Recovery Begins Here

Addiction Guide

What Is Drug Addiction?
The Addiction Epidemic
How Treatment Works
Levels of Care

The addiction epidemic is one of the most pressing issues that the United States is facing today. Opioids are driving addiction and overdose rates and continue to be the biggest drug threat by a wide margin. The National Institute on Drug Abuse (NIDA) estimates that 115 people die every day from an opioid overdose. While opioids continue to be a problem, alcohol and other drugs also pose a threat to people across all demographics.

Addiction is often a byproduct of substance abuse or overuse of addictive drugs. Though most substance use disorders are caused by drug abuse, there are some prescription medications can lead to physical dependence after normal use like benzodiazepines and potent opioids. The majority of substance use disorders begin by recreationally using the prescription of illicit drugs. According to NIDA, as much as 75 percent of people who are addicted to heroin started by abusing prescription opioids. No one starts using drugs expecting to become addicted; it’s often a consequence of drug abuse.

Addiction can affect people differently. Two people can use the same drug, and the same dose and frequency, and one will develop a substance use disorder while the other doesn’t it’s difficult to point to anyone definitive cause for addiction. Instead, it’s usually a combination of causes like childhood trauma, early exposure to drugs, heredity, and development. Addiction can also cause a number of issues from legal troubles to medical issues. Because addiction is so complex, treatment is highly personalized. For treatment to be effective, no two addiction treatment plans should be identical.

Addiction is a chronic disease that is difficult to overcome on your own. However, it is treatable, and it’s possible to live a life free from active addiction. Spotting the signs and seeking help are the first steps toward a long-lasting recovery.

Learn more about alcohol and drug addiction and how it can be effectively treated.

What Is Drug Addiction?

Drug addiction is a disease that primarily affects the brain, but it has wide-reaching effects in a person’s like. Addiction is diagnosed as a severe substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). A substance use disorder becomes an addiction when it becomes difficult to control. Someone with an addiction may use compulsively, despite serious consequences.

Addiction affects the brain by changing the way you perceive drug use, particularly in the reward center. Reward is primarily controlled in the limbic system of the brain, and it’s also the main target of a severe substance use disorder. The reward center is designed to take notice of chemical rewards that come as a result of positive actions like eating, sleeping, and positive physical contact. However, psychoactive drugs can also cause a release of those chemical rewards in the brain, to a greater effect.

Addiction Treatment Pages

For instance, cocaine blocks the reuptake process of dopamine, a powerful, naturally occurring chemical reward in the brain. Reuptake would normally remove excess dopamine from your system, but cocaine causes it to remain to bind to more receptors.

The Signs of Addiction

Though addiction is a serious disease, it often comes after several signs and symptoms. Substance use disorders usually start with periods of abuse and chemical dependence before becoming an addiction. Learning to recognize these symptoms can help you or someone you love to avoid some of the serious consequences that come with addiction. Though, it’s important to note that even severe substance abuse disorders can be treated successfully, even if you’ve relapsed before.

Tolerance

Substance use becomes a disorder when you start using drugs illegally, without a prescription, or when you use more than directed. One of the first signs that abuse or overuse is becoming a problem is a growing tolerance. Tolerance is when your body starts to get used to the drug you are using. It may feel like your normal dose is less potent than it used to be. In reality, your brain is starting to counteract the drug with its own chemicals to balance brain chemistry.

You can start to develop a tolerance to certain drugs even with normal prescribed use, particularly if you use benzodiazepines for several weeks. If you start to feel a growing tolerance, speak to your doctor about switching medications or cutting back.

Dependence

If you continue to use or compensate for your growing tolerance, you may start to develop a chemical dependence. Dependence occurs when your brain starts to rely on the chemical to maintain balanced brain chemistry. Your nervous system will adapt to the presence of the foreign chemical. At this point, your drug or alcohol use will change. Instead of using the drug for recreation, you may start to use it to feel “normal.” You may also feel the need to use when you’re alone or at odd times like first thing in the morning. If you stop using, you may experience symptoms of withdrawal. Withdrawal symptoms vary based on the drug you use, and they can range from uncomfortable to life-threatening, especially if you’ve used benzodiazepines, alcohol, or barbiturates. If you start to feel withdrawal symptoms, speak to a medical professional before quitting depressant sleep aids cold turkey.

Addiction

Addiction is characterized by compulsive used that gets out of control. In some cases, a person may realize their drug use has become a problem and still can’t stop using. In other cases, a person with an addiction may be in denial that consequences are related to their drug use. Either way, a severe substance use disorder can be hidden at first, but it will slowly start to take over multiple aspects of your life.

