Problem drinking that becomes severe is given the medical diagnosis of “alcohol use disorder” or AUD. Approximately 7.2 percent or 17 million adults in the United States ages 18 and older had an AUD in 2012. This includes 11.2 million men and 5.7 million women. Adolescents can be diagnosed with an AUD as well, and in 2012, an estimated 855,000 adolescents ages 12–17 had an AUD.
To be diagnosed with an AUD, individuals must meet certain criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Under DSM–5, the current version of the DSM, anyone meeting any two of the 11 criteria during the same 12-month period receives a diagnosis of AUD. The severity of an AUD—mild, moderate, or severe—is based on the number of criteria met.
To assess whether you or loved one may have an AUD, here are some questions to ask. In the past year, have you:
Had times when you ended up drinking more, or longer than you intended?
More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
Spent a lot of time drinking? Or being sick or getting over the aftereffects?
Experienced craving — a strong need, or urge, to drink?
Found that drinking — or being sick from drinking — often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
Continued to drink even though it was causing trouble with your family or friends?
Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating? Or sensed things that were not there?
If you have any of these symptoms, your drinking may already be a cause for concern. The more symptoms you have, the more urgent the need for change. A health professional can conduct a formal assessment of your symptoms to see if an alcohol use disorder is present.
However severe the problem may seem, most people with an alcohol use disorder can benefit from treatment. Unfortunately, only of a fraction of people who could benefit from treatment receive help. In 2012, for example, 1.4 million adults received treatment for an AUD at a specialized facility (8.4 percent of adults in need). This included 416,000 women (7.3 percent of women in need) and 1.0 million men (8.9 percent of men in need).
Ultimately, receiving treatment can improve an individual’s chances of success in overcoming an AUD. Talk with your doctor to determine the best course of action for you.
Many people do not understand why or how other people become addicted to drugs. It is often mistakenly assumed that drug abusers lack moral principles or willpower and that they could stop using drugs simply by choosing to change their behavior. In reality, drug addiction is a complex disease, and quitting takes more than good intentions or a strong will. In fact, because drugs change the brain in ways that foster compulsive drug abuse, quitting is difficult, even for those who are ready to do so. Through scientific advances, we know more about how drugs work in the brain than ever, and we also know that drug addiction can be successfully treated to help people stop abusing drugs and lead productive lives.
Drug abuse and addiction have negative consequences for individuals and for society. Estimates of the total overall costs of substance abuse in the United States, including productivity and health- and crime-related costs, exceed $600 billion annually. This includes approximately $193 billion for illicit drugs,1 $193 billion for tobacco,2 and $235 billion for alcohol.3 As staggering as these numbers are, they do not fully describe the breadth of destructive public health and safety implications of drug abuse and addiction, such as family disintegration, loss of employment, failure in school, domestic violence, and child abuse.
What Is Drug Addiction?
Addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use, despite harmful consequences to the addicted individual and to those around him or her. Although the initial decision to take drugs is voluntary for most people, the brain changes that occur over time challenge an addicted person’s self-control and hamper his or her ability to resist intense impulses to take drugs.
Fortunately, treatments are available to help people counter addiction’s powerful disruptive effects. Research shows that combining addiction treatment medications with behavioral therapy is the best way to ensure success for most patients. Treatment approaches that are tailored to each patient’s drug abuse patterns and any co-occurring medical, psychiatric, and social problems can lead to sustained recovery and a life without drug abuse.
Similar to other chronic, relapsing diseases, such as diabetes, asthma, or heart disease, drug addiction can be managed successfully. And as with other chronic diseases, it is not uncommon for a person to relapse and begin abusing drugs again. Relapse, however, does not signal treatment failure—rather, it indicates that treatment should be reinstated or adjusted or that an alternative treatment is needed to help the individual regain control and recover.
What Happens to Your Brain When You Take Drugs?
Drugs contain chemicals that tap into the brain’s communication system and disrupt the way nerve cells normally send, receive, and process information. There are at least two ways that drugs cause this disruption: (1) by imitating the brain’s natural chemical messengers and (2) by overstimulating the “reward circuit” of the brain.
