Drug and alcohol abuse is a major problem, both for the directly affected individual and for society as a whole.
In 2014 alone, nearly 1 in 10 Americans reported illicit use of substances in the past month—higher than every year from 2002 until 2013.1 With such widespread abuse, it is important to stay informed about the most common questions regarding substance use and abuse.
Here are some commonly asked questions (and answers!) when it comes to drug and alcohol abuse.
Why do people abuse them?
People have many different reasons for using psychoactive substances. The most commonly reported reasons include social and recreational motivations, coping with negative emotions, and simply for the effects that the substances produce.2, 3 Additionally, the presence of these often-reported reasons are predictive of future problematic use and substance addiction.2
Is it possible to abuse over-the-counter drugs?
Abuse of over-the-counter (OTC) drugs is not only possible, it is very dangerous. Many of these substances contain ingredients in addition to the sought-after psychoactive drug that are carefully dosed by the manufacturer for the user’s safety. When taken in excess, these extra ingredients can cause extreme organ damage or worse, death.
For example, cough medicine, which is sometimes abused for its psychoactive ingredient dextromethorphan (DXM), also contains acetaminophen, a pain killer and fever reducer that can cause serious liver damage if taken in higher doses than directed.4
Cough medicine isn’t the only OTC drug containing acetaminophen—it is an active ingredient in hundreds of medications that are available without a prescription.
OTC drugs may seem safe because they’re widely available and medically trusted, but risking your body or life is simply not worth the high.
How do I know if I have an addiction?
Being addicted to drugs and having a physical dependence to them are very different. An addiction to a substance requires a number of behavioral diagnostic criteria as determined by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), the specifics of which vary by each particular substance use disorder. The general criteria for addiction include:
- Taking the drug in higher doses or for a longer time than intended.
- Unsuccessful efforts to cut back on use.
- Extreme cravings for the substance.
- Use of the substance has led to problems in work, school, or relationships.
- Continuing to use the substance despite negative life consequences.
- Responsibilities are neglected in favor of substance use.
While addiction is defined as a set of behaviors, dependence is a separate beast for a person to tackle. Dependence occurs when a person must continue taking the substance in order to avoid an uncomfortable or deadly withdrawal syndrome. Withdrawal occurs when the user’s body and brain have normalized or adjusted to the presence of the substance such that, in its absence, users feel the negative backlash of their abuse.
Is sharing prescription drugs illegal?
Sharing a prescription medication with someone else is known as drug diversion, and it is illegal. This has been a major problem with both prescription opioids and prescription stimulants.5, 6, 7 Although it may seem harmless, drug diversion can be very dangerous.
When a person is prescribed a medication, the dosing is carefully chosen based on that person’s medical history. Even if the same dose is taken by someone else, he or she runs the risk of allergic reactions to unknown ingredients, interactions with other medications, the eventual development of dependence or addiction, or even an overdose.
What are withdrawal symptoms?
Withdrawal symptoms are the name for the various discomforts that occur when a person stops using a substance after an extended period of chronic use. To various extents, they can arise after physical or psychological dependence to a substance has developed. Almost all of the commonly abused substances can produce withdrawal symptoms, and the specific syndrome will vary by drug.
Some withdrawal syndromes can be deadly, as is the case with opioids, alcohol, and benzodiazepines.8, 9, 10 Others are just extremely uncomfortable. The symptoms and severity will vary by the amount of drug a person was taking and how long they were using, so professional help weaning off a drug is often advised.
How long will drugs and alcohol show up on a drug test?
To some extent, the amount of time it takes to be completely clean from a substance is determined by its half-life, which refers to the amount of time it takes for the kidneys and liver to process half the amount of the drug in the body. For example, marijuana’s half-life varies by frequency of use: an infrequent user can eliminate half the amount of THC in about 1.3 days, whereas a frequent user will take 5 to 13 days to process half the THC present.11
The half-life of a substance will fractionally decrease. This means that if a drug’s half-life is 2 days, half the drug will be eliminated within 2 days, and it will take an additional 2 days to process half of the remaining half (i.e. one-quarter of the original substance amount). The user would still have 25% of the original amount in their system after 4 days, 12.5% after 6 days, and so on.