If you are worried about a friend or loved one who’s using, you might notice a few signs and symptoms from an outside perspective. If you notice that a loved one might be struggling with addiction, you might be able to help get them the treatment they need. It can be difficult to encourage someone to make a change, but the first step is recognizing the signs, which can include:

Signs of Addiction

Isolation
Odd sleep patterns
Loss of interest in usual activities
Withdrawing from family and friends
Mood swings
Lying about drug use
Hiding drugs
Using at odd times or alone
Trying and failing to stop using
Using more than intended
Medical, financial, or legal issues
Struggling at work or in school
Symptoms of withdrawal or intoxication

While there is no known cure for addiction, it can be treated with personalized therapy and help from professionals. Addiction, like other diseases, can often result in relapse. In fact, it has similar relapse rates to other chronic illnesses like hypertension and asthma, at 40 percent to 60 percent.

However, addiction can be successfully treated, even after one or more relapse. For that reason, a good portion of addiction treatment is devoted to preparing relapse prevention strategies. But a relapse doesn’t mean that treatment failed; it just means that your strategies have to be revisited. Just like asthma, you wouldn’t stop treating a disease after a relapse. Learning to recognize the signs of addiction is the first step in preventing and addressing a substance use disorder. The faster you treat addiction, the more likely you are to avoid some of the most severe consequences like infectious diseases, legal issues, and overdose.

The Addiction Epidemic

The problems of addiction and overdose have been steadily increasing over the last 20 years. Between 1999 and 2016, 350,000 people were killed in overdoses. According to the U.S. Centers for Disease Control and Prevention, around 66 percent of the overdose deaths in 2016 involved opioids. The addiction epidemic in the United States is primarily centered around the opioid crisis, but other drugs also pose a threat. In fact, many people who struggle with a substance use disorder use multiple drugs at once.

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Polydrug use can make abuse even more dangerous. For instance, mixing opioids and central nervous system depressants can increase your risk of experiencing fatal overdose symptoms like respiratory depression. According to NIDA, more than 60 percent of opioid overdoses also involved benzodiazepines.
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NIDA

There are two main sources for the rise in opioid use and addiction in the U.S. First, pharmaceutical companies started to prescribe more and more opioids, even though Americans were not statistically reporting more pain. Excessive pain pills are placed in medicine cabinets within reach of other people in the house, or they are given to family and friends. The number one source for opioid prescription abusers was from friends and acquaintances.

Opioids also come into the U.S. through the black market. Specifically, from transnational criminal organizations like Mexican cartels. According to the U.S. Drug Enforcement Administration, the availability of heroin has significantly increased because of the influx of black market drugs.

The prevalence of prescriptions opioids and the influx of cheaper heroin, has led to a path to addiction that starts with prescription abuse and often ends with an overdose on illicit substances.

How Drug Addiction Treatment Works

Addiction is a complicated disease and treating it requires a complex response. Each person who enters addiction treatment comes with a unique set of underlying issues. It’s difficult to point to any one cause of addiction, and it’s usually a combination of biological, environmental, and developmental factors. Addiction can also cause a variety of consequences that also have to be addressed. Addiction as the tendency to slowly take over different parts of your life like your health, finances, relationships, and it can even lead to legal issues. If left untreated or unaddressed, these issues can lead to a relapse, limiting the effectiveness of treatment.

For these reasons, addiction treatment needs to be tailored to your individual needs. When you first enter addiction treatment, you will go through an intake and assessment process that’s designed to place you in a level of care that’s ideal for your needs. Clinicians use a tool called the ASAM Criteria to help determine the level of care that’s appropriate for any given individual. The Criteria involve six dimensions that need to be considered, which include:

