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Drug addiction treatments include organized inpatient or outpatient treatment programs, counseling, and self-help groups to help you resist using the addictive drug again. Depending on your level of addiction, you may need steps to help you withdraw from using the drug (detoxification).

Therapies such as counseling, addiction treatment programs and self-help group meetings can help you overcome an addiction and stay sober.
•Treatment programs. Treatment programs generally include educational and therapy sessions focused on getting sober and preventing relapse. This may be accomplished in individual, group or family sessions. These programs are available in various settings from outpatient to residential and inpatient programs.
•Counseling. Individual or family counseling with a psychologist, psychiatrist or addiction counselor may help you resist the temptation to resume using addicting drugs. Behavior therapies can help you develop ways to cope with your drug cravings, suggest strategies to avoid drugs and prevent relapse, and offer suggestions on how to deal with a relapse if it occurs. Counseling can also involve talking about your job, legal problems, and relationships with family and friends. Counseling with family members can help them develop better communication skills and be more supportive.
•Self-help groups. Many, though not all, of these groups tend to use the 12-step model first developed by Alcoholics Anonymous. Self-help groups, such as Narcotics Anonymous, exist for people addicted to drugs, such as cocaine, sedatives and narcotics. The message is that addiction is a chronic disorder with a danger of relapse and that ongoing maintenance treatment — which may include medications, counseling and self-help group meetings — is necessary to prevent a relapse. Your doctor or counselor can help you locate a self-help group. You also can find listings for self-help groups in the phone book, at the library and on the Internet.

Withdrawal therapy

The goal of withdrawal therapy (detoxification) is for you to stop taking the addicting drug as quickly and safely as possible. Detoxification may involve gradually reducing the dose of the drug or temporarily substituting other substances, such as methadone, that have less severe side effects. For some people, it may be safe to undergo withdrawal therapy on an outpatient basis; others may require admission to a hospital or a residential treatment center.

Withdrawal from different categories of drugs produces different side effects and requires different approaches.
•Depressants (includes barbiturates, benzodiazepines and others). Minor side effects of withdrawal may include restlessness, anxiety, sleep problems and sweating. More-serious signs and symptoms also could include hallucinations, whole-body tremors, seizures, and increased blood pressure, heart rate and body temperature. Withdrawal therapy may involve gradually scaling back the amount of the drug, adding another medication to help stabilize the nerve cells during detoxification or both.
•Stimulants (includes amphetamines, methamphetamine, cocaine, Ritalin and others). Side effects of withdrawal typically include depression, fatigue, anxiety and intense cravings. In some cases, signs and symptoms may include suicidal thoughts and suicide attempts, paranoia, and decreased contact with reality (acute psychosis). Treatment during withdrawal is usually limited to emotional support from your family, friends and doctor. Your doctor may recommend medications to treat paranoid psychosis or depression.
•Opioids (includes heroin, morphine, codeine, OxyContin and others). Withdrawal side effects of opioids can range from relatively minor to severe. On the minor end, they may include runny nose, sweating, yawning, anxiety and drug cravings. Severe reactions can include sleeplessness, depression, dilated pupils, rapid pulse, rapid breathing, high blood pressure, abdominal cramps, tremors, bone and muscle pain, vomiting, and diarrhea. Doctors may substitute an artificial opiate, such as methadone or buprenorphine (Subutex, others), to reduce the craving for heroin during recovery.