Because every substance has a different half-life, the amount of time a substance will test positive on a test will vary by the amount taken, frequency of use, individual metabolism rates, and the type of test implemented.12 Substances linger longer in fat, hair, and fingernails than in blood and urine, so a user will test positive for substances longer with certain types of drug tests. Urine and saliva tests have a much shorter detection frame than hair analysis or blood analysis.
How long do treatment programs last?
The length of substance abuse treatment depends on each person’s individual needs. Recovery plans are customized to address particular issues or challenges that a person may face. While there is no treatment length that has been shown to be an effective recovery minimum, most treatment programs offer 30-day, 60-day, and 90-day recovery plans to help users through the difficult beginnings of abstinence. In general, the longer a person works with a professional treatment plan, the better his or her recovery outcome can be.13
How much does it cost to treat someone with a substance abuse or addiction problem?
Treatment costs can vary widely, from free therapy services to $25,000 or more per month for executive inpatient programs. Certain factors affect the cost of a recovery program:
- Residential or inpatient programs tend to cost more than outpatient programs.
- Longer program stays generally cost more than shorter ones.
- Luxury program services cost more than standard services.
- Urban treatment centers tend to have a higher price than rural ones.
- Smaller program size may be more expensive than larger programs.
The more services, luxuries, and program overhead costs, the more a recovery program will cost. While the cost of rehab may seem daunting, remember that the cost of addiction is just as high, if not higher, due to the extensive medical and personal health costs that hide behind the basic substance price.
Many programs offer payment options that help reduce the financial impact of treatment. Payment plans help by splitting up the total cost over monthly payments. Sliding scale payment methods involve an income-based fee structure and what a person can reasonably afford to pay. Some facilities even offer recovery scholarships to cover part or all of the rehab costs, so make sure to ask about these options.
What is a co-occurring disorder?
Having a co-occurring disorder can refer to two different substance use disorders present in the same person or having a dual diagnosis of a substance use disorder and a mental health disorder. Co-occurring disorders are somewhat common, with nearly 6% of people seeking mental health treatment having a co-occurring non-alcohol substance use disorder, 4% an alcohol use disorder, and 4% having a use disorder involving both alcohol and other drugs.14
Sometimes, one disorder can arise from another. For example, a person struggling with depression may begin abusing stimulants for their euphoric effects. Conversely, a person abusing stimulants may begin developing depression as a result of negative life consequences associated with their addiction.
Treatment for co-occurring disorders must be tailored to the specific dual diagnosis. Mood disorders have a particularly strong association with substance use problems, and therapy and treatment should adequately address both issues.15
Are older adults at risk for drug and alcohol abuse?
Anyone can struggle with substance abuse, no matter their age. Substance abuse among older adults is nothing new: people 65 and older account for more than one-third of U.S. spending on prescription medications—many of which can be abused—despite only accounting for 13% of the population.16
Unfortunately, substance abuse in this population is often overlooked, perhaps due to the shame associated with use, but more likely due to the symptom similarities between substance abuse and common behavioral and medical disorders in this age group.17 Regardless of a person’s age, substance abuse treatment is a vital step toward recovery from substance abuse.
How can a 12-step program help?
Well-known 12-step programs like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are free support programs for recovering substance abusers. The topics of these support groups cover most substance classes, but there are 12-step groups for all kinds of issues related to addiction. These groups can range from behavioral addictions, like Sex Addicts Anonymous, to support for family and friends of substance users.
Programs such as these offer community-level support and foster a network of sober-minded individuals. Members are able to help and learn from each other along their recovery path. In fact, there is some evidence that participation in a 12-step program like AA predicts longer abstinence than not participating in a support program.18, 19
How many people overcome their addictions?
Unfortunately, reliable information on rates of abstinence following treatment is difficult to find. Measuring recovery is a tricky endeavor, because people recover at their own pace and in their own way. Recovery is a life-long process, not a one-and-done deal, and many people will struggle with relapse, but this does not mean that recovery is impossible. Entering treatment can be one of the most important and life-changing decisions substance users can make, setting them on their journey toward sobriety with the tools and support to best prepare them for the challenges to come.
