Drug Abuse and Addiction

Do you or someone you know have a drug problem? Explore the warning signs and symptoms and learn how substance abuse problems develop.

When does drug use become drug abuse or addiction?

People from all walks of life can experience problems with their drug use, regardless of age, race, background, or the reason they started using drugs in the first place. Some people experiment with recreational drugs out of curiosity, to have a good time, because friends are doing it, or to ease problems such as stress, anxiety, or depression. However, it’s not just illegal drugs, such as cocaine or heroin, that can lead to abuse and addiction. Prescription medications such as painkillers, sleeping pills, and tranquilizers can cause similar problems. In fact, next to marijuana, prescription painkillers are the most abused drugs in the U.S. and more people die from overdosing powerful opioid painkillers each day than from traffic accidents and gun deaths combined. And addiction to opioid painkillers can be so powerful it has become the major risk factor for heroin abuse.

Of course, drug use—either illegal or prescription—doesn’t automatically lead to abuse. Some people are able to use recreational or prescription drugs without experiencing negative effects, while others find that substance use takes a serious toll on their health and well-being. Similarly, there is no specific point at which drug use moves from casual to problematic. Drug abuse and addiction is less about the type or amount of the substance consumed or the frequency of your drug use, and more about the consequences of that drug use. If your drug use is causing problems in your life—at work, school, home, or in your relationships—you likely have a drug abuse or addiction problem.

If you’re worried about your own or a loved one’s drug use, learning how drug abuse and addiction develops—and why it can have such a powerful hold—will give you a better understanding of how to best deal with the problem and regain control of your life. Recognizing that you have a problem is the first step on the road to recovery, one that takes tremendous courage and strength. Facing your problem without minimizing the issue or making excuses can feel frightening and overwhelming, but recovery is within reach. If you’re ready to seek help, you can overcome your addiction and build a satisfying, drug-free life for yourself.

Risk factors for drug addiction

While anyone can develop problems from using drugs, vulnerability to substance addiction differs from person to person. While your genes, mental health, family and social environment all play a role, risk factors that increase your vulnerability include:

Family history of addiction
Abuse, neglect, or other traumatic experiences
Mental disorders such as depression and anxiety
Early use of drugs
Method of administration—smoking or injecting a drug may increase its addictive potential

Myths and facts about drug abuse and addiction

Five common myths
Myth 1: Overcoming addiction is simply a matter of willpower. You can stop using drugs if you really want.Fact: Prolonged exposure to drugs alters the brain in ways that result in powerful cravings and a compulsion to use. These brain changes make it extremely difficult to quit by sheer force of will.
Myth 2: Using drugs like opioid painkillers are safe since they’re so commonly prescribed by doctors.Fact: Short-term medical use of opioid painkillers can help to manage severe pain after an accident or surgery, for example. However, regular or longer-term use of opioids can lead to addiction. Misuse of these drugs or taking someone else’s medication can have dangerous—even deadly—consequences.
Myth 3: Addiction is a disease; there’s nothing that can be done about it.Fact: Most experts agree that addiction is a disease that affects the brain, but that doesn’t mean anyone is helpless. The brain changes associated with addiction can be treated and reversed through therapy, medication, exercise, and other treatments.
Myth 4: Addicts have to hit rock bottom before they can get better.Fact: Recovery can begin at any point in the addiction process—and the earlier, the better. The longer drug abuse continues, the stronger the addiction becomes and the harder it is to treat. Don’t wait to intervene until the addict has lost everything.
Myth 5: You can’t force someone into treatment; they have to want help.Fact: Treatment doesn’t have to be voluntary to be successful. People who are pressured into treatment by their family, employer, or the legal system are just as likely to benefit as those who choose to enter treatment on their own. As they sober up and their thinking clears, many formerly resistant addicts decide they want to change.
Myth 6: Treatment didn’t work before, so there’s no point trying again.Fact: Recovery from drug addiction is a long process that often involves setbacks. Relapse doesn’t mean that treatment has failed or that sobriety is a lost cause. Rather, it’s a signal to get back on track, either by going back to treatment or adjusting the treatment approach.

