Drug addiction, tolerance, and dependence are often mistakenly used interchangeably among everyday society; however, these are distinct behaviors with specific definitions. Drug abuse or addiction is a neurobiological condition affecting the brain that is characterized by compulsive drug-seeking behavior. Over time the brain becomes rewired, and the chemistry is altered, resulting in a change in the reward and pleasure pathways. These pathways elicit more intense cravings for the addicted substance. As a result, the individual will go to extreme lengths and adopt compulsive and addictive behaviors to please their brain’s reward system. Addiction affects every aspect of one’s life, including their relationships, home life, and professional life.
Drug tolerance is defined as the individual’s diminished response to a drug after its repeated use. The more often an individual uses alcohol or an illegal substance to get high, the less of a response their body will have to that stimulus, and therefore, more of that drug will be needed to reach the same effects. This physical effect of repeated drug use is not associated with addiction, per se, meaning that an individual can develop a tolerance to alcohol or heroin without necessarily being addicted.
Drug dependence is known as the body’s physical adaptation to the abused substance of choice. Once the individual stops taking the abused substance, the body will undergo predictable and painful symptoms known as withdrawals. Withdrawal symptoms must be present for tolerance to occur. Each drug has its own withdrawal symptoms. For example, nausea, vomiting, diarrhea, irritability, headaches, and extreme muscle aches are characteristics of opioid withdrawal, whereas a high heart rate, elevated blood pressure, excessive sweating, tactile, auditory, and visual hallucinations, and seizures.
Addiction usually begins due to many different factors, including peer pressure, curiosity, the inability to relieve chronic or acute pain, and the need to mask feelings associated with underlying mental health disorders. Drugs can numb emotional and physical pain and can be used as a temporary escape from reality, but with every use, the brain becomes more and more hooked due to dopamine release.
Legal drugs can either be bought over-the-counter or with a prescription from a medical doctor. Illegal drugs cannot legally be manufactured, bought, or sold in the United States. And some other drugs are legal in some situations but illegal when abused.
Some drugs only become illegal when an individual uses them without a prescription, takes more than the recommended dosage, or mixes them together to alter the drug’s effects.
Most illegal drugs are also controlled substances in the United States, but not all controlled substances are considered illegal. Even legal drugs have the potential for abuse and dependence, so an individual must understand that all drugs, both legal and illegal, can be dangerous and can potentially be abused if misused.
Examples of legal drugs: cough medications, Ritalin, Adderall, Xanax, Ativan, Ambien, Percocet, and marijuana. Not that many of these legal drugs are obtained by prescription only, and even when taken correctly can become addictive. Additionally, when these prescription medications are misused, such as when they are given away, sold on the street, or taken for the wrong reasons, they became illegal. Hence the lines between legal and illegal drugs can often be blurred, especially for prescription drug abuse.
Some of the most commonly abused drugs; legal and illegal include the following:
Whether accidental or intentional, drug overdoses are the leading cause of death for Americans under 50 years old. Accidental overdoses tend to happen when people take more of a prescription medication than initially intended to achieve specific results or when they use too much of an illegal drug trying to get a better high. Intentional overdoses are usually a result of someone trying to commit suicide. Regardless of the intent, any loss of life due to an overdose is tragic. An overdose can have severe and lasting repercussions not just on the individual but also on their family and friends.
Just like an overdose, drugs are misused when individuals take more of a prescription medication than prescribed to achieve certain results, when they use too much of an illegal drug trying to get a better high, or when a prescription is given to or sold to someone else other than the prescribed individual. Prescription drug abuse is one of the most common ways drugs are being misused in the United States. Prescription drug abuse commonly occurs with sleeping pills, benzodiazepines, and prescription opioids.
Cocaine is an attractive, illegal recreational used substance commonly snorted intranasally to enhance mood, energy, and produce euphoria. It is classified as a stimulant and was first isolated and extracted from coca leaves in the mid-1800s and before then, the leaves were used by the ancient Incas and native Peruvians to combat the effects of living at high altitude and also for religious ceremonial purposes.
Currently, there is no medical indication for cocaine, and therefore, this is known as a very expensive and dangerous addictive street drug in its purest form. Cocaine can be cut with impure ingredients making it less expensive and even more dangerous. Crack cocaine is the solid crystal form of cocaine and can be smoked or heated down to liquid to be injected. Crack is the most potent form of cocaine and, therefore, the most dangerous. Cocaine is known to be one of the top five drugs involved in drug-related deaths in most areas in the United States. Cocaine is extremely dangerous as it can cause sudden heart attacks and strokes and therefore is the second most common drug-related emergency room visit after alcohol.
