Kratom is an herbal supplement that shares structural similarities with opioid analgesics
Opioid-like dependence due to chronic kratom use can be successfully treated with buprenorphine, according to a recent case report published in the Journal of Addiction Medicine.
Kratom, an herbal supplement that shares structural similarities with opioid analgesics, has recently grown in popularity as an unapproved opioid replacement therapy. The drug is easily obtained via the Internet (as it does not require a prescription), but oftentimes contains higher than typical doses and may be mixed with adulterants, increasing the risk of toxicity.
In their article, the authors report on two patients who used kratom to self-treat their chronic pain after they could no longer receive opioid analgesics from healthcare providers. Both patients presented to the clinic with evidence of kratom dependence and withdrawal and underwent home initiation of sublingual buprenorphine-naloxone therapy. In each case, transitioning to buprenorphine-naloxone maintenance led to control of both their chronic pain and opioid withdrawal symptoms.
“Although some debate whether kratom is a true opioid or not, this case series shows that opioid agonist treatment with buprenorphine-naloxone is effective for some patients with kratom dependence and demonstrates 2 safe home initiations of buprenorphine,” concluded the authors.
There’s a lot of confusion about what drug addiction (also called substance use disorder, or SUD) actually means, even though it’s a problem that affects millions of Americans from all walks of life. The National Institute on Drug Abuse (NIDA) defines drug addiction as a chronic brain disease and one in which relapses are very common. It isn’t, though, a sign of weak moral character or lack of willpower. What might start as a choice to try a drug (as a legitimate prescription or recreationally) can result, over time, in someone losing the ability to choose and becoming addicted.
People with addiction cannot abstain, stop their drug-seeking behavior or control cravings without getting help. They compulsively need to use, regardless of the damage the addiction is causing in their lives – physically, mentally, emotionally, educationally, socially, spiritually, financially. Treatment is often necessary because the disease typically gets progressively worse and can even lead to disability or premature death. In fact, according to NIDA, using tobacco products is the number one preventable cause of disease, disability and death in the U.S.
Drugs of Addiction
To make matters more complicated, there are many types of drugs that people can become addicted to, and each has its own way of affecting the body, including its own unique withdrawal symptoms. Commonly abused substances include not just illicit drugs but also some prescription medications such as opioids (like oxycodone and hydrocodone), stimulants (such as cocaine and dextroamphetamine) and depressants (including benzodiazepines and barbiturates). These drugs may at first be prescribed for medical reasons and a person later takes the medication in a way that wasn’t prescribed by their healthcare provider, or illegally takes a medication without a prescription. Still others become addicted to over-the-counter medications like cough or cold syrups and sleeping pills that are readily available, legal drugs. Other commonly abused drugs include hallucinogens, inhalants, sedatives, hypnotics, cannabis (marijuana, for non-medical purposes), alcohol and, as mentioned above, tobacco.
Drugs Change the Brain
Part of the reason substance use disorders are so complex to understand and to treat is that over time drugs of abuse can actually change circuits in the brain – and those changes can persist even after stopping the drug and going through detoxification, or “detox.” Some drugs activate the brain’s reward system in such an intense way that a person can start to ignore activities they once enjoyed as they seek the intense pleasure or “high” the drug gives, driving them to keep using; cocaine and methamphetamine are good examples of this. When a drug user experiences this feeling of intoxication, it can affect their thinking, judgment, emotions and behavior and can lead to breathing problems, seizures, coma or even death. The brain can adapt to produce less dopamine (the neurotransmitter that controls the body’s reward and pleasure centers); the result is that the addict needs an ever-larger dose to experience the same high. Still other drugs, such as marijuana and heroin, work to dupe the brain into believing they’re brain chemical messengers known as neurotransmitters.
It’s important to understand that not everyone who tries a drug of abuse becomes addicted. Several factors are involved, including one’s biology (which includes family history and physiology), environment (whether friends and family use illicit drugs, for example) and developmental stage (adolescents are particularly vulnerable because their brains are still developing). All drugs have the potential to be addictive. But, in general, addiction to cocaine, methamphetamine and heroin can happen more quickly with fewer doses. (Alcohol is a very commonly abused drug, too; for more information on alcoholism, please visit the Alcoholism section.)
How Big is the Problem?
