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Substance Abuse

Straight Talk About Substance Abuse

  • It is hard to understand why people get hooked on drugs.
  • People often think of drug abuse and addiction as a social problem. Or, they may think that people who take drugs are morally weak.
  • People often think that drug and alcohol abusers should be able to just stop. They don’t understand why substance abusers don’t just stop.
  • Many people don’t realize that addiction is a disease that affects the brain. Stopping substance abuse is not just a matter of willpower.
  • Through scientific advances we now know much more about how drugs work in the brain.
  • We also know how to treat drug addiction. We can help people stop using and get their lives back.


What is drug addiction?

Drug addiction is a brain disease. People with addiction can have relapses, even if it has been a long time since they used drugs. Addiction causes a person to keep using drugs and alcohol, even when they are having a lot of serious problems.

  • In the beginning most people choose to take drugs. Over time, though, drugs can cause changes in the brain. These changes can affect a person’s self control. This makes it harder to make good decisions, and harder to resist the urge to take drugs. That makes it very hard to recover from drug addiction.
  • There are treatments that can help people fight back against addiction. Treatment can help you get back control of your life. Going to counseling can work for most people. Sometimes you can take medicine that can help too. Treatment can be set up to help you with your specific type of addiction problem. It can also help you with medical, emotional or social problems. When you work on all of these problems in treatment it can help you recover and a have life without substance abuse.
  • Addiction is like diabetes, asthma, and heart disease. If you have one of those diseases you can’t be cured. You have to learn how to deal with it for the rest of your life. Addiction is the same as these diseases. You can’t ever be totally cured, but you can learn how to handle it so that it doesn’t cause problems anymore.
  • Sometimes during recovery you might relapse and start abusing drugs and alcohol again. That doesn’t mean you’ve failed. It means you should get back into treatment, or you should figure out how to change your treatment, so that you can get back on track.


Why do some people become addicted, while others do not?

It’s hard to predict whether or not someone will become addicted to drugs. Things like your genes, your environment, and your personal development all can affect your risk for addiction. The more risk factors you have, the greater the chance that taking drugs or drinking can lead to addiction.

  • Biology. The genes that you are born with account for about half of your risk for addiction. Your sex, your ethnicity, and whether or not you have other psychological problems also affect your risk for drug abuse and addiction.
  • Environment. Your environment includes a lot of things, like your family and friends, your socioeconomic status, and your quality of life. It also includes things like peer pressure, being abused as a child, and stress.
  • Development. If you start using drugs when you are still a kid or teenager, it is more likely that you will progress to more serious abuse. Taking drugs when you are young is also dangerous because your brain is still developing. Sometimes you don’t make good decisions because of this, and taking drugs can make that problem worse.

What is alcoholism?

Alcoholism is a brain disease. Sometimes alcoholism is also called “alcohol dependence.” It includes the following four symptoms:

  • Craving is a strong need, or urge, to drink.
  • Loss of control is not being able to stop drinking once you start drinking.
  • Physical dependence means you get sick if you stop drinking for more than a day or two. You might feel sick to your stomach, you might get sweaty, you might be shaky, or you might feel very anxious. Some people can have very dangerous symptoms like seizures, if they stop drinking without medical care.
  • Tolerance is the need to drink more alcohol to get "high” than you used to need to drink.


Do you have to be an alcoholic to experience problems?

No. You can abuse alcohol and you still might not be an alcoholic. You may drink too much or you may have a lot of problems from drinking, but you still might not be dependent on alcohol. Some of the problems you might have when you abuse alcohol include these things:

  • You have problems keeping up with work, keeping up with school, or keeping up with things they have to do at home;
  • You get arrested for drunk driving or you have a car accident;
  • You have health problems because of drinking;
  • You drink when it’s dangerous to drink.

Sometimes, it can be dangerous for you to drink even a little bit. It is dangerous to drink if you are driving a car, if you are pregnant, or if you are taking certain medications.


How can you tell if someone has a problem?

You can answer the following four questions to help figure out if you have a drinking problem.

  • Have you ever felt you should cut down on your drinking?
  • Have people annoyed you by criticizing your drinking?
  • Have you ever felt bad or guilty about your drinking?
  • Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

If you answered “yes” to one of these questions, you might have an alcohol problem. If you answered “yes” to more than one question, there is a very good chance that you have a problem with drinking.

If you think that you or someone you know might have an alcohol problem, it is important to see a doctor right away. They can help you figure out if you have a drinking problem and to figure out what to do next.


What is good substance abuse treatment?