Dependence on drugs can create a number of life-changing complications. They can include:
•Health problems. Drug addiction can lead to a range of both short- and long-term mental and physical health problems. These depend on what drug is taken.
•Unconsciousness, coma and sudden death. Taking some drugs can be particularly risky, especially if you take high doses or combine them with other drugs or alcohol.
•Getting a communicable disease. People who are addicted to a drug are more likely to get an infectious disease, such as HIV, either through unsafe sex or by sharing needles.
•Accidents. If you’re addicted to a drug, you’re more likely to drive or do other dangerous activities while intoxicated.
•Suicide. People who are addicted to drugs commit suicide more often than do people who aren’t.
•Family problems. Behavioral changes may cause marital or family strife and custody issues.
•Work issues. Work performance may decline, and you may be absent from work more often.
•Problems at school. Academic performance and motivation to excel in school may suffer.
•Legal issues. These can stem from stealing to support your drug addiction, driving while under the influence of drugs or alcohol, and disputes over child custody.
•Financial problems. Spending money to support your habit takes away money from your other needs, could put you into debt, and could lead you into illegal or unethical behaviors.

People of any age, sex or economic status can become addicted to a drug. However, certain factors can affect the likelihood of your developing an addiction:
•Family history of addiction. Drug addiction is more common in some families and likely involves the effects of many genes. If you have a blood relative, such as a parent or sibling, with alcohol or drug problems, you’re at greater risk of developing a drug addiction.
•Being male. Men are twice as likely to have problems with drugs.
•Having another psychological problem. If you have a psychological problem, such as depression, attention-deficit/hyperactivity disorder or post-traumatic stress disorder, you’re more likely to become dependent on drugs.
•Peer pressure. Particularly for young people, peer pressure is a strong factor in starting to use and abuse drugs.
•Lack of family involvement. A lack of attachment with your parents may increase the risk of addiction, as can a lack of parental supervision.
•Anxiety, depression and loneliness. Using drugs can become a way of coping with these painful psychological feelings.
•Taking a highly addictive drug. Some drugs, such as heroin and cocaine, cause addiction faster than do others.

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Most drug addictions start with casual or social use of a drug. For some people, using the drug becomes a habit, and its use becomes more and more frequent. 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 becomes increasingly difficult to go without the drug. Stopping may cause intense cravings and make you feel physically ill (withdrawal symptoms).

Drug addiction symptoms or behaviors include:
•Feeling that you have to use the drug regularly — this can be daily or even several times a day
•Failing in your attempts to stop using the drug
•Making certain that you maintain a supply of the drug
•Spending money on the drug, even though you can’t afford it
•Doing things to obtain the drug that you normally wouldn’t do, such as stealing
•Feeling that you need the drug to deal with your problems
•Driving or doing other risky activities when you’re under the influence of the drug
•Focusing more and more time and energy on getting and using the drug

Recognizing drug abuse in teenagers

It can sometimes be difficult to distinguish normal teenage moodiness or angst from signs of drug use. Possible indications that your teenager is using drugs include:
•Problems at school. Frequently missing classes or missing school, a sudden disinterest in school or school activities, or a drop in grades may be indicators of drug use.
•Physical health issues. Lack of energy and motivation may indicate your child is using certain drugs.
•Neglected appearance. Teenagers are generally concerned about how they look. A lack of interest in clothing, grooming or looks may be a warning sign of drug use.
•Changes in behavior. Teenagers enjoy privacy, but exaggerated efforts to bar family members from entering their rooms or knowing where they go with their friends might indicate drug use. Also, drastic changes in behavior and in relationships with family and friends may be linked to drug use.
•Spending money. Sudden requests for money without a reasonable explanation for its use may be a sign of drug use. You may also discover money stolen from previously safe places at home. Items may disappear from your home because they’re being sold to support a drug habit.

Recognizing signs of drug use and dependence

The particular signs and symptoms of drug use and dependence vary depending on the type of drug. You might be able to tell that a family member or a friend is using or abusing a drug based on the physical and behavioral signs and symptoms associated with the drug.

Marijuana and hashish

It’s possible to develop a psychological addiction to cannabis compounds including tetrahydrocannabinol (THC) found in marijuana and hashish. People who have a marijuana addiction generally use the drug on a daily basis. They don’t actually have a chemical dependence on the drug but rather feel the need to regularly use the drug.

