To add to that, repeated use of drugs can damage the essential decision-making center at the front of the brain. This area, known as the prefrontal cortex, is the very region that should help you recognize the harms of using addictive substances.
The Science of Drug Use: A Resource for the Justice Sector
People use drugs for many reasons: they want to feel good, stop feeling bad, or perform better in school or at work, or they are curious because others are doing it and they want to fit in. The last reason is very common among teens.
Drugs excite the parts of the brain that make you feel good. But after you take a drug for a while, the feel-good parts of your brain get used to it. Then you need to take more of the drug to get the same good feeling. Soon, your brain and body must have the drug just to feel normal. You feel sick, awful, anxious, and irritable without the drug. You no longer have the good feelings that you had when you first used the drug. This is true if you use illegal drugs or if you misuse prescription drugs. Misuse includes taking a drug differently than how your doctor tells you to (taking more or crushing pills to “shoot up” or snort), taking someone else’s prescription, or taking it just to get “high.”
Drug use can start as a way to escape—but it can quickly make your life worse. Besides just not feeling well, different drugs can affect your brain and body in many different ways. Here are a few:
- Alcohol: You might have trouble making decisions, solving problems, remembering,
and learning. - Marijuana: You might forget things you just learned or have trouble focusing.
- Prescription pain relievers (opioids) or sedatives: Your heart rate and breathing
may slow to dangerous levels, leading to coma or death. - Heroin: Similar to opioid pain relievers, your heart rate and breathing may slow
to dangerous levels, leading to coma or death. - Prescription stimulants (e.g., ADHD medications): Your body temperature could
get dangerously high, or you may have an irregular heartbeat, heart failure, or seizures. - Cocaine and methamphetamine: You may get violent, have panic attacks or feel
paranoid, or have a heart attack. - MDMA (Ecstasy or Molly): You may feel confused for a long time after you take it
and have problems with attention, memory, and sleep. - LSD: Your emotions may change quickly, and you might not be able to recognize
reality; frightening flashbacks can happen long after use. - Inhalants: Your heart, kidneys, lungs, and brain may get damaged; even a healthy
person can suffer heart failure and death within minutes of sniffing a lot of an inhalant.
Many drugs can also make driving a car unsafe. Marijuana can slow reaction time, make you judge time and distance poorly, and decrease coordination (how you move your body). Cocaine and methamphetamine can make a driver aggressive and reckless. Certain kinds of sedatives, called benzodiazepines, can make you dizzy or drowsy. These effects can lead to crashes that can cause injuries and even death.
What is drug addiction?
Drug addiction is when you can’t stop taking the drug even if you want to. The urge is too strong to control, even if you know the drug is causing harm. The addiction can become more important than the need to eat or sleep. The urge to get and use the drug can fill every moment of your life. The addiction replaces all the things you used to enjoy. A person who is addicted might do almost anything—lie, steal, or hurt people—to keep taking the drug. This can lead to problems with your family and friends, and can even lead to arrest and jail. You can get addicted to illegal drugs as well as prescription drugs if you misuse them.
Drug addiction is a chronic disease. That means it stays with you for a long time, even if you stop using for a while. It doesn’t go away like a cold. A person with an addiction can get treatment, but quitting for good can be very hard.
Can I just use willpower to stop using drugs?
At first, taking drugs is usually your choice. But as you continue to take them, using self-control can become harder and harder; this is the biggest sign of addiction. Brain studies of people with addiction show physical changes in parts of the brain that are very important for judgment, making decisions, learning and memory, and controlling behavior. Scientists have shown that when this happens to the brain, it changes how the brain works and it explains the harmful behaviors of addiction that are so hard to control.
If I stay off drugs for a while (e.g., in the criminal justice system or in residential treatment), will it be easy to remain drug-free?
Sometimes people quit their drug use for a while because they’re away from triggers that remind them about their drug use. Away from home, drugs might be less available. Once you go back to normal life, you’re likely to start using again unless you take action to avoid your triggers. This return to drug use is called a relapse. People recovering from addiction often have one or more relapses along the way if they don’t take steps to avoid their triggers.
What is a trigger?
A trigger is anything that makes you feel the urge to go back to using drugs. It can be a place, person, thing, smell, feeling, picture, or memory that reminds you of taking a drug and getting high. A trigger can be something stressful that you want to escape from. It can even be something that makes you feel happy. People fighting addiction need to stay away from the people and triggers that can make them start using drugs again, just like people with breathing problems need to avoid smoke and dust.
