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The Basics What is drug addiction? Addiction is defined as 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. Why study drug abuse and addiction? How are drug disorders categorized?

In , APA updated the DSM, replacing the categories of substance abuse and substance dependence with a single category: The symptoms associated with a substance use disorder fall into four major groupings: The new DSM describes a problematic pattern of use of an intoxicating substance leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a month period: The substance is often taken in larger amounts or over a longer period than was intended.

There is a persistent desire or unsuccessful effort to cut down or control use of the substance. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects. Craving, or a strong desire or urge to use the substance. Recurrent use of the substance resulting in a failure to fulfill major role obligations at work, school, or home.

Continued use of the substance despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use. Important social, occupational, or recreational activities are given up or reduced because of use of the substance.

Recurrent use of the substance in situations in which it is physically hazardous. Use of the substance is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.

Tolerance, as defined by either of the following: A need for markedly increased amounts of the substance to achieve intoxication or desired effect. A markedly diminished effect with continued use of the same amount of the substance.

Withdrawal, as manifested by either of the following: The characteristic withdrawal syndrome for that substance as specified in the DSM- 5 for each substance. The substance or a closely related substance is taken to relieve or avoid withdrawal symptoms. Current national surveys of drug use have not yet been modified to reflect the new DSM-5 criteria of substance use disorders and therefore still report substance abuse and dependence separately.

How does NIDA use the terms drug abuse and addiction? People use substances for a variety of reasons. It becomes drug abuse when people use illegal drugs or use legal drugs inappropriately.

Addiction occurs when a person cannot control the impulse to use drugs even when there are negative consequencesóthe defining characteristic of addiction. The DSM does not use the term addiction. What is the difference between physical dependence, dependence, and addiction? Physical dependence is not equivalent to dependence or addiction, and may occur with the regular daily or almost daily use of any substance, legal or illegal, even when taken as prescribed.

It occurs because the body naturally adapts to regular exposure to a substance e. When that substance is taken away, symptoms can emerge while the body re-adjusts to the loss of the substance. Physical dependence can lead to craving the drug to relieve the withdrawal symptoms.

Drug dependence and addiction refer to substance use disorders, which may include physical dependence but must also meet additional criteria. How do drugs work in the brain to produce pleasure? Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, cognition, motivation, and feelings of pleasure. The overstimulation of this system, which rewards our natural behaviors, produces the euphoric effects sought by people who use drugs and teaches them to repeat the behavior.

Is drug abuse a voluntary behavior? The initial decision to take drugs is mostly voluntary. Brain-imaging studies from people addicted to drugs show physical changes in areas of the brain that are critical for judgment, decisionmaking, learning, memory, and behavior control.

Scientists believe that these changes alter the way the brain works and may help explain the compulsive and destructive behaviors of an addicted person. Can addiction be treated successfully? Addiction is a treatable, chronic disease that can be managed successfully.

Research shows that combining behavioral therapy with medications, where available, is the best way to ensure success for most patients. Does relapse to drug use mean treatment has failed? The chronic nature of addiction means that relapsing to drug use is not only possible but also likely. Relapse rates are similar to those for other well-characterized chronic medical illnesses such as diabetes, hypertension, and asthma, which also have both physiological and behavioral components.

Treatment of chronic diseases involves changing deeply imbedded behaviors. For the addicted patient, lapses back to drug use indicate that treatment needs to be reinstated or adjusted, or that alternate treatment is needed. How many people die from drug use? The Centers for Disease Control and Prevention CDC report that there were more than 40, unintentional drug overdose deaths in the United States in , a percent increase since More than 22, people die every year from prescription drug abuse, 6 more than heroin and cocaine combined.

Relapse is common and similar across these illnesses as is adherence to medication. Thus, drug addiction should be treated like any other chronic illness, with relapse serving as a trigger for renewed intervention.

National Drug Intelligence Center. United States Department of Justice, Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders.

Centers for Disease Control and Prevention. Department of Health and Human Services. A Report of the Surgeon General. Prescription Drug Overdose in the United States: Prescription Painkiller Overdoses in the US. This page was last updated October Contents.

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