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Drugs, Brains, and Behavior The Science of Addiction
Drugs, Brains, and Behavior The Science of Addiction 43
Drugs, Brains, and Behavior
The Science of Addiction
Image: White Matter Fibers, Parietal Areas • www.humanconnectomeproject.orgThis publication is in the public domain and may be used or reproduced in its entirety
without permission from NIDA. Citation of the source is appreciated.
NIH Pub No. 145605
Printed April 2007
Revised February 2008, August 2010, July 2014CONTENTS
I. Drug Abuse and Addiction ........................................................................................................................................... 5
II. Preventing Drug Abuse: The Best Strategy................................................................................................................. 11
III. Drugs and the Brain................................................................................................................................................ 15
IV. Addiction and Health................................................................................................................................................ 21
V. Treatment and Recovery ............................................................................................................................................ 25
VI. Advancing Addiction Science and Practical Solutions............................................................................................... 29
References .................................................................................................................................................................... 31
I“Drug addiction is a brain disease that can be treated.”
Nora D. Volkow, M.D.
National Institute on Drug AbusePREFACE
How Science Has Revolutionized the Understanding of Drug Addiction
or much of the past century, scientists studying drug abuse 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 addicted to drugs were thought to be
Fmorally flawed and lacking in willpower. Those views shaped society’s responses to drug abuse, 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 other 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 disease that affects both the brain and behavior. We have identified many of the
biological and environmental factors and are beginning to search for the genetic variations that contribute to the development and
progression of the disease. Scientists use this knowledge to develop effective prevention and treatment approaches that reduce the toll
drug abuse takes on individuals, families, and communities.
Despite these advances, many people today do not understand why people become addicted to drugs or how drugs change the brain to
foster compulsive drug use. This booklet aims to fill that knowledge gap by providing scientific information about the disease of drug
addiction, including the many harmful consequences of drug abuse and the basic approaches that have been developed to prevent and treat
substance use disorders. 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 sciencebased policies and programs that reduce drug abuse and
addiction in their communities, and support scientific research that improves the Nation’s wellbeing.
Nora D. Volkow, M.D.
National Institute on Drug AbuseMEDICAL SOCIAL ECONOMIC CRIMINAL JUSTICE
The consequences of drug abuse are vast and varied
and affect people of all ages.INTRODUCTION
Why study drug abuse and addiction
buse of and addiction to alcohol, nicotine, and illicit and prescription drugs cost Americans more than 700 billion a year in
increased health care costs, crime, and lost productivity. Every year, illicit and prescription drugs and alcohol contribute to the
A death of more than 90,000 Americans, while tobacco is linked to an estimated 480,000 deaths per year. (Hereafter, unless
otherwise specified, drugs refers to all of these substances.)
People of all ages suffer the harmful consequences of drug abuse and addiction.
z Babies exposed to drugs in the womb may be born premature and underweight. This exposure can slow the child’s intellectual
development and affect behavior later in life.
z Adolescents who abuse drugs often act out, do poorly academically, and drop out of school. They are at risk for unplanned
pregnancies, violence, and infectious diseases.
z Adults who abuse drugs often have problems thinking clearly, remembering, and paying attention. They often develop poor social
behaviors as a result of their drug abuse, and their work performance and personal relationships suffer.
z Parents’ drug abuse often means chaotic, stressfilled homes, as well as child abuse and neglect. Such conditions harm the well
being and development of children in the home and may set the stage for drug abuse in the next generation.
How does science provide solutions for drug abuse and addiction
Scientists study the effects that drugs have on the brain and on people’s behavior. They use this information to develop programs for
preventing drug abuse and for helping people recover from addiction. Further research helps transfer these ideas into practice in our
3I. DRUG ABUSE AND ADDICTION
What is drug addiction
DECREASED BRAIN METABOLISM IN PERSON WHO ABUSES DRUGS
ddiction is defined as a chronic, relapsing brain
disease that is characterized by compulsive drug
A 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 longlasting, and can lead to the
harmful behaviors seen in people who abuse drugs.
Healthy Brain Diseased Brain/Cocaine Abuser
DECREASED HEART METABOLISM IN
HEART DISEASE PATIENT
Addiction is a lot like other diseases,
such as heart disease. Both disrupt the
normal, healthy functioning of the
underlying organ, have serious harmful
consequences, and are preventable and
treatable, but if left untreated, can last
Healthy Heart Diseased Heart
Source: From the laboratories of
Drs. N. Volkow and H. Schelbert
†The term addiction as used in this booklet may be regarded as equivalent to a severe substance use disorder as defined by the Diagnostic and Statistical Manual of
Mental Disorders, Fifth Edition (DSM5, 2013).
Why do people take drugs
In general, people begin taking drugs for a variety of reasons:
z To feel good. Most abused drugs produce intense feelings of pleasure. This initial sensation of euphoria is followed by other effects, which differ
with the type of drug used. For example, with stimulants such as cocaine, the “high” is followed by feelings of power, selfconfidence, and
increased energy. In contrast, the euphoria caused by opiates such as heroin is followed by feelings of relaxation and satisfaction.
z To feel better. Some people who suffer from social anxiety, stressrelated disorders, and
depression begin abusing drugs in an attempt to lessen feelings of distress. Stress can play a
major role in beginning drug use, continuing drug abuse, or relapse in patients recovering from
z To do better. Some people feel pressure to
chemically enhance or improve their cognitive or
athletic performance, which can play a role in initial
experimentation and continued abuse of drugs such
as prescription stimulants or anabolic/androgenic
z Curiosity and “because others are doing it.”
In this respect adolescents are particularly vulnerable
because of the strong influence of peer pressure.
Teens are more likely than adults to engage in risky or
daring behaviors to impress their friends and express
their independence from parental and social rules.