If you’re reading this because you’re concerned that you or a loved one may have a substance use problem, you’re not alone. Drug use is very common:
Nearly 25 million Americans were illicit drug users in 2013, according to the National Survey on Drug Use and Health (NSDUH), which came out in 2014.
That same report shows that an estimated 21.6 million Americans ages 12 and older had a substance use disorder in the previous year, meaning an addiction to drugs or alcohol.
Depression and other mental health issues play an important role in the prevalence of drug addiction; many people have both an SUD and a mental health issue (what’s known as co-occurring disorders). In other cases, people who become addicted to a drug of abuse may go on to experience one or more symptoms of a mental health problem such as an anxiety disorder, depression or psychosis – what’s known as a substance-induced mental disorder.
An SUD can be mild, moderate or severe, depending on how many symptoms a person has. The more symptoms, the greater the severity of the drug addiction. Many illicit drugs, but not all, produce withdrawal symptoms; those that do include opioids, sedatives, hypnotics (such as LSD) and anxiolytics (drugs to treat anxiety). Tobacco products, stimulants and marijuana have less apparent withdrawal symptoms, according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, but they still cause withdrawal.
When people are addicted to a substance, it means in part that they’ve built up a tolerance to the drug; cravings make quitting extremely difficult – one of the reasons stopping a drug should be done under medical supervision. The first step, detoxification, is often done with the help of prescription medication to make the process more comfortable, but counseling is also needed to prevent the relapses that are common with this disease. Unfortunately, millions of addicts who could benefit from care at a specialty facility like a rehabilitation center don’t receive it, according to the NSDUH. For those who are addicted to two or more substances (what’s called a poly-drug addiction), treatment providers need to consider every substance a person is using when creating a treatment plan.
If you suspect that you or a loved one has a substance use problem, talk to a doctor, health care professional, addiction specialist or psychotherapist. These professionals can evaluate symptoms and make an accurate diagnosis that will help the recovery process begin.
People who abuse substances often say they take them to have fun or get high. It’s not that simple for addicts, though. An addicted person can no longer control whether or not he/she uses. Mentally and physically, the addict feels compelled to have the drug. Addiction is considered a chronic disease with the possibility of relapse an ever-present reality.
What you should know:
Addiction is a disease that is complex but treatable.
Prolonged drug use affects brain function.
Illegal drugs are defined as controlled substances under federal and state law. They are monitored and enforced by the Drug Enforcement Agency (DEA).
Marijuana is the most-used illicit drug, with 19.8 million U.S. users age 12 and over, according to the 2013 National Survey on Drug Use and Health (NSDUH), which is published by the Substance Abuse and Mental Health Services Administration (SAMHSA).
Six-and-a-half million Americans use prescription pain relievers non-medically, and 1.5 million are dependent on or abusing cocaine, according to SAMHSA’s 2013 NSDUH survey.
In 2013, 22.7 million people 12 and over who could have benefited from substance use treatment in a specialty facility did not receive that help. It’s a myth that someone must want to go into treatment for substance abuse for it to be effective, says the National Institute on Drug Abuse (NIDA).
For decades, researchers have been trying to figure out what leads people to become addicted to drugs. While there’s no single root cause of drug addiction, experts think a combination of the following are most likely to play a role:
Your role models. Your early years, including your mother’s and father’s parenting styles and whether one or both parents or even an older sibling abused substances can affect whether you experiment with drugs and go on to develop an addiction. Our early role models, for good or ill, influence our behavior. They can also teach us appropriate ways to handle problems, bounce back and persevere; these coping skills make it less likely someone will develop an addiction. A family history of substance abuse is also linked to an increased risk. For more on the role of genetics, go the Risk Factors section.
Your personal history. Stressful or traumatic events, living in poverty, the availability of illegal drugs, peer pressure and whether or not your friends and family use drugs – all are associated with a greater likelihood of developing a substance abuse problem.
Your psychological makeup. How you feel about yourself, especially your self-esteem during adolescence, your temperament, a tendency toward impulsive behavior and exhibiting aggressive or antisocial behavior early in life are thought to forecast later drug or alcohol problems as well as a tendency toward violence.
On the flip side, there are factors that can lower someone’s chances of having an addiction; these include developing good self-control, practicing religious beliefs, having healthy relationships with family and friends and being involved in social activities in the community, reports SAMSHA.