Acute intoxication or withdrawal potential. When you first arrive, are you currently intoxicated or have you stopped using recently? If so, you may need a higher level of care. Withdrawal symptoms can be extremely uncomfortable or even life-threatening without medical supervision. This dimension measures the severity of your potential withdrawal and determines what might be needed to treat it.
Biomedical conditions and complications. Addiction treatment follows Maslow’s Hierarchy of Needs, which means your physiological needs are met first. For instance, if you are cold, you will be given a blanket or sweater before you are given psychotherapy. This dimension considers your need for medical interventions based on your health and medical history.
Emotional, behavioral, or cognitive needs. Addiction often comes with psychological issues and co-occurring mental disorders. To be effective, treatment has to address these issues. This factor helps clinicians determine your level psychological needs and the types of treatment that might help.
Readiness to change. Not everyone enters treatment ready to make a change. Some people seek treatment to appease family members or because a judge ordered them. Some therapies are designed to advance you on the transtheoretical model (or the stages of change). This factor could shape your treatment plan and your level of care.
Relapse or continued use potential. Addiction, by definition, is a disease that affects the brain that is difficult to control. It causes drug cravings and compulsions to use that can lead to relapse. Clinicians will assess your potential for relapse or continued use frequently and at each level of care. If you have a high potential for relapse, you will need a higher level of care.
Recovery environment. The environment you live in while you go through recovery can help or hurt your efforts. If you live with someone who is still using, it can lead to a relapse. If you live in a home with an abusive relationship, it can cause triggers that lead to relapse and other problems. A high level of need in this dimension could mean that an inpatient or residential treatment program is ideal for you. Or your case manager can help you find a sober living environment.

The assessment process doesn’t end with your initial intake. Once you enter treatment, as soon as you are able, you will sit down with your therapist and create a treatment plan that can address all of your most pressing needs. You may also go through a biopsychosocial assessment, which is an in-depth interview that helps your therapist get to the bottom of your biological, psychological, and social needs.

As you go through your treatment plan, you will continue to be assessed each week. If your needs change, or if you advance, your treatment plan will adapt. It’s important to note that these assessments are not tests that you can pass or fail. They are designed to help personalize treatment, and create the most effective treatment plan possible.

The Levels of Care

Your initial assessment is designed to help clinicians determine the best level of care for your specific needs. There are four main levels of care in addiction treatment, and a few have sublevels that help to pinpoint your needs better. You may start in one level of care, but as you progress, you will advance to new levels, generally lowering the intensiveness of your treatment. This process is called the continuum of care.

Here are four main levels of care in addiction treatment:

Medical detox. Also called medically managed intensive inpatient services, detox is the highest level of care in addiction treatment. It involves 24 hours of medical care that’s designed to keep you safe through withdrawal and any other medical conditions or complications. You may be treated with medications to alleviate symptoms or wean you off the drug you are dependent on.
Inpatient services. Inpatient services include residential treatment, clinically managed treatment, and medically monitored treatment. This level involves 24 hours of care to help monitor your health and safety. This is ideal for people who are in relatively stable condition but require monitoring for ongoing medical or psychological concerns.
Intensive Outpatient. Intensive outpatient treatment is a high level of care that also allows you to live independently. It involves no less than nine hours of clinical services every week, but it can involve partial hospitalization which can provide as much as 12 hours of treatment per day.
Outpatient. This is the lowest level of care in addiction treatment and involves less than nine hours of care every week. This level offers a step in between more intensive care and complete independence. In outpatient treatment, you will have time to start pursuing goals and responsibilities in real life while also having clinical support to fall back on.

After treatment is completed, it’s important to maintain a commitment to recovery, even outside of formal clinical services. Treatment centers often have aftercare programs that are designed to connect you to community resources after addiction treatment. Services like career centers, 12-step meetings, and other resources can help you safeguard your recovery for years to come. People can relapse for a variety of reasons, but it’s often because they disconnected from their recovery efforts.

Sources

CDC. (2017, August 30). Opioid Overdose. from https://www.cdc.gov/drugoverdose/epidemic/index.html

SAMHSA. (2014, September 30). Substance Use Disorders. from https://www.samhsa.gov/disorders/substance-use

National Institute on Drug Abuse. (2018, March 06). Opioid Overdose Crisis. from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis

National Institute on Drug Abuse. (2018, January). Prescription opioid use is a risk factor for heroin use. from https://www.drugabuse.gov/publications/research-reports/relationship-between-prescription-drug-heroin-abuse/prescription-opioid-use-risk-factor-heroin-use

National Institute on Drug Abuse. (2018, July). Treatment and Recovery. from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery

National Institute on Drug Abuse. (2018, March 15). Benzodiazepines and Opioids. from https://www.drugabuse.gov/drugs-abuse/opioids/benzodiazepines-opioids

National Institute on Drug Abuse. (2018, June). Understanding Drug Use and Addiction. from https://www.drugabuse.gov/publications/drugfacts/understanding-drug-use-addiction

ScienceDirect. (n.d.). Transtheoretical model. from https://www.sciencedirect.com/topics/nursing-and-health-professions/transtheoretical-model

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