How drug abuse and addiction develops

There’s a fine line between regular drug use and drug abuse and addiction. Very few drug abusers or addicts are able to recognize when they’ve crossed that line. While frequency or the amount of drugs consumed do not necessarily constitute drug abuse or addiction, they can often be indicators of drug-related problems.

If the drug fulfills a valuable need, you may find yourself increasingly relying on it. You may take illegal drugs to calm or energize yourself or make you more confident. You may start abusing prescription drugs to relieve pain, cope with panic attacks, or improve concentration at school or work. If you are using drugs to fill a void in your life, you’re more at risk of crossing the line from casual drug use to drug abuse and addiction. To maintain a healthy balance in your life, you need to have positive experiences and feel good about your life without any drug use.

Drug abuse may start as a way to socially connect. People often try drugs for the first time in social situations with friends and acquaintances. A strong desire to fit in to the group can make it feel like doing the drugs with them is the only option.

Problems can sometimes sneak up on you, as your drug use gradually increases over time. Smoking a joint with friends over the weekend, or taking ecstasy at a rave, or painkillers when your back aches, for example, can change from using drugs a couple of days a week to using them every day. Gradually, getting and using the drug becomes more and more important to you.

As drug abuse takes hold, you may miss or frequently be late for work or school, your job performance may progressively deteriorate, and you may start to neglect social or family responsibilities. Your ability to stop using is eventually compromised. What began as a voluntary choice has turned into a physical and psychological need.

Eventually drug abuse can consume your life, stopping social and intellectual development. This only reinforces feelings of isolation.

Drug addiction and the brain

While each drug produces different physical effects, all abused substances share one thing in common: repeated use can alter the way the brain functions. This includes commonly abused prescription medications as well as recreational drugs.

Taking the drug causes a rush of the hormone dopamine in your brain, which triggers feelings of pleasure. Your brain remembers these feelings and wants them repeated.
When you become addicted, the substance takes on the same significance as other survival behaviors, such as eating and drinking.
Changes in your brain interfere with your ability to think clearly, exercise good judgment, control your behavior, and feel normal without drugs.
No matter which drug you’re addicted to, the uncontrollable craving to use grows more important than anything else, including family, friends, career, and even your own health and happiness.
The urge to use is so strong that your mind finds many ways to deny or rationalize the addiction. You may drastically underestimate the quantity of drugs you’re taking, how much it impacts your life, and the level of control you have over your drug use.

With the right treatment and support, you can counteract the disruptive effects of drug use and regain control of your life. The first obstacle is to recognize and admit you have a problem, or listen to loved ones who are often better able to see the negative effects drug use is having on your life.

Signs and symptoms of drug abuse and addiction

Although different drugs have different physical effects, the symptoms of addiction are similar. If you recognize yourself in the following signs and symptoms of substance abuse and addiction, talk to someone about your drug use.

Common signs and symptoms of drug abuse

Neglecting responsibilities at school, work, or home (e.g. flunking classes, skipping work, neglecting your children).

Using drugs under dangerous conditions or taking risks while high, such as driving while on drugs, using dirty needles, or having unprotected sex.

Experiencing legal trouble, such as arrests for disorderly conduct, driving under the influence, or stealing to support a drug habit.

Problems in your relationships, such as fights with your partner or family members, an unhappy boss, or the loss of friends.

Common signs and symptoms of drug addiction

You’ve built up a drug tolerance. You need to use more of the drug to experience the same effects you used to attain with smaller amounts.

You use to avoid or relieve withdrawal symptoms. If you go too long without drugs, you experience symptoms such as nausea, restlessness, insomnia, depression, sweating, shaking, and anxiety.

Loss of control over your drug use. You often do drugs or use more than you planned, even though you told yourself you wouldn’t. You may want to stop using, but you feel powerless.

Your life revolves around drug use. You spend a lot of time using and thinking about drugs, figuring out how to get them, or recovering from the drug’s effects.

You’ve abandoned activities you used to enjoy, such as hobbies, sports, and socializing, because of your drug use.

You continue to use drugs, despite knowing it’s hurting you. It’s causing major problems in your life—blackouts, financial issues, infections, mood swings, depression, paranoia—but you use anyway.

