Criteria for diagnosing addiction:

If a  substance is frequently used for longer periods of time or at a higher dosage than originally intended.

1. 1. Efforts to control or lesson substance use are unsuccessful.
   2. A significant amount of time is spent on obtaining, using and dealing with the effects of substances.
   3. A heightened urge or desire to regularly use substances is present.
   4. Regular drug use prevents completion of obligations at home, school, or work.
   5. Recurrent substance use despite continued social or relationship issues related to drug use and its effects.
   6. A reduction or abandonment of valuable or important social activities in favor of drug use.
   7. Substance use taking place during dangerous situations or times (driving, caring for children, etc.).
   8. Continued substance use despite underlying medical or physical issues that are exacerbated by the drug.
   9. Development of tolerance, which can involve:
      • An increased dosage amount to achieve the desired effects.
      • Decreased effects or response to the same amount of a particular substance.

• Common signs of addiction:
  • Unintentional weight loss
  • Loss of sleep
  • Skin problems (lesions, scratch marks, rashes, pimples, bruises, or needle marks at an intravenous injection site)
  • Cool, unnaturally pale skin
  • Bloodshot eyes
  • Unusual odors (may be chemical smells or strong body odors)
  • Tremors or loss of motor coordination
  • Slurred speech
  • Frequent nausea
  • Irregular heart rate
  • Shallow breathing

• Common psychological and behavioral signs of addiction:
  • Anxiety
  • Restlessness
  • Uncharacteristic lying
  • Confusion
  • Memory loss or blackouts
  • Stealing money or medications
  • Irregular sleep patterns
  • Self-isolation
  • Depression
  • Mood swings
  • Unusual personality changes or mood swings
  • Failure at school or on the job
  • Increased secrecy
  • Legal problems

• Some of the most severe side effects may include:
  • Insomnia
  • Loss of appetite and weight loss
  • An abnormally slow or rapid heart rate
  • Slow or rapid breathing
  • Increased blood pressure
  • Heart attack
  • Stroke
  • Respiratory distress
  • Fever
  • Muscle spasms
  • Seizures
  • Increased risk of accidental injuries
  • Exposure to blood-borne diseases (for IV drug users)

• How common are drug addictions?According to the results of a survey published in the Archives of General Psychiatry, approximately 2.6 percent of American adults meet the criteria for drug dependence and drug addiction. Globally, the figure is similar; the World Health Organization estimates that nearly 3 percent of adults around the world suffer from a drug use disorder. At first glance, these numbers may seem small. However, these statistics do not reflect the number of people who have tried illicit drugs, or who have abused illicit substances or prescription medications. The National Institute on Drug Abuse reports that almost 10 percent of American adults have tried illicit drugs. Anyone who uses drugs recreationally or experimentally is at risk of developing dependence and drug addiction.
• What is the difference in addictions to specific substances?“Drug addiction” is a general term that refers to the compulsive need to seek and use substances, in spite of the harmful consequences. But in fact, drugs vary in their addictive properties, and social trends influence the popularity of certain drugs. Listed below are some of the most commonly abused substances:
  • Marijuana has become one of the most widely used — and abused — drugs in the United States. The Journal of the American Medical Association notes that while the prevalence of marijuana use in the US hasn’t changed much since the 1990s, the prevalence of cannabis abuse and addiction has greatly increased. The 2012 Monitoring the Future survey, which tracks drug use among American teens, showed that marijuana use has increased among high school students in recent years, while disapproval of cannabis among teens has declined. At one time, marijuana was not considered to be addictive, but recent studies have shown that this drug can cause symptoms of dependence and addiction, including cravings, insomnia, anxiety, depression, and agitation.
  • Cocaine/ Crack Cocaine. This central nervous system stimulant remains one of the most popular drugs of abuse in the United States. Its euphoric, energizing effects are not only seductive, but also highly addictive. The 2012 National Survey on Drug Use and Health reported that nearly 640,000 American adults tried cocaine for the first time in that year, an average of almost 2,000 per day. Over 1 million Americans met the criteria for dependence on cocaine that same year. Crack cocaine, a more potent form of the drug, is between 75 and 100 percent more powerful than the powdered form, according to the Foundation for a Drug-Free World. Crack is highly addictive, causing changes in brain chemistry that quickly lead to compulsive abuse and dependence.
  • Methamphetamine. Known as “meth,” “crank,” “ice,” “crystal,” “glass,” and many other street names, methamphetamine is a central nervous system stimulant that has become increasingly popular in recent years. The effects of meth are similar to the effects of cocaine, but methamphetamine is generally less expensive and easier to obtain. The production of meth in underground labs around the US has become increasingly common, contributing to the rise in addiction. The U.S. Department of Justice reports that in 2011, there were over 13,000 incidents involving the discovery of meth labs, dump sites, or lab equipment in this country.
  • Opiates. This group of potent pain-relieving substances includes all drugs that are derived from opium, a compound found in the opium poppy. Some of these drugs, like morphine and codeine, are classified as non-synthetic opiates, while others, like heroin, hydrocodone, methadone, and oxycodone, are produced synthetically in laboratories. Until recently, heroin was considered to be the most addictive of the opiates. Today, however, opiate pain medications have surpassed heroin and cocaine in their popularity as drugs of abuse. According to Harvard University, the number of opiate addicts in the US increased threefold between 1991 and 2001, largely because of the increase in nonmedical use of drugs like hydrocodone (Vicodin), oxycodone (OxyContin, Percocet) and hydromorphone (Dilaudid). Harvard estimates that as of 2007, approximately 2 million people in the US were dependent on opiates, a number that continues to increase.
  • Hallucinogenic drugs. Hallucinogens are psychoactive drugs that affect the way you experience the world around you. A few of the most popular hallucinogenic drugs include Ecstasy, LSD PCP, and mushrooms. The effects of hallucinogenic drugs can range from pleasant sensory distortions and feelings of empathy to terrifying hallucinations and violent impulses. These psychedelic substances are popular among young people, many of whom are introduced to hallucinogenic drugs at clubs, raves, concerts, or parties. Although hallucinogenic drugs are commonly believed to be non-addictive, clinical research has shown that drugs like Ecstasy can cause signs of physical and psychological dependence, including withdrawal symptoms, obsessive thoughts, and cravings.
  • Pharmaceutical drugs. When it comes to prescription drug abuse and drug addiction, opiate pain medications are the most widely abused. The Centers for Disease Control and Prevention (CDC) notes that in 2012, over 250 million prescriptions were written for analgesics like Vicodin, Norco, and Percocet. At the same time, the CDC estimates that 46 Americans die every day from overdoses on narcotic pain relievers, and that addiction to prescription drugs now surpasses both heroin and cocaine. However, opiates aren’t the only prescription medications that can cause dependence and addiction. Other commonly abused prescription drugs include sedatives in the benzodiazepine family (Valium, Klonopin, Ativan, Xanax), stimulants used to treat attention deficit hyperactivity disorder (Adderall, Ritalin, Concerta), and prescription sleeping pills (Ambien, Lunesta).
• What causes addiction?There are many factors that contribute to drug addiction: genetic makeup, family background, social influences, neurological factors, and environmental issues. Having a close family member who is addicted to drugs, or growing up in an environment where drug use is widely accepted, can increase your chances of dependence and drug addiction. A co-occurring mental illness makes you vulnerable to addictive drug use.

