely to use marijuana, and twelve to twenty times more likely to use illegal street drugs such as heroin, Ecstasy and cocaine than teens who do not abuse prescription drugs.

In 2007, the Drug Enforcement Administration found that abuse of the painkiller Fentanyl killed more than 1,000 people that year in the US. It is thirty to fifty times more powerful than heroin.

“I realized I was using more Xanax on a regular basis. I took time off work to get off it. Without the knowledge I was addicted, I went ‘cold turkey.’ For four days and nights I was bedridden. I didn’t sleep or eat. I vomited. I had hallucinations. On about the third day without Xanax I started to become uncoordinated and unbalanced and bumped into things. On about the fourth day I became really worried when I started having twitching sensations.” —Patricia

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Latest Key findings from the CDC (Centers for Disease Control)

  • Over the last 10 years, the percentage of Americans who took at least one prescription drug in the past month increased from 44% to 48%. The use of two or more drugs increased from 25% to 31%. The use of five or more drugs increased from 6% to 11%.
  • In 2007-2008, 1 out of every 5 children and 9 out of 10 older Americans reported using at least one prescription drug in the past month.
  • Those who were without a regular place for health care, health insurance, or prescription drug benefit had less prescription drug use compared with those who had these benefits.
  • The most commonly used types of drugs included: asthma medicines for children, central nervous system stimulants for adolescents, antidepressants for middle-aged adults, and cholesterol lowering drugs for older Americans.

In the United States, spending for prescription drugs was $234.1 billion in 2008, which was more than double what was spent in 1999 (1). As new drugs are introduced and new uses for old drugs are found, more patients can have improved health and quality of life with the appropriate use of prescription drugs. Current prescription drug use patterns need to be better understood. This report provides an overview of current prescription drug use in the United States, how many and what kinds of drugs are currently being prescribed, and who receives them.


What are the trends in prescription drug use in the United States over the past 10 years?

Prescription drug use in the United States increased from 1999-2000 through 2007-2008 (Figure 1).

Figure 1 is a line graph showing the trends in prescription drug use in the United States from 1999 through 2008.

  • The percentage of Americans who used at least one prescription drug in the past month increased from 44% in 1999-2000 to 48% in 2007-2008.
  • The percentage of persons who used two or more prescription drugs increased from 25% in 1999-2000 to 31% in 2007-2008.
  • The percentage of persons who used five or more prescription drugs increased from 6% in 1999-2000 to 11% in 2007-2008.

What percentage of Americans used multiple prescription drugs in the past month and how did this vary by age?

The use of multiple prescription drugs in the past month varied by age (Figure 2).

Figure 2 is a bar chart showing the number of prescription drugs used in the United States from 2007 through 2008.

  • Among children (under age 12), less than 10% used two or more prescription drugs in the past month and only 1% used five or more.
  • Among older Americans (aged 60 and over), more than 76% used two or more prescription drugs and 37% used five or more.

Did prescription drug use vary among demographic subgroups?

There were differences in prescription drug use by age, sex, and race and ethnicity (Figure 3).

Figure 3 is a bar chart showing the prevalence of prescription drug use by age, gender, and race and ethnicity from 2007 through 2008.

  • Prescription drug use increased with age.
  • Women were more likely to use prescription drugs than men.
  • The non-Hispanic white population had the highest prescription drug use and the Mexican-American population had the lowest.

What is the relationship between access to health care services and prescription drug use?

Having a regular source of health care, health insurance, and health insurance with prescription drug benefits were all associated with increased use of prescribed medicines (Figure 4).

Figure 4 is a bar chart showing the prevalence of prescription drug use by health care, health insurance, and prescription drug benefit status from 2007 through 2008.

  • Persons with a regular place for health care were 2.7 times as likely to have used prescription drugs in the past month as those without a regular place for health care.
  • Those with health insurance were almost twice as likely to have used at least one prescription drug in the past month as those without health insurance coverage.
  • Among people with health insurance, those having a prescription drug benefit were 22% more likely to use prescription drugs than those who did not have this benefit.

What were the most frequently used types of prescription drugs?

The types of prescription drugs used by Americans varied by age (Figure 5).