Courtesy: Vivian FelsenNo single factor determines whether a person
will become addicted to drugs.
addiction show physical changes in areas of the brain that are
If taking drugs makes people feel good or
critical to judgment, decision making, learning and memory,
better, what’s the problem
and behavior control. Scientists believe that these changes alter
When they first use a drug, people may perceive what seem to
the way the brain works and may help explain the compulsive
be positive effects; they also may believe that they can control
and destructive behaviors of addiction.
their use. However, drugs can quickly take over a person’s life.
Why do some people become addicted to
Over time, if drug use continues, other pleasurable activities
drugs, while others do not
become less pleasurable, and taking the drug becomes neces
sary for the user just to feel “normal.” They may then compul
As with any other disease, vulnerability to addiction differs from
sively seek and take drugs even though it causes tremendous
person to person, and no single factor determines whether a
problems for themselves and their loved ones. Some people may
person will become addicted to drugs. In general, the more risk
start to feel the need to take higher or more frequent doses,
factors a person has, the greater the chance that taking drugs
even in the early stages of their drug use. These are the telltale
signs of an addiction.
RISK AND PROTECTIVE FACTORS
FOR DRUG ABUSE AND ADDICTION
Even relatively moderate drug use poses dangers. Consider how
Risk Factors Protective Factors
a social drinker can become intoxicated, get behind the wheel
Aggressive behavior Good selfcontrol
of a car, and quickly turn a pleasurable activity into a tragedy
that affects many lives.
Lack of parental Parental monitoring
supervision and support
Is continued drug abuse a voluntary
Poor social skills Positive relationships
Drug experimentation Academic competence
The initial decision to take drugs is typically voluntary. However, Availability of drugs School antidrug
at school policies
with continued use, a person’s ability to exert selfcontrol can
Community poverty Neighborhood pride
become seriously impaired; this impairment in selfcontrol is
the hallmark of addiction. Brain imaging studies of people withChildren’s earliest interactions within the family
are crucial to their healthy development and
risk for drug abuse.
will lead to abuse and addiction. Protective factors, on
the other hand, reduce a person’s risk of developing
addiction. Risk and protective factors may be either envi
ronmental (such as conditions at home, at school, and in
the neighborhood) or biological (for instance, a person’s
genes, their stage of development, and even their gender
Genetics Chaotic home and abuse
Gender Parent’s use and attitudes
or ethnicity). n n
Mental disorders Peer influences
Route of administration n
Poor school achievement
Effect of drug itself
What environmental factors increase
the risk of addiction
z Home and Family. The influence of the home envi
ronment, especially during childhood, is a very impor
tant factor. Parents or older family members who abuse
alcohol or drugs, or who engage in criminal behavior,
can increase children’s risks of developing their own
What biological factors increase the risk of addiction
z Peer and School. Friends and acquaintances can have
Scientists estimate that genetic factors account for between 40 and 60 percent of a
an increasingly strong influence during adolescence.
person’s vulnerability to addiction; this includes the effects of environmental factors
Drugusing peers can sway even those without risk fac
on the function and expression of a person’s genes. A person’s stage of development
tors to try drugs for the first time. Academic failure or
and other medical conditions they may have are also factors. Adolescents and people
poor social skills can put a child at further risk for
with mental disorders are at greater risk of drug abuse and addiction than the general
using or becoming addicted to drugs.
z Method of Administration. Smoking a drug or injecting it into
What other factors increase the risk of
a vein increases its addictive potential. Both smoked and injected
drugs enter the brain within seconds, producing a powerful rush
z Early Use. Although taking drugs at any age can lead to addiction,
of pleasure. However, this intense “high” can fade within a few
research shows that the earlier a person begins to use drugs, the minutes, taking the abuser down to lower, more normal levels.
more likely he or she is to develop serious problems. This may Scientists believe this starkly felt contrast drives some people to
reflect the harmful effect that drugs can have on the developing
repeated drug taking in an attempt to recapture the fleeting
brain; it also may result from a mix of early social and biological pleasurable state.
vulnerability factors, including unstable family relationships,
exposure to physical or sexual abuse, genetic susceptibility, or
mental illness. Still, the fact remains that early use is a strong
indicator of problems ahead, including addiction.Addiction is a developmental disease—
it typically begins in childhood or adolescence.
The brain continues to develop into adulthood
ImAGeS OF bRAIN Dev eLOPmeNT IN
HeALTHy CHILDReN AND TeeNS (AGeS 5–20) and undergoes dramatic changes during
One of the brain areas still maturing during adolescence is the
prefrontal cortex—the part of the brain that enables us to assess
situations, make sound decisions, and keep our emotions and
desires under control. The fact that this critical part of an
adolescent’s brain is still a work in progress puts them at
increased risk for making poor decisions (such as trying drugs
or continuing to take them). Also, introducing drugs during this
period of development may cause brain changes that have
profound and longlasting consequences.
Blue represents maturing of brain areas.
Source: PNAS 101:8174–8179, 2004.II. PREVENTING DRUG ABUSE:
THE BEST STRATEGY
Why is adolescence a critical time for preventing drug addiction
s noted previously, early use of drugs increases a person’s chances of developing addiction. Remember, drugs change brains—and
this can lead to addiction and other serious problems. So, preventing early use of drugs or alcohol may go a long way in reducing
A these risks. If we can prevent young people from experimenting with drugs, we can prevent drug addiction.
Risk of drug abuse increases greatly during times of transition. For an adult, a divorce or loss of a job may lead to drug abuse; for a teenag
er, risky times include moving or changing schools. In early adolescence, when children advance from elementary through middle school,
they face new and challenging social and academic situations. Often during this period, children are exposed to abusable substances such as
cigarettes and alcohol for the first time. When they enter high school, teens may encounter greater availability of drugs, drug use by older
teens, and social activities where drugs are used.