  Even now, many people assume that drug addiction is caused by a failure of willpower or by weak character. But the medical community now recognizes that addiction is a brain disease, not a character flaw. The repeated use of drugs like heroin, cocaine, meth, or prescription opiates causes profound changes in the structure and function of the brain. These substances interfere with the way your brain processes and responds to neurotransmitters, chemicals that control emotion, energy levels, pain response, judgment, sleep patterns, and metabolism.

  The more you use these drugs, the more your brain and nerves come to rely on these substances to produce feelings of pleasure, excitement, relaxation, or euphoria. Drug addiction occurs when repeated use of a drug changes the brain in such a way that the user can no longer function normally without it.

• How long does it take to become dependent on drugs?The U.S. National Library of Medicine states that there is no hard and fast rule on how long it takes for an individual to become dependent on drugs or develop a drug addiction. The length of time can depend on the type of drug you’re using, the amount of the drug you take, and whether you abuse a combination of drugs (including alcohol). Other factors, like your physical and psychological health, can also influence drug dependence. Certain drugs, like cocaine, meth, heroin, and prescription drugs in the benzodiazepine family, are known to cause physical and psychological dependence very quickly. For some users, the signs of drug tolerance and physical dependence can develop after only a few uses, while others may take weeks or months to become addicted.
• How long does withdrawal last?Drug withdrawal can last from a few days to a week or more. Some of the late signs of drug withdrawal, such as anxiety, depression, or cognitive impairment, may linger after the detoxification phase. There are a number of factors that can influence the duration and severity of withdrawal symptoms:
  • Your primary drug of abuse
  • The length of time you’ve been using
  • The amount of the drug you’ve been taking
  • Your age
  • Your size
  • Your physical condition
  • Your psychological health

  With opiate abuse (heroin, morphine, OxyContin, Vicodin), withdrawal symptoms usually start within a matter of hours and last for several days. With stimulants like cocaine or methamphetamine, withdrawal may be more extensive, with cravings, depression, and anxiety lasting for several months. Withdrawal from prescription medications, such as sedatives in the benzodiazepine family (Valium, Xanax, Ativan) may require a drug taper lasting a number of weeks to clear the chemical safely from your system.

