What are drugs?

Drugs are chemical substances that can change how your body and mind work. They include prescription medicines, over-the-counter medicines, alcohol, tobacco, and illegal drugs.

What is drug use?

Drug use, or misuse, includes:

• Using illegal substances, such as
  • Anabolic steroids
  • Club drugs
  • Cocaine
  • Heroin
  • Inhalants
  • Marijuana
  • Methamphetamines
• Misusing prescription medicines, including opioids. This means taking the medicines in a different way than the health care provider prescribed. This includes
  • Taking a medicine that was prescribed for someone else
  • Taking a larger dose than you are supposed to
  • Using the medicine in a different way than you are supposed to. For example, instead of swallowing your tablets, you might crush and then snort or inject them.
  • Using the medicine for another purpose, such as getting high
• Misusing over-the-counter medicines, including using them for another purpose and using them in a different way than you are supposed to

Drug use is dangerous. It can harm your brain and body, sometimes permanently. It can hurt the people around you, including friends, families, kids, and unborn babies. Drug use can also lead to addiction.

What is drug addiction?

Drug addiction is a chronic brain disease. It causes a person to take drugs repeatedly, despite the harm they cause. Repeated drug use can change the brain and lead to addiction.

The brain changes from addiction can be lasting, so drug addiction is considered a "relapsing" disease. This means that people in recovery are at risk for taking drugs again, even after years of not taking them.

Does everyone who takes drugs become addicted?

Not everyone who uses drugs becomes addicted. Everyone's bodies and brains are different, so their reactions to drugs can also be different. Some people may become addicted quickly, or it may happen over time. Other people never become addicted. Whether or not someone becomes addicted depends on many factors. They include genetic, environmental, and developmental factors.

Who is at risk for drug addiction?

Various risk factors can make you more likely to become addicted to drugs, including:

• Your biology. People can react to drugs differently. Some people like the feeling the first time they try a drug and want more. Others hate how it feels and never try it again.
• Mental health problems. People who have untreated mental health problems, such as depression, anxiety, or attention deficit/hyperactivity disorder (ADHD) are more likely to become addicted. This can happen because drug use and mental health problems affect the same parts of the brain. Also, people with these problems may use drugs to try to feel better.
• Trouble at home. If your home is an unhappy place or was when you were growing up, you might be more likely to have a drug problem.
• Trouble in school, at work, or with making friends. You might use drugs to get your mind off these problems.
• Hanging around other people who use drugs. They might encourage you to try drugs.
• Starting drug use when you're young. When kids use drugs, it affects how their bodies and brains finish growing. This increases your chances of becoming addicted when you're an adult.

What are the signs that someone has a drug problem?

Signs that someone has a drug problem include:

• Changing friends a lot
• Spending a lot of time alone
• Losing interest in favorite things
• Not taking care of themselves - for example, not taking showers, changing clothes, or brushing their teeth
• Being really tired and sad
• Eating more or eating less than usual
• Being very energetic, talking fast, or saying things that don't make sense
• Being in a bad mood
• Quickly changing between feeling bad and feeling good
• Sleeping at strange hours
• Missing important appointments
• Having problems at work or at school
• Having problems in personal or family relationships

What are the treatments for drug addiction?

Treatments for drug addiction include counseling, medicines, or both. Research shows that combining medicines with counseling gives most people the best chance of success.

The counseling may be individual, family, and/or group therapy. It can help you:

• Understand why you got addicted
• See how drugs changed your behavior
• Learn how to deal with your problems so you won't go back to using drugs
• Learn to avoid places, people, and situations where you might be tempted to use drugs

Medicines can help with the symptoms of withdrawal. For addiction to certain drugs, there are also medicines that can help you re-establish normal brain function and decrease your cravings.

If you have a mental disorder along with an addiction, it is known as a dual diagnosis. It is important to treat both problems. This will increase your chance of success.

If you have a severe addiction, you may need hospital-based or residential treatment. Residential treatment programs combine housing and treatment services.

Can drug use and addiction be prevented?

Drug use and addiction are preventable. Prevention programs involving families, schools, communities, and the media may prevent or reduce drug use and addiction. These programs include education and outreach to help people understand the risks of drug use.

What is drug addiction?

Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences. It is considered a brain disorder, because it involves functional changes to brain circuits involved in reward, stress, and self-control. Those changes may last a long time after a person has stopped taking drugs.

Addiction is a lot like other diseases, such as heart disease. Both disrupt the normal, healthy functioning of an organ in the body, both have serious harmful effects, and both are, in many cases, preventable and treatable. If left untreated, they can last a lifetime and may lead to death.

Why do people use drugs?

People use drugs for many reasons: they want to feel good, stop feeling bad, or perform better in school or at work, or they are curious because others are doing it and they want to fit in. The last reason is very common among teens.

Drugs excite the parts of the brain that make you feel good. But after you take a drug for a while, the feel-good parts of your brain get used to it. Then you need to take more of the drug to get the same good feeling. Soon, your brain and body must have the drug just to feel normal. You feel sick, awful, anxious, and irritable without the drug. You no longer have the good feelings that you had when you first used the drug. This is true if you use illegal drugs or if you misuse prescription drugs. Misuse includes taking a drug differently than how your doctor tells you to (taking more or crushing pills to "shoot up" or snort), taking someone else’s prescription, or taking it just to get “high.”

Drug use can start as a way to escape—but it can quickly make your life worse. Besides just not feeling well, different drugs can affect your brain and body in many different ways. Here are a few:

• Alcohol: You might have trouble making decisions, solving problems, remembering,
  and learning.
• Marijuana: You might forget things you just learned or have trouble focusing.
• Prescription pain relievers (opioids) or sedatives: Your heart rate and breathing
  may slow to dangerous levels, leading to coma or death.
• Heroin: Similar to opioid pain relievers, your heart rate and breathing may slow
  to dangerous levels, leading to coma or death.
• Prescription stimulants (e.g., ADHD medications): Your body temperature could
  get dangerously high, or you may have an irregular heartbeat, heart failure, or seizures.
• Cocaine and methamphetamine: You may get violent, have panic attacks or feel
  paranoid, or have a heart attack.
• MDMA (Ecstasy or Molly): You may feel confused for a long time after you take it
  and have problems with attention, memory, and sleep.
• LSD: Your emotions may change quickly, and you might not be able to recognize
  reality; frightening flashbacks can happen long after use.
• Inhalants: Your heart, kidneys, lungs, and brain may get damaged; even a healthy
  person can suffer heart failure and death within minutes of sniffing a lot of an inhalant.

Many drugs can also make driving a car unsafe. Marijuana can slow reaction time, make you judge time and distance poorly, and decrease coordination (how you move your body). Cocaine and methamphetamine can make a driver aggressive and reckless. Certain kinds of sedatives, called benzodiazepines, can make you dizzy or drowsy. These effects can lead to crashes that can cause injuries and even death.

What is drug addiction?

Drug addiction is when you can’t stop taking the drug even if you want to. The urge is too strong to control, even if you know the drug is causing harm. The addiction can become more important than the need to eat or sleep. The urge to get and use the drug can fill every moment of your life. The addiction replaces all the things you used to enjoy. A person who is addicted might do almost anything—lie, steal, or hurt people—to keep taking the drug. This can lead to problems with your family and friends, and can even lead to arrest and jail. You can get addicted to illegal drugs as well as prescription drugs if you misuse them.

Drug addiction is a chronic disease. That means it stays with you for a long time, even if you stop using for a while. It doesn't go away like a cold. A person with an addiction can get treatment, but quitting for good can be very hard.

Can I just use willpower to stop using drugs?

At first, taking drugs is usually your choice. But as you continue to take them, using self-control can become harder and harder; this is the biggest sign of addiction. Brain studies of people with addiction show physical changes in parts of the brain that are very important for judgment, making decisions, learning and memory, and controlling behavior. Scientists have shown that when this happens to the brain, it changes how the brain works and it explains the harmful behaviors of addiction that are so hard to control.

If I stay off drugs for a while (e.g., in the criminal justice system or in residential treatment), will it be easy to remain drug-free?

