Understanding Pharmaceutical Drug Addiction: Types, Signs, Treatments

August 24, 2023 - Drug addiction and treatment have become an increasingly serious problem in the United States healthcare system. Substance use disorders are life-threatening mental illnesses that continue to take lives, alter families, and burden healthcare workers.

Understanding the types of drug abuse, signs, and symptoms may provide a clearer understanding of the problem and how to address it.

Substance Use Disorders

The National Institute of Mental Health (NIMH), a subset of the National Institutes of Health (NIH), defines substance use disorder as “a treatable mental disorder that affects a person’s brain and behavior, leading to their inability to control their use of substances like legal or illegal drugs, alcohol, or medications.”

According to the Addiction Center, while substance abuse or misuse may encompass various addictive compounds, six common addictive substances contribute to substance use disorders: alcohol, benzodiazepines, opiates, sleeping pills, and stimulants.

Although not all substance use disorders are drug addictions, pharmaceutical drug addiction is one of the leading contributors to substance use disorders.

Substance Use Disorders and Mental Illness

According to the NIMH, there is a strong link between substance use disorder and other mental health disorders, including anxiety, depression, ADHD, bipolar disorder, personality disorders, and schizophrenia. Although not all people with mental health conditions have substance use disorders, and there isn’t a known link, researchers have proposed three potential explanations for the connection.

First, both conditions have similar risk factors, including stress, trauma, environmental risk, and genetic predisposition. Additionally, patients with mental illness may self-medicate to alleviate symptoms and unintentionally become addicted to these substances.

Finally, researchers postulate that substance use can cause neurological changes that trigger mental health issues.

Symptoms

The American Psychiatric Association (APA) divides symptoms of substance use disorders into four categories: impaired control, social problems, risky use, and drug effects.

According to the Tennessee Department of Mental Health and Substance Abuse Services, multiple signs and symptoms of prescription drug abuse can signify that a patient, family member, or loved one is dealing with substance use issues. Physical warning signs can generally include changes in appetite, altered sleep patterns, appearance changes, and more.

Other warning signs may include mood swings, personality changes, increased aggressiveness, paranoia, and social withdrawal.

Treatment and Disease Management

The treatment plan for a patient’s substance use disorder may vary depending on the type of substance use, age, support system, access to resources, and more.

There are two general buckets of treatment for managing substance use and addiction. The first is behavioral therapies, which include multiple kinds of addiction treatment and may also address other symptoms.

Adults with SUD may include cognitive behavioral therapy (CBT), dialectical behavior therapy, assertive community treatment (ACT), therapeutic communities — such as residential treatment centers — and contingency management.

For children and adolescents, behavioral therapy may include brief strategic family therapy (BSFT), multidimensional family therapy (MDFT), and multisystemic therapy (MST).

The other treatment bucket includes medications to manage specific conditions.

In a 2018 report, the National Institute on Drug Abuse (NIDA) issued a research-based guide to drug addiction treatment, which highlighted 13 principles of effective drug abuse treatment. Below are each of these principles:

1. Addiction is complicated, altering brain function and behavior; however, it is treatable.
2. SUD treatments are not universal; treatment programs should be altered to address individual patients.
3. Access to prompt treatment is vital.
4. Treatment should address more than just drug abuse, including other confounding issues.
5. Adequate treatment length is vital.
6. Behavioral therapies are standard tools for drug abuse treatment.
7. Medications can be combined with behavioral therapies to address drug addiction in some patients.
8. Addiction treatment plans should be flexible and adjusted to meet patient needs.
9. Patients with drug addiction often experience other mental health issues that must be addressed.
10. While detoxification and withdrawal symptom management is the first step in addiction treatment, it is insufficient for managing the condition independently.
11. External, involuntary factors can be effective in increasing treatment rates.
12. Drug use needs to be continually monitored.
13. Treatment plants should consider infectious diseases that may be transmitted through high-risk behaviors.

