assignment on drug addiction

• Patient Care & Health Information
• Diseases & Conditions
• Drug addiction (substance use disorder)

Diagnosing drug addiction (substance use disorder) requires a thorough evaluation and often includes an assessment by a psychiatrist, a psychologist, or a licensed alcohol and drug counselor. Blood, urine or other lab tests are used to assess drug use, but they're not a diagnostic test for addiction. However, these tests may be used for monitoring treatment and recovery.

For diagnosis of a substance use disorder, most mental health professionals use criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

• Care at Mayo Clinic

Our caring team of Mayo Clinic experts can help you with your drug addiction (substance use disorder)-related health concerns Start Here

Although there's no cure for drug addiction, treatment options can help you overcome an addiction and stay drug-free. Your treatment depends on the drug used and any related medical or mental health disorders you may have. Long-term follow-up is important to prevent relapse.

Treatment programs

Treatment programs for substance use disorder usually offer:

• Individual, group or family therapy sessions
• A focus on understanding the nature of addiction, becoming drug-free and preventing relapse
• Levels of care and settings that vary depending on your needs, such as outpatient, residential and inpatient programs

Withdrawal therapy

The goal of detoxification, also called "detox" or withdrawal therapy, is to enable you to stop taking the addicting drug as quickly and safely as possible. For some people, it may be safe to undergo withdrawal therapy on an outpatient basis. Others may need admission to a hospital or a residential treatment center.

Withdrawal from different categories of drugs — such as depressants, stimulants or opioids — produces different side effects and requires different approaches. Detox may involve gradually reducing the dose of the drug or temporarily substituting other substances, such as methadone, buprenorphine, or a combination of buprenorphine and naloxone.

Opioid overdose

In an opioid overdose, a medicine called naloxone can be given by emergency responders, or in some states, by anyone who witnesses an overdose. Naloxone temporarily reverses the effects of opioid drugs.

While naloxone has been on the market for years, a nasal spray (Narcan, Kloxxado) and an injectable form are now available, though they can be very expensive. Whatever the method of delivery, seek immediate medical care after using naloxone.

Medicine as part of treatment

After discussion with you, your health care provider may recommend medicine as part of your treatment for opioid addiction. Medicines don't cure your opioid addiction, but they can help in your recovery. These medicines can reduce your craving for opioids and may help you avoid relapse. Medicine treatment options for opioid addiction may include buprenorphine, methadone, naltrexone, and a combination of buprenorphine and naloxone.

Behavior therapy

As part of a drug treatment program, behavior therapy — a form of psychotherapy — can be done by a psychologist or psychiatrist, or you may receive counseling from a licensed alcohol and drug counselor. Therapy and counseling may be done with an individual, a family or a group. The therapist or counselor can:

• Help you develop ways to cope with your drug cravings
• Suggest strategies to avoid drugs and prevent relapse
• Offer suggestions on how to deal with a relapse if it occurs
• Talk about issues regarding your job, legal problems, and relationships with family and friends
• Include family members to help them develop better communication skills and be supportive
• Address other mental health conditions

Self-help groups

Many, though not all, self-help support groups use the 12-step model first developed by Alcoholics Anonymous. Self-help support groups, such as Narcotics Anonymous, help people who are addicted to drugs.

The self-help support group message is that addiction is an ongoing disorder with a danger of relapse. Self-help support groups can decrease the sense of shame and isolation that can lead to relapse.

Your therapist or licensed counselor can help you locate a self-help support group. You may also find support groups in your community or on the internet.

Ongoing treatment

Even after you've completed initial treatment, ongoing treatment and support can help prevent a relapse. Follow-up care can include periodic appointments with your counselor, continuing in a self-help program or attending a regular group session. Seek help right away if you relapse.

More Information

Drug addiction (substance use disorder) care at Mayo Clinic

• Cognitive behavioral therapy

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Coping and support

Overcoming an addiction and staying drug-free require a persistent effort. Learning new coping skills and knowing where to find help are essential. Taking these actions can help:

• See a licensed therapist or licensed drug and alcohol counselor. Drug addiction is linked to many problems that may be helped with therapy or counseling, including other underlying mental health concerns or marriage or family problems. Seeing a psychiatrist, psychologist or licensed counselor may help you regain your peace of mind and mend your relationships.
• Seek treatment for other mental health disorders. People with other mental health problems, such as depression, are more likely to become addicted to drugs. Seek immediate treatment from a qualified mental health professional if you have any signs or symptoms of mental health problems.
• Join a support group. Support groups, such as Narcotics Anonymous or Alcoholics Anonymous, can be very effective in coping with addiction. Compassion, understanding and shared experiences can help you break your addiction and stay drug-free.