Sometimes people quit their drug use for a while because they’re away from triggers that remind them about their drug use. Away from home, drugs might be less available. Once you go back to normal life, you’re likely to start using again unless you take action to avoid your triggers. This return to drug use is called a relapse. People recovering from addiction often have one or more relapses along the way if they don’t take steps to avoid their triggers.

What is a trigger?

A trigger is anything that makes you feel the urge to go back to using drugs. It can be a place, person, thing, smell, feeling, picture, or memory that reminds you of taking a drug and getting high. A trigger can be something stressful that you want to escape from. It can even be something that makes you feel happy. People fighting addiction need to stay away from the people and triggers that can make them start using drugs again, just like people with breathing problems need to avoid smoke and dust.

People who have stayed sober for a while, either because they were in jail or in treatment, should know that they are at a high risk of overdose if they relapse and take the same amount of drug they used to. Their cravings may not have decreased, but their tolerance has, meaning their body can’t handle high doses of the drug anymore. Without immediate treatment, overdose often leads to death. This is why you often hear about people dying of an overdose soon after leaving rehab.

What makes people more likely to get addicted to drugs?

• Trouble at home. If your home is an unhappy place, or was when you were growing up, you might be more likely to have a drug problem. When kids aren't well cared for, or there are lots of fights, or a parent is using drugs, the chance of addiction goes up.
• Mental health problems. People who have untreated mental health problems, such as depression or anxiety, or untreated attention-deficit/hyperactivity disorder (ADHD) are more likely to become addicted. They might use drugs to try to feel better.
• Trouble in school, trouble at work, trouble with making friends. Failures at school or work, or trouble getting along with people, can make life hard. You might use drugs to get your mind off these problems.
• Hanging around other people who use drugs. Friends or family members who use drugs might get you into trouble with drugs as well.
• Starting drug use when you're young. When kids or teens use drugs, it affects how their bodies and brains finish growing. Using drugs when you're young increases your chances of becoming addicted when you're an adult.
• Your biology. Everyone's bodies react to drugs differently. Some people like the feeling the first time they try a drug and want more. Other people hate how it feels and never try it again. Scientists don’t have a test yet that will predict how each person will react.

Can drug addiction be treated?

Yes. People who get treatment and stick with it can stop using drugs. They can change their lives so they don't go back to taking drugs. But they have to try hard and follow the treatment program for a long time. Recovery from addiction means you have to stop using drugs AND learn new ways of thinking, feeling, and dealing with problems. It’s best not to use in the first place. If you do get addicted, it’ll be a long and difficult road.

After you've stopped using the drug, you still have a lot to do:

• You have to relearn how to live without using drugs.
• You have to work on the problems your drug use caused with your family, your job, your friends, and your money.
• You have to stay away from people you used drugs with and places where you used.
• You have to learn what makes you want to take drugs again (your triggers), so you can avoid or work on those things.
• You may also need treatment for problems that led to your drug use, such as depression, anxiety,
  or other mental health problems.

Where to Get Help

You can call 1-800-662-HELP (4357) (toll free) or go to findtreatment.gov at any time to find drug treatment centers near you. If a person is in medical crisis, someone should drive them to the emergency room or call 911. This is particularly true for someone overdosing on heroin or a prescription opioid medication.

What is polysubstance use?

The use of more than one drug, also known as polysubstance use, is common. This includes when two or more are taken together or within a short time period, either intentionally or unintentionally.

Intentional polysubstance use occurs when a person takes a drug to increase or decrease the effects of a different drug or wants to experience the effects of the combination.

Unintentional polysubstance use occurs when a person takes drugs that have been mixed or cut with other substances, like fentanyl, without their knowledge.

Whether intentional or not, mixing drugs is never safe because the effects from combining drugs may be stronger and more unpredictable than one drug alone, and even deadly.

What about prescription drugs?

The dangers of polysubstance use also apply to prescription drugs. Always let your doctor know what drugs you are taking to prevent any adverse reactions with newly prescribed medications. Never take pills that did not come from a pharmacy and weren’t prescribed to you.

Get the facts

250+ —The number of American lives lost to drugs every day.

50% — In 2019, nearly half of drug overdose deaths involved multiple drugs.

The dangers of polysubstance use

Mixing stimulants

Examples of stimulants: ecstasy (MDMA), cocaine, methamphetamines, amphetamines (speed)

Stimulants (also known as uppers) can increase your heart rate and blood pressure to dangerous levels and increase your risk of several serious health problems. Combining stimulants may even directly or indirectly increase your risk of:

• Brain injury
• Liver damage
• Heart attack
• Stroke

Signs of use/overdosethat may occur when mixing stimulants:

• Fast/troubled breathing
• Increased body temperature
• Nausea or vomiting
• Chest pain
• Seizures or tremors

Mixing depressants

Examples of depressants: opioids (heroin, morphine, oxycodone, hydrocodone, fentanyl), benzodiazepines

Depressants (also known as downers) can slow down your breathing and increase your risk of several adverse health outcomes. Combining depressants can also directly or indirectly increase your risk of:

• Damage to the brain and other organs
• Overdose
• Death

Signs of use/overdosewhen mixing depressants:

• Slow breathing
• Weak pulse
• Altered mental status or confusion
• Passing out

Mixing stimulants and depressants

Mixing stimulants and depressants doesn’t balance or cancel them out. In fact, the results of combining drugs are unpredictable, often modifying or even masking the effects of one or both drugs. This may trick you into thinking that the drugs are not affecting you, making it easier to overdose.

Drinking alcohol while using other drugs

Drinking alcohol while using other drugs isn’t safe. Alcohol is a depressant with similar effects to other downers. Mixing alcohol with other drugs can increase your risk of overdose and serious damage to the brain, heart, and other organs.

What to do if you think someone is overdosing

It may be hard to tell whether a person is high or experiencing an overdose. If you aren’t sure, treat it like an overdose—you could save a life.

• Call 911 Immediately.*

• Administer naloxone, if available. **

• Try to keep the person awake and breathing.

• Lay the person on their side to prevent choking.

• Stay with the person until emergency assistance arrives.

*Most states have laws that may protect a person who is overdosing or the person who called for help from legal trouble.

**Naloxone is a life-saving medication that can reverse the effects of opioid overdose and save lives. It is available in all 50 states and can be purchased from a local pharmacy without a prescription in most states.

Why do some people become addicted to drugs, while others do not?

As with other diseases and disorders, the likelihood of developing an addiction differs from person to person, and no single factor determines whether a person will become addicted to drugs. In general, the more risk factors a person has, the greater the chance that taking drugs will lead to drug use and addiction. Protective factors, on the other hand, reduce a person's risk. Risk and protective factors may be either environmental or biological.

What biological factors increase risk of addiction?

Biological factors that can affect a person's risk of addiction include their genes, stage of development, and even gender or ethnicity. Scientists estimate that genes, including the effects environmental factors have on a person's gene expression, called epigenetics, account for between 40 and 60 percent of a person's risk of addiction. Also, teens and people with mental disorders are at greater risk of drug use and addiction than others.

Children's earliest interactions within the family are crucial to their healthy development and risk for drug use.

What environmental factors increase the risk of addiction?

Environmental factors are those related to the family, school, and neighborhood. Factors that can increase a person's risk include the following:

• Home and Family. The home environment, especially during childhood, is a very important factor. Parents or older family members who use drugs or misuse alcohol, or who break the law, can increase children's risk of future drug problems.
• Peer and School. Friends and other peers can have an increasingly strong influence during the teen years. Teens who use drugs can sway even those without risk factors to try drugs for the first time. Struggling in school or having poor social skills can put a child at further risk for using or becoming addicted to drugs.

What other factors increase the risk of addiction?

• Early use. Although taking drugs at any age can lead to addiction, research shows that the earlier people begin to use drugs, the more likely they are to develop serious problems. This may be due to the harmful effect that drugs can have on the developing brain. It also may result from a mix of early social and biological risk factors, including lack of a stable home or family, exposure to physical or sexual abuse, genes, or mental illness. Still, the fact remains that early use is a strong indicator of problems ahead, including addiction.
• How the drug is taken. Smoking a drug or injecting it into a vein increases its addictive potential. Both smoked and injected drugs enter the brain within seconds, producing a powerful rush of pleasure. However, this intense high can fade within a few minutes. Scientists believe this powerful contrast drives some people to repeatedly use drugs to recapture the fleeting pleasurable state.