Symptoms of Drug Addiction
There are a number of signs that may indicate a substance abuse problem, including:
A change in friends and hangouts
An unexplained need for cash
Bloodshot eyes or enlarged pupils
Sudden weight changes (gain or loss)
Tremors in the hands
A drop in attendance at work or school
Changes in sleep, mood, motivation or attitude
Keep in mind that physical dependence on a drug or medication is not the same thing as having an addiction; a person may be dependent on a drug if he or she experiences withdrawal symptoms if the drug is stopped. Someone may also develop a tolerance to the substance so that he or she requires increasingly larger doses of a drug in order to achieve the same effect or high. And when a drug user comes off a substance, he or she may experience withdrawal symptoms that vary depending on the substance(s). According to the American Psychiatric Association’s (APA) diagnostic manual, DSM-5, “Neither tolerance nor withdrawal is necessary for a diagnosis of a substance use disorder.”
Doctors, therapists and addiction counselors look at a variety of factors when deciding whether someone has a substance use disorder. If you or a loved one have two or three of the indicators below, it can point to a mild problem with drugs, while having four or five symptoms can underscore a moderate problem. Six or more of these symptoms may signal a severe substance use disorder. No matter how serious a drug problem is, recognizing the symptoms of drug addiction is the all-important first step to getting help – and recovering. So ask yourself these questions:
Are you or a loved one…
Using a substance over a longer time period of time than planned?
Making unsuccessful attempts to control or stop taking the drug(s)?
Spending a lot of time finding, using or recovering from using a substance(s)?
Experiencing cravings for a substance(s)?
Failing to show up or fulfill expectations at work, school or home?
Continuing to use an illegal substance(s) despite problems it’s causing in relationships?
Giving up activities once enjoyed in order to use a drug(s)?
Using a drug(s) regularly while in situations where it poses physical danger (such as driving, operating machinery or boating)?
Ignoring physical or psychological problems resulting from drug use?
Developing a tolerance for a drug’s effects?
Experiencing withdrawal symptoms or masking them with another substance(s)?
The more you know about substance abuse, the better the chances of avoiding a drug addiction before it starts. Here are several red flags that raise the risk of becoming a substance abuser:
Inheriting the genes
As mentioned above, your biological makeup has a lot to do with whether you’ll develop an addiction. In fact, the APA goes so far as to say that 50% of your susceptibility to becoming addicted is related to genetic factors. And when it comes to tobacco, genetics account for 75% of a person’s tendency to try smoking and 60% of their chances of becoming hooked. But DNA alone isn’t destiny. Besides the genes you’re born with, environmental factors, like how you were raised; whether you were sexually or physically abused; and whether you grew up in poverty or witnessed violence can also influence a person’s vulnerability to addiction.
Dealing with a mental health issue
If you or someone you love suffers from a mental disorder such as depression, anxiety, attention deficit disorder, post-traumatic stress disorder schizophrenia or an eating disorder, among other conditions, substance abuse is likelier to become a problem. In 2013, nearly eight million U.S. adults had both a substance use disorder and at least one mental issue. And 2.3 million of that group had a co-occurring SUD and a serious mental health issue, which the NSDUH defines as “a mental, behavioral or emotional disorder that substantially interferes with or limits one or more major life activities.”
Experimenting at an early age
In 2013, nearly 9% of U.S. adolescents ages 12 to 17 were illicit drug users, and 1.3 million teens had a diagnosed SUD. While it’s possible to become an addict at any age, many teens are natural risk-takers, mostly because the parts of the brain in charge of self-control and good judgment are still developing in adolescence. That can make trying illicit drugs a lot more attractive. The trouble is, say experts at NIDA, “the earlier drug use begins, the more likely it will progress to more serious abuse.” And there’s some evidence to suggest that how a drug is taken – especially if it’s smoked or injected into a vein – may increase its risk of becoming addictive.
There’s no single treatment that’s right for someone trying to overcome a substance addiction. Treatment for a substance use disorder (SUD) usually begins with detoxification or “detox” – a process during which the patient is medically supported while the substance(s) is removed from the person’s system. When someone enters treatment, one of the first things he/she may experience during the detox process is withdrawal, which can include physical symptoms such as nausea, diarrhea, shaking, fever, insomnia and sweating and/or psychological symptoms such as depression, anxiety, anger and upset. In some cases, a drug rehabilitation center will use FDA-approved medications to help counteract withdrawal symptoms with the goal of weaning the patient off the medication as soon as possible; although sometimes medication-assisted therapy is needed on a long-term basis to prevent cravings that can trigger drug-seeking behavior and relapse. While detox is the first step to any kind of treatment, counseling is also typically needed to achieve lasting results.