Preparing for your appointment

It may help to get an independent perspective from someone you trust and who knows you well. You can start by discussing your substance use with your primary care provider. Or ask for a referral to a specialist in drug addiction, such as a licensed alcohol and drug counselor, or a psychiatrist or psychologist. Take a relative or friend along.

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment, be prepared:

• Be honest about your drug use. When you engage in unhealthy drug use, it can be easy to downplay or underestimate how much you use and your level of addiction. To get an accurate idea of which treatment may help, be honest with your health care provider or mental health provider.
• Make a list of all medicines, vitamins, herbs or other supplements that you're taking, and the dosages. Tell your health care provider and mental health provider about any legal or illegal drugs you're using.
• Make a list of questions to ask your health care provider or mental health provider.

Some questions to ask your provider may include:

• What's the best approach to my drug addiction?
• Should I see a psychiatrist or other mental health professional?
• Will I need to go to the hospital or spend time as an inpatient or outpatient at a recovery clinic?
• What are the alternatives to the primary approach that you're suggesting?
• Are there any brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your provider is likely to ask you several questions, such as:

• What drugs do you use?
• When did your drug use first start?
• How often do you use drugs?
• When you take a drug, how much do you use?
• Do you ever feel that you might have a problem with drugs?
• Have you tried to quit on your own? What happened when you did?
• If you tried to quit, did you have withdrawal symptoms?
• Have any family members criticized your drug use?
• Are you ready to get the treatment needed for your drug addiction?

Be ready to answer questions so you'll have more time to go over any points you want to focus on.

• Substance-related and addictive disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. American Psychiatric Association; 2013. https://dsm.psychiatryonline.org. Accessed Aug. 15, 2022.
• Brown AY. Allscripts EPSi. Mayo Clinic. April 13, 2021.
• DrugFacts: Understanding drug use and addiction. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/drugfacts/understanding-drug-use-addiction. Accessed Aug. 15, 2022.
• American Psychiatric Association. What is a substance use disorder? https://psychiatry.org/patients-families/addiction-substance-use-disorders/what-is-a-substance-use-disorder. Accessed Sept. 2, 2022.
• Eddie D, et al. Lived experience in new models of care for substance use disorder: A systematic review of peer recovery support services and recovery coaching. Frontiers in Psychology. 2019; doi:10.3389/fpsyg.2019.01052.
• Commonly used drugs charts. National Institute on Drug Abuse. https://www.drugabuse.gov/drug-topics/commonly-used-drugs-charts. Accessed Aug. 16, 2022.
• Drugs, brains, and behavior: The science of addiction. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction. Accessed Aug. 16, 2022.
• Drugs of abuse: A DEA resource guide/2020 edition. United States Drug Enforcement Administration. https://admin.dea.gov/documents/2020/2020-04/2020-04-13/drugs-abuse. Accessed Aug. 31, 2022.
• Misuse of prescription drugs research report. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs/overview. Accessed Aug. 17, 2022.
• Principles of drug addiction treatment: A research-based guide. 3rd ed. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/preface. Accessed Aug. 17, 2022.
• The science of drug use: A resource for the justice sector. National Institute on Drug Abuse. https://nida.nih.gov/drug-topics/criminal-justice/science-drug-use-resource-justice-sector. Accessed Sept. 2, 2022.
• Naloxone DrugFacts. National Institute on Drug Abuse. https://nida.nih.gov/publications/drugfacts/naloxone. Accessed Aug. 31, 2022.
• Drug and substance use in adolescents. Merck Manual Professional Version. https://www.merckmanuals.com/professional/pediatrics/problems-in-adolescents/drug-and-substance-use-in-adolescents. Accessed Sept. 2, 2022.
• DrugFacts: Synthetic cannabinoids (K2/Spice). National Institute on Drug Abuse. https://www.drugabuse.gov/publications/drugfacts/synthetic-cannabinoids-k2spice. Accessed Aug. 18, 2022.
• Hall-Flavin DK (expert opinion). Mayo Clinic. March 5, 2021.
• Poppy seed tea: Beneficial or dangerous?

