Drug addiction and abuse: challenges and solutions

If you or a loved one are struggling with drug addiction, you are not alone. Research estimates that substance use disorders affect 8–10% of the general population. 

For those seeking healthcare, the numbers are even higher. Approximately 20% of primary care patients, 40% of general hospital inpatients, and more than 70% of patients in emergency or urgent care clinics are also dealing with drug abuse (McLellan, 2017).

Recovery from drug dependence is a life-long process, but it is possible. The sooner you recognize the signs and seek out treatment, the sooner you can seek out effective treatments and begin the journey of recovery.

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Substance abuse disorder is a chronic, relapsing medical condition. In drug addiction, the brain’s dopamine reward system, the anti-reward/stress system, and the central immune system are involved in reinforcing behaviors and producing memories that lead to substance dependence and relapse after withdrawal (Liu, 2018).

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) includes ten separate classes of commonly abused drugs. These include legal substances, prescription drugs, and illicit drugs (Alozai, 2020):

• Alcohol

• Caffeine

• Cannabis

• Hallucinogens

• Inhalants

• Opioids

• Sedative/ hypnotics

• Anxiolytics/ benzodiazepines

• Stimulants

• Tobacco 

These addictive drugs may produce an intense activation of the brain’s reward system, resulting in the person neglecting normal activities in favor of drug use. Each of the drugs listed affects the body differently, but all of them produce a feeling of pleasure in the brain, usually called a “high” (Alozai, 2020).

The DSM-5 lists the following signs that you may have a problematic pattern of substance use. If you have experienced two or more of the following symptoms in the last 12 months, you should consult a healthcare provider for help in cutting down or stopping your drug use (Alozai, 2020):

• Often take in larger amounts or over a longer period than was intended

• A persistent desire or unsuccessful efforts to cut down or control use

• A great deal of time is spent in activities necessary to obtain, use, or recover from the substance’s effects

• Drug craving or a strong desire or urge to use the substance.

• Recurrent use resulting in a failure to fulfill major role obligations at work, school, or home

• Continued use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by its effects

• Important social, occupational, or recreational activities are given up or reduced because of the use

• Recurrent use in situations in which it is physically hazardous

• Continued use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance

• Tolerance

• Experience withdrawal symptoms

There is no single cause for drug addiction. As with most behavioral disorders, it results from a combination of genetic risk factors, personality traits, and the surrounding environment. Certain risk factors may predispose individuals to use substances earlier in life. Once exposed, the brain’s reward systems reinforce drug use resulting in repeated use and addiction (Alozai, 2020).

Various risk factors can make someone more likely to have a problem with substance abuse; these are (U.S. National Library of Medicine, 2021):

• Your biology

• A history of prolonged stress or trauma

• Other mental health problems

• Your home environment

• Social difficulties

• Having peers who use drugs

• Experimenting with drugs at a young age

The physical effects of substance use disorder vary depending on the drug of choice, but over the long term, all drug abuse is toxic to the body (Fluyau, 2020).

Some of the physical consequences of drug abuse can include (Fluyau, 2020):

• Heart disease

• Increased rates of falls and accidents

• Liver disease

• Elevated heart rate and blood pressure

• Exposure to contagious illnesses such as hepatitis or HIV 

• Overdose or death

Abusing drugs can result in several substance-induced mental health disorders such as (Alozai, 2020):

• Psychotic disorders

• Bipolar disorder

• Depressive disorder

• Anxiety disorder

• Obsessive-compulsive disorder

• Sleep disorders

• Sexual dysfunction

• Delirium

• Neurocognitive disorders

If you feel unable to control your drug use, think you are experiencing adverse side effects of substance use, or are experiencing withdrawal, you should see your primary care physician (PCP) or another healthcare professional. 

Your provider will take a detailed history of your substance use, your family history of addiction, stressors going on in your life, and any other mental or physical conditions that you may have. They will also conduct a physical exam and possibly lab work (Alozai, 2020).

Your healthcare provider can help you develop a treatment plan, prescribe medications to ease detox symptoms, and decide if outpatient, inpatient, or residential treatment would be best for your situation. Some drug addiction treatment programs or detoxification centers will require you to get a referral from a healthcare professional.

Recovery from drug addiction is a long-term commitment. Several interventions have been scientifically shown to be effective for addiction treatment. These include medications, behavioral therapies, and recovery support groups. As a result of professional, continuing, evidenced-based care, even those with severe addictions have the possibility of recovery (McLellan, 2017).

Medications

Two medications work well for preventing relapse in people with opioid addiction. Methadone has been shown to be more effective and result in fewer relapses; however, it has a more significant potential for abuse. Buprenorphine is slightly less effective at preventing relapse but has a lower potential for abuse than methadone (Guenzel, 2020).

Multiple studies have been conducted to find medications to assist with preventing relapse on cannabis and methamphetamine. Currently, none have produced significant results. Research is still ongoing, but it is unlikely that an effective relapse prevention medication for these two drugs will be available soon (Guenzel, 2020).

Individual therapy

Several forms of therapy have been studied to help people with drug addiction. These treatment approaches share many common elements, and no studies show that one is better than the others (Guenzel, 2020). 

Motivational interviewing is an approach that seeks to increase a person’s readiness to change behaviors that are detrimental to their health. A therapist may use different techniques such as discussing barriers to change, calling to mind the reasons for change, and developing a plan to change behaviors (Guenzel, 2020).

Cognitive-behavioral therapy (CBT) is one of the most widely used therapies for substance use disorder. This technique helps individuals identify and overcome the thoughts and feelings that have led to drug/alcohol use. Several different skills are employed. One skill, mindfulness, is increasingly being studied for its potential health benefits (Guenzel, 2020).

Peer support groups

Peer support groups such as Narcotics Anonymous (NA) and Self-Management and Recovery Training (SMART) were established to allow individuals in the early stages of recovery to receive support and assistance from those who achieved longer periods of sobriety (Guenzel, 2020).

The evidence for the efficacy of peer support groups in helping those in recovery remain drug-free is limited. A small study did find that a similar group, Alcoholics Anonymous, may help with treatment acceptance and retention in the recovery program (Guenzel, 2020).

If you are looking for additional support for yourself or a family member dealing with mental illness or drug addiction, call the Substance Abuse and Mental Health Services Administration (SAMHSA)’s national helpline. 

SAMHSA’s helpline is a confidential, free, 24-hour-a-day, 365-day-a-year information service. They can provide referrals to local treatment facilities, support groups, and community-based organizations. It is available in both English and Spanish.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

May 26, 2021

Written by

Ellyn Vohnoutka, BSN, RN

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.