Some drugs (e.g., marijuana and heroin) have a similar structure to chemical messengers called neurotransmitters, which are naturally produced by the brain. This similarity allows the drugs to “fool” the brain’s receptors and activate nerve cells to send abnormal messages.
Other drugs, such as cocaine or methamphetamine, can cause the nerve cells to release abnormally large amounts of natural neurotransmitters (mainly dopamine) or to prevent the normal recycling of these brain chemicals, which is needed to shut off the signaling between neurons. The result is a brain awash in dopamine, a neurotransmitter present in brain regions that control movement, emotion, motivation, and feelings of pleasure. The overstimulation of this reward system, which normally responds to natural behaviors linked to survival (eating, spending time with loved ones, etc.), produces euphoric effects in response to psychoactive drugs. This reaction sets in motion a reinforcing pattern that “teaches” people to repeat the rewarding behavior of abusing drugs.
As a person continues to abuse drugs, the brain adapts to the overwhelming surges in dopamine by producing less dopamine or by reducing the number of dopamine receptors in the reward circuit. The result is a lessening of dopamine’s impact on the reward circuit, which reduces the abuser’s ability to enjoy not only the drugs but also other events in life that previously brought pleasure. This decrease compels the addicted person to keep abusing drugs in an attempt to bring the dopamine function back to normal, but now larger amounts of the drug are required to achieve the same dopamine high—an effect known as tolerance.
Long-term abuse causes changes in other brain chemical systems and circuits as well. Glutamate is a neurotransmitter that influences the reward circuit and the ability to learn. When the optimal concentration of glutamate is altered by drug abuse, the brain attempts to compensate, which can impair cognitive function. Brain imaging studies of drug-addicted individuals show changes in areas of the brain that are critical to judgment, decision making, learning and memory, and behavior control. Together, these changes can drive an abuser to seek out and take drugs compulsively despite adverse, even devastating consequences—that is the nature of addiction.
Why Do Some People Become Addicted While Others Do Not?
No single factor can predict whether a person will become addicted to drugs. Risk for addiction is influenced by a combination of factors that include individual biology, social environment, and age or stage of development. The more risk factors an individual has, the greater the chance that taking drugs can lead to addiction. For example:
Biology. The genes that people are born with—in combination with environmental influences—account for about half of their addiction vulnerability. Additionally, gender, ethnicity, and the presence of other mental disorders may influence risk for drug abuse and addiction.
Environment. A person’s environment includes many different influences, from family and friends to socioeconomic status and quality of life in general. Factors such as peer pressure, physical and sexual abuse, stress, and quality of parenting can greatly influence the occurrence of drug abuse and the escalation to addiction in a person’s life.
Development. Genetic and environmental factors interact with critical developmental stages in a person’s life to affect addiction vulnerability. Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it will progress to more serious abuse, which poses a special challenge to adolescents. Because areas in their brains that govern decision making, judgment, and self-control are still developing, adolescents may be especially prone to risk-taking behaviors, including trying drugs of abuse.
Prevention Is the Key
Drug addiction is a preventable disease. Results from NIDA-funded research have shown that prevention programs involving families, schools, communities, and the media are effective in reducing drug abuse. Although many events and cultural factors affect drug abuse trends, when youths perceive drug abuse as harmful, they reduce their drug taking. Thus, education and outreach are key in helping youth and the general public understand the risks of drug abuse. Teachers, parents, and medical and public health professionals must keep sending the message that drug addiction can be prevented if one never abuses drugs.
Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.
Every day, across the nation, 2,500 of America’s youth abuse a prescription drug for the first time.
Every year, more people initiate abuse of prescription drugs than any other drug. More than 2.1 million people a year begin abusing prescription drugs, compared to just over two million that begin to abuse marijuana. Placing third with more than a million initiates per year is abuse of tranquilizers.
Out of the top ten drugs people start to abuse each year, three are prescription drugs. In all, approximately 3.3 million people start to abuse these three prescription drugs each year. About a million of these people are between 12 and 17 years of age.
In all, more than six million Americans abuse prescription drugs each year. That number is steeply up from 3.8 million in 2000.
