Drug Addiction (Substance Use Disorder)
Source: Mayo Clinic, Accessed October 24, 2023
https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112

Overview

Drug addiction, also called substance use disorder, is a disease that affects a person's brain and behavior and leads to an inability to control the use of a legal or illegal drug or medicine. Substances such as alcohol, marijuana and nicotine also are considered drugs. When you're addicted, you may continue using the drug despite the harm it causes.

Drug addiction can start with experimental use of a recreational drug in social situations, and, for some people, the drug use becomes more frequent. For others, particularly with opioids, drug addiction begins when they take prescribed medicines or receive them from others who have prescriptions.

The risk of addiction and how fast you become addicted varies by drug. Some drugs, such as opioid painkillers, have a higher risk and cause addiction more quickly than others.

As time passes, you may need larger doses of the drug to get high. Soon you may need the drug just to feel good. As your drug use increases, you may find that it's increasingly difficult to go without the drug. Attempts to stop drug use may cause intense cravings and make you feel physically ill. These are called withdrawal symptoms.

Help from your health care provider, family, friends, support groups or an organized treatment program can help you overcome your drug addiction and stay drug-free.

Symptoms

Drug addiction symptoms or behaviors include, among others:

• Feeling that you have to use the drug regularly — daily or even several times a day
• Having intense urges for the drug that block out any other thoughts
• Over time, needing more of the drug to get the same effect
• Taking larger amounts of the drug over a longer period of time than you intended
• Making certain that you maintain a supply of the drug
• Spending money on the drug, even though you can't afford it
• Not meeting obligations and work responsibilities, or cutting back on social or recreational activities because of drug use
• Continuing to use the drug, even though you know it's causing problems in your life or causing you physical or psychological harm
• Doing things to get the drug that you normally wouldn't do, such as stealing
• Driving or doing other risky activities when you're under the influence of the drug
• Spending a good deal of time getting the drug, using the drug or recovering from the effects of the drug
• Failing in your attempts to stop using the drug
• Experiencing withdrawal symptoms when you attempt to stop taking the drug

 Recognizing unhealthy drug use in family members

 Sometimes it's difficult to distinguish normal teenage moodiness or anxiety from signs of drug use. Possible signs that your teenager or other family member is using drugs include:

•  Problems at school or work — frequently missing school or work, a sudden disinterest in school activities or work, or a drop in grades or work performance
•  Physical health issues — lack of energy and motivation, weight loss or gain, or red eyes
•  Neglected appearance — lack of interest in clothing, grooming or looks
• Changes in behavior — major efforts to bar family members from entering the teenager's room or being secretive about going out with friends; or drastic changes in behavior and in relationships with family and friends
• Money issues — sudden requests for money without a reasonable explanation; or your discovery that money is missing or has been stolen or that items have disappeared from your home, indicating maybe they're being sold to support drug use

Recognizing signs of drug use or intoxication

Signs and symptoms of drug use or intoxication may vary, depending on the type of drug. Below you'll find several examples.

Marijuana, hashish and other cannabis-containing substances

People use cannabis by smoking, eating or inhaling a vaporized form of the drug. Cannabis often precedes or is used along with other substances, such as alcohol or illegal drugs, and is often the first drug tried.

Signs and symptoms of recent use can include:

•   A sense of euphoria or feeling "high"
•   A heightened sense of visual, auditory and taste perception
•   Increased blood pressure and heart rate
•  Red eyes
•   Dry mouth
•   Decreased coordination
•   Difficulty concentrating or remembering
•   Slowed reaction time
•   Anxiety or paranoid thinking
•   Cannabis odor on clothes or yellow fingertips
•   Major cravings for certain foods at unusual times

Long-term use is often associated with:

• Decreased mental sharpness
• Poor performance at school or at work
• Ongoing cough and frequent lung infections

  K2, Spice and bath salts

Two groups of synthetic drugs — synthetic cannabinoids and substituted or synthetic cathinones — are illegal in most states. The effects of these drugs can be dangerous and unpredictable, as there is no quality control and some ingredients may not be known.

