Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Drug Abuse and Drug Addiction

(Drug Dependence)
by Debra Wood, RN
Definition

Drug abuse is a disease characterized by continued misuse of drugs even when faced with drug-related job, legal, health, or family difficulties. Problems associated with drug abuse must have existed a minimum of 12 months to meet the diagnosis.

Drug dependence refers to long-term, compulsive drug use, perhaps with attempts to stop but repeatedly returns to drug use. Drug dependence also means that your body has begun to require the drug in higher doses to avoid withdrawal symptoms.

Drug abuse and drug dependence are not terms that should be used to describe people who are taking appropriate dosages of prescribed drugs (pain medication, for example) and who have become physically dependent on them. Diagnosis of both drug abuse and drug dependence requires the presence of specific behavioral symptoms.

Some of the most commonly abused substances include:

  • Cocaine
  • Ecstasy
  • GHB
  • Heroin
  • Inhalants
  • Ketamine
  • LSD
  • Legal drugs that are used improperly or without a prescription, such as:
    • Drugs for treating anxiety
    • Amphetamines
    • Narcotic painkillers
    • Sleeping pills
  • Marijuana
  • Morphine
  • PCP
  • Sedatives
  • Speed (methamphetamine, “crystal meth”)
  • Steroids
Causes

The cause of drug abuse and dependence is unknown, although there are a variety of theories. One theory holds that there may be a genetic component that predisposes a person toward using and abusing drugs. Another theory is that drug abuse is a learned behavior and that people begin to use drugs by copying the behavior of those around them. Medical professionals have not been able to target a specific cause.

Brain chemicals may alter the user's perception of the drug's effects. Long-term drug use changes brain function and may reinforce the desire to keep using drugs regardless of the consequences.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors include:

  • Age: youth
  • Anxiety
  • Associating with people who abuse drugs
  • Depression
  • Early antisocial behavior
  • Easy access to drugs
  • Family members with substance abuse problems
  • Panic disorders
  • Sex: male
  • Social and peer pressure
  • Stress
Symptoms

Denial that a drug problem exists is common. Drug abuse can occur without physical dependence.

To definitively diagnose drug abuse, the symptoms must have lasted for at least 12 months.

Symptoms include:

  • Continued use of drugs even though it means risking physical safety
  • Continuing to use drugs despite drug-related problems in personal relationships
  • Recurring trouble with the law related to drug use, including impaired driving
  • Repeated work, school, or home problems due to drug use

Drug abuse often progresses to drug dependence. Symptoms of drug dependence include at least three of the following:

  • Craving for the substance
  • Drug use continues even when it causes or worsens health and/or psychological problems
  • Giving up activities to use drugs or recover from the effects
  • Inability to stop or limit drug use
  • Significant amounts of time trying to acquire drugs and recover from their effects
  • Tolerance—taking greater amounts to feel the same effect
  • Withdrawal symptoms that occur when the drug is stopped
Diagnosis

The doctor will ask about:

  • Drug use:
    • How often you use drugs
    • What amount and if you have increased the amount to receive the same desired effect
    • Which drugs you use
  • Emotional problems that may have occurred while using drugs
  • Problems with a job, your family, or the law

Tests may include:

  • Blood and urine tests to check for the presence of drugs
Treatment

There is no cure for drug abuse or drug dependence.

There are three main treatment goals:

  • To decrease the toxic effects of the drugs being used and to aid in symptoms of drug withdrawal (“detoxification”)
  • To help patients stop using drugs
  • To prevent relapse

Successful treatment depends on the drug user's recognition of the problem and desire to change. Recovery takes a long time and is not an easy process. Patients may need multiple courses of treatment.

Therapies include:

Medications

Drugs may help alleviate symptoms of withdrawal. In some cases, medication may be ordered to prevent relapse. People addicted to heroin may be given methadone to help taper them off. Methadone may also be given on a long-term basis to improve the chance of staying in treatment. Methadone is a narcotic that blocks cravings as well as the pleasurable effects of heroin and other opiates.

Other drugs that are used in treatment are:

  • Buprenorphine (eg, Subutex, which is similar to methadone)
  • Naltrexone (eg, ReVia, which blocks the effect of opiates)
Counseling

Therapy raises awareness of underlying issues and lifestyles that promote drug use. It works to improve coping and problem-solving skills and to develop other ways of dealing with stress or pain. Through counseling, a person can learn how to handle situations associated with drug use and replace drug-using activities with other activities that are more meaningful . Family support is encouraged.

Self-help Organizations

There are numerous organizations or support groups dedicated to helping people to stop using drugs. Two examples are Narcotics Anonymous and Cocaine Anonymous. These are 12-step programs and members of these organizations meet regularly to talk about their drug-related troubles. They provide a network of support for each other.

Prevention

Drug education programs may be helpful. Suggested strategies to lower the risk of drug abuse or dependence include:

  • Seek counseling for anxiety, depression , and other mental health problems.
  • Do not spend time with people who are using illegal drugs.
  • Having a good relationship with your children may reduce their risk of using drugs.
  • Learn about risks related to drug use.
  • Learn ways to handle peer pressure.

Last reviewed: September 2011 by Ryan Estevez, MD, PhD, MPH.

RESOURCES:
CANADIAN RESOURCES:
References:
  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text Revision. Washington, DC: American Psychiatric Association; 2000.
  • Cami J, Farre M. Drug addiction. N Engl J Med. 2003;349(10):975-986.
  • Dambro MR, Griffith JA. Griffith's 5-Minute Clinical Consult. Philadelphia, PA: Lippincott Williams and Wilkins; 2006.
  • Goldman L, Ausiello DA, Arend W, et al. Cecil Textbook of Medicine. 23rd ed. Philadelphia, PA: WB Saunders; 2007.
  • National Institute on Drug Abuse website. Available at: http://www.nida.nih.gov/ . Updated July 2009. Accessed July 8, 2009.
  • 2/4/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Schinke SP, Fang L, Cole KC. Computer-delivered, parent-involvement intervention to prevent substance use among adolescent girls. Prev Med. 2009;49;429-35.