At the same time, many behaviors that are a normal aspect of their development, such as the desire to try new things or take greater risks,
may increase teen tendencies to experiment with drugs. Some teens may give in to the urging of drugusing friends to share the experience
with them. Others may think that taking drugs (such as steroids) will improve their appearance or their athletic performance or that abusing
substances such as alcohol or MDMA (ecstasy or “Molly”) will ease their anxiety in social situations. A growing number of teens are abusing
prescription ADHD stimulants such as Adderall to help them study or lose weight. Teens’ stilldeveloping judgment and decisionmaking
skills may limit their ability to accurately assess the risks of all of these forms of drug use.
Using abusable substances at this age can disrupt brain function in areas critical to motivation, memory, learning, judgment, and behavior
control. So, it is not surprising that teens who use alcohol and other drugs often have family and social problems, poor academic perform
ance, healthrelated problems (including mental health), and involvement with the juvenile justice system.
11National drug use surveys indicate some children are
already using drugs by age 12 or 13.
Can researchbased programs
The Drug Danger Zone: Most Illicit Drug Use Starts in the Teenage Years
prevent drug addiction in
Yes. The term “researchbased” means that
these programs have been rationally designed
based on current scientific evidence, rigor
ously tested, and shown to produce positive
results. Scientists have developed a broad
range of programs that positively alter the
1415 balance between risk and protective factors
for drug abuse in families, schools, and
communities. Studies have shown that
researchbased programs, such as those
described in NIDA’s Preventing Drug Use
among Children and Adolescents: A
ResearchBased Guide for Parents,
Educators, and Community Leaders, can
significantly reduce early use of tobacco,
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, 13
alcohol, and illicit drugs.
National Survey on Drug Use and Health, 2011 and 2012.
Percentage of PastYear Initiates among Those Who Have Never Used13
How do researchbased prevention programs work
These prevention programs work to boost protective factors and eliminate or reduce risk factors for drug use. The programs are
designed for various ages and can be designed for individual or group settings, such as the school and home. There are three
types of programs:
z Universal programs address risk and protective factors common to all children in a given setting, such as a school or
z Selective programs target groups of children and teens who have factors that put them at increased risk of drug use.
z Indicated programs are designed for youth who have already begun using drugs.
Are all prevention programs effective in reducing drug abuse
When researchbased substance use prevention programs are properly implemented by schools and communities, use of alco
hol, tobacco, and illegal drugs is reduced. Such programs help teachers, parents, and health care professionals shape youths’
perceptions about the risks of substance use. While many social and cultural factors affect drug use trends, when young people
perceive drug use as harmful, they reduce their level of use.n
Prevention is the best strategy
DRUG USe DeCReASeS WHeN DRUGS ARe PeRCeIv eD AS HARmFUL, AND v ICe v eRSA
12THGRADe STUDeNTS RePORTING PASTmONTH
12THGRADe STUDeNTS RePORTING PASTmONTH
mARIJUANA USe AND PeRCePTION OF HARm,
CIGAReTTe USe AND PeRCePTION OF HARm,
1975 TO 2013
1975 TO 2013
Perceived Risk of Harm
60 Cigarette smoking
among teens is at its
lowest point since
Perceived Risk of Harm
NIDA began tracking
1/2 a pack+/day
it in 1975. But
marijuana use has
increased over the
past several years as
perception of its
risks has declined.
Source: 2013 Monitoring the Future survey. University of Michigan, with funding from the National Institute on Drug Abuse.
For more information on prevention, see NIDA’s most recent edition of Preventing Drug Use among Children and Adolescents: A Research
Based Guide for Parents, Educators, and Community Leaders at www.drugabuse.gov/Prevention/Prevopen.html.
PercentIII. DRUGS AND THE BRAIN
Introducing the Human brain
he human brain is the most complex organ in the body. This threepound mass of gray and white matter sits at the center of all
human activity—you need it to drive a car, to enjoy a meal, to breathe, to create an artistic masterpiece, and to enjoy everyday activi
T ties. In brief, the brain regulates your body’s basic functions; enables you to interpret and respond to everything you experience; and
shapes your thoughts, emotions, and behavior.
The brain is made up of many parts that all work together as a team. Different parts of the brain are responsible for coordinating and per
forming specific functions. Drugs can alter important brain areas that are necessary for lifesustaining functions and can drive the compul
sive drug abuse that marks addiction. Brain areas affected by drug abuse include:
z The brain stem, which controls basic functions critical to life, such as heart rate, breathing, and sleeping.
z The cerebral cortex, which is divided into areas that control specific functions.
Different areas process information from our senses, enabling us to see, feel, hear, and
taste. The front part of the cortex, the frontal cortex or forebrain, is the thinking center
of the brain; it powers our ability to think, plan, solve problems, and make decisions.
z The limbic system, which contains the brain’s reward circuit. It links together a
number of brain structures that control and regulate our ability to feel pleasure. Feeling
pleasure motivates us to repeat behaviors that are critical to our existence. The limbic
system is activated by healthy, lifesustaining activities such as eating and socializing—
but it is also activated by drugs of abuse. In addition, the limbic system is responsible
for our perception of other emotions, both positive and negative, which explains the
moodaltering properties of many drugs.
z Neurotransmitters—The Brain’s Chemical Messengers
How do the parts of the brain communicate
The messages are typically carried between neurons by chemicals
The brain is a communications center consisting of billions of
neurons, or nerve cells. Networks of neurons pass messages back
z Receptors—The Brain’s Chemical Receivers
and forth among different structures within the brain, the spinal cord,
The neurotransmitter attaches to a specialized site on the receiving
and nerves in the rest of the body (the peripheral nervous system).
neuron called a receptor. A neurotransmitter and its receptor oper
These nerve networks coordinate and regulate everything we feel, ate like a “key and lock,” an exquisitely specific mechanism that
ensures that each receptor will forward the appropriate message
think, and do.
only after interacting with the right kind of neurotransmitter.
z Neuron to Neuron
z Transporters—The Brain’s Chemical Recyclers
Each nerve cell in the brain sends and receives messages in the
Located on the neuron that releases the neurotransmitter, trans
form of electrical and chemical signals. Once a cell receives and
porters recycle these neurotransmitters (that is, bring them back
processes a message, it sends it on to other neurons.
into the neuron that released them), thereby shutting off the signal
To send a message, a brain
Here’s how people communicate. Here’s how brain cells communicate.
cell (neuron) releases a
into the space (synapse)
between it and the next
cell. The neurotransmitter
crosses the synapse and
attaches to proteins (recep
tors) on the receiving brain
cell. This causes changes in
the receiving cell—the
Transmitter Receptor Neurotransmitter Receptor
message is delivered.