Images of Brain Development in Healthy Children and Teens (Ages 5-20)

The brain continues to develop into adulthood and undergoes dramatic changes during adolescence.

One of the brain areas still maturing during adolescence is the prefrontal cortex—the part of the brain that allows people to assess situations, make sound decisions, and keep emotions and desires under control. The fact that this critical part of a teen’s brain is still a work in progress puts them at increased risk for trying drugs or continuing to take them. Introducing drugs during this period of development may cause brain changes that have profound and long-lasting consequences.

In general, people take drugs for a few reasons:

• To feel good. Drugs can produce intense feelings of pleasure. This initial euphoria is followed by other effects, which differ with the type of drug used. For example, with stimulants such as cocaine, the high is followed by feelings of power, self-confidence, and increased energy. In contrast, the euphoria caused by opioids such as heroin is followed by feelings of relaxation and satisfaction.
• To feel better. Some people who suffer from social anxiety, stress, and depression start using drugs to try to feel less anxious. Stress can play a major role in starting and continuing drug use as well as relapse (return to drug use) in patients recovering from addiction.
• To do better. Some people feel pressure to improve their focus in school or at work or their abilities in sports. This can play a role in trying or continuing to use drugs, such as prescription stimulants or cocaine.
• Curiosity and social pressure. In this respect, teens are particularly at risk because peer pressure can be very strong. Adolescence is a developmental period during which the presence of risk factors, such as peers who use drugs, may lead to substance use.

If taking drugs makes people feel good or better, what's the problem?

When they first use a drug, people may perceive what seem to be positive effects. They also may believe they can control their use. But drugs can quickly take over a person's life. Over time, if drug use continues, other pleasurable activities become less pleasurable, and the person has to take the drug just to feel “normal.” They have a hard time controlling their need to take drugs even though it causes many problems for themselves and their loved ones. Some people may start to feel the need to take more of a drug or take it more often, even in the early stages of their drug use. These are the signs of an addiction.

Even relatively moderate drug use poses dangers. Consider how a social drinker can become intoxicated, get behind the wheel of a car, and quickly turn a pleasurable activity into a tragedy that affects many lives. Occasional drug use, such as misusing an opioid to get high, can have similarly disastrous effects, including impaired driving and overdose.

Do people choose to keep using drugs?

The initial decision to take drugs is typically voluntary. But with continued use, a person's ability to exert self-control can become seriously impaired. This impairment in self-control is the hallmark of addiction.

Brain imaging studies of people with addiction show physical changes in areas of the brain that are critical to judgment, decision-making, learning and memory, and behavior control. These changes help explain the compulsive nature of addiction.

No single factor determines whether a person will become addicted to drugs.

People with addiction lose control over their actions. They crave and seek out drugs, alcohol, or other substances no matter what the cost—even at the risk of damaging friendships, hurting family, or losing jobs. What is it about addiction that makes people behave in such destructive ways? And why is it so hard to quit?

NIH-funded scientists are working to learn more about the biology of addiction. They’ve shown that addiction is a long-lasting and complex brain disease, and that current treatments can help people control their addictions. But even for those who’ve successfully quit, there’s always a risk of the addiction returning, which is called relapse.

The biological basis of addiction helps to explain why people need much more than good intentions or willpower to break their addictions.

“A common misperception is that addiction is a choice or moral problem, and all you have to do is stop. But nothing could be further from the truth,” says Dr. George Koob, director of NIH’s National Institute on Alcohol Abuse and Alcoholism. “The brain actually changes with addiction, and it takes a good deal of work to get it back to its normal state. The more drugs or alcohol you’ve taken, the more disruptive it is to the brain.”

Researchers have found that much of addiction’s power lies in its ability to hijack and even destroy key brain regions that are meant to help us survive.

A healthy brain rewards healthy behaviors—like exercising, eating, or bonding with loved ones. It does this by switching on brain circuits that make you feel wonderful, which then motivates you to repeat those behaviors. In contrast, when you’re in danger, a healthy brain pushes your body to react quickly with fear or alarm, so you’ll get out of harm’s way. If you’re tempted by something questionable—like eating ice cream before dinner or buying things you can’t afford—the front regions of your brain can help you decide if the consequences are worth the actions.

But when you’re becoming addicted to a substance, that normal hardwiring of helpful brain processes can begin to work against you. Drugs or alcohol can hijack the pleasure/reward circuits in your brain and hook you into wanting more and more. Addiction can also send your emotional danger-sensing circuits into overdrive, making you feel anxious and stressed when you’re not using the drugs or alcohol. At this stage, people often use drugs or alcohol to keep from feeling bad rather than for their pleasurable effects.

To add to that, repeated use of drugs can damage the essential decision-making center at the front of the brain. This area, known as the prefrontal cortex, is the very region that should help you recognize the harms of using addictive substances.

“Brain imaging studies of people addicted to drugs or alcohol show decreased activity in this frontal cortex,” says Dr. Nora Volkow, director of NIH’s National Institute on Drug Abuse. “When the frontal cortex isn’t working properly, people can’t make the decision to stop taking the drug—even if they realize the price of taking that drug may be extremely high, and they might lose custody of their children or end up in jail. Nonetheless, they take it.”

Scientists don’t yet understand why some people become addicted while others don’t. Addiction tends to run in families, and certain types of genes have been linked to different forms of addiction. But not all members of an affected family are necessarily prone to addiction. “As with heart disease or diabetes, there’s no one gene that makes you vulnerable,” Koob says.

Other factors can also raise your chances of addiction. “Growing up with an alcoholic; being abused as a child; being exposed to extraordinary stress—all of these social factors can contribute to the risk for alcohol addiction or drug abuse,” Koob says. “And with drugs or underage drinking, the earlier you start, the greater the likelihood of having alcohol use disorder or addiction later in life.”

Teens are especially vulnerable to possible addiction because their brains are not yet fully developed—particularly the frontal regions that help with impulse control and assessing risk. Pleasure circuits in adolescent brains also operate in overdrive, making drug and alcohol use even more rewarding and enticing.

NIH is launching a new nationwide study to learn more about how teen brains are altered by alcohol, tobacco, marijuana, and other drugs. Researchers will use brain scans and other tools to assess more than 10,000 youth over a 10-year span. The study will track the links between substance use and brain changes, academic achievement, IQ, thinking skills, and mental health over time.

Although there’s much still to learn, we do know that prevention is critical to reducing the harms of addiction. “Childhood and adolescence are times when parents can get involved and teach their kids about a healthy lifestyle and activities that can protect against the use of drugs,” Volkow says. “Physical activity is important, as well as getting engaged in work, science projects, art, or social networks that do not promote use of drugs.”

To treat addiction, scientists have identified several medications and behavioral therapies—especially when used in combination—that can help people stop using specific substances and prevent relapse. Unfortunately, no medications are yet available to treat addiction to stimulants such as cocaine or methamphetamine, but behavioral therapies can help.

“Treatment depends to a large extent on the severity of addiction and the individual person,” Koob adds. “Some people can stop cigarette smoking and alcohol use disorders on their own. More severe cases might require months or even years of treatment and follow-up, with real efforts by the individual and usually complete abstinence from the substance afterward.”

NIH-funded researchers are also evaluating experimental therapies that might enhance the effectiveness of established treatments. Mindfulness meditation and magnetic stimulation of the brain are being assessed for their ability to strengthen brain circuits that have been harmed by addiction. Scientists are also examining the potential of vaccines against nicotine, cocaine, and other drugs, which might prevent the drug from entering the brain.

“Addiction is a devastating disease, with a relatively high death rate and serious social consequences,” Volkow says. “We’re exploring multiple strategies so individuals will eventually have more treatment options, which will increase their chances of success to help them stop taking the drug.”