Sleeping pills, which can be over the counter or prescription, fall into a category of drugs formally known as “sedative hypnotics” and depressants, depending on the specific drug. These sleep medications work by slowing down the activity of the brain to induce sleep. There are two types of sleep: REM, when people dream, and non-REM, which has light, medium, and deep portions. Sleeping pills mainly increase the amount of medium-depth non-REM sleep.
Many people experience better sleep while taking sleep aids, but there is also a large proportion of individuals who wake up feeling groggy, confused, anxious, and hung-over. Sleep aids can be restorative for the right person, but they can also come with the potential for addiction. There are multiple classes of “sedative-hypnotics” which include the following:
Sleep aids should only be taken for a short time to alleviate temporary insomnia. Individuals may take them for a long flight or drive or may need them for a few days to help them get their sleep schedule back on track. When sleep medications are used longer than necessary (more than a few days), they can become very addictive.
Over time, the brain and body build up a tolerance to sleep aids, and as a result, the individual will need a higher dose to produce the same effects. Individuals can become physically addicted to sleeping aids, a term is known as physical dependence. This happens when individuals stop taking sleep medications and experience rebound insomnia, a sign of sleep medication withdrawal. Rebound insomnia occurs when the body becomes addicted to sleeping aids and cannot fall asleep without them. As a result, many individuals will continue to take sleep medications, and this vicious cycle repeats itself.
You may have heard of individuals who walk around the block, drive their car or shop online while sleeping, and have no recollection of these actions when they awake. Sleep aids often induce parasomnias such as sleepwalking and can potentially be very dangerous. The following are additional side effects associated with sleep aid dependence:
Opioids, also known as nature’s painkillers or narcotics, are incredibly addictive and are responsible for the opioid crisis, which has taken thousands of lives over two decades. Opioids are derived from the opium poppy plants, but many are now synthesized in a laboratory and can be deemed both illegal (heroin) and legal (Vicodin, if taken as prescribed).
Prescription opioids such as Percocet, Vicodin, and Lortab are strong pain relievers used short term for severe pain but are often overprescribed for mild and chronic pain. Stronger opioids such as morphine and fentanyl are commonly used in hospitals, end-of-life care, and cancer-related pain. Opioids are incredibly addictive and not only suppress physical pain but also create a sense of euphoria. Opioids work on the brain’s reward center, and therefore the cravings become stronger after each use.
Hallucinogens are mind-altering substances that enhance or alter mood and perception by modifying sight, sound, and other sensations. Most classic hallucinogens can produce exceedingly unpleasant experiences at high doses, although the effects are not necessarily life-threatening. Many of these unpleasant side effects can result in a visit to the emergency room. Overdose is most common from dissociative drugs such as ketamine. However, high doses of PCP can cause seizures, coma, and death.
Benzodiazepines commonly called nerve pills, benzos, downers, or tranks, are some of the most frequently prescribed medications in the United States. Benzodiazepines have a calming effect and are known to lower inhibitions, making them very addictive, especially if one is in a high-stress environment or struggles with anxious thoughts. Familiar names include Xanax, Valium, Ativan, Klonopin, and Librium.
Benzodiazepines are often prescribed to help treat specific anxiety disorders, alcohol withdrawal, seizure disorders, and sleep disorders such as insomnia; and are generally only prescribed for very short-term use, unless they are long-acting such as Klonapin, which is sometimes prescribed for longer periods of time in smaller dosages. Abuse and addiction commonly occur when individuals use benzodiazepines longer than prescribed. Benzodiazepines have similar effects on the body and brain as alcohol as they both work on the same GABA receptor in the brain. Benzodiazepines act on the central nervous system to produce sedation, muscle relaxation, and to decrease anxiety levels. Both overdose and withdrawal from benzodiazepines can be life-threatening.
One of the most common misconceptions is that alcohol is not a drug. Though legal, alcohol is a mind-altering substance. When taken in combination with other drugs, the effects can be deadly. Alcohol is also extremely addictive. In fact, it is one of the most addictive substances worldwide and accounts for the highest emergency room visits and addiction treatment center admissions across the United States. Alcohol can have many serious physical complications, worsen underlying mental health disorders, and fuel co-occurring addictions.
Alcohol abuse or alcohol use disorder is defined by the presence of alcohol cravings and the inability to quit drinking due to physical and psychological withdrawal effects.
Individuals with alcohol addiction, and with any other type of drug addiction, will use extreme measures to obtain their substance of abuse. This may include stealing, lying, hiding alcohol, pouring alcohol into shampoo bottles, or drinking household items that contain alcohol due to intense cravings and fear of withdrawal. Like benzodiazepines, withdrawing from alcohol can be dangerous and even lethal. As a result, the individual must be weaned off of alcohol under medical supervision, whether it is in an inpatient or outpatient setting. Individuals should seek professional help when trying to quit their drinking habits.