Figure 5 is a bar chart showing the type of prescription drugs used most often by age from 2007 through 2008

The most commonly used types of prescription drugs in the United States by age were:

  • Bronchodilators for children aged 0-11.
  • Central nervous system stimulants for adolescents aged 12-19.
  • Antidepressants for adults aged 20-59.
  • Cholesterol lowering drugs for adults aged 60 and over.

Among children under age 6, penicillin antibiotics were the most frequently used prescription drugs.

Diuretics and β-blockers were also very commonly used drugs in adults and older Americans. These are usually used to treat high blood pressure and heart problems.

Summary

Over the last decade the percentage of Americans who took at least one prescription drug in the past month increased by 10%. The use of multiple prescription drugs increased by 20% and the use of five or more drugs increased by 70%. By 2007-2008, one-half of Americans used at least one or more prescription drugs; and 1 out of 10 used five or more. One out of every five children used at least one or more prescription drugs compared with 9 of every 10 adults aged 60 and over. Women were more likely to use prescription drugs than were men. Those who were without a regular place for health care, health insurance, or prescription drug benefit were less likely to have used prescription medication compared with their counterparts.

The types of prescription drugs that were most commonly used were asthma medicines for children, central nervous system stimulants for adolescents, antidepressants for middle-aged adults, and cholesterol lowering and high blood pressure drugs for older Americans. These patterns reflect the main chronic diseases common at these ages, but may also likely reflect more aggressive treatments for chronic medical conditions such as high cholesterol and high blood pressure as recommended in the updated clinical guidelines (2,3).

Those without a regular place for health care, health insurance, or prescription drug benefits had lower prescription drug use rates. Lack of access to medicines may impact health and quality of life, as prescription drugs are essential to treat acute and chronic diseases.

Finally, almost 40% of older Americans used five or more prescription drugs in the past month. This likely reflects the need to treat the many diseases that commonly occur in this age group; however, excessive prescribing or polypharmacy is also an acknowledged safety risk for older Americans, and a continuing challenge that may contribute to adverse drug events, medication compliance issues, and increased health care costs (4-6).

Definitions

Prescription drug use: National Health and Nutrition Examination Survey (NHANES) participants were asked if they had taken a prescription drug in the past month. Those who answered “yes” were asked to show the interviewer the medication containers of all prescription drugs. For each drug reported, the interviewer recorded the product’s complete name from the container (7).

Therapeutic drug class (type of drugs): Prescription drugs were classified based on the three-level nested therapeutic classification scheme of Cerner Multum’s Lexicon. Up to four classes were assigned to each drug. The most commonly cited second level of drug categorical codes were used in this analysis (7).

Health care access: Based on the question, “Is there a place you usually go when you are sick or you need advice about your health?”

Health insurance coverage: Based on the question, “Are you covered by health insurance or some other kind of health care plan?”

Prescription drug benefit: Based on the question, “Do any of these plans cover any part of cost of prescriptions?”

Data source and methods

NHANES data were used for these analyses (7). NHANES is designed to monitor the health and nutritional status of the civilian noninstitutionalized U.S. population. NHANES is nationally representative. Sample weights, accounting for the differential probabilities of selection, nonresponse, and noncoverage were used for analyses. Variance estimates accounted for the complex survey design using Taylor series linearization. Apart from age-specific estimates, all estimates were age adjusted to the 2000 U.S. standard population using four age groups: under age 12, 12-19, 20-59, and 60 and over (8). Trends were tested to evaluate changes in estimates across survey periods and age groups. Differences among groups were evaluated using a univariate t statistic. All significance tests were two-sided using p < 0.05 as the level of statistical significance. For comparison of estimates by race and ethnic groups, adjustments for multiple comparisons were made using the Bonferroni method (9). Reported differences are statistically significant unless otherwise indicated. Statistical analyses were conducted using SAS version 9.2 (SAS Institute, Cary, N.C.) and SUDAAN version 10.0 (Research Triangle Institute, Research Triangle Park, N.C.).

About the authors

Qiuping Gu, Charles F. Dillon, and Vicki L. Burt are with the Centers for Disease Control and Prevention’s National Center for Health Statistics, Division of Health and Nutrition Examination Surveys.