Whether a substance use disorder is mild, moderate or severe, some kind of treatment is usually necessary, which makes it tragic that only a small number of those who need help actually get it. According to the Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health (2013), only 2.5 million people out of the 22.7 million people who needed treatment for drug or alcohol use actually received help at a specialty facility While there’s no cure for drug addiction, for most (though not all), abstinence or giving up the substance entirely is necessary.
Below are some of the most common treatment options for substance use disorders. If you or a loved one seek treatment for drug addiction, it’s likely that a combination of several of these approaches will be recommended and used:
Drug rehabilitation programs use a variety of counseling approaches to help people experience lasting recovery. Types of counseling include:
SMART Recovery® (Self-Management and Recovery Training): This community-support program has a four-point plan to teach self-reliance, and clients using SMART Recovery benefit from online support groups, message boards and chat rooms as well as in-person meetings to stay motivated in their recovery efforts.
BRENDA: BRENDA combines psychosocial counseling and pharmacotherapy (prescription drugs) to help patients deal with substance addiction. The acronym refers to the steps a counselor takes in treating a client using this method:
Report to the patient on evaluation findings
Needs identified by both the patient and therapist
Direct advice to the patient
Assessing the patient’s reaction to advice; modifying the plan when needed
This treatment model uses a type of psychotherapy called cognitive-behavioral therapy (CBT) in which a therapist will help clients examine their thinking and feelings in an effort to change negative and unproductive thoughts and beliefs that may lead to drug use.
Other types of counseling:
Motivational incentives: For gains made in treatment, drug and alcohol counselors may offer a reward system to encourage patients to work hard in recovery. Rewards might be for a special privilege, outing or voucher.
Motivational Interviewing (MI): Therapists who use MI help clients feel inspired and empowered to make needed life changes and to reach recovery goals.
Multidimensional Family Therapy (MDFT): Sometimes the whole family needs to be willing to evaluate its dynamics in order to help one or more member(s) overcome an addiction and/or another mental health issue. MDFT involves the whole family in the healing process to improve relationships, end enabling behavior and create harmony.
Sometimes the right option for treating drug addiction may be going to an inpatient or residential treatment center to live for a period of time. How long depends on the severity of the addiction, the kind of addiction(s) and the patient’s progress. These specialized facilities offer medically-supervised detox, which is a process to get drugs out of the bloodstream and tissues. In rehab, patients also receive intensive counseling to cope with triggers, cravings and any co-occurring mental health disorders. It’s helpful to think of rehab as a kind of retreat where the addict lives and works on learning to overcome triggers of addiction and manage any underlying mental disorders that require treatment along with the substance use disorder.
There are also outpatient rehab programs where patients live at home but attend a drug treatment (or partial hospitalization) program during the day, which may last for seven or eight hours. Or you or your loved one may attend an evening program that meets several times a week for several hours in the evenings only. With outpatient day or evening programs, patients sleep at home, which can be successful as long as drug networks, old haunts and triggers don’t interfere with the progress of treatment. While in treatment, patients in these programs, too, work on understanding their addiction and any mental health issues through counseling.
When selecting a program, be aware that there are customized programs tailored to groups of people who are like-minded; by bringing together people from similar backgrounds who are grappling with the same or similar issue, members can effectively work together as a group. Program alumni may even meet up later for special weekends and offer one another ongoing support in recovery. Read on for several examples of custom-tailored programs now being offered by some treatment centers:
Christian programs address drug addiction with a Bible-based approach, so attendees can find strength through faith. Treatment may include counseling and 12-step or other community-support programs, yet the focus on scripture allows members of these programs to be guided to recovery in large part through their beliefs.
Women-only programs address both the substance use disorder as well as any past history of abuse or trauma or mental illness that may underpin a drug addiction.
Adolescent programs tend to be gender-specific and allow teens a safe place where they can work to overcome drug addiction while also attending classes, so they don’t fall behind in school during treatment.
Spanish-speaking programs make treatment more relatable for those who speak English as a second language. Counselors, too, speak Spanish, and all written materials are printed in Spanish.