Concept courtesy: B.K. MadrasMost drugs of abuse target the brain’s reward
system by flooding it with dopamine.
How do drugs work in the brain
Drugs are chemicals that affect the brain by tapping into its communication system and interfering with the way neurons
normally send, receive, and process information. Some drugs, such as marijuana and heroin, can activate neurons because their
chemical structure mimics that of a natural neurotransmitter. This similarity in structure “fools” receptors and allows the drugs
to attach onto and activate the neurons. Although these drugs mimic the brain’s own chemicals, they don’t activate neurons in the
same way as a natural neurotransmitter, and they lead to abnormal messages being transmitted through the network.
Other drugs, such as amphetamine or cocaine, can cause the neurons to release abnormally large amounts of natural neuro
transmitters or prevent the normal recycling of these brain chemicals. This disruption produces a greatly amplified message,
ultimately disrupting communication channels.
How do drugs work in the brain to produce pleasure
Most drugs of abuse directly or indirectly target the brain’s reward system by flooding the circuit with dopamine. Dopamine is a
neurotransmitter present in regions of the brain that regulate movement, emotion, motivation, and feelings of pleasure. When
activated at normal levels, this system rewards our natural behaviors. Overstimulating the system with drugs, however, produces
euphoric effects, which strongly reinforce the behavior of drug use—teaching the user to repeat it.18
How does stimulation of the brain’s Why are drugs more addictive than
pleasure circuit teach us to keep natural rewards
When some drugs of abuse are taken, they can release 2 to 10 times
the amount of dopamine that natural rewards such as eating and sex
Our brains are wired to ensure that we will repeat lifesustaining activ
do. In some cases, this occurs almost immediately (as when drugs
ities by associating those activities with pleasure or reward. Whenever
are smoked or injected), and the effects can last much longer than
this reward circuit is activated, the brain notes that something impor
those produced by natural rewards. The resulting effects on the brain’s
tant is happening that needs to be remembered, and teaches us to do it
pleasure circuit dwarf those produced by naturally rewarding behav
again and again without thinking about it. Because drugs of abuse
stimulate the same circuit, we learn to abuse drugs in the same way. iors. The effect of such a powerful reward strongly motivates peo
ple to take drugs again and again.
This is why scientists sometimes say
DRUGS OF Ab USe TARGeT THe b RAIN’S PLeASURe CeNTeR
that drug abuse is something we
learn to do very, very well.
Brain reward (dopamine) pathways Drugs of abuse increase dopamine
F Fr ro on nt ta all C Co or rt te ex x
N Nu uc clle eu us s
A Ac cc cu um mb be en ns s
WHILE EATING FOOD
WHILE USING COCAINE
These brain circuits are important for natural Typically, dopamine increases in response to natural rewards such as food.
rewards such as food, music, and sex. When cocaine is taken, dopamine increases are exaggerated, and communication is altered.Longterm drug abuse impairs brain functioning.
ing surges in dopamine (and other neurotransmitters) by
What happens to your brain
producing less dopamine or by reducing the number of
if you keep taking drugs
receptors that can receive signals. As a result, dopamine’s
For the brain, the difference between normal rewards and
impact on the reward circuit of the brain of someone who
drug rewards can be described as the difference between
abuses drugs can become abnormally low, and that per
someone whispering into your ear and someone shouting
son’s ability to experience any pleasure is reduced.
into a microphone. Just as we turn down the volume on a
This is why a person who abuses drugs eventually feels flat,
radio that is too loud, the brain adjusts to the overwhelm
lifeless, and depressed, and is unable to enjoy things that
were previously pleasurable. Now, the person needs to
keep taking drugs again and again just to try and bring his
DeCReASeD DOPAmINe TRANSPORTeRS IN A
or her dopamine function back up to normal—which only
makes the problem worse, like a vicious cycle. Also, the
person will often need to take larger amounts of the drug
to produce the familiar dopamine high—an effect known
How does longterm drug taking affect
We know that the same sort of mechanisms involved in the
development of tolerance can eventually lead to profound
changes in neurons and brain circuits, with the potential to
severely compromise the longterm health of the brain. For20
example, glutamate is another neurotransmitter that influences the
What other brain changes
reward circuit and the ability to learn. When the optimal concentration
occur with drug abuse
of glutamate is altered by drug abuse, the brain attempts to compen
Chronic exposure to drugs of abuse disrupts the way critical brain
sate for this change, which can cause impairment in cognitive function.
structures interact to control and inhibit behaviors related to drug use.
Similarly, longterm drug abuse can trigger adaptations in habit or
Just as continued abuse may lead to tolerance or the need for higher
nonconscious memory systems. Conditioning is one example of this
drug dosages to produce an effect, it may also lead to addiction, which
type of learning, in which cues in a person’s daily routine or environ
can drive a user to seek out and take drugs compulsively. Drug addic
ment become associated with the drug experience and can trigger
tion erodes a person’s selfcontrol and ability to make sound deci
uncontrollable cravings whenever the person is exposed to these cues,
sions, while producing intense impulses to take drugs.
even if the drug itself is not available. This learned “reflex” is extreme
ly durable and can affect a person who once used drugs even after
many years of abstinence.