Warning Signs of Addiction

Warning signs of substance abuse or addiction may include:

• sleep difficulties
• anxiety or depression
• memory problems
• mood swings (temper flare-ups, irritability, defensiveness)
• rapid increases in the amount of medication needed
• frequent requests for refills of certain medicines
• a person not seeming like themselves (showing a general lack of interest or being overly energetic)
• “doctor shopping” (moving from provider to provider in an effort to get several prescriptions for the same medication)
• use of more than one pharmacy
• false or forged prescriptions

Addiction can happen at any age, but it usually starts when a person is young. It’s the result of changes in the brain that can come from drug use. Addiction affects how people think and what they do. But what exactly are the signs?

First, it’s important to know that there is no “type” of person who becomes addicted. People can face addiction no matter where they’re from, what they look like, or how much money they have.

One important sign of addiction is that a person continues to use drugs even though it’s harming their life: physical health, performance at school or work, or relationships. They feel like they can’t stop using drugs, no matter what happens.

Other signs can include:

• Hanging out with different friends than usual.
• Not caring about their appearance.
• Getting lower grades in school.
• Missing classes or skipping school.
• Losing interest in their favorite activities.
• Getting in trouble in school or with the law.
• Having different eating or sleeping habits.
• Having more problems with family members and friends.

To address addiction, talk to a medical professional.

Can drug addiction be treated?

Yes, but it’s not simple. Because addiction is a chronic disease, people can’t simply stop using drugs for a few days and be cured. Most patients need long-term or repeated care to stop using completely and recover their lives.

Addiction treatment must help the person do the following:

• stop using drugs
• stay drug-free
• be productive in the family, at work, and in society

Principles of Effective Treatment

Based on scientific research since the mid-1970s, the following key principles should form the basis of any effective treatment program:

• Addiction is a complex but treatable disease that affects brain function and behavior.
• No single treatment is right for everyone.
• People need to have quick access to treatment.
• Effective treatment addresses all of the patient’s needs, not just his or her drug use.
• Staying in treatment long enough is critical.
• Counseling and other behavioral therapies are the most commonly used forms of treatment.
• Medications are often an important part of treatment, especially when combined with behavioral therapies.
• Treatment plans must be reviewed often and modified to fit the patient’s changing needs.
• Treatment should address other possible mental disorders.
• Medically assisted detoxification is only the first stage of treatment.
• Treatment doesn't need to be voluntary to be effective.
• Drug use during treatment must be monitored continuously.
• Treatment programs should test patients for HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as teach them about steps they can take to reduce their risk of these illnesses.

What are treatments for drug addiction?

There are many options that have been successful in treating drug addiction, including:

• behavioral counseling
• medication
• medical devices and applications used to treat withdrawal symptoms or deliver skills training
• evaluation and treatment for co-occurring mental health issues such as depression and anxiety
• long-term follow-up to prevent relapse

A range of care with a tailored treatment program and follow-up options can be crucial to success. Treatment should include both medical and mental health services as needed. Follow-up care may include community- or family-based recovery support systems.

How are medications and devices used in drug addiction treatment?

Medications and devices can be used to manage withdrawal symptoms, prevent relapse, and treat co-occurring conditions.

Withdrawal. Medications and devices can help suppress withdrawal symptoms during detoxification. Detoxification is not in itself "treatment," but only the first step in the process. Patients who do not receive any further treatment after detoxification usually resume their drug use. One study of treatment facilities found that medications were used in almost 80 percent of detoxifications (SAMHSA, 2014). In November 2017, the Food and Drug Administration (FDA) granted a new indication to an electronic stimulation device, NSS-2 Bridge, for use in helping reduce opioid withdrawal symptoms. This device is placed behind the ear and sends electrical pulses to stimulate certain brain nerves.

Relapse prevention. Patients can use medications to help re-establish normal brain function and decrease cravings. Medications are available for treatment of opioid (heroin, prescription pain relievers), tobacco (nicotine), and alcohol addiction. Scientists are developing other medications to treat stimulant (cocaine, methamphetamine) and cannabis (marijuana) addiction. People who use more than one drug, which is very common, need treatment for all of the substances they use.

• Opioids:Methadone (Dolophine^®, Methadose^®), buprenorphine (Suboxone^®, Subutex^®, Probuphine^® , Sublocade^™), and naltrexone (Vivitrol^®) are used to treat opioid addiction. Acting on the same targets in the brain as heroin and morphine, methadone and buprenorphine suppress withdrawal symptoms and relieve cravings. Naltrexone blocks the effects of opioids at their receptor sites in the brain and should be used only in patients who have already been detoxified. All medications help patients reduce drug seeking and related criminal behavior and help them become more open to behavioral treatments. A NIDA study found that once treatment is initiated, both a buprenorphine/naloxone combination and an extended release naltrexone formulation are similarly effective in treating opioid addiction. Because full detoxification is necessary for treatment with naloxone, initiating treatment among active users was difficult, but once detoxification was complete, both medications had similar effectiveness.
• Tobacco:Nicotine replacement therapies have several forms, including the patch, spray, gum, and lozenges. These products are available over the counter. The U.S. Food and Drug Administration (FDA) has approved two prescription medications for nicotine addiction: bupropion (Zyban^®) and varenicline (Chantix^®). They work differently in the brain, but both help prevent relapse in people trying to quit. The medications are more effective when combined with behavioral treatments, such as group and individual therapy as well as telephone quitlines.
• Alcohol: Three medications have been FDA-approved for treating alcohol addiction and a fourth, topiramate, has shown promise in clinical trials (large-scale studies with people). The three approved medications are as follows:
  • Naltrexone blocks opioid receptors that are involved in the rewarding effects of drinking and in the craving for alcohol. It reduces relapse to heavy drinking and is highly effective in some patients. Genetic differences may affect how well the drug works in certain patients.
  • Acamprosate (Campral^®) may reduce symptoms of long-lasting withdrawal, such as insomnia, anxiety, restlessness, and dysphoria (generally feeling unwell or unhappy). It may be more effective in patients with severe addiction.
  • Disulfiram (Antabuse^®) interferes with the breakdown of alcohol. Acetaldehyde builds up in the body, leading to unpleasant reactions that include flushing (warmth and redness in the face), nausea, and irregular heartbeat if the patient drinks alcohol. Compliance (taking the drug as prescribed) can be a problem, but it may help patients who are highly motivated to quit drinking.
• Co-occuring conditions: Other medications are available to treat possible mental health conditions, such as depression or anxiety, that may be contributing to the person’s addiction.

How are behavioral therapies used to treat drug addiction?

Behavioral therapies help patients:

• modify their attitudes and behaviors related to drug use
• increase healthy life skills
• persist with other forms of treatment, such as medication

Patients can receive treatment in many different settings with various approaches.

Outpatient behavioral treatment includes a wide variety of programs for patients who visit a behavioral health counselor on a regular schedule. Most of the programs involve individual or group drug counseling, or both. These programs typically offer forms of behavioral therapy such as:

• cognitive-behavioral therapy, which helps patients recognize, avoid, and cope with the situations in which they are most likely to use drugs
• multidimensional family therapy—developed for adolescents with drug abuse problems as well as their families—which addresses a range of influences on their drug abuse patterns and is designed to improve overall family functioning
• motivational interviewing, which makes the most of people's readiness to change their behavior and enter treatment
• motivational incentives (contingency management), which uses positive reinforcement to encourage abstinence from drugs

Treatment is sometimes intensive at first, where patients attend multiple outpatient sessions each week. After completing intensive treatment, patients transition to regular outpatient treatment, which meets less often and for fewer hours per week to help sustain their recovery. In September 2017, the FDA permitted marketing of the first mobile application, reSET^®, to help treat substance use disorders. This application is intended to be used with outpatient treatment to treat alcohol, cocaine, marijuana, and stimulant substance use disorders. In September 2017, the FDA permitted marketing of the first mobile application, reSET^®, to help treat substance use disorders. This application is intended to be used with outpatient treatment to treat alcohol, cocaine, marijuana, and stimulant substance use disorders.