Associated Procedures

News from mayo clinic.

• Science Saturday: Preclinical research identifies brain circuit connected to addictive behaviors July 22, 2023, 11:00 a.m. CDT
• What is naloxone and should everyone have access to it? Feb. 16, 2023, 05:06 p.m. CDT

Products & Services

• A Book: Mayo Clinic Family Health Book
• Newsletter: Mayo Clinic Health Letter — Digital Edition
• Symptoms & causes
• Diagnosis & treatment
• Doctors & departments

Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.

• Opportunities

Mayo Clinic Press

Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press .

• Mayo Clinic on Incontinence - Mayo Clinic Press Mayo Clinic on Incontinence
• The Essential Diabetes Book - Mayo Clinic Press The Essential Diabetes Book
• Mayo Clinic on Hearing and Balance - Mayo Clinic Press Mayo Clinic on Hearing and Balance
• FREE Mayo Clinic Diet Assessment - Mayo Clinic Press FREE Mayo Clinic Diet Assessment
• Mayo Clinic Health Letter - FREE book - Mayo Clinic Press Mayo Clinic Health Letter - FREE book

5X Challenge

Thanks to generous benefactors, your gift today can have 5X the impact to advance AI innovation at Mayo Clinic.

A .gov website belongs to an official government organization in the United States.

A lock ( ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

• Managing Substance Use Disorders
• Health Equity
• Data Resources
• Additional HHS Resources
• Overdose Prevention Resources
• Management and Treatment of Pain
• Clinical Practice Guideline at a Glance
• Clinical Care and Treatment
• Health Care Provider Toolkits
• Health Care Provider Trainings
• Electronic CDS Tools for Opioids
• Strategies and Partnerships
• Resources for Public Health Professionals
• Public Health Professional Toolkits
• Public Health Professional Trainings
• Journal Articles
• MMWR Articles
• Guides and Meeting Reports
• Related Publications

Related Topics:

• View All Home
• Rx Awareness
• Stop Overdose
• Overdose Resource Exchange

Treatment of Substance Use Disorders

• Millions of Americans have a substance use disorder (SUD), and it remains an important health issue in our country.
• In 2022, more than one in six Americans aged 12 or older reported experiencing a SUD.
• With effective treatment, recovery is possible for everyone. There is strength in getting help.

What is an SUD?

A substance use disorder (SUD) is a treatable, chronic disease characterized by a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems. 1 In 2022, more than one in six Americans aged 12 or older reported experiencing a SUD. 2

SUDs can lead to significant problems in all aspects of a person's life. Patterns of symptoms resulting from substance use (drugs or alcohol) can help a doctor diagnose a person with a SUD or SUDs and connect them to appropriate treatment.

For certain drug types, some symptoms are less prominent, and in some cases, not all symptoms apply. For example, withdrawal symptoms are not specified for inhalant use.

SUDs can range in severity from mild to severe and can affect people of any race, gender, income level, or social class. A SUD can be applied to the following types of drugs: 1

• Hallucinogens
• Opioids (Prescription and Illegal)
• Sedatives, hypnotics, or anxiolytics
• Stimulants and Psychostimulants
• Tobacco (nicotine)
• Other (unknown) substance

Treatment and recovery options

Addiction is a disease, not a character flaw. People experiencing SUDs have trouble controlling their drug use even though they know drugs are harmful.

Overcoming an SUD is not as simple as resisting the temptation to take drugs. Recovery may involve medication to help with cravings and withdrawal as well as different forms of therapy. It may even require checking into a rehabilitation facility.

Addiction is a treatable disease

Like many other chronic conditions, treatment is available for substance use disorders. While no single treatment method is right for everyone, recovery is possible, and help is available for patients with SUDs.

Evidence-based guidelines can assist doctors with choosing the right treatment options. These guidelines help evaluate a patient's clinical needs and situation to match them with the right level of care, in the most appropriate available setting. For more information on evidence-based guidelines visit Addiction Medicine Primer .

Recovery options

There are safe and effective ways to recover from SUDs. Finding the right treatment option can be the key to a successful recovery journey.

Outpatient counseling

Helps people understand addiction, their triggers, and their reasons for using drugs. This form of treatment can be done at a doctor’s office or via telehealth appointment.