Synthetic cannabinoids, also called K2 or Spice, are sprayed on dried herbs and then smoked, but can be prepared as an herbal tea. A liquid form can be vaporized in electronic cigarettes. Despite manufacturer claims, these are chemical compounds rather than "natural" or harmless products. These drugs can produce a "high" similar to marijuana and have become a popular but dangerous alternative.

Signs and symptoms of recent use can include:

• A sense of euphoria or feeling "high"
• Elevated mood
• An altered sense of visual, auditory and taste perception
• Extreme anxiety or agitation
• Paranoia
• Hallucinations
• Increased heart rate and blood pressure or heart attack
• Vomiting
• Confusion
• Violent behavior

 Substituted cathinones, also called "bath salts," are mind-altering (psychoactive) substances similar to amphetamines such as ecstasy (MDMA) and cocaine. Packages are often labeled as other products to avoid detection.

 Despite the name, these are not bath products such as Epsom salts. Substituted cathinones can be eaten, snorted, inhaled or injected and are highly addictive. These drugs can cause severe intoxication, which results in dangerous health effects or even death.

Signs and symptoms of recent use can include:

•  Feeling "high"
•  Increased sociability
• Increased energy and agitation
•  Increased sex drive
•  Increased heart rate and blood pressure
•  Problems thinking clearly
•  Loss of muscle control
•  Paranoia
• Panic attacks
•  Hallucinations
•  Delirium
•  Psychotic and violent behavior

Barbiturates, benzodiazepines and hypnotics

Barbiturates, benzodiazepines and hypnotics are prescription central nervous system depressants. They're often used and misused in search for a sense of relaxation or a desire to "switch off" or forget stress-related thoughts or feelings.

•   Barbiturates. An example is phenobarbital.
•   Benzodiazepines. Examples include sedatives, such as diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin) and chlordiazepoxide (Librium).
•   Hypnotics. Examples include prescription sleeping medicines such as zolpidem (Ambien) and zaleplon (Sonata).

 Signs and symptoms of recent use can include:

• Drowsiness
•  Slurred speech
• Lack of coordination
•  Irritability or changes in mood
•  Problems concentrating or thinking clearly
•  Memory problems
•  Involuntary eye movements
•  Lack of inhibition
•  Slowed breathing and reduced blood pressure
•  Falls or accidents
•  Dizziness

Meth, cocaine and other stimulants

Stimulants include amphetamines, meth (methamphetamine), cocaine, methylphenidate (Ritalin, Concerta, others) and amphetamine-dextroamphetamine (Adderall XR, Mydayis). They're often used and misused in search of a "high," or to boost energy, to improve performance at work or school, or to lose weight or control appetite.

Signs and symptoms of recent use can include:

• Feeling of happy excitement and too much confidence
• Increased alertness
• Increased energy and restlessness
• Behavior changes or aggression
• Rapid or rambling speech
• Larger than usual pupils, the black circles in the middle of the eyes
• Confusion, delusions and hallucinations
• Irritability, anxiety or paranoia
• Changes in heart rate, blood pressure and body temperature
• Nausea or vomiting with weight loss
• Poor judgment
• Nasal congestion and damage to the mucous membrane of the nose (if snorting drugs)
• Mouth sores, gum disease and tooth decay from smoking drugs ("meth mouth")
• Insomnia
• Depression as the drug wears off

 Club drugs

Club drugs are commonly used at clubs, concerts and parties. Examples include methylenedioxymethamphetamine, also called MDMA, ecstasy or molly, and gamma-hydroxybutyric acid, known as GHB. Other examples include ketamine and flunitrazepam or Rohypnol — a brand used outside the U.S. — also called roofie. These drugs are not all in the same category, but they share some similar effects and dangers, including long-term harmful effects.

Because GHB and flunitrazepam can cause sedation, muscle relaxation, confusion and memory loss, the potential for sexual misconduct or sexual assault is associated with the use of these drugs.

