INTRODUCTION

Drug abuse and addiction, now both grouped as substance or drug use
disorder, is a condition characterized by a self-destructive pattern of
using a substance that leads to significant problems and distress, which
may include tolerance to or withdrawal from the substance.
Drug addiction disorder is unfortunately quite common, affecting more
than 8% of people.Dual diagnosis refers to the presence of both a drug-
use issue addition to a serious mental health condition in an individual.
While the specific physical and psychological effects of drug use
disorder tend to vary based on the particular substance involved, the
general effects of a substance use disorder involving any drug can be
devstating. Symptoms of a drug problem include recurrent drug use
that results in legal problems, occurs in potentially dangerous
situations, interfere with important obligations, results in social or
relationship problems, tolerance, withdrawal symptoms, using a lot of
the drug or for a long period of time, persistent desire to use the drug,
unsuccessful efforts to stop using the drug, neglecting other aspects of
life use of their drug use, and spending inordinate amounts of time or
energy getting, using, or recovering from the effects of the drug. Drugs
particularly affect the brain’s ability to inhibit actions that the person
would otherwise delay or prevent.The treatment of dual diagnosis is
more effective when treatment of the sufferer’s mental illness occurs in
tandem with the treatment of the individual’s chemical dependency.
Drug addiction increases the risk of a number of negative life stressors
and conditions, particularly if left untreated.

DRUG ABUSE AND ADDICTION DISORDER

Formerly separately called substance or drug abuse and addiction, drug

use disorder, is an illness characterized by a destructive pattern of using
a substance that leads to significant problems or distress, including
tolerance to or withdrawal from the substance. The effects of drug use
disorders on society are substantial.The term dual diagnosis refers to
the presence of both a drug use disorder and a serious mental health
problem in a person. Substance use disorders, unfortunately, occur
quite commonly in people who also have a severe mental illness.

GOALS AND OBJECTIVES

A central element of NIDA’s mission is strategically supporting and
conducting basic and clinical research on drug abuse . The goals and
objectives laid out in this strategic plan provide an overview of the
broad research priorities in this area spanning basic science,
translational, clinical,and population-based research. This plan outlines
four priority focus areas that present unique opportunities to leverage
over the next 5 years.
The four strategic goals are:
GOAL 1: Identify the biological, environmental, behavioral, and social
causes and consequences of drug use and addiction across the lifespan.

GOAL 2: Develop new and improved strategies to prevent drug use and
its consequences.

GOAL 3: Increase the public health impact of NIDA research and

programs.

GOAL 4: Develop new and improved treatments to help people with

substance use disorders achieve and maintain a meaningful and
sustained recovery

DRUG CLASSIFICATION BASED ON CHEMICAL MAKEUP

The following are many of the drugs and types of drugs that people
commonly abuse or result in dependence:

Alcohol: Alcohol is a toxic substance, especially for a developing fetus

when a mother consumes this drug during pregnancy. One of the most
common addictions.

Amphetamine: Medications like methylphenidate,

dextroamphetamine and amphetamine to illegally manufactured drugs
like methamphetamine (“crystal meth”). Overdose of any of these
substances can result in seizures and death.
Anabolic steroids: It is abused by bodybuilders and other athletes, this
group of drugs can lead to devastating emotional symptoms like
aggression and paranoia, and long-term physical effects like infertility
and organ failure.

Caffeine: While many people consume coffee, tea, and soda, when
consumed in excess, this substance can be habit-forming, insomnia,
tremors, and significant anxiety.

Ecstacy: Also called MDMA to denote its chemical composition

(methylenedioxymethamphetamine), this drug tends to create a sense
of euphoria and an expansive love or desire to nurture others. In
overdose, it can increase body temperature to the point of causing
death.

Hallucinogen: Examples include LSD and mescaline, as well as so-called

naturally occurring hallucinogens like certain mushrooms. These drugs
can be dangerous in their ability to alter the perceptions of the user.