Warning signs that a friend or loved one is abusing drugs

Drug abusers often try to conceal their symptoms and downplay their problem. If you’re worried that a friend or loved one might be abusing drugs, look for the following warning signs:

Physical warning signs

Bloodshot eyes, pupils larger or smaller than usual
Changes in appetite or sleep patterns
Sudden weight loss or weight gain
Deterioration of physical appearance, personal grooming habits
Unusual smells on breath, body, or clothing
Tremors, slurred speech, or impaired coordination

Behavioral warning signs

Drop in attendance and performance at work or school
Unexplained financial problems; borrowing or stealing
Engaging in secretive or suspicious behaviors
Sudden change in friends, favorite hangouts, and hobbies
Frequently getting into trouble (fights, accidents, illegal activities)

Psychological warning signs

Unexplained change in personality or attitude
Sudden mood swings, irritability, or angry outbursts
Periods of unusual hyperactivity, agitation, or giddiness
Lack of motivation; appears lethargic or “spaced out”
Appears fearful, anxious, or paranoid

Warning signs of commonly abused drugs

Marijuana: Glassy, red eyes; loud talking, inappropriate laughter followed by sleepiness; loss of interest, motivation; weight gain or loss.

Stimulants (including amphetamines, cocaine, crystal meth): Dilated pupils; hyperactivity; euphoria; irritability; anxiety; excessive talking followed by depression or excessive sleeping at odd times; may go long periods of time without eating or sleeping; weight loss; dry mouth and nose.

Inhalants (glues, aerosols, vapors): Watery eyes; impaired vision, memory and thought; secretions from the nose or rashes around the nose and mouth; headaches and nausea; appearance of intoxication; drowsiness; poor muscle control; changes in appetite; anxiety; irritability; lots of cans/aerosols in the trash.

Hallucinogens (LSD, PCP): Dilated pupils; bizarre and irrational behavior including paranoia, aggression, hallucinations; mood swings; detachment from people; absorption with self or other objects, slurred speech; confusion.

Heroin: Contracted pupils; no response of pupils to light; needle marks; sleeping at unusual times; sweating; vomiting; coughing, sniffling; twitching; loss of appetite.

Warning signs of prescription drug abuse and addiction

In recent years, prescription drug abuse has become an escalating problem, most commonly involving opioid painkillers, anti-anxiety medications, sedatives, and stimulants. Many people start taking these drugs to cope with a specific medical problem—taking painkillers following injury or surgery, for example. However, over time, increased doses are needed to achieve the same level of pain relief and some users can become physically dependent, experiencing withdrawal symptoms if they try to quit. One of the earliest warning signs of a developing problem is going through the medication at a faster-than-expected rate. In other cases, people start abusing medication not prescribed for them in order to experience a high, relieve tension, increase alertness, or improve concentration.

To avoid developing problems with a prescription medication, it’s important to take it only as directed, use the lowest dose for the shortest period possible, and to talk to your doctor about other methods of treating the problem. Being aware of any signs of dependency can help identify prescription drug problems at an early stage and help to prevent them progressing into an addiction.

Warning signs of commonly abused prescription drugs

Opioid painkillers (including OxyContin, Vicodin, Norco): Drooping eyes, constricted pupils even in dim light, sudden itching or flushing, slurred speech; drowsiness, lack of energy; inability to concentrate, lack of motivation, decline in performance at work or school; neglecting friendships and social activities.

Anti-anxiety medications, sedatives, and hypnotics (including Xanax, Valium, Ambien): Contracted pupils; drunk-like, slurred speech, difficulty concentrating, clumsiness; poor judgment, drowsiness, slowed breathing.

Stimulants (including Ritalin, Concerta, Adderall, Dexedrine): Dilated pupils, reduced appetite; agitation, anxiety, irregular heartbeat, high body temperature; insomnia, paranoia.

When a loved one has a drug problem

If you suspect that a friend or family member has a drug problem, here are a few things you can do:

Speak up. Talk to the person about your concerns, and offer your help and support without being judgmental. The earlier addiction is treated, the better. Don’t wait for your loved one to hit bottom! List specific examples of your loved one’s behavior that have you worried and urge them to seek help.

Take care of yourself. Stay safe. Don’t put yourself in dangerous situations. Don’t get so caught up in someone else’s drug problem that you neglect your own needs. Make sure you have people you can talk to and lean on for support.