For more information on drugs and the brain, order NIDA’s Teaching Packets CDROM series or the Mind Over Matter series at
www.drugabuse.gov/parentteacher.html. These items and others are available to the public free of charge.IV. ADDICTION AND HEALTH
What are the medical consequences of drug addiction
eople who suffer from addiction often have one or more accompanying medical issues, which may include lung or cardiovascular dis
ease, stroke, cancer, and mental disorders. Imaging scans, chest Xrays, and blood tests show the damaging effects of longterm drug
Pabuse throughout the body. For example, research has shown that tobacco smoke causes cancer of the mouth, throat, larynx, blood,
lungs, stomach, pancreas, kidney, bladder, and cervix. In addition, some drugs of abuse, such as inhalants, are toxic to nerve cells and may
damage or destroy them either in the brain or the peripheral nervous system.
Does drug abuse cause mental disorders, or vice versa
THe ImPACT OF
ADDICTION CAN b e Drug abuse and mental illness often coexist. In some cases, mental disorders such as anxiety,
FARReACHING depression, or schizophrenia may precede addiction; in other cases, drug abuse may trigger
or exacerbate those mental disorders, particularly in people with specific vulnerabilities.
Hepatitis B and C
21Addiction and HIV/AIDS are intertwined epidemics.
z Increased spread of infectious diseases
How can addiction harm other people
Injection of drugs such as heroin, cocaine, and methamphetamine
Beyond the harmful consequences for the person with the addiction,
currently accounts for about 12 percent of new AIDS cases.
drug abuse can cause serious health problems for others. Three of the
Injection drug use is also a major factor in the spread of hepatitis
more devastating and troubling consequences of addiction are:
C, a serious, potentially fatal liver disease. Injection drug use is not
the only way that drug abuse contributes to the spread of infectious
z Negative effects of prenatal drug exposure on infants
and children diseases. All drugs of abuse cause some form of intoxication, which
interferes with judgment and increases the likelihood of risky sexu
A mother's abuse of heroin or prescription opioids during pregnan
al behaviors. This, in turn, contributes to the spread of HIV/AIDS,
cy can cause a withdrawal syndrome (called neonatal abstinence
hepatitis B and C, and other sexually transmitted diseases.
syndrome, or NAS) in her infant. It is also likely that some drug
exposed children will need educational support in the classroom to
help them overcome what may be subtle deficits in developmental
areas such as behavior, attention, and thinking. Ongoing research is
1 OUT OF 3 U.S. AIDS DeATHS ARe
investigating whether the effects of prenatal drug exposure on the
ReLATeD TO DRUG Ab USe
brain and behavior extend into adolescence to cause developmental
problems during that time period.
z Negative effects of secondhand smoke
Secondhand tobacco smoke, also called environmental tobacco
smoke (ETS), is a significant source of exposure to a large number
of substances known to be hazardous to human health, particularly
to children. According to the Surgeon General’s 2006 Report, The
Health Consequences of Involuntary Exposure to Tobacco
Smoke, involuntary exposure to secondhand smoke increases the
risks of heart disease and lung cancer in people who have never
smoked by 25–30 percent and 20–30 percent, respectively.Tobacco use is responsible for an estimated
5 million deaths worldwide each year.
What are some effects
TOb ACCO SmOKe AFFeCTS THe WHOLe b ODy
of specific abused substances
Monoamine Oxidase B Smoking causes cancer throughout the body.
z Nicotine is an addictive stimulant found in cigarettes and
other forms of tobacco. Tobacco smoke increases a user’s risk
of cancer, emphysema, bronchial disorders, and cardiovascu
Larynx (voice box)
lar disease. The mortality rate associated with tobacco addic
tion is staggering. Tobacco use killed approximately 100 mil
Lung Blood (leukemia)
lion people during the 20th century, and, if current smoking Stomach
trends continue, the cumulative death toll for this century has Bladder
been projected to reach 1 billion.
z Alcohol consumption can damage the brain and most body
organs. Areas of the brain that are especially vulnerable to
alcoholrelated damage are the cerebral cortex (largely
z Prescription medications, including opioid pain relievers (such as
® ® ®
responsible for our higher brain functions, including problem solving
OxyContin and Vicodin ), antianxiety sedatives (such as Valium
® ® ®
and decision making), the hippocampus (important for memory and
and Xanax ), and ADHD stimulants (such as Adderall and Ritalin ),
learning), and the cerebellum (important for movement coordination). are commonly misused to selftreat for medical problems or abused
for purposes of getting high or (especially with stimulants) improving
z Marijuana is the most commonly abused illegal substance. This drug
performance. However, misuse or abuse of these drugs (that is, taking
impairs shortterm memory and learning, the ability to focus attention,
them other than exactly as instructed by a doctor and for the purposes
and coordination. It also increases heart rate, can harm the lungs,
prescribed) can lead to addiction and even, in some cases, death.
and can increase the risk of psychosis in those with an underlying
Opioid pain relievers, for instance, are frequently abused by being
crushed and injected or snorted, greatly raising the risk of addiction
and overdose. Unfortunately, there is a common misperception that
because medications are prescribed by physicians, they are safe even
when used illegally or by another person than they were prescribed for.Nearly half of high school seniors report having used
marijuana, and 6.5 percent are daily marijuana users.
z Inhalants are volatile substances found in many household prod but do not exist. Users also may have traumatic experiences and
emotions that can last for many hours.