Alcohol Use Disorder

Although alcohol use disorder is not a pharmaceutical drug addiction, it is a common substance use disorder that requires attention from healthcare professionals.

Most of the substances discussed in this article are controlled to a certain level; however, many could argue that alcohol is one of the least controlled addictive substances. Across the US, alcohol can be legally purchased by anyone 21 and older.

It is not uncommon for underage individuals to also obtain alcohol with relative ease. While not everyone who drinks will have alcohol use disorder (AUD), excessive and persistent consumption of alcohol is a good indicator of the condition.

In general, AUD is diagnosed in women who have more than three standard drinks per day, and men who have more than four standard drinks per day are at risk for AUD.

Prescription Drug Abuse

Focusing exclusively on prescription drug abuse, the NIDA notes that opioids, central nervous system depressants (such as tranquilizers, sedatives, and hypnotics), and stimulants are the most likely to be abused in prescription drug addiction.

According to NIDA, in 2021, 5.1% of people 12 and older in the US reported misusing prescription psychotherapeutic drugs. Approximately 1.3%, 1.7%, 1.4%, and 3.1% reported misusing prescription stimulants, tranquilizers or sedatives, benzodiazepines, and pain relievers, respectively.

Opioids

One of the most well-known types of drug use and addiction disorders is opioid use disorder (OUD). OUD results from addiction to opioids, which are prescription painkillers often prescribed after significant surgeries.

Opioids and morphine derivatives are common addictive substances. This category may include codeine, morphine, methadone, fentanyl, oxycodone (such as OxyContin), hydrocodone (such as Vicodin), oxymorphone, meperidine, and propoxyphene.

Opioids work by attaching opioid receptors in the brain and blocking pain signals. Common side effects of these medications include drowsiness, confusion, nausea, constipation, respiratory depression, and euphoria.

The Mayo Clinic notes that opioids can also cause slowed breathing rates, poor coordination, and increased pain sensitivity that requires higher doses of medication.

Patients with physical dependence on opioids may experience withdrawal symptoms like restlessness, muscle pain, insomnia and other sleep disorders, diarrhea, vomiting, and cold flashes when they discontinue the medication.

NIDA highlights multiple medications used to manage opioid use disorder, including methadone, buprenorphine, and naltrexone.

Central Nervous System Depressants

Central nervous system depressants can include barbiturates, benzodiazepines, and sleep medications.

Barbiturates, such as Amytal, cause sedation, drowsiness, reduced anxiety, and poor coordination. These drugs have been known to cause life-threatening withdrawal for chronic users, with symptoms such as euphoria, unusual excitement, fever, and irritability.

Benzodiazepines (Benzos) are a common prescription medication that can contribute to drug abuse. Benzos, including Ativan, Halcion, Klonopin, Librium, Xanax, and Valium, are often prescribed to manage mental disorders like anxiety. However, continued use of benzos can cause patients to build a tolerance and, eventually, a dependency on these medications.

Ambien, Amytal, Lunesta, and Sonata comprise an additional prescription drug use and misuse category in the US: sleeping pills.

Depressants can cause slowed heart rate, reduced blood pressure, breathing issues, and respiratory distress.

Stimulants

Amphetamines, methylphenidates, and other stimulants are often used to manage behavioral health conditions, such as attention deficit hyperactivity disorder (ADHD). However, stimulants, including Adderall, some antidepressants, Concerta, Dexedrine, diet pills, Ritalin, and anabolic steroids, are highly addictive substances with potentially fatal side effects.

Stimulants can cause irregular heart rate and high blood pressure or body temperature. Other side effects include weight loss, hallucinations, heart attacks, and stroke.

Beyond prescription drug abuse, dextromethorphan, which is found in some over-the-counter cough medications, can also be abused.

Understanding the different substances involved in prescription drug abuse is vital for providers who prescribe these medications and patients who take them. An open dialogue about the medication’s risks and regular monitoring can help prevent misuse and its potentially fatal effects.