Many of the tens of thousands of people who use addictive substances, including alcohol and drugs, will need professional addiction treatment to help them end their dependence, whether it’s physical, psychological, or both.
There are many stereotypes about substance addiction, including what it is and who it affects. These erroneously held beliefs stop many people from getting the help they need or even realizing their substance use has turned into something more serious. Factors like misinformation or stigma can be disastrous to those that are in the middle of active addiction.
Scientists continue to study addiction, and the views about this health condition continue to evolve and inform. It was once believed that having an addiction meant substance users had a moral defect of character or a lack of willpower to stop using.
Now, the view that addiction is a brain disease is more widely accepted, and scientists continue to study the brain’s response to addiction and the behavior that results from chronic use of addictive substances.
The American Society of Addiction Medicine’s short definition of addiction describes it as “The primary, chronic disease of brain reward, motivation, memory and related circuitry.
Dysfunction in these circuits leads to characteristic biological, psychological, [and] social and spiritual manifestation. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.”
The National Institute on Drug Abuse (NIDA) explains that addiction is “A chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.
It is considered a brain disease because drugs change the brain; they change its structure and how it works.
These brain changes can be long-lasting and can lead to many harmful, often self-destructive, behaviors.”
The institute also writes, “Addiction occurs when a person cannot control the impulse to use drugs even when there are negative consequences—the defining characteristic of addiction.”
Causes of Addiction
Pinpointing one specific factor that causes addiction is difficult to do. Many people engage in recreational drug or alcohol use, but that doesn’t mean they will become addicted to these substances despite the substances’ addictive potential. However, for other people, this recreational substance use can lead to substance use disorder and possibly addiction. In some cases, it only takes one use to become addicted. In others, recreational use gradually becomes an addiction. Each person’s struggle is different and should be treated differently.
There are a variety of risk factors that can cause addictions. The most common ones are:
Research continues into how genetic factors can make some people more susceptible to addiction than others. According to the U.S. National Library of Science, a genetic predisposition “results from specific genetic variations that are often inherited from a parent.” It also writes, “These genetic changes contribute to the development of a disease but do not directly cause it. Some people with a predisposing genetic variation will never get the disease while others will, even within the same family.”
People may abuse substances as a result of the environment they grew up in or spend time in. Other people’s behavior and decisions can influence others. Being around people who do drugs or drink alcohol can result in someone deciding to do the same thing to fit in, keep someone company, etc. Environmental influences also can include substance use or addiction in the family or among peers, access to an addictive substance, or exposure to popular culture references that encourage substance use, such as those in the media).
This includes stress, depression, anxiety, personality traits such as high impulsivity or risk-seeking, eating disorders, and other psychiatric disorders can make someone susceptible to addiction.
Early Substance Use/Abuse
Abusing alcohol and drugs during adolescence or teenhood, or even at earlier stages in life, can put someone on the path of addiction.
Specific Brain Characteristics
Specific brain characteristics that are unique to each person can make someone more vulnerable to addictive substances than someone else.
Excessive use of addictive substances can cause lead to addiction. According to the National Center on Addiction and Substance Abuse, psychological and environmental factors appear to be more influential in determining if someone starts to use substances. It also says biological or genetic factors appear to influence which people move from substance use to addiction.
The more risk factors that are present, the greater the risk of developing an addiction. Still, if all of these factors are present, it doesn’t mean one will become an addict.
Warning Signs of Substance Addiction
Addiction experiences vary according to the person but there are clues that signal when a person is battling a substance use disorder or addiction. Overall, addiction manifests itself in the following ways:
- Intense cravings for drugs or alcohol
- Strong focus on obtaining addictive substances
- Strong need to use an addictive substance(s) daily
- Spending money on a substance habit that is unaffordable
- High tolerance for a substance.
- Experiencing withdrawal symptoms once use has stopped
- Using drugs or alcohol as a coping mechanism
- Exhibiting high-risk behavior under the influence
- Failing to stop substance use despite earlier attempts
- Continuing to use despite negative results such as losing a job
There also are common signs and symptoms that are unique to the substance being abused or at the center of a person’s addiction. Here are a few for the substances listed below.