References

  1. Centers for Medicare & Medicaid Services. National Health Expenditure Accounts, Historical.External Web Site Icon
  2. National Cholesterol Education Program expert panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) expert panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 106(25):3143-421. 2002.
  3. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 42(6):1206-52. 2003.
  4. Qato DM, Alexander GC, Conti RM, Johnson M, Schumm P, Lindau ST. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA 300(24):2867-78. 2008.
  5. O’Mahony D, Gallagher PF. Inappropriate prescribing in the older population: Need for new criteria. Age Ageing 37(2):138-41. 2008.
  6. Trygstad TK, Christensen DB, Wegner SE, Sullivan R, Garmise JM. Analysis of the North Carolina long-term care polypharmacy initiative: A multiple-cohort approach using propensity-score matching for both evaluation and targeting. Clin Ther 31(9):2018-37. 2009.
  7. CDC. National Center for Health Statistics. National Health and Nutrition Examination Surveys, 1999-2008.
  8. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes, no 20. Hyattsville, MD: National Center for Health Statistics. 2001.
  9. Miller RG Jr. Developments in multiple comparisons 1966-1976. J Am Stat Assoc 72(360):779-88. 1977.

Suggested citation

Gu Q, Dillon CF, Burt VL. Prescription drug use continues to increase: U.S. prescription drug data for 2007-2008. NCHS data brief, no 42. Hyattsville, MD: National Center for Health Statistics. 2010.

Copyright information

All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

National Center for Health Statistics

Edward J. Sondik, Ph.D., Director
Jennifer H. Madans, Ph.D., Associate Director for Science

Division of Health and Nutrition Examination Surveys

Cliff L. Johnson, M.S.P.H., Director

SIGNS, SYMPTOMS, AND HELP FOR DRUG PROBLEMS AND SUBSTANCE ABUSE


Drug Abuse and Addiction: Signs, Symptoms, Effects and Testing

Some people are able to use recreational or prescription drugs without ever experiencing negative consequences or addiction. For many others, substance use can cause problems at work, home, school, and in relationships, leaving you feeling isolated, helpless, or ashamed.

If you’re worried about your own or a friend or family member’s drug use, it’s important to know that help is available. Learning about the nature of drug abuse and addiction—how it develops, what it looks like, and why it can have such a powerful hold—will give you a better understanding of the problem and how to best deal with it.

Understanding drug use, drug abuse, and addiction

People experiment with drugs for many different reasons. Many first try drugs out of curiosity, to have a good time, because friends are doing it, or in an effort to improve athletic performance or ease another problem, such as stress, anxiety, or depression. Use doesn’t automatically lead to abuse, and there is no specific level at which drug use moves from casual to problematic. It varies by individual. Drug abuse and addiction is less about the amount of substance consumed or the frequency, and more to do with theconsequences of drug use. No matter how often or how little you’re consuming, if your drug use is causing problems in your life—at work, school, home, or in your relationships—you likely have a drug abuse or addiction problem.

Why do some drug users become addicted, while others don’t?

As with many other conditions and diseases, vulnerability to addiction differs from person to person. Your genes, mental health, family and social environment all play a role in addiction. Risk factors that increase your vulnerability include:

  • Family history of addiction
  • Abuse, neglect, or other traumatic experiences in childhood
  • Mental disorders such as depression and anxiety
  • Early use of drugs
  • Method of administration—smoking or injecting a drug may increase its addictive potential

Drug addiction and the brain

Learn more about how addiction hijacks the brain.

Read Article by Harvard Health Publications

Addiction is a complex disorder characterized by compulsive drug use. While each drug produces different physical effects, all abused substances share one thing in common: repeated use can alter the way the brain looks and functions.

  • Taking a recreational drug causes a surge in levels of dopamine in your brain, which trigger feelings of pleasure. Your brain remembers these feelings and wants them repeated.
  • If you become addicted, the substance takes on the same significance as other survival behaviors, such as eating and drinking.
  • Changes in your brain interfere with your ability to think clearly, exercise good judgment, control your behavior, and feel normal without drugs.
  • Whether you’re addicted to inhalants, heroin, Xanax, speed, or Vicodin, the uncontrollable craving to use grows more important than anything else, including family, friends, career, and even your own health and happiness.
  • The urge to use is so strong that your mind finds many ways to deny or rationalize the addiction. You may drastically underestimate the quantity of drugs you’re taking, how much it impacts your life, and the level of control you have over your drug use.