Signs of use and dependence can include:
•A heightened sense of visual, auditory and taste perception
•Poor memory
•Increased blood pressure and heart rate
•Red eyes
•Decreased coordination
•Difficulty concentrating
•Increased appetite
•Slowed reaction time
•Paranoid thinking

Barbiturates and benzodiazepines

Barbiturates and benzodiazepines are prescription central nervous system depressants. Phenobarbital, amobarbital (Amytal) and secobarbital (Seconal) are examples of barbiturates. Benzodiazepines include tranquilizers, such as diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin) and chlordiazepoxide (Librium). If you’re prescribed these drugs, take them exactly as ordered. If you feel your need for these medications is increasing, talk to your doctor.

Signs of use and dependence can include:
•Drowsiness
•Slurred speech
•Lack of coordination
•Memory problems
•Confusion
•Slowed breathing and decreased blood pressure
•Dizziness
•Depression

Methamphetamine, cocaine and other stimulants

This class of drugs includes amphetamines, methamphetamine, cocaine and methylphenidate (Ritalin).

Signs of use and dependence can include:
•Euphoria
•Decreased appetite
•Rapid speech
•Irritability
•Restlessness
•Depression as the drug wears off
•Nasal congestion and damage to the mucous membrane of the nose in users who snort drugs
•Insomnia
•Weight loss
•Increased heart rate, blood pressure and temperature
•Paranoia

Methamphetamine, also known as “meth,” is a particularly dangerous drug. It’s highly addictive and causes a number of short-term and long-term health consequences. Methamphetamine is relatively inexpensive and widely available.

Club drugs

Club drugs are drugs commonly used by teens and young adults at clubs, concerts and parties. Examples include Ecstasy (MDMA), GHB, Rohypnol (“roofies”) and ketamine. These drugs are not all classified in the same category, but they share some similar effects and dangers.

Signs of club drug use and dependence can include:
•An exaggerated feeling of great happiness or well-being (euphoria)
•Reduced inhibitions
•A heightened or altered sense of sight, sound and taste
•Amphetamine-like effects (with ketamine and Ecstasy)
•Decreased coordination
•Poor judgment
•Memory problems or loss of memory
•Increased or decreased heart rate and blood pressure
•Drowsiness and loss of consciousness (with GHB and Rohypnol)

GHB and Rohypnol are particularly dangerous. At high doses, they can cause seizures, coma and death. The danger increases when these drugs are taken with alcohol. Because they worsen consciousness and memory and they’re easy to give someone without his or her knowledge or consent, these drugs are both commonly used as date-rape drugs.

One particular danger of club drugs is that the liquid, pill or powder forms of these drugs available on the street often contain unknown substances that can be harmful, including other illegally manufactured or pharmaceutical drugs.

Hallucinogens

Use of hallucinogens produces different signs and symptoms depending on the drug. The most common hallucinogens are LSD and phencyclidine (PCP).

Signs of LSD use include:
•Hallucinations
•Greatly reduced perception of reality, for example, interpreting input from one of your senses as another, such as hearing colors
•Permanent mental changes in perception
•Rapid heart rate
•High blood pressure
•Tremors
•Flashbacks, a re-experience of the hallucinations — even years later

Signs of PCP use include:
•Hallucinations
•Euphoria
•Delusions
•Panic
•Loss of appetite
•Depression
•Aggressive, possibly violent behavior

Inhalants

The signs and symptoms of inhalant use vary depending on what substance is inhaled. Some commonly inhaled substances include glue, paint thinners, correction fluid, felt tip marker fluid, gasoline, cleaning fluids and household aerosol products.

When inhaled, these products can cause brief intoxication and a decreased feeling of inhibition. Long-term use may cause seizures and damage to the brain, liver and kidneys. Inhalant use can also cause death.