ucts, such as oven cleaners, gasoline, spray paints, and other
aerosols, that induce mindaltering effects; they are frequently the
z Heroin is a powerful opioid drug that produces euphoria and feel
first drugs tried by children or young teens. Inhalants are extremely
ings of relaxation. It slows respiration, and its use is linked to an
toxic and can damage the heart, kidneys, lungs, and brain. Even a
increased risk of serious infectious diseases, especially when taken
healthy person can suffer heart failure and death within minutes of
intravenously. People who become addicted to opioid pain relievers
a single session of prolonged sniffing of an inhalant.
sometimes switch to heroin instead, because it produces similar
effects and may be cheaper or easier to obtain.
z Cocaine is a shortacting stimulant, which can lead users to take
z Steroids, which can also be prescribed for certain
the drug many times in a single session (known as a “binge”).
medical conditions, are abused to increase muscle
Cocaine use can lead to severe medical consequences related to the
mass and to improve athletic performance or physi
heart and the respiratory, nervous, and digestive systems.
cal appearance. Serious consequences of abuse can
z Amphetamines, including methamphetamine, are powerful stim
include severe acne, heart disease, liver problems,
ulants that can produce feelings of euphoria and alertness.
stroke, infectious diseases, depression, and suicide.
Methamphetamine’s effects are particularly longlasting and harmful
z Drug combinations. A particularly dangerous
to the brain. Amphetamines can cause high body temperature and
and common practice is the combining of two or more drugs.
can lead to serious heart problems and seizures.
The practice ranges from the coadministration of legal drugs, like
z MDMA (Ecstasy or “Molly”) produces both stimulant and mind
alcohol and nicotine, to the dangerous mixing of prescription
altering effects. It can increase body temperature, heart rate, blood
drugs, to the deadly combination of heroin or cocaine with fentanyl
pressure, and heartwall stress. MDMA may also be toxic to nerve
(an opioid pain medication). Whatever the context, it is critical to
realize that because of drug–drug interactions, such practices often
pose significantly higher risks than the already harmful individual
z LSD is one of the most potent hallucinogenic, or perceptionalter
ing, drugs. Its effects are unpredictable, and abusers may see vivid
colors and images, hear sounds, and feel sensations that seem real
For more information on the nature and extent of common drugs of abuse and their health consequences, go to NIDA’s Web site
(www.drugabuse.gov) to view the popular Research Reports (www.drugabuse.gov/ResearchReports/ResearchIndex.html), DrugFacts fact sheets and
other publications.V. TREATMENT AND RECOVERY
Can addiction be treated successfully
Addiction is a treatable disease. Research in the science of addiction and the treatment of substance use disorders has led to
YES. the development of evidencebased interventions that help people stop abusing drugs and resume productive lives.
Can addiction be cured
Not always—but like other chronic diseases, addiction can be managed successfully. Treatment enables people to counteract addiction’s powerful
disruptive effects on their brain and behavior and regain control of their lives.
bRAIN ReCOv eRy WITH PROLONGeD AbSTINeNCe
These images showing the den
sity of dopamine transporters in
a brain area called the striatum
illustrate the brain’s remarkable
potential to recover, at least
partially, after a long abstinence
from drugs—in this case,
Healthy Person METH Abuser METH Abuser
1 month abstinence 14 months abstinence
25Addiction need not be a life sentence.
Does relapse to drug abuse mean
COmPARISON OF ReLAPSe RATeS beTWeeN
DRUG ADDICTION AND OTHeR CHRONIC ILLNeSSeS
treatment has failed
No. The chronic nature of the disease means that relapsing to drug
abuse at some point is not only possible, but likely. Relapse rates (i.e.,
50 to 70 50 to 70
how often symptoms recur) for people with addiction and other sub 40 to 60
30 to 50
stance use disorders are similar to relapse rates for other wellunder
stood chronic medical illnesses such as diabetes, hypertension, and 20
asthma, which also have both physiological and behavioral compo
Drug Type I Hypertension Asthma
nents. Treatment of chronic diseases involves changing deeply imbed
ded behaviors, and relapse does not mean treatment has failed. For a
Relapse rates for people treated for substance use disorders are compared with those for people
person recovering from addiction, lapsing back to drug use indicates with diabetes, hypertension, or asthma. Relapse is common and similar across these illnesses (as is
adherence/nonadherence to medication). Thus, drug addiction should be treated like any other
that treatment needs to be reinstated or adjusted or that another treat
chronic illness; relapse serves as a trigger for renewed intervention.
ment should be tried.
Source: JAMA, 284:16891695, 2000
What are the principles of effective substance
How can medications help treat
use disorder treatment
Research shows that combining treatment medications (where avail
Different types of medications may be useful at different stages of treat
able) with behavioral therapy is the best way to ensure success for
ment to help a patient stop abusing drugs, stay in treatment, and avoid
most patients. Treatment approaches must be tailored to address each
patient’s drug use patterns and drugrelated medical, psychiatric, and
z Treating Withdrawal. When patients first stop using drugs, they
can experience a variety of physical and emotional symptoms,
including depression, anxiety, and other mood disorders, as well as
Percent of Patients Who Relapse27
restlessness or sleeplessness. Certain treat z Preventing Relapse. Science has taught
meDICATIONS USeD TO
ment medications are designed to reduce
us that stress, cues linked to the drug expe
TReAT DRUG ADDICTION
these symptoms, which makes it easier to
rience (such as people, places, things, and
stop the drug use.
moods), and exposure to drugs are the
most common triggers for relapse. n
z Staying in Treatment. Some treatment
Medications are being developed to inter
• Nicotine replacement
medications are used to help the brain
fere with these triggers to help patients sus
therapies (available as a patch,
adapt gradually to the absence of the
tain recovery. inhaler, or gum)
abused drug. These medications act slowly
to stave off drug cravings and have a calm • Bupropion
ing effect on body systems. They can help
How do behavioral therapies treat
patients focus on counseling and other psy
chotherapies related to their drug treat
Behavioral treatments help engage people in
substance use disorder treatment, modifying
their attitudes and behaviors related to drug
Alcohol and Drug Addiction
use and increasing their life skills to handle
stressful circumstances and environmental • Naltrexone
cues that may trigger intense craving for drugs
and prompt another cycle of compulsive use.