These startling figures serve to point out the tragic growth in the abuse of prescription drugs. While proper use according to doctor’s directions can be therapeutic, when they are abused, the playing field is wide open and the results can be deadly.
Recovery from Addiction to Prescription Medications is No Easier Than Any Other Drug
Sadly, many people become addicted to pain medication, sedatives, sleep aids or stimulants even when they were properly prescribed these drugs and used them according to the instructions. Some people find they can’t stop taking them when they want to and some people phase into recreational use. Either way, many people who find themselves addicted to medication need help getting through withdrawal and full recovery.
Withdrawal can be a difficult phase of recovery unless one has the correct support. Some people find it so difficult that doctors will administer other opioids such as buprenorphine to prevent withdrawal symptoms. While the idea is that a person can be tapered off buprenorphine after a period of time, that period often stretches into years, meaing that a person who is trying to recover from addiction is still influenced by a drug for years.
It is possible to go through a tolerable withdrawal process as part of a substance abuse treatment program – if you choose the right program.
Factors that influence young people to abuse prescription drugs include:
Desire to eliminate unpleasant emotions or stresses
Initiation of prescription drug patterns resulting from medical treatment
Many young people feel that since prescription drugs are manufactured by reputable companies, abusing these drugs is safer than using illicit drugs such as cocaine, heroin or methamphetamine. Many youth and young adults freely exchange supplies of controlled prescription substances they have obtained from their own medicine chests or those of other family members.
Seventy percent of people who abuse prescription pain relievers such as OxyContin (oxycodone), Vicodin (hydrocodone), morphine, codeine or methadone got these drugs from a relative or friend, often without their knowledge. Some young people admit checking out the bathroom cabinets when they visit other people’s homes to see what they can find, taking only a few pills so their theft is not obvious.
When asked why they started using either prescription drugs or illicit drugs, young people cited stress about school or home problems or wanting to fit in or feel more comfortable socially as major reasons. Without intending to become addicted, a young person may abuse prescription drugs on the weekends a few times and then find that the cravings quickly convert recreational use into habitual use.
Another factor that comes into play in the abusing of prescription medication by youth is the pattern of liberal administration of drugs by doctors. Ritalin, Adderall, Concerta, Strattera and other drugs are stimulants prescribed to treat Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder in millions of American youth. Doctors also liberally prescribe pain relievers such as Vicodin or OxyContin for pain, especially sports injury pain. Even a loving parent’s administration of over-the-counter cough syrups such as NyQuil or Robitussin may open the door to the abuse of the same substance when the child is older.
Overdose Deaths from Prescription Medications Increasing
A recent report from Florida provided some insight into how deadly prescription drugs can be and how fast death statistics are growing. The Florida Department of Law Enforcement worked with the state’s Medical Examiners to analyze the death toll being created by prescription drug abuse. In 2008, 8,500 individuals were found to have died with one or more drugs in their bodies. The most common prescription medications found in these deaths were benzodiazepines (such as alprazolam, sold as Xanax) or the painkiller oxycodone, often sold as OxyContin. Coroners found alprazolam in 25 percent more deaths in 2008 than the prior year.
More than half the times that painkillers methadone or oxycodone were found in a deceased person’s body, that drug itself was the cause of death. Deaths caused by oxycodone increased 33.5 percent over the prior year.
The report also noted that when alcohol was excluded from these results, prescription drugs accounted for 75 percent of all drug occurrences in these deaths.
It’s easy to see that abuse of prescription medications can be just as deadly as the abuse of any illicit drug. Across the country, states report that their deaths from prescription medication abuse are doubling and tripling in just a few years.
A tolerable withdrawal process can be created through the following means:
Nutritional support in the form of vitamins, minerals and other supplements that help the body detoxify
Ample healthful food and drink available at all hours
Around the clock supervision to handle any problems that might come up
Mineral and nutritional sleep aids.
Gentle re-orientation exercises that help the person focus on a new, safe environment instead of the dangerous or unprotected environment they may have seen in
Physical assists that calm muscular spasms and relieve stress and pain