If you are concerned that substance abuse has impacted you or someone you care about, treatment can make all the difference. Treatment plans are catered to the individual’s needs, and there are multiple options available to those seeking help.
- Detoxification, or detox, involves purging the substance from the body through sustained abstinence. Some substances have very dangerous withdrawal symptoms that arise during detox, and professional detox services can be important in case an emergency arises.
- Inpatient treatment involves leaving home and staying at a treatment facility for 24-hour care. This allows recovering users to focus entirely on recovery and learn how to practice lasting sobriety.
- Outpatient treatment is when the recovering user continues to live at home and go to work, but attends regular check-ins and therapy sessions at a treatment facility.
- Medication-assisted treatment (MAT) involves a combination of FDA-approved medications beneficial for a number of types of substance dependence (e.g., alcohol dependence, opioid dependence) with behavioral therapies focused on lasting recovery.
- Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health.
- Terry-McElrath, Y. M., O’Malley, P. M. & Johnston, L. D. (2009). Reasons for drug use among American youth by consumption level, gender, and race/ethnicity: 1976-2005. Journal of Drug Issues, 39(3), 677-714.
- Patrick, M. E., Schulenberg, J. E., O’Malley, P. M., Johnston, L. D. & Bachman, J. G. (2011). Adolescents’ reported reasons for alcohol and marijuana use as predictors of substance use and problems in adulthood. Journal on the Study of Alcohol and Drugs, 72(1), 106-116.
- U.S. Food and Drug Administration. (2016). Acetaminophen information.
- McCabe, S. E., Teter, C. J. & Boyd, C. J. (2006). Medical use, illicit use and diversion of prescription stimulant medication. Journal of Psychoactive Drugs, 38(1), 43-56.
- Wilens, T. E., Adler, L. A., Adams, J., Sgambati, S., Rotrosen, J., Sawtelle, R., Utzinger, L. & Fusillo, S. (2008). Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature. Journal of American Academy of Child and Adolescent Psychiatry, 47(1), 21-31.
- Center for Medicare and Medicaid services. (2016). Prescription opioids– an overview for prescribers and pharmacists.
- U.S. National Library of Medicine. (2016). Opiate and opioid withdrawal.
- U.S. National Library of Medicine. (2016). Alcohol withdrawal.
- Petursson, H. (1994). The benzodiazepine withdrawal syndrome. Addiction, 89(11), 1455-1459.
- Smith-Kielland, A., Skuterud, B. & Morland, J. (1999). Urinary excretion of 11-nor-9-carboxy-delta 9-tetrahydrocannabinol and cannabinoids in frequent and infrequent drug users. Journal of Analytical Toxicology, 23(5), 323–332.
- U.S. Food and Drug Administration. (2014). Drugs of abuse home use test.
- Moos, R. H. & Moos, B. S. (2003). Long-term influence of duration and intensity of treatment on previously untreated individuals with alcohol use disorders. Addiction, 98(3), 325-337.
- Ponizovsky, A. M., Rosca, P., Haklai, Z. & Goldberger, N. (2015). Trends in dual diagnosis of severe mental illness and substance use disorders, 1996-2010, Israel. Drug and Alcohol Dependence, 148, 203-208.
- Grant, B. F., Stinson, F. S., Dawson, D. A., Chou, P., Dufour, M. C., Compton, W., Pickering, R. P. & Kaplan, K. (2004). Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry, 61(8), 807-816.
- National Institute on Drug Abuse. (2014). Prescription drug abuse: older adults.
- Center for Substance Abuse Treatment. (1998). Substance Abuse Among Older Adults: Chapter 1 – Substance Abuse Among Older Adults: An Invisible Epidemic. Rockville (MD): Substance Abuse and Mental Health Services Administration (US).
- Moos R.H. & Moos B.S. (2006). Participation in treatment and Alcoholics Anonymous: a 16-year follow-up of initially untreated individuals. Journal of Clinical Psychology, 62(6), 735-750.
- Connors G.J., Tonigan J.S. & Miller W.R. (2001). A longitudinal model of intake symptomatology, AA participation, and outcome: retrospective study of the Project MATCH outpatient and aftercare samples. Journal of Studies on Alcohol, 62(6), 817-825.