People who have stayed sober for a while, either because they were in jail or in treatment, should know that they are at a high risk of overdose if they relapse and take the same amount of drug they used to. Their cravings may not have decreased, but their tolerance has, meaning their body can’t handle high doses of the drug anymore. Without immediate treatment, overdose often leads to death. This is why you often hear about people dying of an overdose soon after leaving rehab.
What makes people more likely to get addicted to drugs?
- Trouble at home. If your home is an unhappy place, or was when you were growing up, you might be more likely to have a drug problem. When kids aren’t well cared for, or there are lots of fights, or a parent is using drugs, the chance of addiction goes up.
- Mental health problems. People who have untreated mental health problems, such as depression or anxiety, or untreated attention-deficit/hyperactivity disorder (ADHD) are more likely to become addicted. They might use drugs to try to feel better.
- Trouble in school, trouble at work, trouble with making friends. Failures at school or work, or trouble getting along with people, can make life hard. You might use drugs to get your mind off these problems.
- Hanging around other people who use drugs. Friends or family members who use drugs might get you into trouble with drugs as well.
- Starting drug use when you’re young. When kids or teens use drugs, it affects how their bodies and brains finish growing. Using drugs when you’re young increases your chances of becoming addicted when you’re an adult.
- Your biology. Everyone’s bodies react to drugs differently. Some people like the feeling the first time they try a drug and want more. Other people hate how it feels and never try it again. Scientists don’t have a test yet that will predict how each person will react.
Can drug addiction be treated?
Yes. People who get treatment and stick with it can stop using drugs. They can change their lives so they don’t go back to taking drugs. But they have to try hard and follow the treatment program for a long time. Recovery from addiction means you have to stop using drugs AND learn new ways of thinking, feeling, and dealing with problems. It’s best not to use in the first place. If you do get addicted, it’ll be a long and difficult road.
After you’ve stopped using the drug, you still have a lot to do:
- You have to relearn how to live without using drugs.
- You have to work on the problems your drug use caused with your family, your job, your friends, and your money.
- You have to stay away from people you used drugs with and places where you used.
- You have to learn what makes you want to take drugs again (your triggers), so you can avoid or work on those things.
- You may also need treatment for problems that led to your drug use, such as depression, anxiety,
or other mental health problems.
Where to Get Help
You can call the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP (4357) (toll free) or go to FindTreatment.gov at any time to learn more about substance use treatment and recovery support resources near you. If you or someone you know is experiencing severe symptoms or is in immediate danger, seek immediate medical attention by calling 9-1-1 or visit an emergency department.
If you or someone you know is experiencing a substance use and/or mental health crisis or any other kind of emotional distress, call or text 988 or chat www.988lifeline.org to reach SAMHSA’s 988 Suicide and Crisis Lifeline. Trained counsellors are available 24/7 to help you.
Loved ones of people with substance use disorders may be interested in SAMHSA’s Resources for Families Coping with Mental and Substance Use Disorders.
For information and help to quit smoking, visit SmokeFree.gov or call the National Cancer Institute Quitline at 1-877-44U-QUIT (1-877-448-7848).
Prevention Resources
For adults needing information for their own children or for children they care about:
- Underage Drinking Prevention: Talk. They Hear You (SAMHSA)
- Partnership for Drug-Free Kids (Drugfree.org)
- Alcohol Use: Conversation Starters (Health.gov)
Biology of Addiction
People with addiction lose control over their actions. They crave and seek out drugs, alcohol, or other substances no matter what the cost—even at the risk of damaging friendships, hurting family, or losing jobs. What is it about addiction that makes people behave in such destructive ways? And why is it so hard to quit?
NIH-funded scientists are working to learn more about the biology of addiction. They’ve shown that addiction is a long-lasting and complex brain disease, and that current treatments can help people control their addictions. But even for those who’ve successfully quit, there’s always a risk of the addiction returning, which is called relapse.
The biological basis of addiction helps to explain why people need much more than good intentions or willpower to break their addictions.
“A common misperception is that addiction is a choice or moral problem, and all you have to do is stop. But nothing could be further from the truth,” says Dr. George Koob, director of NIH’s National Institute on Alcohol Abuse and Alcoholism. “The brain actually changes with addiction, and it takes a good deal of work to get it back to its normal state. The more drugs or alcohol you’ve taken, the more disruptive it is to the brain.”