Cannabis: More usually called marijuana, the scientific name for

cannabis is tetrahydrocannabinol (THC). Marijuana is the most
commonly used illicit drug, with nearly 14 million people 12 years or
older reporting having used this drug in the past year. In addition to the
negative effects, the drug itself can produce for eg, infertility.
DRUG CLASSIFICATION BASED ON EFFECT
Depressants
More commonly referred to as “downers,” Depressants create feelings
of relaxation and tiredness. While many serve legitimate purposes in
the fight against mental illness and sleep deprivation, they are very
commonly abused because they may also create feelings of euphoria.
Depressants are not only some of the most highly addictive drugs, but
they are also some of the most highly dangerous and likely to cause
overdose. Examples of Depressants include:

• Alcohol
• Opiates
 • Barbiturates
Stimulants
Also known as “uppers,” the primary use of Stimulants is to increase
energy, concentration, and wakefulness. Stimulants are said to provide
a “rush.” In the short term, Stimulants are believed to increase
productivity and performance while producing an excited high of
pleasure. In the long term, Stimulants are incredibly addictive and have
a very high potential for abuse. Examples of Stimulants include:

• Adderall
• Cocaine
• Meth
Hallucinogens
Hallucinogens alter the user’s perception of reality. Often this results in
auditory and visual hallucinations, a process known as “tripping.”
Although Hallucinogens are generally less addictive than other drug
classifications, their immediate impacts are generally more severe and
dangerous. Examples of Hallucinogens include:

• LSD
• Psilocybin Mushrooms
• PCP
Inhalants
Inhalants are a vast range of chemicals that are ingested primarily by
breathing them in, or huffing. Most inhalants are commonly used
materials that are in no way designed to be ingested by humans. While
there is incredible variety between inhalants, most produce feelings of a
high. Inhalants are less studied than most other drugs. While they tend
to be less addictive than many other substances, the use of Inhalants is
incredibly dangerous and causes many serious health effects. Examples
of commonly abused Inhalants include:

• Paint thinner
• Nail polish remover
• Gasolinees with sexual performance .

Drug Classifications Based On Legal Definitions

• The Federal Government passed the Controlled Substances Act in
1970 in response to the drug epidemic. This act established 5 drug
classifications or schedules. What schedule a drug is placed in is
determined by its legitimacy and the value of its potential medical
uses, along with its potential for abuse and risk of addiction. The
exception to this is international treaties. The United States must
classify certain drugs in certain schedules to comply with certain
diplomatic agreements, such as the Single Convention on Narcotic
Drugs.

Schedule V
Schedule V drugs have the fewest regulations and lowest penalties of
any federal drug classification. Schedule V drugs have a legitimate
accepted medical purpose, have a lower potential for abuse than
Schedule IV drugs, and have a lower potential for addiction than
Schedule IV drugs. Examples include:

• Lomotil
• Motofen
 • Lyrica
Schedule IV
Schedule IV drugs have regulations and penalties in between those of
Schedule V and Schedule III drugs. Schedule IV drugs have a legitimate
accepted medical purpose, have a low potential for abuse, and have a
low potential for addiction. Examples include:

• Ambien
• Darvocet
• Tramadol
Schedule III
Schedule III drugs have more regulations and harsher penalties than
Schedule IV drugs and fewer regulations and less severe penalties than
Schedule II drugs. Schedule III drugs have a legitimate acceptable
medical purpose, have a lower abuse potential than Schedule I and II
drugs, and have a moderate or low potential for addiction. Examples of
Schedule III drugs include:

• Anabolic steroids
• Ketamine
• Vicodin
Schedule II
Schedule II drugs have more regulations and harsher penalties than any
drug classification other than Schedule I drugs. Schedule II drugs have a
legitimate accepted medical use, a high potential for abuse, and a
severe dependence risk. Examples of Schedule II drugs include:

• Codeine
 • Methadone
• Ritalin
Schedule I
drugs have the most regulations and harshest penalties of any drugs.
Schedule I drugs have no legitimate accepted medical use and a high
potential for abuse. Examples of Schedule I drugs include:

• Ecstasy
• Quaaludes
• GHB

Risk factors for addiction

People of all backgrounds and beliefs can experience addiction. It can
be hard to understand why some people are more prone to it than
others. Regardless of your upbringing or moral code, many factors can
raise your risk of becoming addicted to alcohol and other drugs. Your
genetics, environment, medical history, and age all play a role. Certain
types of drugs, and methods of using them, are also more addictive
than others.