Behavioral therapies can also enhance the
effectiveness of medications and help people
remain in treatment longer.
Discoveries in science lead to advances in drug abuse treatment.Treatment must address the whole person.
How do the best treatment programs help
patients recover from the pervasive effects of
Gaining the ability to stop abusing drugs is just one part of a long and
complex recovery process. When people enter treatment for a sub
stance use disorder, addiction has often taken over their lives. The
compulsion to get drugs, take drugs, and experience the effects of
drugs has dominated their every waking moment, and abusing drugs
has taken the place of all the things they used to enjoy doing. It has
disrupted how they function in their family lives, at work, and in the
community, and has made them more likely to suffer from other seri
z Cognitive Behavioral Therapy seeks to help patients recognize, avoid,
ous illnesses. Because addiction can affect so many aspects of a per
and cope with the situations in which they are most likely to abuse drugs.
son’s life, treatment must address the needs of the whole person to be
z Contingency Management uses positive reinforcement such as providing
successful. This is why the best programs incorporate a variety of reha
rewards or privileges for remaining drug free, for attending and participating
bilitative services into their comprehensive treatment regimens.
in counseling sessions, or for taking treatment medications as prescribed.
Treatment counselors may select from a menu of services for meeting
the specific medical, psychological, social, vocational, and legal needs
z Motivational Enhancement Therapy uses strategies to evoke rapid and
of their patients to foster their recovery from addiction.
internally motivated behavior change to stop drug use and facilitate treat
For more information on substance use disorder treatment,
see Principles of Drug Addiction Treatment: A ResearchBased
z Family Therapy (especially for youth) approaches a person’s drug
Guide (www.drugabuse.gov/PODAT/PODATIndex.html) and Principles
problems in the context of family interactions and dynamics that may con
tribute to drug use and other risky behaviors. of Adolescent Substance Use Disorder Treatment: A ResearchBased
stanceusedisordertreatmentresearchbasedguide). VI. ADVANCING ADDICTION SCIENCE
AND PRACTICAL SOLUTIONS
Leading the Search for Scientific Solutions
o address all aspects of drug abuse and its harmful consequences, NIDA’s research program ranges from
DRUG ABUSE ADDICTION
basic studies of the addicted brain and behavior to health services research. NIDA’s research program
at All Levels
T develops prevention and treatment approaches and ensures they work in realworld settings. In this con
text, NIDA is strongly committed to developing a research portfolio that addresses the special vulnerabilities and
health disparities that exist among ethnic minorities or that derive from gender differences.
bringing Science to RealWorld Settings
z Clinical Trials Network (CTN)
CTN “road tests” researchbased drug abuse treatments in community treatment programs around the country.
z Criminal Justice Drug Abuse Treatment Studies (CJDATS)
Led by NIDA, CJDATS is a network of research centers, in partnership with criminal justice professionals, drug
abuse treatment providers, and Federal agencies responsible for developing integrated treatment approaches
for criminal justice offenders and testing them at multiple sites throughout the Nation.
z Juvenile Justice Translational Research on Interventions in the Legal System (JJTRIALS)
JJTRIALS is a sevensite cooperative research program designed to identify and test strategies for improving
the delivery of evidencebased substance abuse and HIV prevention and treatment services for justiceinvolved
Sharing Free Information With the Public
NIDA further increases the impact of its research on the problems of addiction by sharing free information about its findings with professional audiences and the
general public. Special initiatives target students and teachers as well as designated populations and ethnic groups.
Principles of Adolescent Substance Use
NIDA’s Special Initiatives for Special Initiative for Clinicians
Disorder Treatment: A ResearchBased
Students, Teachers, and Parents
Guide—This guide discusses the urgency of
treating addictions and other substance use
Heads Up: Real News About
NIDAMED— Tools and resources to increase
disorders in teenagers, answers common
Drugs and Your Body—A
awareness of the impact of substance use on
questions about how young people are treated
drug education series created by
patients' overall health and help clinicians and
for drug problems, and describes effective
NIDA and SCHOLASTIC INC. for students in
those in training identify patient drug use early and
treatment approaches supported by scientific
grades 6 to 12.
prevent it from escalating to abuse or addiction.
Principles of Drug Abuse Treatment
NIDA for Teens: The Science
Publications on Prevention
for Criminal Justice Populations:
Behind Drug Abuse—An inter
and Treatment Principles
A ResearchBased Guide—NIDA’s
active Web site geared specifically
researchbased guide for treating people with
Preventing Drug Use among Children and
to teens, with ageappropriate
addiction who are involved with the criminal
Adolescents: A ResearchBased Guide for
facts on drugs.
justice system provides 13 essential treatment
Parents, Educators, and Community
principles, and includes answers to frequently
Leaders—NIDA’s researchbased guide for prevent
asked questions and resource information.
ing drug abuse among children and adolescents pro
Drug Facts Chat Day—
vides 16 principles derived from effective drugpre
A Web chat between NIDA
vention research and includes answers to questions For more information:
scientists and teens, held
through school computer labs once a year on risk and protective factors as well as on commu All NIDA publications are available at
www.drugabuse.gov. Some publications
during National Drug Facts Week (below). nity planning and implementation.
www.drugabuse.gov/chat are also available in print, free of charge.
Principles of Drug Addiction Treatment: A
To order print copies call the DRUGPubs
ResearchBased Guide—This guide summarizes
National Drug Facts Week—
Research Dissemination Center at
the 13 principles of effective treatment, answers
A weeklong observance that
1–877–NIH– N IDA or go to
common questions, and describes types of treatment,
drugpubs.drugabuse.gov. Watch NIDA videos
providing examples of scientifically based and tested
events and dialogue between teens and scientists
(NIDA TV) at: www.drugabuse.gov/nidatv.
during National Drug Facts Week (below).