Inpatient rehabilitation

A full-time facility provides a supportive environment to help people recover without distractions or temptations.

Behavioral health care

Trained providers who help with mental health concerns.

Medications for opioid use disorder (MOUD)

Specific conditions like opioid use disorder may require medication as the first course of treatment. MOUD can help with cravings and withdrawal symptoms. 3 MOUD is effective in helping people reduce illegal opioid use, stay in treatment longer, and reduce the risk of opioid-involved overdose. 4

MOUD medications approved by the Food and Drug Administration (FDA):

• Buprenorphine

Research has demonstrated that MOUD is effective in helping people recover from their OUD. 5 6 7 It is important to find what works best each individual.

Resource‎

Reducing stigma is important, addiction can happen to anyone.

SUD is a treatable, chronic disease that can affect people of any race, gender, income level, or social class. No one driving factor leads to SUD. Some people may use drugs to help cope with stress and trauma or to help with mental health issues. Some may develop a SUD after taking opioids that are prescribed to them by doctors. In any case, using drugs over time may cause changes in a person's brain, leading to intense cravings and continued use. 8

Some may view acknowledging and receiving treatment for an SUD as a sign of personal failure and weakness. The associated shame felt by patients and families can make it difficult to seek treatment. Finding a doctor who is comfortable discussing SUDs can help ensure long-term recovery.

Find treatment services

Use these resources to find services that fit your needs:

Mental Health and Addiction Insurance Help (HHS)

Health Center Locator (HRSA)

Behavioral Health Treatment Services (SAMHSA)

Opioid Treatment Program Directory by State (SAMHSA)

Buprenorphine Providers Locator (SAMHSA)

Learn more about recovery

SAMHSA Behavioral Health Treatment Services Locator

Rx Awareness: Real Stories

Recovery is Possible: Know the Options

What You Need to Know About Treatment and Recovery

Opioid Therapy and Different Types of Pain

Addiction Medicine Toolkit

Medication-Assisted Treatment (MAT) | SAMHSA

Decisions in Recovery: Treatment for Opioid Use Disorder

Stigma Reduction

Addiction Treatment Locator, Assessment, and Standards (ATLAS) Platform

Linking People with Opioid Use Disorder to Medication Treatment

Working Together With Your Doctor to Manage Your Pain

• American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.
• Substance Abuse and Mental Health Services Administration. (2023). Key substance use and mental health indicators in the United States: Results from the 2022 National Survey on Drug Use and Health (HHS Publication No. PEP23-07-01-006, NSDUH Series H-58). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/2022-nsduh-annual-national-report
• SAMHSA. 2022, March 22. Medications, Counseling, and Related Conditions. Retrieved from https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-conditions
• TIP 63: Medications for Opioid Use Disorder - Full Document | SAMHSA
• Mattick, R. P., Breen, C., Kimber, J., & Davoli, M. (2014). Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. The Cochrane database of systematic reviews , 2014 (2), CD002207. https://doi.org/10.1002/14651858.CD002207.pub4
• Mattick, R. P., Breen, C., Kimber, J., & Davoli, M. (2003). Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. The Cochrane database of systematic reviews , (2), CD002209. https://doi.org/10.1002/14651858.CD002209
• Fullerton, C. A., Kim, M., Thomas, C. P., Lyman, D. R., Montejano, L. B., Dougherty, R. H., Daniels, A. S., Ghose, S. S., & Delphin-Rittmon, M. E. (2014). Medication-assisted treatment with methadone: assessing the evidence. Psychiatric services (Washington, D.C.) , 65 (2), 146–157. https://doi.org/10.1176/appi.ps.201300235
• https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction

Overdose Prevention

Overdose prevention is a CDC priority that impacts families and communities. Drug overdose is a leading cause of preventable death in the U.S.

For Everyone

Health care providers, public health.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Addict Sci Clin Pract
• v.4(1); 2007 Dec

Assessing Addiction: Concepts and Instruments

Sharon samet.

1 New York State Psychiatric Institute, New York, New York

2 Columbia University School of Social Work, New York, New York

Rachel Waxman

Mark hatzenbuehler.

3 Department of Psychology, Yale University, New Haven, Connecticut

Deborah S. Hasin

4 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York

5 Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York

Efficient, organized assessment of substance use disorders is essential for clinical research, treatment planning, and referral to adjunctive services. In this article, we discuss the basic concepts of formalized assessment for substance abuse and addiction, as established by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, and describe six widely used structured assessment instruments. Our aim is to help researchers and clinical programs identify the instruments that best suit their particular situations and purposes.