Genetics
Addiction isn’t a matter of weak willpower or lack of morals. The
chemical reactions that happen in your brain when you have an
addiction are quite different than those that happen in someone
without one. That explains why one person may be able to smoke
cigarettes every so often for pleasure, while another needs them on a
daily basis to function.
Heredity is a major risk factor for addiction. According to the National
Institute on Drug AbuseTrusted Source, up to half of your risk of
addiction to alcohol, nicotine, or other drugs is based on genetics. If you
have family members who’ve experienced addiction, you’re more likely
to experience it too.

If you have an “addictive personality,” you may be at risk of a wide

range of addictions. For example, if you have an alcoholic parent, you
might choose not to drink but still become addicted to smoking or
gambling.

Environment
Environmental factors can also raise your risk of addiction. For children
and teens, lack of parental involvement can lead to greater risk-taking
or experimentation with alcohol and other drugs. Young people who
experience abuse or neglect from parents may also use drugs or alcohol
to cope with their emotions.

Peer pressure is another risk factor for addiction, especially among

young people. Even when it’s not overt or aggressive, pressure from
friends to fit in can create an environment of “experimentation” with
substances that can lead to addiction. The availability of a substance in
your social group can also affect your risk of becoming addicted. For
example, large amounts of alcohol are available in many social settings
that are popular among college students.

If you’re trying to recover from an addiction, you may need to avoid

environmental triggers, including some activities, settings, or people.
For example, you may need to avoid the people that you previously
used drugs with. You may experience cravings in certain social circles
and situations, raising your risk of relapse. This might be the case even
after a long period of sobriety.

PHYSICAL AND PSYCHOLOGICAL EFFECT OF DRUG ABUSE

Psychologically, intoxication withdrawal from a substance can cause
everything from euphoria as with alcohol, Ecstasy, or inhalant
intoxication, to paranoia with marijuana or steroid intoxication, to
severe depression or suicidal thoughts with cocaine or amphetamine
withdrawal.
In terms of effects on the body, intoxication with a drug can cause
physical effects that range from marked sleepiness and slowed
breathing as with intoxication with heroin or sedative-hypnotic drugs,
to the rapid heart rate of cocaine intoxication, or the tremors to
seizures of alcohol withdrawal.
 SIGN AND SYMPTOMS OF DRUG ABUSE
• Having intense urges for the drug that blockout any other
thoughts
• Over time, needing more of the drug to get the same effect
• Taking larger amounts of the drug over a longer period of time
than you intended
• Making certain that you maintain a supply of the drug
• Spending money on the drug, even though you can’t afford
• Doing things to get the drug that you normally wouldn’t do, such
as stealing
• Driving or doing other risky activities when you’re under the
influence of the drug.
• Anxiety or paranoid thinking
• Cannabis odor on clothes or yellow fingertips
• Exaggerated cravings for certain foods at unusual times
• Poor performance at school or at work
• Reduced number of friends and interests

EFFECT ON BRAIN WHEN YOU TAKEN DRUG

Most drugs affect the brain’s “reward circuit,” causing euphoria as well
as flooding it with the chemical messenger dopamine. A properly
functioning reward system motivates a person to repeat behaviors
needed to thrive, such as eating and spending time with loved ones.
Surges of dopamine in the reward circuit cause the reinforcement of
pleasurable but unhealthy behaviors like taking drugs, leading people
to repeat the behavior again and again.Despite being aware of these
harmful outcomes, many people who use drugs continue to take them,
which is the nature of addiction.