1. National Drug Intelligence Center. The Economic Impact of Illicit Drug Use on American Society. Washington, DC: United States Department of Justice, 2011.
2. Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, Patra J. Global burden of disease and injury and economic cost attributable to alcohol use and alcoholuse disorders. Lancet
3. Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs — 2014. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control
and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
4. Centers for Disease Control and Prevention (CDC). AlcoholRelated Disease Impact (ARDI). Atlanta, GA: CDC.
5. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
6. Shankaran S, Lester BM, Das A, Bauer CR, Bada HS, Lagasse L, Higgins R. Impact of maternal substance use during pregnancy on childhood outcome. Semin Fetal Neonatal Med 12(2):143150, 2007.
7. Fowler JS, Volkow ND, Kassed CA, Chang L. Imaging the addicted human brain. Sci Pract Perspect 3(2):416, 2007.
8. Lynskey MT, Heath AC, Bucholz KK, Slutske WS, Madden PAF, Nelson EC, Statham DJ, Martin NG Escalation of drug use in earlyonset cannabis users vs cotwin controls. JAMA 289:42733, 2003.
9. Verebey K, Gold MS. From coca leaves to crack: the effects of dose and routes of administration in abuse liability. Psychiatr Annals 18:513–520, 1988.
10. Hatsukami DK, Fischman MW. Crack cocaine and cocaine hydrochloride: Are the differences myth or reality. JAMA 276:15801588, 1996.
11. Gogtay N, Giedd JN, Lusk L, Hayashi KM, Greenstein D, Vaituzis AC, Nugent TF 3rd, Herman DH, Clasen LS, Toga AW, Rapoport JL, Thompson PM. Dynamic mapping of human cortical development
during childhood through early adulthood. Proc Natl Acad Sci 101(21):81748179, 2004.
12. Krohn MD, Lizotte AJ, Perez CM. The interrelationship between substance use and precocious transitions to adult statuses. J Health Soc Behav 38(1):87103, 1997.
13. National Institute on Drug Abuse. Preventing Drug Abuse among Children and Adolescents: A ResearchBased Guide for Parents, Educators, and Community Leaders (Second Edition) (NIH Publication
No. 044212A). Rockville, MD, 2003.
14. Johnston, L. D., O'Malley, P. M., Miech, R. A., Bachman, J. G., Schulenberg, J. E. (2014). Monitoring the Future national survey results on drug use: 19752013: Overview, key findings on adolescent
drug use. Ann Arbor: Institute for Social Research, The University of Michigan.
15. Di Chiara G, Imperato A. Drugs abused by humans preferentially increase synaptic dopamine concentrations in the mesolimbic system of freely moving rats. Proc Natl Acad Sci 85:52745278, 1988.
16. Fiorino DF, Phillips AG. Facilitation of sexual behavior and enhanced dopamine efflux in the nucleus accumbens of male rats after Damphetamine behavioral sensitization. J Neurosci 19:456463, 1999.
17. Di Chiara G, Tanda G, Cadoni C, Acquas E, Bassareo V, Carboni E. Homologies and differences in the action of drugs of abuse and a conventional reinforcer (food) on dopamine transmission: an
interpretive framework of the mechanism of drug dependence. Adv Pharmacol 42:983987, 1998.
18. Volkow ND, Chang L, Wang GJ, Fowler JS, LeonidoYee M, Franceschi D, Sedler MJ, Gatley SJ, Hitzemann R, Ding YS, Logan J, Wong C, Miller EN. Association of dopamine transporter reduction
with psychomotor impairment in methamphetamine abusers. Am J Psychiatry 158(3):377382, 2001.
19. U.S. Department of Health and Human Services. The health consequences of smoking: a report of the Surgeon General. Atlanta, Ga.: Dept. of Health and Human Services, Centers for Disease Control
and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; Washington, DC, 2004.
20. U.S. Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and
21. Centers for Disease Control and Prevention. HIV/AIDS Statistics Overview. See http://www.cdc.gov/hiv/statistics/basics/index.html
22. Centers for Disease Control and Prevention. HIV Surveillance Report, 2011; vol. 23. http://www.cdc.gov/hiv/topics/surveillance/resources/reports/. Published February 2013. Accessed May 2,2014.
23. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2005. Vol. 17. Rev ed. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention;
2007: Also available at: http://www.cdc.gov/hiv/topics/surveillance/resources/reports/.
24. Ezzati M, and Lopez AD. Estimates of global mortality attributable to smoking in 2000. Lancet 362(9387):847852, 2003.
25. Richard Peto and Alan D Lopez. Global Health in the 21st Century, published by JosseyBass, New York, edited by C Everett Koop, Clarence E Pearson and M Roy Schwarz, 2000.
26. Fowler JS, Logan J, Wang GJ, Volkow ND, Telang F, Zhu W, Franceschi D, Pappas N, Ferrieri R, Shea C, Garza V, Xu Y, Schlyer D, Gatley SJ, Ding YS, Alexoff D, Warner D, Netusil N, Carter P,
Jayne M, King P, Vaska P. Low monoamine oxidase B in peripheral organs in smokers. Proc Natl Acad Sci 100(20):1160011605, 2003.
27. Volkow ND, Chang L, Wang GJ, Fowler JS, Franceschi D, Sedler M, Gatley SJ, Miller E, Hitzemann R, Ding YS, Logan J. Loss of dopamine transporters in methamphetamine abusers recovers with
protracted abstinence. J Neurosci 21(23):94149418, 2001.
28. McLellan AT, Lewis DC, O’Brien CP, Kleber HD. Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA 284(13):16891695, 2000.
31NIH Pub No. 145605
Printed April 2007
Revised February 2008, August 2010, July 2014