• What should I do if I believe a loved one has a drug addiction?If you’ve noticed the signs or symptoms of drug addiction in someone you love, don’t hesitate to intervene. Many people are reluctant to talk to a friend or family member about drug addiction, either because they’re afraid of jumping to conclusions, or because they don’t want to make the problem worse. Although it’s never easy or comfortable to bring up the topic of substance abuse, reaching out to an addict could stop the progression of a fatal disease. Here are a few steps you can take to communicate your concerns, while protecting yourself and your loved ones from the repercussions of addiction:
  • Initiate a one-on-one conversation. If you don’t bring up the topic of drug addiction, it’s unlikely that your loved one will initiate the discussion. Denial is one of the strongest side effects of addiction, and it’s all too easy for spouses, partners, or children to ignore the problem along with the addict. Have an honest, heart-to-heart talk with your loved one about how their behavior is affecting you and other people in your home.
  • Seek advice and support from others. Counselors, therapists, and support groups can be valuable sources of advice when you’re trying to deal with an addicted loved one. A substance abuse therapist can give you pointers on how to communicate effectively with someone who’s in denial. Twelve-step groups like Al-Anon or Nar-Anon can offer support and coping strategies, as well.
  • Start researching treatment options. It’s never too soon to start exploring drug treatment programs for your loved one. Rehab facilities, recovery services, and detox programs are listed publicly. You can also use the Internet to find recovery centers in your community or out of state.
  • Work with an intervention specialist. If your loved one is in strong denial about the problem, he or she will probably refuse to get treatment or even to listen to you. A substance abuse counselor or therapist who specializes in intervention can help you plan a formal meeting to confront your loved one with the consequences of their behavior and propose a treatment plan.
• How should I tell my loved ones that I have a drug addiction?The best way to tell your loved ones that you’re addicted is to be as honest and as open as possible. Be prepared for the possibility that they won’t understand your disease — even today, many people don’t realize that addiction is a chronic condition on the same level as diabetes, cancer, or hypertension. Your loved ones may criticize you; they may even try to persuade you that you don’t have a problem. It’s important to stand firm in your new self-awareness and stay on track with your plan for treatment.

  If you fear that your loved ones will reject or judge you, consider inviting them to a session with a substance abuse counselor or a 12-step meeting. Educating your loved ones about the realities of drug addiction may make them more receptive and supportive. Having the support of professionals and peers will also help you stick with your convictions about recovery.

• What types of medications are available to treat drug addiction?Addiction medications make the recovery process easier by easing the cravings and side effects associated with withdrawal. In the advanced stages of recovery, some people continue to take these medications in order to maintain their sobriety. Addiction medication should be taken only under a doctor’s supervision. These drugs can have serious side effects, including physical dependence and tolerance. Ironically, the medications used to treat opiate addiction have addictive properties themselves.

  Listed below are three medications that have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of drug addiction:

  • Methadone is a synthetic opioid that has been prescribed since the 1960s as a form of treatment for heroin addiction. When taken in small, controlled doses, methadone allows heroin addicts to withdraw gradually and to maintain a drug-free life.
  • In 2002, the FDA approved buprenorphine for the treatment of opioid addiction. Buprenorphine is a semi-synthetic opioid that is prescribed to help addicts manage their cravings and reduce the need for opiates. Buprenorphine is sold under a number of brand names, including Suboxone, Butrans, and Buprenex.
  • Naltrexone was approved by the FDA in 1994 for the treatment of alcoholism; however, it is currently prescribed for the treatment of opioid addiction. Sold in oral or injectable forms (ReVia and Vivitrol), naltrexone can help block the effects of opioids on the brain, making it less pleasurable to use these powerful drugs. Naltrexone is prescribed for opiate users who have been through the withdrawal phase and who are motivated to stick to a recovery program.

  Other medications are prescribed to help manage the pain, muscle spasms, nausea, and anxiety of drug withdrawal. When they are used as part of a comprehensive recovery plan, these medications can make withdrawal more tolerable, increasing the chances that the patient will progress to the next stage of recovery.

• What are the recovery rates for people with a drug addiction?With the help of professional drug treatment programs, a large number of addicts have learned to live meaningful, drug-free lives. Relapse rates among recovering opiate addicts are as high as 90 percent, according to a study published in the Irish Medical Journal; however, addicts in this study who completed an inpatient treatment program were more likely to avoid relapse and remain drug-free.

  Drug addiction is a chronic disease, and relapse is one of its major symptoms. It’s important for a recovering addict to realize that relapse is the rule rather than the exception. Relapse prevention therapy can help addicts learn how to avoid lapses, or how to minimize the severity of a relapse if they do slip. The sooner you seek help after a relapse, the sooner you’ll get back on track with your recovery program.

  Recovery rates are higher for patients who have access to aftercare support after they are discharged from treatment. Aftercare services include case management, alumni groups, community referrals, counseling services, sober housing, medication management, and more. These services provide a source of stability and support for recovering addicts during the vulnerable transitional period from drug treatment back to the community.

  A longitudinal study of drug-dependent individuals who participated in a six-month aftercare program showed that participants were less likely to relapse into drug or alcohol use. This study, published in Addictive Behaviors, indicates that the support, information, and coping strategies gained from aftercare play a big part in the success of a recovery program.