Signs and symptoms of use of club drugs can include:

• Hallucinations
• Paranoia
• Larger than usual pupils
• Chills and sweating
• Involuntary shaking (tremors)
• Behavior changes
• Muscle cramping and teeth clenching
• Muscle relaxation, poor coordination or problems moving
• Reduced inhibitions
• Heightened or altered sense of sight, sound and taste
• Poor judgment
• Memory problems or loss of memory
• Reduced consciousness
• Increased or decreased heart rate and blood pressure

Hallucinogens

Use of hallucinogens can produce different signs and symptoms, depending on the drug. The most common hallucinogens are lysergic acid diethylamide (LSD) and phencyclidine (PCP).

LSD use may cause:

• Hallucinations
• Greatly reduced perception of reality, for example, interpreting input from one of your senses as another, such as hearing colors
• Impulsive behavior
• Rapid shifts in emotions
• Permanent mental changes in perception
• Rapid heart rate and high blood pressure
• Tremors
• Flashbacks, a reexperience of the hallucinations — even years later

PCP use may cause:

•  A feeling of being separated from your body and surroundings
•  Hallucinations
•  Problems with coordination and movement
• Aggressive, possibly violent behavior
•  Involuntary eye movements
•  Lack of pain sensation
•  Increase in blood pressure and heart rate
•  Problems with thinking and memory
•  Problems speaking
•  Poor judgment
•  Intolerance to loud noise
•  Sometimes seizures or coma

Inhalants

Signs and symptoms of inhalant use vary, depending on the substance. Some commonly inhaled substances include glue, paint thinners, correction fluid, felt tip marker fluid, gasoline, cleaning fluids and household aerosol products. Due to the toxic nature of these substances, users may develop brain damage or sudden death.

 Signs and symptoms of use can include:

• Possessing an inhalant substance without a reasonable explanation
• Brief happy excitement
• Behaving as if drunk
• Reduced ability to keep impulses under control
• Aggressive behavior or eagerness to fight
• Dizziness
•  Nausea or vomiting
•  Involuntary eye movements
•  Appearing under the influence of drugs, with slurred speech, slow movements and poor coordination
•  Irregular heartbeats
•  Tremors
•  Lingering odor of inhalant material
•  Rash around the nose and mouth

Opioid painkillers

Opioids are narcotic, painkilling drugs produced from opium or made synthetically. This class of drugs includes, among others, heroin, morphine, codeine, methadone, fentanyl and oxycodone.

Sometimes called the "opioid epidemic," addiction to opioid prescription pain medicines has reached an alarming rate across the United States. Some people who've been using opioids over a long period of time may need physician-prescribed temporary or long-term drug substitution during treatment.

Signs and symptoms of narcotic use and dependence can include:

• A sense of feeling "high"
• Reduced sense of pain
• Agitation, drowsiness or sedation
• Slurred speech
• Problems with attention and memory
• Pupils that are smaller than usual
• Lack of awareness or inattention to surrounding people and things
• Problems with coordination
• Depression
• Confusion
• Constipation
• Runny nose or nose sores (if snorting drugs)
•  Needle marks (if injecting drugs)

________________________________________________________________________________

Fentanyl Addiction: Symptoms and Signs of Abuse
American Addictions Center, September 13, 2022
Source: https://americanaddictioncenters.org/fentanyl-treatment/signs-of-abuse

What Is Fentanyl?

Fentanyl is a highly addictive synthetic opiate used to treat chronic and severe pain. Fentanyl is at least 50-100 times stronger than morphine. Symptoms of fentanyl abuse and/or withdrawal may include:

• A rapid heartbeat
• Pounding in the ears
• Chest tightness
• Mood changes
• Poor balance or coordination
• Hallucinations
• Abnormal thoughts
• Opening a fentanyl patch to eat its gel beads
• Buying fentanyl illegally from people who may have a lawful prescription
• Showing fear at the prospect of not having access to fentanyl

As the National Institute on Drug Abuse (NIDA) explains, fentanyl is a generic synthetic opioid.

This means that fentanyl is a narcotic pain reliever that carries a high risk of abuse. Typically, fentanyl is used after surgery for the treatment of severe pain. The drug is the main ingredient in different branded drugs, including but not limited to Fentora, Sublimaze, and Duragesic. This manmade narcotic comes in different formats, including as a tablet, patch, spray, and lozenge. All formats are potent, addictive, and an overdose could prove fatal. In fact, fentanyl is 50-100 times more powerful than morphine (an opiate derived from the poppy plant, as is heroin).