How drug abuse and addiction can develop

Learn how drugs block emotions

Watch a 3 -min. video: Roadblocks to awareness

People who experiment with drugs continue to use them because the substance either makes them feel good, or stops them from feeling bad. In many cases, however, there is a fine line between regular use and drug abuse and addiction. Very few addicts are able to recognize when they have crossed that line. While frequency or the amount of drugs consumed don’t in themselves constitute drug abuse or addiction, they can often be indicators of drug-related problems.

  • Problems can sometimes sneak up on you, as your drug use gradually increases over time. Smoking a joint with friends at the weekend, or taking ecstasy at a rave, or cocaine at an occasional party, for example, can change to using drugs a couple of days a week, then every day. Gradually, getting and using the drug becomes more and more important to you.
  • If the drug fulfills a valuable need, you may find yourself increasingly relying on it. For example, you may take drugs to calm you if you feel anxious or stressed, energize you if you feel depressed, or make you more confident in social situations if you normally feel shy. Or you may have started using prescription drugs to cope with panic attacks or relieve chronic pain, for example. Until you find alternative, healthier methods for overcoming these problems, your drug use will likely continue.
  • Similarly, if you use drugs to fill a void in your life, you’re more at risk of crossing the line from casual use to drug abuse and addiction. To maintain healthy balance in your life, you need to have other positive experiences, to feel good in your life aside from any drug use.
  • As drug abuse takes hold, you may miss or frequently be late for work or school, your job performance may progressively deteriorate, and you start to neglect social or family obligations. Your ability to stop using is eventually compromised. What began as a voluntary choice has turned into a physical and psychological need.

The good news is that with the right treatment and support, you can counteract the disruptive effects of drug use and regain control of your life. The first obstacle is to recognize and admit you have a problem, or listen to loved ones who are often better able to see the negative effects drug use is having on your life.

5 Myths about Drug Abuse and Addiction

MYTH 1: Overcoming addiction is a simply a matter of willpower. You can stop using drugs if you really want to. Prolonged exposure to drugs alters the brain in ways that result in powerful cravings and a compulsion to use. These brain changes make it extremely difficult to quit by sheer force of will.

MYTH 2: Addiction is a disease; there’s nothing you can do about it. Most experts agree that addiction is a brain disease, but that doesn’t mean you’re a helpless victim. The brain changes associated with addiction can be treated and reversed through therapy, medication, exercise, and other treatments.

MYTH 3: Addicts have to hit rock bottom before they can get better. Recovery can begin at any point in the addiction process—and the earlier, the better. The longer drug abuse continues, the stronger the addiction becomes and the harder it is to treat. Don’t wait to intervene until the addict has lost it all.

MYTH 4: You can’t force someone into treatment; they have to want help. Treatment doesn’t have to be voluntary to be successful. People who are pressured into treatment by their family, employer, or the legal system are just as likely to benefit as those who choose to enter treatment on their own. As they sober up and their thinking clears, many formerly resistant addicts decide they want to change.

MYTH 5: Treatment didn’t work before, so there’s no point trying again. Recovery from drug addiction is a long process that often involves setbacks. Relapse doesn’t mean that treatment has failed or that you’re a lost cause. Rather, it’s a signal to get back on track, either by going back to treatment or adjusting the treatment approach.

Signs and symptoms of drug abuse and drug addiction

Although different drugs have different physical effects, the symptoms of addiction are similar. See if you recognize yourself in the following signs and symptoms of substance abuse and addiction. If so, consider talking to someone about your drug use.

Common signs and symptoms of drug abuse

  • You’re neglecting your responsibilities at school, work, or home (e.g. flunking classes, skipping work, neglecting your children) because of your drug use.
  • You’re using drugs under dangerous conditions or taking risks while high, such as driving while on drugs, using dirty needles, or having unprotected sex.
  • Your drug use is getting you into legal trouble, such as arrests for disorderly conduct, driving under the influence, or stealing to support a drug habit.
  • Your drug use is causing problems in your relationships, such as fights with your partner or family members, an unhappy boss, or the loss of old friends.