Inpatient or residential treatment can also be very effective, especially for those with more severe problems (including co-occurring disorders). Licensed residential treatment facilities offer 24-hour structured and intensive care, including safe housing and medical attention. Residential treatment facilities may use a variety of therapeutic approaches, and they are generally aimed at helping the patient live a drug-free, crime-free lifestyle after treatment. Examples of residential treatment settings include:

• Therapeutic communities, which are highly structured programs in which patients remain at a residence, typically for 6 to 12 months. The entire community, including treatment staff and those in recovery, act as key agents of change, influencing the patient’s attitudes, understanding, and behaviors associated with drug use.
• Shorter-term residential treatment, which typically focuses on detoxification as well as providing initial intensive counseling and preparation for treatment in a community-based setting.
• Recovery housing, which provides supervised, short-term housing for patients, often following other types of inpatient or residential treatment. Recovery housing can help people make the transition to an independent life—for example, helping them learn how to manage finances or seek employment, as well as connecting them to support services in the community.

Is treatment different for criminal justice populations?

Scientific research since the mid-1970s shows that drug abuse treatment can help many drug-using offenders change their attitudes, beliefs, and behaviors towards drug abuse; avoid relapse; and successfully remove themselves from a life of substance abuse and crime. Many of the principles of treating drug addiction are similar for people within the criminal justice system as for those in the general population. However, many offenders don’t have access to the types of services they need. Treatment that is of poor quality or is not well suited to the needs of offenders may not be effective at reducing drug use and criminal behavior.

In addition to the general principles of treatment, some considerations specific to offenders include the following:

• Treatment should include development of specific cognitive skills to help the offender adjust attitudes and beliefs that lead to drug abuse and crime, such as feeling entitled to have things one’s own way or not understanding the consequences of one’s behavior. This includes skills related to thinking, understanding, learning, and remembering.
• Treatment planning should include tailored services within the correctional facility as well as transition to community-based treatment after release.
• Ongoing coordination between treatment providers and courts or parole and probation officers is important in addressing the complex needs of offenders re-entering society.

Challenges of Re-entry

Drug abuse changes the function of the brain, and many things can "trigger" drug cravings within the brain. It’s critical for those in treatment, especially those treated at an inpatient facility or prison, to learn how to recognize, avoid, and cope with triggers they are likely to be exposed to after treatment.

How many people get treatment for drug addiction?

According to SAMHSA's National Survey on Drug Use and Health, 22.5 million people (8.5 percent of the U.S. population) aged 12 or older needed treatment for an illicit* drug or alcohol use problem in 2014. Only 4.2 million (18.5 percent of those who needed treatment) received any substance use treatment in the same year. Of these, about 2.6 million people received treatment at specialty treatment programs (CBHSQ, 2015).

*The term "illicit" refers to the use of illegal drugs, including marijuana according to federal law, and misuse of prescription medications.

Points to Remember

• Drug addiction can be treated, but it’s not simple. Addiction treatment must help the person do the following:
  • stop using drugs
  • stay drug-free
  • be productive in the family, at work, and in society
• Successful treatment has several steps:
  • detoxification
  • behavioral counseling
  • medication (for opioid, tobacco, or alcohol addiction)
  • evaluation and treatment for co-occurring mental health issues such as depression and anxiety
  • long-term follow-up to prevent relapse
• Medications and devices can be used to manage withdrawal symptoms, prevent relapse, and treat co-occurring conditions.
• Behavioral therapies help patients:
  • modify their attitudes and behaviors related to drug use
  • increase healthy life skills
  • persist with other forms of treatment, such as medication
• People within the criminal justice system may need additional treatment services to treat drug use disorders effectively. However, many offenders don’t have access to the types of services they need.

A person who uses drugs can run into all kinds of problems at work, school, and home. But did you know that drug use—and its consequences—can also hurt the person’s family?

That doesn’t mean that the person using drugs wants to hurt the family. It just means that the disease of addiction can lead to real-world problems that, sooner or later, affect family members’ lives in a very disruptive way.

Ripple effects

For example, someone who has a problem with drugs might buy the drugs with money that was set aside for the family’s rent, food, or transportation.

Or, drug use could lead to problems at work that result in the person losing a job. Unemployment, in turn, might reduce the income or benefits (like health insurance) that a family needs. Families might have to dip into college or retirement savings to help their loved one get treatment, which can be very expensive.

Unfortunately, sometimes drug use can lead to even more serious problems like divorce, complicated medical issues, domestic or child abuse, or death. Any of these can create challenges for families and heartache for years to come.

Vicious cycle

The person using drugs may feel guilty or ashamed of the addiction and the troubles it brings loved ones. Sometimes, this can create a vicious cycle where shame makes drug use even harder for the person to resist.

This all sounds heavy, and it is. But there’s another side to the story. If someone you love has a problem with drug use, there are ways you can try to help them or find help for them. Remember to take care of yourself, too.

Peer pressure can lead some people to make risky choices, like using drugs. But scientists are discovering that connecting with other people may also create a positive effect; it might even help some people who have problems with drugs.

In a recent animal study involving rats, for instance, many of the rats chose to hang out with other rats in their cages instead of pressing a lever to get more of a drug.

Does this mean that socializing could also help some people avoid using drugs?

Changing the brain

People who use drugs over time can develop a brain disease called addiction. Addiction changes the brain and can cause a person to seek out drugs even when the person understands that drug use is a bad choice. Someone with an addiction can also return to drug use after not using drugs for a while (this is called a relapse).

All this makes addiction hard to overcome. But the recent animal study suggests that positive social connections, like friendships and healthy family relationships, might undo some of the negative effects caused by drug use.

Socializing might help

Scientists aren’t sure yet how social interactions positively affect the human brain, but some of the most effective treatments for addiction already involve helping the person to create healthy social relationships that don’t involve drug use.

For people with substance use disorders, connecting in a meaningful way with other people—including others who are recovering from the same disorders—seems to help limit the urge to use drugs.

So even though rats’ social needs are different from humans’, this study adds to the evidence that having strong social connections with people who don’t use drugs can be an important part of treatment for addiction.

For people living with addiction, knowing that social connections might help them overcome the disease could bring a lot of hope.

Why do some people become addicted while others don't? Family studies that include identical twins, fraternal twins, adoptees, and siblings suggest that as much as half of a person’s risk of becoming addicted to nicotine, alcohol, or other drugs depends on his or her genetic makeup. Pinning down the biological basis for this risk is an important avenue of research for scientists trying to solve the problem of drug addiction.

Genes—functional units of DNA that make up the human genome—provide the information that directs a body’s basic cellular activities. Research on the human genome has shown that, on average, the DNA sequences of any two people are 99.9 percent the same. However, that 0.1 percent variation is profoundly important—it’s still 3 million differences in the nearly 3 billion base pairs of DNA sequence! These differences contribute to visible variations, like height and hair color, and invisible traits, such as increased risk for or protection from certain diseases such as heart attack, stroke, diabetes, and addiction.

Some diseases, such as sickle cell anemia or cystic fibrosis, are caused by an error, known as a mutation, in a single gene. Some mutations, like the BRCA 1 and 2 mutations that are linked to a much higher risk of breast and ovarian cancer, have become critical medical tools in evaluating a patient’s risk for serious diseases. Medical researchers have had striking success at unraveling the genetics of these single-gene disorders, though finding treatments or cures has not been as simple. Most diseases, including addiction, are complex, and variations in many different genes contribute to a person’s overall level of risk or protection. The good news is that scientists are actively pursuing many more paths to treatment and prevention of these more complex illnesses.

Linking Genes to Health: Genome-Wide Association Studies

Research Advance: Genetic Variation May Increase Risk for Nicotine Addiction and Lung Cancer

NIDA-sponsored research has led to an understanding of how certain gene variants are linked to nicotine dependence. This major breakthrough has paved the way for analysis in animal models, revealing the importance of these variants in the brain’s response to nicotine, including withdrawal and nicotine aversion—the body’s resistance to nicotine addiction. In addition, some genetic variants are associated with a two- to threefold increase in risk for lung cancer, which may be even higher among those who smoke fewer than 20 cigarettes a day. These discoveries have inspired investigators to develop new medications and other ways that affect how agents bind to brain receptors. Gene variants in these nicotinic receptors as well as enzymes that metabolize nicotine are also beginning to provide clinically useful markers to guide treatment decisions.