Physical, Mental & Behavioral Signs of Fentanyl Abuse

The Diagnostic and Statistical Manual of Mental Disorders, 5^th edition (DSM-5), is a main diagnostic tool within the mental health and addiction treatment community. Per the DSM-5, a person is considered to be suffering from a substance use disorder (note, the term addiction is no longer used) if at least two symptoms emerge within the same 12-month period. There are a total of 11 possible symptoms. The more symptoms that are present, the higher the grade of use disorder along a continuum from mild to moderate to severe.

The DSM-5 specifically recognizes opioid use disorder. A person who would be considered, in lay terms, to be experiencing fentanyl addiction would be clinically considered to have an opioid use disorder (at the severe end of the continuum). The following is a paraphrased description of the 11 symptoms associated with an opioid use disorder:

• More fentanyl is taken, or it is taken for a greater length of time than initially intended (i.e., the slippery slope from recreational narcotics use to addiction).
• The individual has the ongoing desire to stop abusing fentanyl, or at least cut down on the abuse, but is unable to do so.
• A significant portion of one’s day, energy, time, and money is used to obtain fentanyl, abuse it, or recover from its use.
• The person has urges or cravings to use fentanyl.
• As a result of the ongoing fentanyl abuse, the person is not able to adequately meet obligations at home, work, or school.
• Even though the fentanyl abuse is causing various problems, the person continues to abuse this narcotic.
• The person withdraws from or reduces participation in work, social, recreational, and other opportunities to abuse fentanyl.
• The individual continues to abuse fentanyl even when there is awareness of the dangerous situations that arise, such as while driving.
• Use of fentanyl continues, even though it is causing or exacerbating a psychological or physical problem.
• The person develops a tolerance to the drug – the natural process whereby the body demands more of a drug in order for the person to experience a high similar to that of an earlier period of use.
• Withdrawal symptoms occur when the fentanyl use stops or the familiar dosage is decreased (symptoms discussed in further detail below).

Side Effects of Fentanyl Use

The side effects associated with fentanyl can emerge, with greater severity, in individuals who abuse this drug. For this reason, it is helpful to consider some of the most common side effects, which include but are not limited to:

 Confusion

• Chest pain
• Convulsions
• Blurred vision
• Black stools
• Labored breathing
• Irregular heartbeat
• Fainting
• Feeling of a tight chest
• Dizziness or lightheadedness
• Decrease in urine flow
• Cough
• Dry mouth
• Fever or chills
• Loss of appetite
• Mood changes
• Pounding in ears
• Pale skin
• Back pain or side pain
• Nervousness
• Tingling or numbness in the hands, lips, or feet
• Ulcers, sores, or white spots in the mouth
• Sneezing, sore throat, or sunken eyes
• Swelling in the calves, ankles, feet, and hands
• Fatigue

One of the most common side effects of fentanyl abuse is the onset of addiction (to be clinically accurate, addiction per the DSM-5, would be called an opioid use disorder). When the body continues to receive fentanyl, it naturally makes adjustments. One adjustment is to build tolerance, which then requires the person to take more fentanyl in order to achieve the desired high.

There is a great danger implicit in tolerance — as the fentanyl intake rises, so too does the risk of harmful side effects. The body wants to promote survival but once drugs are introduced, and drugs are foreign substances to the body, the system gets turned into a potential engine of personal destruction.

More Rare Side Effects

The side effects that are considered rare for individuals who use fentanyl for therapeutic purposes under the control of a doctor may be brought out by abuse of fentanyl. Some of the less common side effects include but are not limited to:

• Problems walking and balancing
• Clumsiness
• Stomach or abdominal
• Headache
• Muscle jerking or twitching
• Less responsiveness to stimuli
• Hallucinations (visual, audio, and tactile)
• Severe constipation
• Extreme sleepiness
• Abnormal thoughts
• Slowed or fast paced heartbeat
• Trembling
• Seizures

Signs of Fentanyl Overdose

When a person uses fentanyl as part of a medically supervised pain management plan, there is little risk of overdose. However, fentanyl abuse exposes a person to an ongoing risk of overdose. The most common signs of fentanyl overdose are slow breathing or acutely shallow breathing. If the following symptoms arise and persist, it may be necessary to seek medical attention:

• Shallow or slowed breathing
• Depression; feeling empty or discouraged
• Loss of strength
• Muscle stiffness
• Lack of interest in activities
• Back pain
• Diarrhea

Signs of Fentanyl Withdrawal

When a person stops using fentanyl or considerably reduces the familiar dose, withdrawal symptoms emerge. The following are some of the most common fentanyl withdrawal symptoms may include: 

• Restlessness
• Yawning
• Chills
• Irritability or anxiety
• Runny nose or watery eyes
• Sweating or chills
• Muscle pain
• Overall weakness
• Stomach cramps
• Widened pupils
• Joint pain
• Backache
• Fast breathing
• High blood pressure
• Increased heart rate
• Nausea
• Vomiting

There is a general advisement in the addiction treatment community that an individual should not attempt to stop using narcotics suddenly. The opioid withdrawal process can be particularly uncomfortable, and suddenly stopping the use of narcotics can trigger severe withdrawal symptoms to emerge. Rehab programs that offer medication-assisted therapy will provide eligible clients with substitution therapy in the form of drugs like methadone or Suboxone (buprenorphine).

It is called substitution therapy because the person is safely transitioned to the treatment medication without fully detoxing from narcotics. Some individuals will remain on an opioid substitution therapy for months or even years. Other individuals will eventually reach full detoxification (i.e., no opioids or opiates in the body).

Behavioral Signs of Fentanyl Abuse

It is helpful to learn about behavioral symptoms of fentanyl abuse from different sources, including a person who has been down that road. Mary Grables (pseudonym) wrote an article for the informational site The Fix, about how she got into fentanyl abuse and some of the ways that she behaved as a result. Based on Mary’s account, the following are things that people who abuse fentanyl may do in order to obtain and use this narcotic:

• They may get pills from and/or trade pills with classmates.
• They may search the Internet for people selling pain pills in free-to-use websites such Craigslist.
• They may buy fentanyl off college students who are drug dealers, or from elderly or disabled individuals. Sometimes, individuals who need extra money will sell their legitimately obtained prescription pills. Pain management doctors conduct blood tests on their patients who have opioids prescriptions, so it is uncertain how sustainable it is for any one person to keep selling their prescriptions, though they may know work-arounds, such as taking a few pills before their next drug test. The entire setup is as testament to the extent to which some people feel desperate for money while others feel desperate for drugs.
• In some instances, medical staff at a hospital (such as a nurse) may resort to selling fentanyl or other pain medications for money. Mary recounts a story of a nurse who was selling drugs to pay for her spouse’s cancer treatment.
• They may open up fentanyl patches to eat the contents. This takes place in an effort to try to get high more quickly (the patch is slow-releasing). Mary describes how she consistently did this.
• Users may perceive themselves to be above the stigma that is sometimes associated with heroin because fentanyl is a synthetic, prescription drug and therefore (erroneously) thought to be less of a street drug. Of course, this isn’t true; it only reflects what individuals who are addicted to fentanyl might believe.
• They may sleep all day, and lose jobs, friends, and relationships in the process.
• They may experience considerable weight gain.

Mary’s experience sheds light on areas that may be too subtle for a research project to discover, such as chewing fentanyl patches. Her account demonstrates that many different behaviors can be expected when a person makes drug use a priority. Mary’s account reflects the great difference in thinking between a person who is in recovery versus one who is firmly in the grip of addiction. Mary encountered numerous players in the illegal prescription drug sale market, yet none of them were the villains that a media story may make people in these situations out to be. Mary’s story only highlights the need for people who are experiencing fentanyl or other drug abuse to get help.

Further, it’s not just that drugs cost money, but that people often stop being able to take care of their basic needs or keep a job. On the one hand, there’s the direct cost of fentanyl use, and on the other hand, there are all of the lost opportunity costs. The recovery process addresses each facet of drug abuse. Treatment can safely transition people to an opioid substitution therapy or guide them through a complete detox process. It can then address the root causes behind the fentanyl abuse and empower them with tools to build a drug-free future.