The appropriate way to assess a substance use disorder depends on the objective. Unstructured clinical interviews serve well enough for many purposes, such as satisfying third-party diagnostic requirements for reimbursement. For many essential clinical and research purposes, however, only structured (scripted) interviews afford sufficient information and reliability. Structured instruments assist treatment planning by providing a standardized comparison of a patient’s characteristics with those of patients who have benefited from interventions in clinical trials. Clinicians also obtain a comprehensive, objective picture of the auxiliary services the patient may need to benefit maximally from treatment. In research, these instruments yield the diagnostic consistency that is indispensable to avoid misclassifying patients and compromising the interpretation of research results.

This article aims to help clinicians and researchers choose the structured assessment instruments appropriate for their needs. For six widely used instruments, we describe the validity and reliability characteristics; administration procedures; training requirements; and advantages and disadvantages based on patient population, treatment orientation, and staff skills. The instruments are the

• Addiction Severity Index (ASI);
• Composite International Diagnostic Interview (CIDI);
• Structured Clinical Interview for DSM-IV (SCID);
• Alcohol Use Disorders and Associated Disabilities Interview Schedule (AUDADIS);
• Psychiatric Research Interview for Substance and Mental Disorders (PRISM); and
• Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA).

Jess Alford/© 2007 Getty Images

WHY CHOOSING THE RIGHT INSTRUMENT MATTERS

Dr. A. Thomas McLellan, principal developer of the ASI, has often contrasted two patients to illustrate the clinical importance of thorough assessments, such as those yielded by the ASI. One patient, a physician, is severely physiologically addicted to opiates. The other, a young woman, has a milder physiological addiction. An assessment that focuses narrowly on drug abuse history might stop here, leaving the impression that the physician faces the greater challenge to recovery. A more thorough evaluation, however, finds that the physician’s interpersonal relationships, although troubled, are still in place, and he is still working. The young woman, on the other hand, has no social supports except other drug abusers, is unemployed, and has never kept a job for long. In fact, she is the one with greater service needs— in particular, training in social and occupational skills.

In research, an appropriate assessment instrument can make the difference between null and significant findings. A recent review of trials to determine whether tricyclic antidepressants can help substance abusers with comorbid depression provides an illustrative example ( Nunes and Levin, 2004 ). Early trials demonstrated little or no benefit from the medications. These trials admitted patients based on their current depressive symptoms as itemized in instruments such as the Hamilton Depression Scale ( Hamilton, 1960 ) or the Beck Depression Inventory ( Beck et al., 1961 ). Participants would have included some individuals who had comorbid major depression and others who were experiencing transient low moods related to intoxication, withdrawal, or stress reactions. More recent studies, in contrast, admitted only individuals who met formal diagnostic criteria for major depressive disorder, which include persistent symptoms over a period of time. Some recent studies also delayed assessment until candidates had been abstinent for a week to ensure that they were past withdrawal. In these more uniform populations, the medications consistently alleviated patients’ depression and also modestly improved their substance abuse outcomes.

GENERAL FEATURES OF ASSESSMENT INSTRUMENTS

The assessment instruments we will discuss, with the exception of the ASI, all elicit the information required to diagnose substance use disorders and other psychiatric disorders according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV; American Psychiatric Association, 2000 ). Those criteria, the product of more than 30 years of development and testing, now set the standard for both research and clinical assessment (see “The DSM and Standardized Assessment”). Where the instruments differ is in

• Format—that is, whether they are fully structured or semi-structured;
• The particular clinical or research objectives they can serve;
• Reliability and validity for selected uses (see “Reliability and Validity”);
• Convenience features, such as modularity and availability in computer-based formats; and
• Training requirements.

Fully Structured Versus Semi-Structured Formats

A fully structured assessment instrument is a script. It specifies the questions the interviewer is to ask, exactly as written, as well as a choice of responses for the interviewee. When asking the questions, the interviewer skips some, based on patient characteristics or previous responses, and avoids adding probes of his or her own. A semi-structured instrument similarly lists questions to be read verbatim, but also allows the interviewer to add followup queries based on his or her clinical interpretation of the interviewee’s initial response.