Narcotic painkillers

Opioids are narcotic, painkilling drugs produced naturally from opium or made synthetically. This class of drugs includes heroin, morphine, codeine, methadone and oxycodone (OxyContin). If you’re prescribed these medications by a doctor, take them exactly as directed. Don’t increase your dose without first talking to your doctor.

Signs of narcotic use and dependence can include:
•Reduced sense of pain
•Sedation
•Depression
•Confusion
•Constipation
•Slowed breathing
•Needle marks (if injecting drugs)

When to see a doctor

If you think your drug use is out of control or is causing problems, get help. The sooner you seek help, the greater your chances are for a long-term recovery. Your family doctor may be a good place to start, or you may see a mental health provider such as a psychologist or psychiatrist.

Make an appointment to see a doctor if:
•You can’t stop using a drug.
•Your drug use has led to unsafe behavior, such as sharing needles or unprotected sex.
•You think you may be having withdrawal symptoms. If you’re reluctant to approach a doctor, help lines or hotlines may be a good place to learn about treatment. You can find these lines listed in the phone book or on the Internet.

Seek emergency help if you or someone you know has taken a drug and:
•May have overdosed
•Loses consciousness
•Has trouble breathing
•Has seizures
•Has signs of a heart attack, such as chest pain or pressure
•Has any other troublesome physical or psychological reaction to use of the drug

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Drug addiction is a dependence on an illegal drug or a medication. When you’re addicted, you may not be able to control your drug use and you may continue using the drug despite the harm it causes. Drug addiction can cause an intense craving for the drug. You may want to quit, but most people find they can’t do it on their own.

For many people, what starts as casual use leads to drug addiction. Drug addiction can cause serious, long-term consequences, including problems with physical and mental health, relationships, employment and the law.

You may need help from your doctor, family, friends, support groups or an organized treatment program to overcome your drug addiction and stay drug-free.

CAUSES
Like many psychological disorders, drug addiction and dependence depends on several things. Two main factors include:
•Environment. Environmental factors, including your family’s beliefs and attitudes and exposure to a peer group that encourages drug use, seem to play a role in initial drug use.
•Genes. Once you’ve started using a drug, the development into addiction may be influenced by inherited traits.

Changing brain pathways

Physical addiction appears to occur when repeated use of a drug alters the way your brain feels pleasure. The addicting drug causes physical changes to some nerve cells (neurons) in your brain. Neurons use chemicals called neurotransmitters to communicate.

Eating a small snack a few hours before bedtime may help. There are no specific foods that help you sleep. But, it’s a good idea to avoid certain foods late in the day. Here are a few things to keep in mind:
•Don’t go to bed hungry. A light snack before bedtime can keep hunger pangs from waking you up. For example, have a bowl of oatmeal, cereal with low-fat milk or yogurt with granola. If you have diabetes, discuss nighttime snacks with your doctor.
•Avoid large, high-fat meals late in the day. Also avoid garlic-flavored and highly spiced foods. These foods can make you uncomfortable or cause heartburn.
•Avoid alcohol and caffeine. Both can interfere with sleep. Keep in mind, it can take up to eight hours for the stimulating effects of caffeine wear off.
•Don’t drink too much liquid. Drinking lots of fluids before bed can cause you to wake up repeatedly to use the bathroom.

Everyone has trouble sleeping from time to time. But if you frequently have insomnia, see your doctor to find out what steps you can take to improve your sleep.