Researchers have found that much of addiction’s power lies in its ability to hijack and even destroy key brain regions that are meant to help us survive.
A healthy brain rewards healthy behaviors—like exercising, eating, or bonding with loved ones. It does this by switching on brain circuits that make you feel wonderful, which then motivates you to repeat those behaviors. In contrast, when you’re in danger, a healthy brain pushes your body to react quickly with fear or alarm, so you’ll get out of harm’s way. If you’re tempted by something questionable—like eating ice cream before dinner or buying things you can’t afford—the front regions of your brain can help you decide if the consequences are worth the actions.
But when you’re becoming addicted to a substance, that normal hardwiring of helpful brain processes can begin to work against you. Drugs or alcohol can hijack the pleasure/reward circuits in your brain and hook you into wanting more and more. Addiction can also send your emotional danger-sensing circuits into overdrive, making you feel anxious and stressed when you’re not using the drugs or alcohol. At this stage, people often use drugs or alcohol to keep from feeling bad rather than for their pleasurable effects.
To add to that, repeated use of drugs can damage the essential decision-making center at the front of the brain. This area, known as the prefrontal cortex, is the very region that should help you recognize the harms of using addictive substances.
“Brain imaging studies of people addicted to drugs or alcohol show decreased activity in this frontal cortex,” says Dr. Nora Volkow, director of NIH’s National Institute on Drug Abuse. “When the frontal cortex isn’t working properly, people can’t make the decision to stop taking the drug—even if they realize the price of taking that drug may be extremely high, and they might lose custody of their children or end up in jail. Nonetheless, they take it.”
Scientists don’t yet understand why some people become addicted while others don’t. Addiction tends to run in families, and certain types of Stretches of DNA, a substance you inherit from your parents, that define characteristics such as your risk for certain disorders, such as addiction. genes have been linked to different forms of addiction. But not all members of an affected family are necessarily prone to addiction. “As with heart disease or diabetes, there’s no one gene that makes you vulnerable,” Koob says.
Other factors can also raise your chances of addiction. “Growing up with an alcoholic; being abused as a child; being exposed to extraordinary stress—all of these social factors can contribute to the risk for alcohol addiction or drug abuse,” Koob says. “And with drugs or underage drinking, the earlier you start, the greater the likelihood of having alcohol use disorder or addiction later in life.”
Teens are especially vulnerable to possible addiction because their brains are not yet fully developed—particularly the frontal regions that help with impulse control and assessing risk. Pleasure circuits in adolescent brains also operate in overdrive, making drug and alcohol use even more rewarding and enticing.
NIH is launching a new nationwide study to learn more about how teen brains are altered by alcohol, tobacco, marijuana, and other drugs. Researchers will use brain scans and other tools to assess more than 10,000 youth over a 10-year span. The study will track the links between substance use and brain changes, academic achievement, IQ, thinking skills, and mental health over time.
Although there’s much still to learn, we do know that prevention is critical to reducing the harms of addiction. “Childhood and adolescence are times when parents can get involved and teach their kids about a healthy lifestyle and activities that can protect against the use of drugs,” Volkow says. “Physical activity is important, as well as getting engaged in work, science projects, art, or social networks that do not promote use of drugs.”
To treat addiction, scientists have identified several medications and behavioral therapies—especially when used in combination—that can help people stop using specific substances and prevent relapse. Unfortunately, no medications are yet available to treat addiction to stimulants such as cocaine or methamphetamine, but behavioral therapies can help.
“Treatment depends to a large extent on the severity of addiction and the individual person,” Koob adds. “Some people can stop cigarette smoking and alcohol use disorders on their own. More severe cases might require months or even years of treatment and follow-up, with real efforts by the individual and usually complete abstinence from the substance afterward.”
NIH-funded researchers are also evaluating experimental therapies that might enhance the effectiveness of established treatments. Mindfulness meditation and magnetic stimulation of the brain are being assessed for their ability to strengthen brain circuits that have been harmed by addiction. Scientists are also examining the potential of vaccines against nicotine, cocaine, and other drugs, which might prevent the drug from entering the brain.
“Addiction is a devastating disease, with a relatively high death rate and serious social consequences,” Volkow says. “We’re exploring multiple strategies so individuals will eventually have more treatment options, which will increase their chances of success to help them stop taking the drug.”