Recent advances in DNA analysis are helping researchers untangle complex genetic interactions by examining a person’s entire genome all at once. Technologies such as genome-wide association studies (GWAS), whole genome sequencing, and exome sequencing (looking at just the protein-coding genes) identify subtle variations in DNA sequence called single-nucleotide polymorphisms(SNPs). SNPs are differences in just a single letter of the genetic code from one person to another. If a SNP appears more often in people with a disease than those without, it is thought to either directly affect susceptibility to that disease or be a marker for another variation that does.

GWAS and sequencing are extremely powerful tools because they can find a connection between a known gene or genes and a disorder, and can identify genes that may have been overlooked or were previously unknown.

Through these methods, scientists can gather more evidence from affected families or use animal models and biochemical experiments to verify and understand the link between a gene and the risk of addiction. These findings would then be the basis for developing new treatment and intervention approaches.

The Role of the Environment in Diseases like Addiction

That old saying "nature or nurture" might be better phrased "nature and nurture" because research shows that a person’s health is the result of dynamic interactions between genes and the environment. For example, both genetics and lifestyle factors—such as diet, physical activity, and stress—affect high blood pressure risk. NIDA research has led to discoveries about how a person’s surroundings affect drug use in particular.

The Promise of BIG DATA in Genetics Research

Scientists doing genetics research have collected millions of data points that could be of use to other scientists. However, different software systems and measurement formats have made sharing data sets difficult. NIH has created "Big Data" policies that will enable better sharing of information. When the data can be combined and harmonized, a process called data integration, the chances of identifying new genetic information that could give rise to new disease insights is amplified.

For example, a community that provides healthy after-school activities has been shown to reduce vulnerability to drug addiction, and recent data show that access to exercise can discourage drug-seeking behavior, an effect that is more pronounced in males than in females.^20-22

In addition, studies suggest that an animal’s drug use can be affected by that of its cage mate,^{23, 24} showing that some social influences can enhance risk or protection. In addition, exposure to drugs or stress in a person’s social or cultural environment can alter both gene expression and gene function, which, in some cases, may persist throughout a person’s life. Research also suggests that genes can play a part in how a person responds to his or her environment, placing some people at higher risk for disease than others.

Epigenetics: Where Genes Meet the Environment

Epigenetics is the study of functional, and sometimes inherited, changes in the regulation of gene activity and expression that are not dependent on gene sequence. "Epi-" itself means "above" or "in addition to." Environmental exposures or choices people make can actually "mark"—or remodel—the structure of DNA at the cell level or even at the level of the whole organism. So, although each cell type in the human body effectively contains the same genetic information, epigenetic regulatory systems enable the development of different cell types (e.g., skin, liver, or nerve cells) in response to the environment. These epigenetic marks can affect health and even the expression of the traits passed to children. For example, when a person uses cocaine, it can mark the DNA, increasing the production of proteins common in addiction. Increased levels of these altered proteins correspond with drug-seeking behaviors in animals.

Histones, as another example, are like protein spools that provide an organizational structure for genes. Genes coil around histones, tightening or loosening to control gene expression. Drug exposure can affect specific histones, modifying gene expression in localized brain regions. Science has shown that manipulation of histone-modifying enzymes and binding proteins may have promise in treating substance use disorders.

Research Advance: Genetics and Smoking Cessation

To determine the best course of smoking cessation treatment, our ultimate goal is for clinicians to combine knowledge of a person’s genetic data; how fast the person’s body metabolizes nicotine; the person’s age, sex, and race; and the number of cigarettes smoked per day to provide the best treatment regimen. Current research suggests that smokers with high-risk genotypes are more likely to receive greater benefits from certain medications. Also, the rate of nicotine metabolism can help inform treatment decisions. One study found that "normal" nicotine metabolizers did better with the help of the drug varenicline (Chantix^®) while "slow" metabolizers did better with the nicotine patch. Helping people quit smoking by understanding the underlying genetic factors underscores its enormous clinical and public health potential related to long-term smoking.

The development of multidimensional data sets that include and integrate genetic and epigenetic information provide unique insights into the molecular genetic processes underlying the causes and consequences of drug addiction. Studying and using these data types to identify biological factors involved in substance abuse is increasingly important because technologic advances have improved the ability of researchers to single out individual genes or brain processes that may inform new prevention and treatment interventions.

Genetics and Precision Medicine

Clinicians often find substantial variability in how individual patients respond to treatment. Part of that variability is due to genetics. Genes influence the numbers and types of receptors in peoples’ brains, how quickly their bodies metabolize drugs, and how well they respond to different medications. Learning more about the genetic, epigenetic, and neurobiological bases of addiction will eventually advance the science of addiction.

Scientists will be able to translate this knowledge into new treatments directed at specific targets in the brain or to treatment approaches that can be customized for each patient—called pharmacogenomics. This emerging science, often called precision medicine, promises to harness the power of genomic information to improve treatments for addiction by tailoring the treatment to the person’s specific genetic makeup. By knowing a person’s genomic information, health care providers will be better equipped to match patients with the most suitable treatments and medication dosages, and to avoid or minimize adverse reactions.

Every addiction starts with gratification of some kind. Drugs of abuse work on different neurotransmitter systems in the brain, but they all act directly or indirectly on the brain's reward (mesolimbic) system and on the amygdala, flooding the reward circuit with dopamine and other neurotransmitters. Dopamine, which is associated with emotion, cognition, and feeling of pleasure, rewards natural behaviors, but drugs release 2 to 10 times the amount of dopamine that natural rewards do. Overstimulation of this system produces the euphoric feelings sought by drug users. Repeatedly activating the brain's reward system with supranatural stimuli results in reinforcement and addiction.

However, the brain adjusts to these overwhelming surges of dopamine and other neurotransmitters by producing less of the neurotransmitters, or by reducing the number of receptors that can receive and transmit signals. Drug abusers' ability to experience pleasure without the drug is reduced, and they begin to feel lifeless and depressed. Now they need to take the drug just to bring their dopamine function up to normal, and must take larger and larger quantities of the drug to experience a high. This is known as developing a tolerance.

Using brain imaging studies, scientists have found that food affects the brain's dopamine systems in much the same way as drugs and alcohol. Comparing brain images of methamphetamine users with obese people, scientists found both groups had significantly fewer dopamine receptors than nonaddicted people, an indication of addiction. Moreover, the higher the body mass index, the fewer dopamine receptors were present. This could help to explain why it is so difficult for obese people to lose weight and keep it off: greater amounts of food are necessary for them to obtain gratification.

Opioid overdose reversal medications (OORMs) are lifesaving medications approved by the Food and Drug Administration (FDA) to reverse an opioid overdose. Two FDA-approved OORMs are naloxone and nalmefene. Examples of opioids include heroin, fentanyl, oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, and morphine.

OORMs are effective in reversing opioid overdose, even in instances when opioids are used in combination with other sedatives or stimulants. OORMs are not effective in treating overdoses of benzodiazepines or stimulant overdoses involving cocaine and amphetamines.

It is critical to obtain medical intervention as soon as possible after administering/receiving an OORM.

You can learn how to administer an OORM from a doctor, pharmacist, or staff at a local harm reduction center. Additionally, there are online resources for naloxone administration and rescue breathing.

What Is Naloxone?

Naloxone is a medication approved by the Food and Drug Administration (FDA) designed to rapidly reverse opioid overdose. It is an opioid antagonist—meaning that it binds to opioid receptors and can reverse and block the effects of other opioids, such as heroin, morphine, and oxycodone. Administered when a patient is showing signs of opioid overdose, naloxone is a temporary treatment and its effects do not last long.

The medication can be given by intranasal spray (into the nose), intramuscular (into the muscle), subcutaneous (under the skin), or intravenous (into a vein) injection.

A practitioner should assess the need to prescribe naloxone for patients who are taking methadone or buprenorphine receiving or otherwise considered a risk for opioid overdose.

In March 2023, the FDA approved naloxone nasal spray as the first over the counter OORM and is available in many pharmacies, through community-based distribution programs, local public health organizations or local health departments, free of charge. Check with your state for your local naloxone availability and restrictions.

What Is Nalmefene?

Nalmefene is another FDA-approved OORM nasal spray that is available by prescription only and is intended for use in health care and community settings for individuals who are 12 years old and over.

Nalmefene is an opioid receptor antagonist used to treat acute opioid overdose. However, it has a higher half-life than naloxone which means it can stay in the body for longer. This can make withdrawal symptoms more severe and last longer.