Waking up in the middle of the night is called sleep maintenance insomnia, and it’s a common problem. Midsleep awakenings often occur during periods of stress. To help stay asleep through the night, try some of these strategies to relieve insomnia:
•Establish a quiet, relaxing bedtime routine. For example, drink a cup of noncaffeinated tea, take a warm shower, or listen to soft music.
•Stretch or do some gentle yoga. This can ease tension and help tight muscles relax.
•Put clocks in your bedroom out of sight. Clock-watching causes stress and makes it harder to go back to sleep if you wake up during the night.
•Avoid caffeine after noon, and limit alcohol to one drink several hours before bedtime. Both caffeine and alcohol can interfere with sleep.
•Get regular exercise. But keep in mind, exercising too close to bedtime may interfere with sleep.
•Go to bed only when you’re sleepy. If you aren’t sleepy at bedtime, do something relaxing that will help you wind down.
•Wake up at the same time every day. If you go to sleep later than usual, resist the urge to sleep in.
•Avoid daytime napping. Napping can throw off your sleep cycle.
•If you wake up and can’t fall back asleep within 20 minutes or so, get out of bed. Go to another room and read or do other quiet activities until you feel sleepy.

In some cases, insomnia is caused by a physical condition such as sleep apnea, restless legs syndrome or chronic pain. Treatment for an underlying condition may be necessary for insomnia to get better.

Insomnia can be linked to mental health disorders, particularly depression. Both depression and insomnia may improve with medications such as antidepressants or psychological counseling.

If you keep having sleep problems, talk to your doctor. In order to determine the cause and best treatment for insomnia, you may need to see a sleep specialist. Over-the-counter sleep aids rarely offer significant help for this problem. Your doctor may prescribe medication and have you try some other strategies to get your sleep pattern back on track.

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Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills

Insomnia is a serious disorder, and effective treatment can be crucial to getting the sleep you need. Explore safe, effective, nondrug insomnia treatments.

Insomnia is a common problem characterized by trouble falling asleep, staying asleep or getting restful sleep, despite the opportunity for adequate sleep. Cognitive behavioral therapy for insomnia, often called CBT-I, is an effective insomnia treatment for chronic sleep problems.

Cognitive behavioral therapy for insomnia is a structured program that helps you identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep. Unlike sleeping pills, CBT-I helps you overcome the underlying causes of your sleep problems.

To make effective changes, it’s important to understand sleep cycles and learn how beliefs, behaviors and outside factors can affect your sleep. To help decide how to best treat your insomnia, your sleep therapist may have you keep a detailed sleep diary for one to two weeks.

How does cognitive behavioral therapy for insomnia work?

Cognitive behavioral therapy for insomnia aims to improve sleep habits and behaviors. The cognitive part of CBT-I teaches you to recognize and change beliefs that affect your ability to sleep. For instance, this may include learning how to control or eliminate negative thoughts and worries that keep you awake. The behavioral part of CBT-I helps you develop good sleep habits and avoid behaviors that keep you from sleeping well.

Depending on your needs, your sleep therapist may recommend some of these CBT-I techniques:
•Stimulus control therapy. This method helps remove factors that condition the mind to resist sleep. For example, you might be coached to set a consistent bedtime and wake time and avoid naps, use the bed only for sleep and sex, and leave the bedroom if you can’t go to sleep within 20 minutes, only returning when you’re sleepy.
•Sleep restriction. Lying in bed when you’re awake can become a habit that leads to poor sleep. This treatment decreases the time you spend in bed, causing partial sleep deprivation, which makes you more tired the next night. Once your sleep has improved, your time in bed is gradually increased.
•Sleep hygiene. This method of therapy involves changing basic lifestyle habits that influence sleep, such as smoking or drinking too much caffeine late in the day, drinking too much alcohol, or not getting regular exercise. It also includes tips that help you sleep better, such as ways to wind down an hour or two before bedtime.
•Sleep environment improvement. This offers ways that you can create a comfortable sleep environment, such as keeping your bedroom quiet, dark and cool, not having a TV in the bedroom, and hiding the clock from view.
•Relaxation training. This method helps you calm your mind and body. Approaches include meditation, imagery, muscle relaxation and others.
•Remaining passively awake. Also called paradoxical intention, this involves avoiding any effort to fall asleep. Paradoxically, worrying that you can’t sleep can actually keep you awake. Letting go of this worry can help you relax and make it easier to fall asleep.
•Biofeedback. This method allows you to observe biological signs such as heart rate and muscle tension and shows you how to adjust them. Your sleep specialist may have you take a biofeedback device home to record your daily patterns. This information can help identify patterns that affect sleep.