Common signs and symptoms of drug addiction

  • You’ve built up a drug tolerance. You need to use more of the drug to experience the same effects you used to attain with smaller amounts.
  • You take drugs to avoid or relieve withdrawal symptoms. If you go too long without drugs, you experience symptoms such as nausea, restlessness, insomnia, depression, sweating, shaking, and anxiety.
  • You’ve lost control over your drug use. You often do drugs or use more than you planned, even though you told yourself you wouldn’t. You may want to stop using, but you feel powerless.
  • Your life revolves around drug use. You spend a lot of time using and thinking about drugs, figuring out how to get them, and recovering from the drug’s effects.
  • You’ve abandoned activities you used to enjoy, such as hobbies, sports, and socializing, because of your drug use.
  • You continue to use drugs, despite knowing it’s hurting you. It’s causing major problems in your life—blackouts, infections, mood swings, depression, paranoia—but you use anyway.

Warning signs that a friend or family member is abusing drugs

Drug abusers often try to conceal their symptoms and downplay their problem. If you’re worried that a friend or family member might be abusing drugs, look for the following warning signs:

Physical warning signs of drug abuse

  • Bloodshot eyes, pupils larger or smaller than usual.
  • Changes in appetite or sleep patterns. Sudden weight loss or weight gain.
  • Deterioration of physical appearance, personal grooming habits.
  • Unusual smells on breath, body, or clothing.
  • Tremors, slurred speech, or impaired coordination.

Behavioral signs of drug abuse

  • Drop in attendance and performance at work or school.
  • Unexplained need for money or financial problems. May borrow or steal to get it.
  • Engaging in secretive or suspicious behaviors.
  • Sudden change in friends, favorite hangouts, and hobbies.
  • Frequently getting into trouble (fights, accidents, illegal activities).

Psychological warning signs of drug abuse

  • Unexplained change in personality or attitude.
  • Sudden mood swings, irritability, or angry outbursts.
  • Periods of unusual hyperactivity, agitation, or giddiness.
  • Lack of motivation; appears lethargic or “spaced out.”
  • Appears fearful, anxious, or paranoid, with no reason.

Warning Signs of Commonly Abused Drugs

  • Marijuana: Glassy, red eyes; loud talking, inappropriate laughter followed by sleepiness; loss of interest, motivation; weight gain or loss.
  • Depressants (including Xanax, Valium, GHB): Contracted pupils; drunk-like; difficulty concentrating; clumsiness; poor judgment; slurred speech; sleepiness.
  • Stimulants (including amphetamines, cocaine, crystal meth): Dilated pupils; hyperactivity; euphoria; irritability; anxiety; excessive talking followed by depression or excessive sleeping at odd times; may go long periods of time without eating or sleeping; weight loss; dry mouth and nose.
  • Inhalants (glues, aerosols, vapors):  Watery eyes; impaired vision, memory and thought; secretions from the nose or rashes around the nose and mouth; headaches and nausea; appearance of intoxication; drowsiness; poor muscle control; changes in appetite; anxiety; irritability; lots of cans/aerosols in the trash.
  • Hallucinogens (LSD, PCP): Dilated pupils; bizarre and irrational behavior including paranoia, aggression, hallucinations; mood swings; detachment from people; absorption with self or other objects, slurred speech; confusion.
  • Heroin: Contracted pupils; no response of pupils to light; needle marks; sleeping at unusual times; sweating; vomiting; coughing, sniffling; twitching; loss of appetite.

Warning signs of teen drug abuse

While experimenting with drugs doesn’t automatically lead to drug abuse, early use is a risk factor for developing more serious drug abuse and addiction. Risk of drug abuse also increases greatly during times of transition, such as changing schools, moving, or divorce. The challenge for parents is to distinguish between the normal, often volatile, ups and downs of the teen years and the red flags of substance abuse. These include:

  • Having bloodshot eyes or dilated pupils; using eye drops to try to mask these signs.
  • Skipping class; declining grades; suddenly getting into trouble at school.
  • Missing money, valuables, or prescriptions.
  • Acting uncharacteristically isolated, withdrawn, angry, or depressed.
  • Dropping one group of friends for another; being secretive about the new peer group.
  • Loss of interest in old hobbies; lying about new interests and activities.
  • Demanding more privacy; locking doors; avoiding eye contact; sneaking around.

Getting help for drug abuse and drug addiction

Finding help and support for drug addiction

  • Visit a Narcotics Anonymous meeting in your area. See below.
  • Call 1-800-662-HELP in the U.S. to reach a free referral helpline from the Substance Abuse and Mental Health Services Administration.