Candidates for OORMs are those who:

• Take high doses of opioids for long-term management of chronic pain
• Receive rotating opioid medication regimens
• Have been discharged from emergency medical care following opioid poisoning or intoxication
• Take certain extended-release or long-acting opioid medication
• Those who have had a period of abstinence to include those recently released from incarceration.

Pregnant women can be safely given both naloxone and nalmefene in limited doses under the supervision of a doctor. Nalmefene can cause opioid withdrawal in an unborn baby so it is important that practitioners know the medication has been used so the patient and baby can be monitored.

Patients prescribed an automatic injection device for naloxone or who use the nasal spray should keep the item available at all times. It is important to remember to replace medication when the expiration date passes and if exposed to temperatures below 39°F or above 104°F.

Nalmefene should be kept at room-temperature and away from direct sunlight. It is important to remember to replace medication when the expiration date passes.

Side Effects of OORMS

Serious side effects should be taken seriously, as some of them may indicate an emergency. Patients should stop taking methadone and contact a doctor or emergency services right away. Patients and practitioners are encouraged to report all side effects online to MEDWatch, FDA’s medical product safety reporting program for health care professionals, patients, and consumers or by calling 1-800-FDA-1088.

Patients who experience an allergic reaction, such as hives or swelling in the face, lips, or throat, should seek medical help immediately. They should not drive or perform other potentially unsafe tasks.

Use of OORMs causes symptoms of opioid withdrawal. Medical assistance must be obtained as soon as possible after administering/receiving an OORM.

Opioid withdrawal symptoms include:

• Feeling nervous, restless, or irritable
• Body aches
• Dizziness or weakness
• Diarrhea, stomach pain, or nausea
• Fever, chills, or goose bumps
• Sneezing or runny nose in the absence of a cold

Opioid Overdose

Opioid overdose is life-threatening and requires immediate emergency attention. Recognizing the signs of opioid overdose is essential to saving lives.

Opioid overdose can happen when:

• A patient misunderstands the directions for use, accidentally takes an extra dose, or deliberately misuses a prescription opioid
• A person uses illicit drugs
• A person takes opioid medications prescribed for someone else
• A person mixes opioids with other medications, alcohol, or over-the-counter drugs

Signs of opioid overdose:

• Person does not wake or respond to touch or voice
• Breathing is not normal, very slow, or has stopped
• Pin-point sized pupils
• Bluish lips and nose

A

Abstinence: Not using drugs or alcohol.

Addiction: A chronic, relapsing disorder characterized by compulsive (or difficult to control) drug seeking and use despite harmful consequences, as well as long-lasting changes in the brain. In the past, people who used drugs were called “addicts.” Current appropriate terms are people who use drugs and drug users.

Agonist: A chemical substance that binds to and activates certain receptors on cells, causing a biological response. Oxycodone, morphine, heroin, fentanyl, methadone, and endorphins are all examples of opioid receptor agonists.

Amphetamine: A stimulant drug that acts on the central nervous system (CNS). Amphetamines are medications prescribed to treat attention deficit hyperactivity disorder (such as Adderall®) and narcolepsy.

Anabolic-androgenic steroids: Synthetic substances similar to the male hormone testosterone. Often known as “anabolic steroids.” They can promote muscle growth (anabolic effects) and produce changes in male sexual characteristics (androgenic effects) in both males and females.

Analgesics: A group of medications that reduce pain.

Anesthetic: A drug that causes insensitivity to pain and is used for surgeries and other medical procedures.

Antagonist: A chemical substance that binds to and blocks the activation of certain receptors on cells, preventing a biological response. Naloxone is an example of an opioid receptor antagonist.

B

Barbiturate: A type of CNS depressant sometimes prescribed to promote relaxation and sleep, but more commonly used in surgical procedures and to treat seizure disorders.

Basal ganglia: The area of the brain that plays an important role in positive forms of motivation, including the pleasurable effects of healthy activities like eating, socializing, and sex, and are also involved in the formation of habits and routines. These areas form a key node of what is sometimes called the brain’s “reward circuit.”

Benzodiazepine: A type of CNS depressant sometimes prescribed to relieve anxiety, panic, or acute stress reactions. Some benzodiazepines are prescribed short-term to promote sleep. Diazepam (Valium®) and alprazolam (Xanax®) are among the most widely prescribed benzodiazepine medications.

Brainstem: A group of brain structures that process sensory information and control basic functions needed for survival such as breathing, heart rate, blood pressure, and arousal.

Buprenorphine: An opioid partial agonist medication prescribed for the treatment of opioid addiction that relieves drug cravings without producing the high or dangerous side effects of other opioids.

C

Cannabidiol (CBD): A component of the marijuana plant without mind-altering effects that is being studied for possible medical uses.

Cannabinoid receptor: The receptor in the brain that recognizes and binds cannabinoids that are produced in the brain (anandamide) or outside the body (THC).

Cannabinoids: Chemicals that bind to cannabinoid receptors in the brain. They are found naturally in the brain (anandamide, 2-arachidonoylglycerol) and also in marijuana (THC and CBD). They are involved in a variety of mental and physical processes, including memory, thinking, concentration, movement, pain regulation, food intake, and reward.

Cannabis: Another name for the marijuana plant, Cannabis sativa.

Cardiovascular system: The system consisting of the heart and blood vessels. It delivers nutrients and oxygen to all cells in the body.

Central nervous system (CNS): The system consisting of the nerves in the brain and spinal cord.

Cerebellum: A part of the brain that helps regulate posture, balance, and coordination. It is also involved in the processes of emotion, motivation, memory, and thought.

Cerebral cortex: The gray matter that covers the surface of the cerebral hemispheres, whose functions include sensory processing and motor control along with language, reasoning, decision-making, and judgment.

Cerebral hemispheres: The right and left halves of the brain.

Cerebrum: The upper part of the brain consisting of the left and right hemispheres.

CNS depressants: A class of drugs that include sedatives, tranquilizers, and hypnotics. These drugs slow brain activity, making them useful for treating anxiety, panic, acute stress reactions, and sleep disorders.

Cognition (n): Of or relating to the act or process of thinking, understanding, learning, and remembering.

Cognitive-behavioral therapy (CBT): A form of psychotherapy that teaches people strategies to identify and correct problematic associations among thoughts, emotions, and behaviors in order to enhance self-control, stop drug use, and address a range of other problems that often co-occur with them.

Comorbidity: When two disorders or illnesses occur in the same person. Drug addiction and other mental illnesses or viral infections (HIV, hepatitis) are often comorbid. Also referred to as co-occurring disorders.

Contingency management: A treatment approach based on providing incentives to support positive behavior change.

Craving: A powerful, often overwhelming desire to use drugs.

D

Dependence: A condition that can occur with the regular use of illicit or some prescription drugs, even if taken as prescribed. Dependence is characterized by withdrawal symptoms when drug use is stopped. A person can be dependent on a substance without being addicted, but dependence sometimes leads to addiction.

Detoxification: A process in which the body rids itself of a drug, or its metabolites. Medically-assisted detoxification may be needed to help manage a person’s withdrawal symptoms. Detoxification alone is not a treatment for substance use disorders, but this is often the first step in a drug treatment program.

Dopamine: A brain chemical, classified as a neurotransmitter, found in regions of the brain that regulate movement, emotion, motivation, and reinforcement of rewarding behavior. Dopamine release in reward areas of the brain is caused by all drugs to which people can become addicted.

Drug abuse: An older diagnostic term that defined use that is unsafe, use that leads a person to fail to fulfill responsibilities or gets them in legal trouble, or use that continues despite causing persistent interpersonal problems. This term is increasingly avoided by professionals because it can perpetuate stigma. Current appropriate terms include: drug use (in the case of illicit substances), drug misuse (in the case of problematic use of legal drugs or prescription medications) and addiction (in the case of substance use disorder).

Drugged driving: Driving a vehicle while impaired due to the intoxicating effects of recent drug use.

E

Electronic cigarette: A battery-operated device that people use to inhale an aerosol, which typically contains nicotine, flavorings, and other chemicals; also called e-cigarette, e-cigs, e-vaporizers, or electronic nicotine delivery system.