COMPLICATIONS DUE TO DRUG ADDICTION DISORDER

Social and occupational complications of drug addiction, there are
many potential medical complications. From respiratory arrest
associated with heroin or sedative overdose to heart attack or stroke
caused by cocaine or amphetamine intoxication, death is a highly
possible complication of a drug use disorder. People who are dependent
on drugs are also vulnerable to developing persistent medical
conditions include:
• Liver or heart failure or
• Pancreatitis associated with alcoholism and brain damage
associated with alcoholism or inhalants.

EFFECT OF DRUG ABUSE AMONG YOUTH

Every year, the International Day against Drug Abuse and Illicit
Trafficking is celebrated on June 26 with the aim to sensitise individuals
and communities around the challenge of drug abuse and addiction as
well as its impact. With this global observance, individuals,
communities and numerous organizations aim to not only raise
awareness to fight against substance abuse but also strengthen
comprehensive action and collaboration to achieve the aim of a global
society free of drug abuse.

The epidemic of substance abuse in adolescents is increasing at an

alarming rate in India and this is the direct result of the changing
cultural values, fierce competition in the fields of education and
employment, growing economic burden on families and declining
supportive bonds for adolescents in this transitional age. The impact is
that adolescents witness their first experimentation towards various
drugs, especially those that are easily available including glues,
tobacco, cannabis, and alcohol. Amongst adolescents, the highest at-
risk population include street children, child labourers, and teens who
have a family history of drug abuse and other emotional and behavioral
challenges at home.

According to a study conducted by the National Commission for

Protection of Child Rights, the most common form of substance abuse
amongst adolescents is tobacco and alcohol, followed by inhalants and
cannabis. The average age of onset of tobacco use was observed to be
as low as 12 years, while another study revealed that 46% of slum
dwelling adolescents started both smokeless and smoking tobacco, as
well as alcohol and cannabis from childhood (1). With easy access to
smokeless tobacco, studies in slums of Delhi have shown the age of
initiation to be as low as 6 years .
The effect of substance abuse is highest on the psychological health of
adolescents with the possibility of developing substance use disorder,
leading to major behaviour changes observed, including mood
disorders, depression, anxiety, thought disorders such as schizophrenia,
as well as a personality disorders like antisocial personality traits. Use
of tobacco (nicotine) in adolescence and young adulthood poses a
unique risk for long-term and long-lasting effects on developing brains
as nicotine changes the way synapses are formed, harming the parts
that control attention and learning. Brain continues to develop until
about the age of 25 years and during adolescence, the brain growth is
not complete and is susceptible to the damaging effects of tobacco
smoke. Consequences of substance abuse also include quarrels with
friends, family or relatives, as well as accidents and severe health
disorders, with some also losing their jobs or dropped out of school due
to poor performance. One study reported that three percent of
adolescents who used substances were also involved in criminal
activities like petty thefts, burglary, vandalism of public and private
property amongst others .

Intervention programmes for substance abuse should have a two-

pronged approach that caters to both the prevention and treatment of
drug abuse. Prevention programmes should focus on addressing
initiation of various drugs. The interventions must be aimed at younger
age groups, focusing on before the usual age of initiation. Effective
enforcement of substance abuse policies like tobacco control act can
efficiently curb access of these products to adolescents. One of the
major contributors to such prevention programmes apart from teachers
should be parents of at-risk youth and adolescents. Such interventions
should focus on psychosocial development than only prevention of
target drug use as it has the potential to improve various aspects of a
person’s development. Regular parental monitoring, supervision, and
enhanced child-parent communication can act as preventive measures
towards substance abuse. Efficient parent training with family skill
building, and structured family therapy can prevent illicit drug use.

PREVENTION TERMINOLOGY
• Prevention programs can be designed to intervene as early as pre-
school to address risk factors for drug abuse, such as aggressive
behavior, poor social skills, and academic difficulties.
• Parental monitoring and supervision are critical for drug abuse
prevention. These skills can be enhanced with training on rule-
setting; techniques for monitoring activities; praise for appropriate
 behavior; and moderate, consistent discipline that enforces
defined family rules.
• Drug education and information for parents or caregivers
reinforces what children are learning about the harmful effects of
drugs and opens opportunities for family discussions about the
abuse of legal and illegal substances.