Recognizing that you have a problem is the first step on the road to recovery, one that takes tremendous courage and strength. Facing your addiction without minimizing the problem or making excuses can feel frightening and overwhelming, but recovery is within reach. If you’re ready to make a change and willing to seek help, you can overcome your addiction and build a satisfying, drug-free life for yourself.

Support is essential to addiction recovery

Don’t try to go it alone; it’s all too easy to get discouraged and rationalize “just one more” hit or pill. Whether you choose to go to rehab, rely on self-help programs, get therapy, or take a self-directed treatment approach, support is essential. Recovering from drug addiction is much easier when you have people you can lean on for encouragement, comfort, and guidance.
Support can come from:

  • family members
  • close friends
  • therapists or counselors
  • other recovering addicts
  • healthcare providers
  • people from your faith community

When a loved one has a drug problem

If you suspect that a friend or family member has a drug problem, here are a few things you can do:

  • Speak up. Talk to the person about your concerns, and offer your help and support, without being judgmental. The earlier addiction is treated, the better. Don’t wait for your loved one to hit bottom! Be prepared for excuses and denial by listing specific examples of your loved one’s behavior that has you worried.
  • Take care of yourself. Don’t get so caught up in someone else’s drug problem that you neglect your own needs. Make sure you have people you can talk to and lean on for support. And stay safe. Don’t put yourself in dangerous situations.
  • Avoid self-blame. You can support a person with a substance abuse problem and encourage treatment, but you can’t force an addict to change. You can’t control your loved one’s decisions. Let the person accept responsibility for his or her actions, an essential step along the way to recovery for drug addiction.

But Don’t

  • Attempt to punish, threaten, bribe, or preach.
  • Try to be a martyr. Avoid emotional appeals that may only increase feelings of guilt and the compulsion to use drugs.
  • Cover up or make excuses for the drug abuser, or shield them from the negative consequences of their behavior.
  • Take over their responsibilities, leaving them with no sense of importance or dignity.
  • Hide or throw out drugs.
  • Argue with the person when they are high.
  • Take drugs with the drug abuser.
  • Feel guilty or responsible for another’s behavior.

Adapted from: National Clearinghouse for Alcohol & Drug Information

When your teen has a drug problem

Discovering your child uses drugs can generate fear, confusion, and anger in parents. It’s important to remain calm when confronting your teen, and only do so when everyone is sober. Explain your concerns and make it clear that your concern comes from a place of love. It’s important that your teen feels you are supportive.

Five steps parents can take:

  • Lay down rules and consequences. Your teen should understand that using drugs comes with specific consequences. But don’t make hollow threats or set rules that you cannot enforce. Make sure your spouse agrees with the rules and is prepared to enforce them.
  • Monitor your teen’s activity. Know where your teen goes and who he or she hangs out with. It’s also important to routinely check potential hiding places for drugs—in backpacks, between books on a shelf, in DVD cases or make-up cases, for example. Explain to your teen that this lack of privacy is a consequence of him or her having been caught using drugs.
  • Encourage other interests and social activities. Expose your teen to healthy hobbies and activities, such as team sports and afterschool clubs.
  • Talk to your child about underlying issues. Drug use can be the result of other problems. Is your child having trouble fitting in? Has there been a recent major change, like a move or divorce, which is causing stress?
  • Get Help. Teenagers often rebel against their parents but if they hear the same information from a different authority figure, they may be more inclined to listen. Try a sports coach, family doctor, therapist, or drug counselor.

Next steps…

Recovering from drug addiction. Addiction is a complex problem that affects every aspect of your life. Overcoming it requires making major changes to the way you live, deal with problems, and relate to others. Learn about the tools that can help you on your journey to sobriety. Read Article.

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Overcoming Drug AddictionOvercoming Drug Addiction Change is possible with treatment and support, and by making lifestyle changes that address the root cause of your addiction.
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Alcoholism & Alcohol AbuseAlcoholism & Alcohol Abuse Your drinking may be a problem if you consume alcohol simply to feel good or to avoid feeling bad.
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Authors: Lawrence Robinson, Melinda Smith, M.A., and Joanna Saisan, M.S.W. Last updated: January 2012.