Avoid self-blame. You can support a person with a substance abuse problem and encourage treatment, but you can’t force an addict to change. You can’t control your loved one’s decisions. Letting the person accept responsibility for their actions is an essential step along the way to recovery.

Don’t…

Attempt to threaten, punish, bribe, or preach.
Make emotional appeals that only add to the user’s feelings of guilt and increase their compulsion to use drugs.
Cover up or make excuses for the drug abuser, or shield them from the consequences of their drug use.
Take over the drug abuser’s responsibilities, diminishing their sense of self-worth.
Hide or throw out drugs.
Argue with the person when they are high.
Use drugs with the person.
Feel guilty or responsible for a drug abuser’s behavior.

When your teen has a drug problem

Discovering your child uses drugs can generate fear, confusion, and anger. It’s important to remain calm when confronting your teen, and to only do so when everyone is sober. Explain your concerns and make it clear that your concern comes from a place of love. It’s important that your teen feels you are supportive.

Warning signs of teen drug abuse

As with adults, teenage drug abuse isn’t limited to illegal drugs. In fact, teens are more likely to abuse prescription and over-the-counter drugs, including painkillers, stimulants, sedatives, and tranquilizers. In many cases, these drugs are much easier for teens to procure, yet they can have dangerous, even lethal, side effects.

While experimenting with any kind of drug doesn’t automatically lead to drug abuse, early use is a risk factor for developing more serious drug abuse and addiction down the road. Risk of drug abuse also increases greatly during times of transition, such as changing schools, moving, or divorce. The challenge for parents is to distinguish between the normal, often volatile, ups and downs of the teen years and the red flags of substance abuse. These include:

Having bloodshot eyes or dilated pupils; using eye drops to try to mask these signs

Skipping class; declining grades; suddenly getting into trouble at school

Missing medications, prescriptions, money or valuables

Acting uncharacteristically isolated, withdrawn, angry, or depressed

Sudden mood changes or repeated health complaints, constant fatigue

Dropping one group of friends for another; being secretive about the new peer group

Loss of interest in old hobbies; lying about new interests and activities

Demanding more privacy; locking doors; avoiding eye contact; sneaking around

7 steps parents can take to curb teen drug use

Talk openly about the dangers of both illegal and prescription drug use with your kids. Providing a safe and open environment to talk about these issues can make a real difference in the likelihood that they’ll use or abuse drugs.
Lay down rules and consequences. Your teen should understand that using drugs comes with specific consequences. But don’t make hollow threats or set rules that you cannot enforce—and make sure your spouse agrees and is prepared to enforce the rules. Remind your teen that taking someone else’s prescription or sharing theirs with others is illegal.
Monitor your teen’s activity. Know where your teen goes and who they hang out with. It’s also important to routinely check potential hiding places for drugs—in backpacks, between books on a shelf, in DVD cases or make-up cases. Monitor your teen’s use of the Internet to check for illegal online purchases.
Keep prescription medicines in a safe place, avoid stockpiling them, and dispose of any unused prescription medicines. Monitor your prescription refills carefully.
Encourage other interests and social activities. Expose your teen to healthy hobbies and activities, such as team sports and after-school clubs.
Talk to your child about underlying issues. Drug use can be the result of other problems. Is your teen having trouble fitting in? Has there been a recent major change, like a move or divorce causing stress?
Get help. Teenagers often rebel against their parents but if they hear the same information from a different authority figure, they may be more inclined to listen. Try a sports coach, family doctor, therapist, or drug counselor.

Next step: Getting help for drug abuse or addiction

Addiction is a complex problem that affects every aspect of your life. Overcoming addiction requires reaching out for support and making changes to the way you live, deal with problems, and relate to others. Recovery is within your reach but don’t try to go it alone; it’s very easy to get discouraged and rationalize “just one more.” Whether you choose to go to rehab, rely on self-help programs, get therapy, or take a self-directed treatment approach, support is essential. Read: Overcoming Drug Addiction.

Get more help

Authors: Lawrence Robinson, Melinda Smith, M.A., and Jeanne Segal, Ph.D. Last updated: October 2019.