Alcohol, a depressant, is the most commonly used and abused addictive substance in the United States. It is legal for purchase to anyone age 21 and older, and it’s widely accessible. Drinking beer, wine, and liquor excessively can harm one’s health and endanger the drinker’s life as well as the lives of the people around them. People with alcohol addiction, or alcohol use disorder, may exhibit the following signs that their drinking is out of control:
- Drinking alone or hiding alcohol consumption
- Lying about your drinking
- Intense cravings for alcohol
- Blacking out, or having no memory of what happened after drinking, on a regular basis
- Withdrawal symptoms
- Inability to function without drinking alcohol
- Choosing alcohol over responsibilities, priorities, or hobbies
- Losing interest in activities that were once enjoyable
- Mood swings and irritability
- Inability to quit drinking on your own or control the amount of alcohol consumed
- Drinking immediately upon awakening
- Feelings of guilt or remorse associated with drinking
- Continuing to drink despite the consequences (physical, mental, financial)
Stimulants are psychoactive drugs that speed up the body’s central nervous system. They also raise alertness and energy levels. Also known as “uppers,” these drugs boost brain activity while activating its pleasure receptors. This category includes caffeine and nicotine, legal prescription stimulants used in the medical field, and illegal street drugs such as methamphetamine and cocaine.
Chronic stimulant abuse or addiction may exhibit the following signs and symptoms:
- High blood pressure
- Damaged blood vessels
- Psychotic behavior
- Kidney damage
- Lung damage
Depressants are medications that slow down the central nervous system and brain activity. This helps to relieve anxiety, stress, or sleep disorders. These drugs are also known as “downers” and include benzodiazepines, barbiturates, and sleep medications. Signs and symptoms of chronic use of depressants include:
- Breathing problems
- Chronic fatigue
- Sleep disturbances
- Sexual dysfunction
Opioids are powerful medications that are prescribed for serious, chronic pain. People who manage chronic may do so because of injuries they have sustained, had surgery, or have a major illness, such as cancer. They are also prescribed for people who have had dental work done or toothaches. Opioids, whose name is taken from the word opium, are manmade and mimic the body’s natural chemicals known as endorphins and bring intense euphoria and pleasurable feelings to people use them and abuse them. These drugs also change how the body perceives pain. This class of drugs includes codeine, heroin, morphine, oxycodone, methadone, and fentanyl, among others. Some of these drugs have made their way to the streets are being combined with popular street drugs, making these substances more dangerous to unsuspecting users.
Signs and symptoms include:
- Shallow or slow breathing
- Poor coordination
- Poor decision-making
- Abandonment of responsibilities
- Slurred speech
- Sleeping more or less than normal
- Mood swings
- Euphoria (intense high)
- Lowered motivation
As mentioned earlier, experiencing withdrawal signs and symptoms after use of a substance has stopped is indicative that an addiction is underway. Some of the common signs of substance withdrawal include shaking, sweating, trouble sleeping, anxiety, diarrhea, vomiting, abdominal cramping, muscle aches, and flu-like symptoms can occur and last for days.
If you or someone you know is in withdrawal, get help immediately. Some symptoms can be mild and non-life-threatening, but some can be dangerous. Many people keep using substances because they don’t want to go through this rough period, but to get to sobriety, you have to let withdrawal run its course. It’s part of the process of getting better. It’s best to get professional help with these symptoms. To avoid treatment is to risk staying physically and psychology dependent on substances that can jeopardize your life.
People commonly—and mistakenly—believe that treatment only involves a medical detoxification (detox for short) or time in a facility akin to a prison that’s also known as rehab. Both are not true. A detox is the important beginning of addiction treatment, not the end. Detox is the right starting point for many people in recovery as it ensures these users will end their alcohol or drug use safety as they are weaned off toxic substances
According to the National Institute on Drug Abuse, medical detoxification is the process that safely manages the acute physical symptoms of withdrawal that comes when substance users stop their drug or alcohol use. A professional medical detox also:
- Safely removes addictive substances and toxins from the body
- Keeps users safe through uncomfortable withdrawal symptoms
- Minimizes the effects of withdrawal symptoms
- Uses necessary medications to ease withdrawal symptoms
- Gives users 24-hour supervision by medical and clinical staff
- Provides information about continuing treatment options
The withdrawal process can last anywhere from three to 10 days or longer. Not everyone’s detox experience will be the same. Factors unique to the individual often determines what that person will experience once detox is started. Some factors that are reviewed before detox begins include:
- How far along the user is in substance withdrawal
- Kinds of symptoms being experienced
- Severity of those symptoms
- Method used to consume the drug
- Frequency of use
- Personal medical history
- Family history of alcohol or drug use/abuse
- Mental health, physical health
It is also important to note that detox is a three-phase process. The three phases are:
Doctors conduct a general physical and mental health exam and screen clients for any mental health disorders that may be present along with substance use disorders. They also measure substance levels in the bloodstream and use this data to determine the best treatment plan for the client.