F

Flashback: A sudden but temporary recurrence of aspects of a drug experience (including sights, sounds, and feelings) that may occur days, weeks, or even more than a year after using drugs that cause hallucinations.

H

Hallucinations: Sensations, sounds and/or images that seem real though they are not.

Hippocampus: An area of the brain crucial for learning and memory.

Hypothalamus: A part of the brain that controls many bodily functions, including eating, drinking, body temperature regulation, and the release of many hormones.

I

Illicit: Illegal or forbidden by law.

Impulsivity: A tendency to act without foresight or regard for consequences and to prioritize immediate rewards over long-term goals.

Injection drug use (IDU): The act of administering drugs by injection. Blood-borne viruses, like HIV and hepatitis, can be transmitted via shared needles or other drug injection equipment.

Intranasal: Taken through the nose.

L

Limbic system: Interconnected brain structures that process feelings, emotions, and motivations. It is also important for learning and memory.

M

Mental disorder: A mental condition marked primarily by disorganization of personality, mind, and emotions that seriously impairs the psychological or behavioral functioning of the individual. This is sometimes referred to as a mental health condition. Addiction is a mental disorder.

Methadone: A long-acting opioid agonist medication used for the treatment of opioid addiction and pain. Methadone used for opioid addiction can only be dispensed by opioid treatment programs certified by SAMHSA and approved by the designated state authority.

Motivational Enhancement Therapy: A counseling approach that uses motivational interviewing techniques to help individuals resolve any uncertainties they have about stopping their substance use. The therapy helps the person strengthen their own plan for change and engagement in treatment.

N

Naloxone: An opioid antagonist medication approved by the FDA to reverse an opioid overdose. It displaces opioid drugs (such as morphine or heroin) from their receptor and prevents further opioid receptor activation.

Naltrexone: A long-acting opioid antagonist medication that prevents receptors from being activated by other opioids. Naltrexone is used to treat alcohol and opioid use disorders.

Neonatal abstinence syndrome (NAS): A condition of withdrawal that occurs when certain drugs pass from the mother through the placenta into the fetus’ bloodstream during pregnancy causing the baby to become drug dependent and experience withdrawal after birth. The type and severity of a baby’s withdrawal symptoms depend on the drug(s) used, how long and how often the mother used, how her body broke down the drug, and if the baby was born full term or prematurely. NAS can require hospitalization and treatment with medication to relieve symptoms.

Neurobiology: The study of the anatomy, function, and diseases of the brain and nervous system.

Neuron (nerve cell): A unique type of cell found in the brain and throughout the body that specializes in the transmission and processing of information.

Neurotransmitter: A chemical compound that acts as a messenger to carry signals from one nerve cell to another.

Norepinephrine: A neurotransmitter that affects heart rate, blood pressure, stress, and attention.

Nucleus accumbens: A brain region in the ventral striatum involved in motivation and reward. Nearly all addictive drugs directly or indirectly increase dopamine in the nucleus accumbens, contributing to their addictive properties.

O

Opioid receptors: Proteins on the surface of neurons, or other cells, that are activated by endogenous opioids, such as endorphins, and opioid drugs, such as heroin. Opioid receptor subtypes include mu, kappa, and delta.

Overdose: An overdose occurs when a person uses enough of a drug to produce a life-threatening reaction or death.

P

Paranoia: Extreme and unreasonable distrust of others.

Partial agonist: A substance that binds to and activates a receptor to a lesser degree than a full agonist.

Pharmacodynamics: The way a drug acts on the body. This includes the drug’s interaction with its biological target and the resulting changes (such as activation or blocking of receptors), as well as the relationship between drug dosing and drug effects.

Pharmacokinetics: What the body does to a drug after it has been taken, including how rapidly the drug is absorbed, broken down, and processed by the body.

Pharmacotherapy: Treatment using medications.

Prefrontal cortex: The front part of the brain responsible for reasoning, planning, problem solving, and other higher cognitive functions. This area of the brain is not fully mature until adulthood, which confers greater vulnerability to drug use on the adolescent brain.

Prescription drug misuse: The use of a medication in ways or amounts other than intended by a doctor, by someone other than for whom the medication is prescribed, or for the experience or feeling the medication causes. This term is used interchangeably with “nonmedical” use, a term employed by many national drug use surveys.

Psychedelic drug: A drug that distorts perception, thought, and feeling. This term is typically used to refer to drugs with hallucinogenic effects.

Psychoactive: Having a specific effect on the brain.

Psychosis: Delusional or disordered thinking detached from reality; symptoms often include hallucinations.

Psychotherapeutics: Drugs that have an effect on the function of the brain and that are often used to treat psychiatric/neurologic disorders; includes pain relievers, tranquilizers, sedatives, and stimulants.

Psychotropic: Mind-altering.

R

Receptor: A molecule located on the surface of a cell that recognizes specific chemicals (normally neurotransmitters, hormones, and similar endogenous substances) and transmits the chemical message into the cell.

Recovery: Individuals may have differing definitions for what recovery from substance use disorder means for them. For some, this term is used to describe the voluntary process of improving health and quality of life by pursuing treatment for substance use disorder and/or controlling problematic substance use.

Relapse: In drug addiction, relapse is the return to drug use after an attempt to stop. Relapse is a common occurrence in many chronic health disorders, including addiction, that requires frequent behavioral and/or pharmacologic adjustments to be treated effectively.

Remission: A medical term meaning that major disease symptoms are eliminated or diminished below a pre-determined harmful level.

Reward: Pleasurable feelings that reinforce behavior and encourage repetition.

Reward system (or brain reward system): A brain circuit that includes the ventral tegmental area, the nucleus accumbens, and the prefrontal cortex.

Risk factors: Factors that increase the likelihood of beginning substance use, of regular and harmful use, and of other behavioral health problems associated with use.

Route of administration: The way a drug is taken into the body. Drugs are most commonly taken by eating, drinking, inhaling, injecting, snorting, or smoking.

S

Self-medication: The use of a substance to lessen the negative effects of stress, anxiety, or other mental disorders (or side effects of their pharmacotherapy) without the guidance of a health care provider. Self-medication may lead to addiction and other drug- or alcohol-related problems.

Serotonin: A neurotransmitter involved in a broad range of effects on perception, movement, and emotions. Serotonin and its receptors are the targets of most hallucinogens.

Stigma: A set of negative attitudes and beliefs that motivate people to fear and discriminate against other people. Many people do not understand that addiction is a disorder just like other chronic disorders. For these reasons, they frequently attach more stigma to it. Stigma, whether perceived or real, often fuels myths and misconceptions, and can influence choices. It can impact attitudes about seeking treatment, reactions from family and friends, behavioral health education and awareness, and the likelihood that someone will not seek or remain in treatment.

Substance use disorder (SUD): A medical illness caused by disordered use of a substance or substances. According to the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), SUDs are characterized by clinically significant impairments in health, social function, and impaired control over substance use and are diagnosed through assessing cognitive, behavioral, and psychological symptoms. An SUD can range from mild to severe.

T

THC: Delta-9-tetrahydrocannabinol; the main mind-altering ingredient in marijuana.

Tolerance: A condition in which higher doses of a drug are required to achieve the desired effect.

V

Vaping: Inhaling the aerosol or vapor from an electronic cigarette, e-vaporizer, or other device.

Ventral striatum: An area of the brain that is part of the basal ganglia and includes the nucleus accumbens; dopamine is released here in the presence of salient stimuli and in response to physically rewarding activities such as eating, sex, and taking drugs, and this process is a key factor behind the desire to repeat the behaviors associated with these rewarding activities.

Ventral tegmental area: An area in the brainstem that contains dopamine neurons that make up a key part of the brain reward system, which also includes the nucleus accumbens and prefrontal cortex.

W

Withdrawal: Symptoms that can occur after long-term use of a drug is reduced or stopped; these symptoms occur if tolerance to a substance has occurred, and vary according to substance. Withdrawal symptoms can include negative emotions such as stress, anxiety, or depression, as well as physical effects such as nausea, vomiting, muscle aches, and cramping, among others. Withdrawal symptoms often lead a person to use the substance again.