Amphetamines are classified as stimulants as they work on the central nervous system to induce high energy and psychoactive properties. Amphetamines are often prescribed for individuals with obesity, narcolepsy, and attention-deficit/hyperactivity disorder (ADHD). Common brands of prescription amphetamines include Adderall, Desoxyn, Dexedrine, and DextroStat. Adderall is commonly abused among college and high school students as a potent study drug, enabling students to stay up all night and cram before a big exam.
Methamphetamine, commonly known as meth or crystal meth, is a specific type of illicit amphetamine often smoked and made in underground laboratories, basements, kitchens, or anywhere with a stove. Some common household ingredients that are often made into meth include drain cleaner, antifreeze, rat poison, battery acid, and kerosene. In some cases, methamphetamine is cut with prescription medications, ranging from antidepressants to laxatives. Common street names for methamphetamine include blue, crystal, ice, meth, and speed and can be smoked, swallowed in pill form, snorted, or injected in powder form after being dissolved in water. Structurally similar to amphetamines, methamphetamine is much more potent and has a higher potential for abuse and addiction.
If you or someone you know demonstrates two or more of the following behaviors over 12 months, we recommend you get screened for drug abuse:
When individuals are in the throes of their addiction, they usually behave irresponsibly and do not function to their full capacity. As a result, other family members will often step in to pick up the slack, which results in them becoming more controlling and overly responsible. The equilibrium or balance of the family system shifts as each member changes and adjusts accordingly. These changes usually occur incrementally, subtly, and unconsciously.
Unfortunately, addiction can wreak havoc on family relationships, destabilize the home environment, compromise finances, and put a damper on everyone’s mental, physical, and emotional health. Not only is the whole family affected by an individual’s addiction, but also family members have a higher likelihood of developing drug abuse if their first-degree relative has a history of drug abuse.
Drug abuse affects every individual, regardless of age, social class, race, education, gender, or ethnicity. Drug abuse is rampant in the homeless population, in the blue-collar workforce, among white-collar executives, and among full-time parents. Celebrities, working professionals, and everyday people are all at risk of drug abuse, even if the stigma says otherwise.
Unfortunately, our society has a lot of false pretenses regarding who is more prone to addiction. Our society often paints a picture that only people who come from lower socio-economic backgrounds, lower education levels, and those who have a criminal history or a record of being homeless are likely to become addicted to drugs. This is not true, drug abuse affects everyone, and it is important that access to substance abuse treatment is available to everyone who is affected.
Everyone has the potential to become addicted to drugs. However, there are certain factors and populations that have a higher likelihood:
Unfortunately, the prison system does not hold much hope for individuals who are struggling with addiction and mental health disorders; however, some prisons do provide access to substance abuse treatment, but it may be limited. Once an individual is released from jail and integrates back into society, many community-based support groups, non-government organizations, and substance abuse treatment centers cater to this population.
The same goes for indigenous people, LGBTQ individuals, teenagers, and victims of abuse. The stigma associated with these populations is slowly but surely being broken down due to education and awareness. As a result, more substance abuse treatment centers are catering to these at-risk populations.
Recovering from substance abuse, whether from heroin, prescription drug use, alcohol, or cocaine, can be one of the most challenging and devastating battles an individual can experience. Addictive substances re-wire the brain, and over time, change an individual’s way of thinking and can also, within time, change their personality. Seeking treatment from a substance abuse treatment center can help individuals take back control of their lives.
One of the most important reasons to enter into a drug abuse treatment program immediately is that a substance abuse treatment center will help you overcome withdrawals, which are among the most common reasons why individuals are unable to become sober. Depending on the substance, the emotional and physical withdrawal symptoms can be debilitating and oftentimes result in relapse. Each drug has its own withdrawal symptoms.
For example, nausea, vomiting, diarrhea, irritability, headaches, and extreme muscle aches are characteristics of opioid withdrawal, whereas a high heart rate, elevated blood pressure, excessive sweating, tactile, auditory, and visual hallucinations, and seizures. One of the first stages in drug rehabilitation is detoxification, which is the elimination of the addictive substance from the body. On average, this can take 48-72 hours, and a professional and compassionate treatment team can administer medications to alleviate some of the withdrawal effects while making sure each client is safely monitored.
Once the client has undergone a professional detoxification program, they will then enter into the program’s rehabilitation stage. This stage consists of several therapeutic approaches, including cognitive-behavioral therapy, dialectal behavioral therapy, interpersonal therapy, and many more in both a group setting and an individual setting. The client may be given medications to manage their cravings further and undergo a nutritional evaluation to determine if they need special diets or vitamins. Addiction often results in malnourishment. Learning how to heal the body through a whole, nutritious food is a large part of drug addiction treatment.