This second step in medical detox takes place during the withdrawal phase of detox. Stabilization involves keeping the person in detox safe as they withdraw from their drug or drugs and minimizing aches, pains, cravings, or discomfort that are experienced during the process. It also involves helping them manage any other unforeseen symptoms or extreme health situations, such as life-threatening seizures.
This is the last step of the medical detox. This is where the client is given information about a treatment program when stabilization ends. Clients receive resources and information about how to proceed with addiction care.
Should I Quit Cold Turkey?
Recovering users are advised to pursue the medical detox route instead of the route of quitting their drug or drugs of choice abruptly. “Going cold turkey,” or suddenly stopping drug or alcohol use, can do more harm than good and lead to serious injury, relapse, overdose, and death. It might seem like a way to end addiction once and for all, but abrupt cessation will almost always result in severe withdrawal symptoms, and in some cases, they can be very serious. This is especially true when it comes to withdrawal from opiates or opioids, benzodiazepines, and alcohol.
Withdrawal Symptoms Can Range From Mild to Severe, Depending on What Drug Was Used And How Often. Symptoms That Send People to Detox Include:
- Flu-like symptoms such as fever or chills
- Muscle pain
- Mood swings
Severe And Dangerous Symptoms, Some of Which Commonly Happen When a Person Withdraws From Alcohol or Opioids, Include:
- Panic attacks
- Suicidal behavior
- Irregular heartbeat
- Delirium tremens
Treatment can be a long and involved process, depending on the situation, and “rehab” is only one kind of treatment. What the addiction recovery process looks like depends on the person receiving treatment. Many will find that treatment centers have a healing environment that is warm, friendly, and supportive. They also will find a community of compassionate and like-minded people who understand recovery and the process of rebuilding one’s life after addiction. According to NIDA, addiction treatment has a greater chance of being effective if it lasts for at least 90 days or three months. There are several kinds of treatment available, including:
An outpatient program allows clients in recovery to live off-site at home or in transitional housing while attending a drug or alcohol rehabilitation program. This arrangement allows them to take care of personal duties and receive the treatment they need to overcome their dependence or addiction. They are, however, still responsible for keeping their appointments and commitment to sobriety.
Outpatient programs generally are for people who:
- Have early-stage substance use disorders
- Have mild or less-severe addictions
- Do not need detoxification from drugs, alcohol, or other addictive substances
- Want to continue aftercare services and support upon exiting from residential/ inpatient treatment
- Cannot pay for inpatient treatment or residential treatment; IOPs are generally less expensive
- Can stay on a schedule and remain committed to sobriety while in recovery
- Benefit from a structured program and can access a network of supportive family and friends
Outpatient programs offer many of the same treatments that inpatient does. Clients who enter this kind of recovery program may be offered:
Outpatient programs can include any of the following:
- Substance abuse education
- Cravings and triggers management
- Life skills
- Individual therapy
- Family therapy
- Group therapy
- Mental health treatment
- Cognitive Behavioral Therapy (CBT)
- 12-step programs
- Transitional living facility referrals (including sober living homes)
- Relapse prevention training
- Anger management
- Random drug testing
Intensive Outpatient Treatment (IOP)
Clients receiving intensive outpatient care can attend between 10 hours and 20 hours of treatment a week at a facility while living away from the premises. Like the outpatient setting, it is medium to high intensity and offers evening or weekend services so outside responsibilities can be met such as work or stay in school. The IOP setting is ideal for people who require multiple services or have accompanying medical or psychological illnesses along with a substance use disorder may benefit from this setting. Individuals who need a higher level of care than outpatient treatment can provide may find that an intensive outpatient program is a better fit.
Partial hospitalization programs allow clients to transfer between residential and outpatient programs. In this medium-to-high-intensity setting, clients attend four to eight hours of treatment daily, or 20 or more weekly, while continuing to live at home or another off-site facility, such as a sober home or transitional living home. As with other outpatient programs, clients do not require 24-hour supervision or receive around-the-clock medical assistance as do residential clients. They are, however, required to meet their weekly commitments and attend intensive therapy sessions. PHPs are an option for people who have a mental health disorder and a substance use disorder. When both are present, the condition is called co-occurring disorders, comorbidity, or dual diagnosis.