Medication-Assisted Therapy (MAT)
The Food and Drug Administration (FDA) has approved several prescription medications for the treatment of substance use disorders. Medication-assisted therapy proves most effective when used in conjunction with other approaches, such as counseling. Pharmacological approaches designed to help substance abusers detox and reduce the chances of relapse include these medications:
For opioids: The FDA has approved several prescription medications for opiate addiction to heroin, morphine or prescription painkillers like oxycodone and hydrocodone. There are a variety of prescription drugs that are used in treating opioid use disorders with active ingredients that either reduce withdrawal symptoms, like cravings, or block the effects of opiates altogether. These include:
Buprenorphine – (brand name: Subutex): An initial treatment to prevent or reduce withdrawal symptoms such as drug cravings
Methadone – (brand names: Dolophine or Methadose): Used to prevent withdrawal symptoms and to block the high from taking illicit opiates. Only authorized, specially licensed facilities can administer methadone maintenance.
Naltrexone – (brand names: Depade, Revia, and Vivitrol): All three block the effects of opioids; Vivitrol is an extended-release injection, given once a month.
Naloxone – (brand name: Suboxone): Prescribed as a maintenance medication that contains buprenorphine as well, Suboxone blocks or reverses the effects of opioids. For opioid overdoses, Evzio, an auto-injector containing naloxone, is available for emergency home use.
While there are other prescription medications in the drug pipeline and now being tested, there are no drugs currently available for the treatment of cocaine, methamphetamine, cannabis (marijuana) or hallucinogen use disorders.
The original 12-step program is one you’ve undoubtedly heard of before: Alcoholics Anonymous (AA), which has been around since 1935. AA has been helping alcoholics get and stay sober for decades with meetings available in big cities and small towns across the globe. Over time, this community of support, in which alcoholics help each other, has inspired other, similar programs for a wide variety of drug addictions that people grapple with:
These 12-step programs borrow at least in part from the AA model, which is based on 12 consecutive processes (each step building on the one(s) preceding it). The steps include minimizing self-centeredness, providing support to others in the group and making amends to those whom the substance abuser has hurt, among others. For a full list of the 12 steps, go to the Get Help section.
While some addicts rely solely on 12-step programs to treat and recover from their drug addiction, others use it in conjunction with counseling. And often 12-step programs are included as part of inpatient and outpatient drug rehabilitation.
For tobacco/nicotine: For tobacco products containing highly addictive nicotine, several nicotine replacement therapies are available over-the-counter at drugstores. These include nicotine patches, sprays, gums and lozenges that alleviate drug cravings. Prescription drugs such as bupropion (brand names: Wellbutrin, Zyban) and varenicline (brand name: Chantix) are also FDA-approved.
If you find yourself asking the question, Am I addicted to drugs? you should take the answer to that question very seriously. Unless recognized and treated, an addiction to a medication or illicit/illegal drug can greatly diminish your chances of leading a functional life, maintaining a daily routine or experiencing an enduring sense of well-being. Fortunately, you can perform a fairly accurate self-assessment of your drug-using status if you know the signs that indicate active addiction.
What Is Drug Addiction?
The potential for drug (and alcohol) addiction arises when your brain starts to treat the chemical changes triggered by your habitual substance intake as a normal operating condition. Experts in the field refer to this state as physical dependence. Physical dependence transitions into active addiction when you lose control over your ability to limit the number of times you use a given substance and/or your ability to limit the amount of that substance you take on any given occasion.
Signs to Look For
In addition to losing control over the frequency and amount of your drug intake, you may also experience a range of other problems that point to the presence of an addiction. Specific things you may notice include:
An intense desire for the drug
The need to increase your intake of the drug in order to keep feeling its effects
Establishment of drug use as your daily priority
Devotion of money to purchasing drugs even if it means failing to meet important financial obligations
A drug-based inability to meet other important personal, social, school-related or work-related responsibilities
Repeated use of drugs in situations that pose a clear danger to yourself or others
Overlap With Substance Abuse
When trying to figure out if you are addicted to drugs, it’s crucial to understand that doctors and public health officials don’t make a firm distinction between drug addiction and non-addicted drug abuse. Even if you don’t have problems with physical dependence, you can experience changes in your thoughts and behaviors that significantly interfere with your ability to function or maintain a feeling of wellness. In fact, the guidelines currently used by doctors in the U.S. include the symptoms of addiction and non-addicted substance abuse in a single illness category called substance use disorder. There are subtypes of this disorder for alcohol and every major addictive drug/medication.