Treatment can help you stop using drugs, avoid relapse, and successfully recover your life. Research shows that there are some things you should look for in a good treatment program:

  • Addiction is a complicated disease. It affects how your brain works and how you behave. Addiction can be treated.
  • Some treatments will be better for you than other treatments. Everybody is different.
  • You need to be able to get treatment when you need it.
  • Treatment works best when it can help you with all of your problems, not just your drug or alcohol abuse.
  • You need to stay in treatment long enough for it to work.
  • Most treatment involves group and individual counseling. Or, it can be other kinds of behavioral therapy.
  • Sometimes medicine can help you with your treatment. Medicine works best when you go to counseling at the same time.
  • Your counselor or therapist should make sure your treatment is working for you. If it isn’t working well enough, they should make changes to be sure it works the best that it can.
  • Many drug- and alcohol-addicted individuals also have other mental disorders.
  • You might need to go to a doctor or to a hospital for detoxification at first. Detoxification is only the first stage of addiction treatment though. It probably won’t help you much by itself.
  • Treatment does not need to be voluntary to be effective.
  • Treatment programs need to check to find out if you are using drugs or alcohol during treatment. Most programs will do tests using your urine to find out if you are using drugs or alcohol. This is because a lot of people make mistakes during treatment, and your counselor needs to be sure they know about it.
  • A lot of people with drug or alcohol problems also have medical problems like HIV/AIDS, hepatitis B and C, or tuberculosis. Your program should check to see if you have any of these problems. Your program should also help you prevent these problems.


Do you have people to help you?

It can be hard to figure out how to live without alcohol and drugs. It may be important to:

  • Help your family and friends understand about your problem
  • Find new things to do and new people to hang out with
  • Consider joining Alcoholics Anonymous, Narcotics Anonymous, or another mutual support group (see “Resources”). If you attend one of these groups regularly you will have a better chance of recovering. You should try out different groups because the groups are all different. You’ll get more out of it if you get actively involved in the group. Get a sponsor and reach out to other members.
  • Ask for help from others. This could include:
    1. Ask people not to offer you alcohol or drugs
    2. Ask people not to use alcohol/drugs around you
    3. Ask people to support you
    4. Ask people not to criticize you right now
    5. Ask people not to make you take on anything new right now
    6. Ask people to go to a group like Al-Anon



When is residential treatment the right choice?

Residential treatment programs can also be very effective, especially if your problem is more severe. For example, therapeutic communities (TCs) are very structured programs where you live for 6 to 12 months. The staff and other people in the program help you change your attitudes, thoughts, and behaviors about drug and alcohol use. People in TCs may include those who have been addicted for a long time, who have a criminal history, or who have a lot of problems with social functioning. There are also TCs for women who are pregnant or have children. TCs help you learn how to live a drug-free, crime–free lifestyle.


Are you ready to make a change?

It’s up to you whether to change your drinking or drugging. Other people may be able to help, but in the end it’s your decision. Weighing your pros and cons can help.

Pros: What are some reasons why you might want to make a change?

  • to improve my health?
  • to improve my relationships?
  • to avoid hangovers or withdrawal?
  • to get a job or to keep the one I have?
  • to save money?
  • to stay out of trouble?
  • to improve my life?
  • Other reasons?

Cons: What are some possible reasons why you might not want to change?

  • You think life will be boring
  • You enjoy getting high
  • You might have to give up your friends
  • Other reasons?

Compare your pros and cons. Put extra check marks by the most important one(s). Is there a difference between where you are and where you want to be?


Where can I get more help?

Professional help

Your regular doctor. Primary care and mental health practitioners can provide effective alcoholism treatment by combining new medications with brief counseling visits. See “Helping Patients Who Drink Too Much” at www.niaaa.nih.gov/guide or call 301–443–3860.

Specialists in alcohol and other drug addiction. For specialty addiction treatment options, contact your doctor, health insurance plan, local health department, or employee assistance program. Other resources include

Medical and non-medical addiction specialists

American Academy of Addiction Psychiatry

American Psychological Association
1–800–964–2000 (ask for your state’s referral number to find psychologists with addiction specialties)

American Society of Addiction Medicine
301–656–3920 (ask for the phone number of your state’s chapter)

NAADAC Substance Abuse Professionals

National Association of Social Workers
(search for social workers with addiction specialties)


Treatment facilities

Substance Abuse Treatment Facility Locator


Mutual-help groups

Alcoholics Anonymous (AA)
212–870–3400 or check your local phone directory under “Alcoholism”

Narcotics Anonymous (NA)
212-929-6262 for Bronx Meetings

Moderation Management

Secular Organizations for Sobriety

SMART Recovery

Women for Sobriety


Groups for family and friends

1–888–425–2666 for meetings

Adult Children of Alcoholics


Information resources

National Institute on Alcohol Abuse and Alcoholism

National Institute on Drug Abuse

National Institute of Mental Health

National Clearinghouse for Alcohol and Drug Information

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