Inpatient treatment, known at some centers as residential treatment, is a high level of care that is believed to be an effective form of treatment. This is particularly true for people who have severe addictions or severe mental health disorders and need monitoring in a structured setting around the clock. In this setting, clients receive detox and rehabilitation services for substance addiction. They also receive these benefits:
- A secure, structured 24-hour environment free from distractions or temptations to use drugs and alcohol and other negative influences can support clients’ commitment to achieving sobriety. Inpatient treatment gives clients a piece of mind as they can focus on getting well.
- Intensive care from caring, compassionate, and professional physicians and nurses who understand addiction and the unique challenges it presents for people in recovery.
- A 24-hour, live-in center where clients can learn or relearn how to be responsible for their well-being and accountable to themselves and others. Clients also learn coping skills and relapse prevention techniques.
- Support from a community that understands your personal story and struggles, and can help you face the challenges that lie ahead.
Some inpatient or residential facilities offer after-care programs and alumni groups to help people after they have ended treatment. Aftercare programs help recovering substance users address real or perceived threats to the sobriety they have worked hard to achieve after they have finished treatment. Aftercare offers quite a few benefits to the person in recovery. Among them are:
- Avoiding isolation
- Connecting to a community
- Learning new techniques to combat cravings
- Adjusting to daily life in sobriety
Counselors and sponsors can help people in recovery practice what they learned in recovery and help them put into practice the strategies and skills they learned in treatment. Aftercare will typically involve several relapse prevention strategies. These may include:
- Keeping milestones. Sobriety milestones are a common part of recovery. Keeping track of your progress and celebrating your victories can help you build a lifestyle committed to recovery.
- Accountability. Linking up with like-minded peers with similar experiences can help people in recovery recognize their personal relapse triggers so they can take action to avoid having one. Peer groups, mentors, and sponsors are there to help people stay on track when moments of weakness arise as well as encourage them to share ways to overcome specific challenges to sobriety.
- Self-improvement. There’s always room for improvement, and pursuing life goals is an integral part of overcoming substance addiction. Some treatment programs offer help in support of people reaching their goals. This help may be an alumni program or sober living house that helps people with finding housing, help with budgeting their finances, doing a resume or helping them launch a job search.
Some common types of aftercare programs are:
- Support Groups. There are various kinds of support groups that are designed to foster a community of people working on recovery from drug addiction and alcohol use disorder. The fellowship Alcoholics Anonymous (AA) is widely considered the standard for alcohol recovery support groups. As the original creator of the 12-step program, AA has a huge presence in the U.S., and it probably won’t be difficult to find a meeting in your area. There’s also Narcotics Anonymous and others that offer services to specific groups.
- Sponsorships. A sponsor is someone with several years of recovery under their belt that can help you along in your recovery. They typically serve to share ideas, wisdom, and make themselves available to you in moments of weakness. Sponsors are available in groups like AA, but you may also find mentors in other capacities, like your center’s alumni program.
- Sober living. Sober living environments help many recovering substance users transition from addiction treatment into everyday life. Sober living houses provide a structured, substance-free environment that allows clients to get used to living on their own again after treatment. It also allows facility residents to put things they learned in rehab into practice.
Relapse, the return of using addictive substances after a period of abstinence, is a real possibility for people in recovery, no matter how long they have abstained from drugs and alcohol. This is why treatment continues as addiction is a chronic disease. A one-time treatment likely will not be enough to deter recovering substance users from using addictive substances. Many people in recovery have to work at staying sober and must create a new life to support this goal in all facets of their daily lives.
The completion of addiction treatment is the beginning of the recovery process
Managing an addiction often is a lifelong process that requires remaining committed to changing daily habits, attending support group meetings, joining groups that share the recovery goals you do, and staying in tune with yourself and surroundings so you can recognize your personal triggers. Those triggers are warning signs that a relapse may be on the horizon.
Relapse is when a person returns to using drugs and alcohol after a period of not using them. The possibility of this happening to someone who has completed addiction treatment is real, and it’s almost expected. It is common that people in substance abuse recovery are prone to returning to using, according to the National Institute on Drug Abuse (NIDA), which reports that relapse happens to 40 to 60 percent of people in recovery, a rate that’s common in other chronic illnesses, such as asthma, diabetes, and hypertension. This happens because addiction changes the brain, sometimes permanently.
Because of this, it is possible that addiction treatment may happen more than once or twice as recovering users work toward ending their substance use. The addiction community as well as in the science and medical fields all believe that relapse is not an indication that treatment didn’t work. Instead, it means treatment needs to be reinstated or adjusted, NIDA explains. It also may mean another form of treatment is needed.