The most effective treatment approach may combine several of these methods.

Cognitive behavioral therapy vs. pills

Sleep medications can be an effective short-term treatment — for example, they can provide immediate relief during a period of high stress or grief. Some newer sleeping medications have been approved for long-term use. But they may not be the best long-term insomnia treatment.

Cognitive behavioral therapy for insomnia may be a good treatment choice if you have long-term sleep problems. You may want to try it if you’re worried about becoming dependent on sleep medications, if medications aren’t effective or if they cause bothersome side effects.

Unlike pills, CBT-I addresses the underlying causes of insomnia rather than just relieving symptoms. But it takes time — and effort — to make it work. In some cases, a combination of sleep medication and CBT-I may be the best approach.

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When doctors believe someone has antisocial personality disorder, they typically run a series of medical and psychological tests and exams to help determine a diagnosis. These evaluations generally include:
•Physical exam. This is done to help rule out other problems that could be causing symptoms and to check for any related complications.
•Lab tests. These may include, for example, a complete blood count (CBC), a thyroid function check, and screening for alcohol and drugs to determine if there are other causes for symptoms.
•Psychological evaluation. A doctor or mental health provider explores thoughts, feelings, relationships, behavior patterns and family history, which may include psychological tests about personality. He or she asks about symptoms, including when they started, how severe they are, how they affect daily life and whether similar episodes have occurred in the past. The doctor also asks about thoughts of suicide, self-injury or harming others.

A person with antisocial personality disorder is unlikely to provide an accurate account of his or her signs and symptoms. Family and friends may be able to provide helpful information.

Pinpointing the type of personality disorder

It’s sometimes difficult to determine if symptoms point to antisocial personality disorder or another personality disorder because some symptoms overlap more than one disorder. A key factor in diagnosis is how the affected person relates to others. Someone with antisocial personality disorder is likely to have an accurate — sometimes superior — understanding of others’ thinking with little awareness or regard for their feelings. This leads the person to act out and make other people miserable — with no feeling of remorse.

Diagnostic criteria

To be diagnosed with antisocial personality disorder, a person must meet the symptom criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual, published by the American Psychiatric Association, is used by mental health providers to diagnose mental illnesses and by insurance companies to reimburse for treatment.

Symptom criteria required for a diagnosis of antisocial personality disorder include:
•Being at least 18 years old
•Having had symptoms of conduct disorder before age 15, which may include such acts as stealing, vandalism, violence, cruelty to animals and bullying

•Repeatedly breaking the law
•Repeatedly conning or lying to others
•Being irritable and aggressive, repeatedly engaging in physical fights or assaults
•Feeling no remorse — or justifying behavior — after harming others
•Having no regard for the safety of self or others
•Acting impulsively and not planning ahead
•Being irresponsible and repeatedly failing to honor work or financial obligations

Personality is the combination of thoughts, emotions and behaviors that makes everyone unique. It’s the way people view, understand and relate to the outside world, as well as how they see themselves. Personality forms during childhood, shaped through an interaction of these factors:
•Genetics. These inherited tendencies are aspects of a person’s personality passed on by parents, such as shyness or having a positive outlook. This is sometimes called temperament.
•Environment. This means the surroundings a person grows up in, events that occurred, and relationships with family members and others. It includes such life situations as the type of parenting a person experienced, whether loving or abusive.

Personality disorders are thought to be caused by a combination of these genetic and environmental influences. Some people may have genes that make them vulnerable to developing antisocial personality disorder — and life situations may trigger its development.

There may be a link between an early lack of empathy — understanding the perspectives and problems of others, including other children — and later onset of antisocial personality disorder. Identifying these personality problems early may help improve long-term outcomes.