HOW HEALTH CARE PROFESSIONALS DIOGNOSES DRUG

ADDICTION
Similar to many mental health diagnoses, there is no one test that
definitively determines that someone has a chemical use disorder.
Therefore, health care professionals diagnose these conditions by
thoroughly gathering medical, family, and mental health information.
The practitioner will also either conduct a physical examination or ask
that the person’s primary care doctor perform one. The medical
assessment will usually include lab tests to evaluate the person’s
general medical health and to explore whether or not the individual
currently has drugs in their system or has a medical problem that might
mimic symptoms of drug addiction.

RECOVERY PROGRAMMES
Recovery-oriented systems of care: These programs embrace a chronic
care management model for severe substance use disorders, which
includes longer-term, outpatient care; recovery housing; and recovery
coaching and management checkups.
Recovery support services: These services refer to the collection of
community services that can provide emotional and practical support
for continued remission. Components include mutual aid groups (e.g.,
12-step groups), recovery coaching, recovery housing, recovery
management (checkups and telephone case monitoring), recovery
community centers, and recovery-based education (high schools and
colleges).
Social and recreational recovery infrastructures and social media: These
programs make it easier for people in recovery to enjoy activities and
social interaction that do not involve alcohol or drugs (e.g., recovery-
specific cafes and clubhouses, sports leagues, and creative arts
programs).
Inpatient Recovery Programs
Inpatient or residential recovery programs are able to offer a relatively
intensive, immersive treatment experience for those seeking to recover
from addiction. The nature of an inpatient setting allows treatment
team member personnel to provide round-the-clock supervision of
program residents.
Individuals at hospital-based facilities stay overnight and have access to
physicians, nurses, or other healthcare professionals 24 hours a day, 7
days a week.Other residential facilities situated outside of a hospital
should be able to arrange for quick access to medical services, when
needed, should a healthcare professional not be on-site at the time.
Inpatient programs strive to provide a safe, supportive environment for
patients while giving them the tools they need to achieve long-term
abstinence. The length of stay in any inpatient or residential recovery
program will be influenced by the nature and severity of the SUD.

What to Expect From Inpatient Recovery Programs

Inpatient recovery programs vary and though not every program will
offer all elements, here are some of the more commonly encountered
treatment elements:
 • Medical supervision—particularly when severe withdrawal is a
risk.
• Prescription and management of treatment medications.
• A comprehensive psychiatric evaluation.
• Dual diagnosis care—where health professionals simultaneously
care for any coexisting medical or mental health conditions.
• Individual, group, and family therapy.
• Support group meeting attendance.
• Relapse prevention education.
Many inpatient and residential programs host aftercare programs
and/or will help patients plan an aftercare regimen to facilitate
continued recovery services even after rehab completion. As part of a
solid aftercare regimen, after leaving an inpatient center patients often
regularly attend group meetings. Support groups help individuals
maintain sobriety by providing peer and mentor relationships as well as
a variety of “tools” that help individuals maintain abstinence.

Outpatient recovery program

For some individuals whose circumstances or conditions don’t require a
full-time, residential recovery process, outpatient treatment may be a
viable rehabilitation option. In an outpatient recovery program,
individuals undergo addiction rehabilitation while living at their own
homes. It can cost less than inpatient treatment and is usually better
for people who have an extensive support system. Outpatient
treatment varies in types of services available.While outpatient
programs do not involve living on the premises of a facility, certain
outpatient models, including intensive day treatment, can be
comparable to residential programs in services and effectiveness,
depending on the individual patient’s characteristics and needs.
In many outpatient programs, group counseling may be a major
component.Outpatient behavioral treatment may include a variety of
programs for patients who meet with a behavioral health counselor
regularly, including individual and group counseling.The types of
behavioral therapy may include the following:

• Cognitive-behavioral therapy, which helps patients recognize,

avoid, and cope with the situations in which they are most likely to
use drugs.
• Multidimensional family therapy—developed for adolescents with
drug use problems as well as their families.
• Motivational interviewing, which makes the most of people’s
readiness to change their behavior and enter treatment.
While certain therapeutic approaches will be similarly utilized in both
inpatient and outpatient recovery settings, outpatient treatment is not
always right for everyone. Many individuals require more intensive
inpatient recovery treatment—including long-term substance users
with significant physical dependence and withdrawal risks, as well as
those with coexisting medical or mental health conditions

TREATMENT OF DRUG ABUSE OR ADDICTION DISORDER

Yes, but it’s not simple. Because addiction is a chronic disease, people
can’t simply stop using drugs for a few days and be cured. Most
patients need long-term or repeated care to stop using completely and
recover their lives.
There are many options that have been successful in treating drug
addiction, including:
• Behavioral counseling.
• Medication.
 • Medical devices and applications used to treat withdrawal
symptoms or deliver skills training.
• Evaluation and treatment for co-occurring mental health issues
such as depression and anxiety.
• Long-term follow-up to prevent relapse.
A range of care with a tailored treatment program and follow-up
options can be crucial to success.
Treatment should be include both medical and mental health services
as needed.

RESEARCH
For much of the past century, scientists studying drugs and drug use
labored in the shadows of powerful myths and misconceptions about
the nature of addiction. When scientists began to study addictive
behavior in the 1930s, people with an addiction were thought to be
morally flawed and lacking in willpower. Those views shaped society’s
responses to drug use, treating it as a moral failing rather than a health
problem, which led to an emphasis on punishment rather than
prevention and treatment.
Today, thanks to science, our views and our responses to addiction and
the broader spectrum of substance use disorders have changed
dramatically. Groundbreaking discoveries about the brain have
revolutionized our understanding of compulsive drug use, enabling us
to respond effectively to the problem.
As a result of scientific research, we know that addiction is a medical
disorder that affects the brain and changes behavior. We have
identified many of the biological and environmental risk factors and are
beginning to search for the genetic variations that contribute to the
development and progression of the disorder. Scientists use this
knowledge to develop effective prevention and treatment approaches
that reduce the toll drug use takes on individuals, families, and
communities.
At the National Institute on Drug Abuse (NIDA), we believe that
increased understanding of the basics of addiction will empower people
to make informed choices in their own lives, adopt science-based
policies and programs that reduce drug use and addiction in their
communities, and support scientific research that improves the Nation’s
well-being.

PEOPLE GET MORE INFORMATION AND HELP FOR DRUG

ABUSE
• Al-Anon-Alateen: 888-4AL-ANON
• Alcoholics Anonymous World Services: 212-870-3400
• Kids Against Drugs: http://www.kidsagainstdrugs.com
• Mothers Against Drunk Driving: 800-GET-MADD
• Narconon: http://www.narconon.org/
 • Narcotics Anonymous: http://www.na.org
• National Clearinghouse for Alcoholism and Drug Information: 800-
729-6686
• National Cocaine Hotline: 800-COCAINE (262-2463)
• National Council on Alcoholism and Drug Dependence: 800-NCA-
CALL.

CONCLUSION
By adopting an evidence-based public health approach, take genuinely
effective steps to prevent and treat substance-related issues. Such an
approach can prevent substance initiation or escalation from use to a
disorder, and thus reduce the number of people suffering with
addiction; it can shorten the duration of illness for sufferers; and it can
reduce the number of substance-related deaths. A public health
approach will also reduce collateral damage created by substance
misuse, such as infectious disease transmission and motor vehicle
crashes. Thus, promoting much wider adoption of appropriate
evidence-based prevention, treatment, and recovery strategies needs to
be a top public health priority.

REFRENCES
The following references have been selected as either summaries of the
literature of the past several years or as the latest findings on specific
aspects of prevention research, which have been cited in this
publication.

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