The client will also learn to recognize their underlying triggers that drive their addiction. Common triggers include low self-esteem, trauma, poor relationships, unhealthy conflict resolution skills, personality disorders, or co-occurring mental health or eating disorder. Learning to recognize these triggers and develop coping mechanisms to overcome these triggers can result in a successful recovery within time. The client will also learn other important skills such as relationship building, healthy communication, and the need for a positive support system and will also learn about community resources such as support groups, community meetings, and online recovery tools.
Most substance abuse treatment centers are in residential neighborhoods, and therefore, the clients have the comfort and privacy of living in a home. Most clients sleep two to a bedroom, and meals and minor cleaning services are provided. At least one house supervisor is in the home at all times to ensure that each client is safe. Random drug testing is usually required during treatment, and depending on the severity of the substance abuse disorder, the average length of stay ranges from 30-90 days. Clients usually have the option to engage in extracurricular activities such as yoga, art therapy, or group activities outside the home, and visitors are usually allowed on certain days and during certain time periods.
Once the client has successfully completed residential treatment, they usually step down to a lower level of care, such as partial hospitalization or intensive outpatient care. They are also provided aftercare resources and are strongly encouraged to become involved in the community, join recovery support groups, and contact their treatment team. Treatment does not stop once the client completes their drug rehabilitation program, but rather, each client learns that treatment is a lifelong process, and they must practice their tools and use their resources wisely in aftercare.
Medication-assisted treatment (MAT) is the use of medications in addiction treatment to alleviate withdrawal symptoms and stop an opioid overdose. MAT is primarily used to treat addiction to opioids and is also used to treat alcohol use disorder and nicotine addiction. These medications are known to reduce or block the euphoric effects of opioids, stabilize brain chemistry, relieve cravings, and normalize body functions.
Suboxone medication-assisted treatment (MAT) is known to help ease withdrawal symptoms in individuals struggling with an opioid abuse disorder. Medication-Assisted treatment has been around for decades and is used in conjunction with counseling and psychosocial support. Suboxone medication-assisted treatment not only eases withdrawal side effects but also helps reduce opioid cravings. Research has shown that Suboxone medication-assisted treatment decreases mortality rates, reduces incarceration, and improves relapse rates.
Suboxone is a combination of buprenorphine and naloxone. Buprenorphine is a partial opioid agonist meaning that it binds to opioid receptors in the brain but without a perfect fit. As a result, buprenorphine will give opioid-like euphoric effects without the dangerous side effects such as respiratory depression. Additionally, suppose the individual tries to take opioids while buprenorphine is bound to the receptors. In that case, they will be unable to experience the euphoric effects of the opioids because buprenorphine is blocking the receptors. Since buprenorphine is a partial opioid agonist and can produce euphoric effects, especially in individuals who are not opioid dependent, there is potential for abuse. Buprenorphine is sold on the street for a profit, and as a result, it is combined with naloxone to decrease the likelihood of potential abuse.
Naloxone is an opioid antagonist and works to kick the opioids off the receptors, producing sudden withdrawal symptoms. Sublingual Suboxone, if taken correctly, works to mitigate opioid withdrawals due to the effects of buprenorphine. When these sublingual tablets are crushed and injected, naloxone dominates and will produce sudden withdrawal symptoms.
The following are additional buprenorphine FDA approved products that are used for the treatment of opioid abuse disorder:
Each client’s treatment is confidential between the client and their treatment team. Family members have visiting hours and are encouraged to have a vital role in the client’s treatment; however, information about the client’s progress is only given with the client’s permission. Just like any medical or hospital setting, client information is private and privileged.
Substance abuse treatment takes time. Depending on the client, the stage of addiction, and the seriousness of the addictive disorder, treatment can range from 30 days to six months between residential and outpatient settings. The drug abuse treatment team will often note the client’s treatment progress weekly and determine if they need more intense treatment or are progressing well. Sometimes there are relapses, which means that another treatment modality may be implemented, such as a new medication, a different therapy technique, or maybe a higher level of care. When the client is progressing in his or her treatment, it may be time to enter into a lower level of care, such as outpatient treatment.
If you or someone you love is struggling with a mental health illness or substance use and addiction disorder, we can help now more than ever! AKUA Mind Body provides an integrative treatment approach with multiple levels of care from detox, residential to virtual outpatient programs. With several facilities throughout the Sacramento Region, Los Angeles & Orange County Region, and San Diego Region, we aim to provide our clients with a solid foundation for healing and transformation. Gender-specific and Co-ed facilities available.