Both formats have advantages and disadvantages. Fully structured interviews are economical. They require no clinical judgment, so trained lay interviewers can administer them. They generally take less time to administer. Many large research studies and large treatment facilities use fully structured instruments, because staff members with little experience can perform the initial and followup assessments. Semi-structured interviews, in contrast, through their open-ended probes, provide greater detail on the client’s status.

Convenience Features

Many assessment instruments are modular, permitting flexibility in the choice of sections used and diagnoses assessed. Thus, for example, researchers or clinicians who do not encounter psychotic individuals because of program regulations or a research protocol may omit a psychosis module.

Several structured and semi-structured diagnostic interviews are available in computer-assisted formats. Interviewers read questions to interviewees and enter responses into a computer rather than a paper form. This reduces administration time and rater error, as the program automatically skips or adjusts the wording of questions based on patients’ previous responses. Further, computerized administration saves many hours of data entry and avoids the errors that can occur in transferring data from paper into a computer database for analysis. Computerizing the logic of the interview also reduces the need for post-interview data cleaning. The data go directly into a database that can immediately generate reports and statistics.

A BASIC MENU OF ASSESSMENT INSTRUMENTS

Of the instruments we discuss here, the ASI and CIDI make up the common assessment battery of the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN), which conducts studies to evaluate evidence-based treatment interventions in widely diverse community-based treatment settings and patient populations nationwide. Prior to adopting these measures, a CTN workgroup evaluated many measures for reliability, validity, efficiency, and suitability for widespread use in nonresearch settings.

RELIABILITY AND VALIDITY

An instrument’s reliability and validity are critical to its value. All the instruments discussed in this article are highly reliable and valid, but the extent of their reliability or validity may differ in particular situations.

Reliability

The question of reliability is: Will users of the instrument consistently reach the same diagnostic conclusions? A straightforward and rigorous way to answer this question is the test-retest method. Two or more clinicians use the instrument to conduct independent assessments of the same patient, and the degree of correlation among their findings is calculated. The standard statistical measure of the degree of the clinicians’ agreement, the kappa coefficient, equals 1 if agreement is complete and less than zero when agreement is no greater than chance might produce ( Cohen, 1960 ). Generally, a test-retest kappa score of 0.75+ indicates excellent reliability; 0.60 to 0.74 is good; 0.40 to 0.59 is fair; and less than 0.40 is poor ( Fleiss, 1981 ).

The question of validity is: Does the instrument truly and unambiguously assess the condition it is designed to evaluate? This question has more dimensions than the estimation of reliability; accordingly, validity is estimated with a number of methods.

The widely used SCID was the first standardized psychiatric interview based on the DSM and has been updated to correspond to the most current DSM criteria. The AUDADIS, PRISM, and SSADDA were specifically designed for substance abuse research, but are adaptable for clinical purposes, too.

Brief descriptions of these instruments follow. For a summary comparison of their properties, see Table 1 .

Characteristics and Selected Assessment Categories of Six Structured Assessment Instruments

The Addiction Severity Index

The ASI ( McLellan et al., 1980 , 1992 ) screens for problems and impairments that commonly accompany drug abuse and dependence. These include, among others, interpersonal difficulties with family, friends, and co-workers; medical conditions such as hepatitis B and C, HIV/AIDS, sexually transmitted diseases, alcoholic liver disease, acute myocardial infarction, pneumonia, and metabolic and endocrine complications ( Kresina et al., 2004 ; Mertens et al., 2003 ); and legal troubles. The ASI provides information that clinicians can use to address these problems with appropriate interventions or referrals.

The semi-structured ASI evaluates patients’ functioning and lifetime experiences in seven domains: (1) medical conditions, (2) employment/support, (3) use of alcohol and drugs, (4) legal issues, (5) family history, (6) family/social relationships, and (7) psychiatric disorders. The administrator asks the patient to rate his or her level of distress in each domain during the past 30 days from 0 (none) to 4 (extreme) and independently rates the patient’s need for treatment in each domain from 0 (none necessary) to 9 (treatment needed to intervene in a life-threatening situation). Finally, the administrator calculates a composite score from a subset of the distress and treatment need responses. This score becomes the basis for treatment planning. Altogether, the ASI takes approximately 45 to 60 minutes to administer, plus 10 to 20 minutes for post-interview scoring.

THE DSM AND STANDARDIZED ASSESSMENT

The year 1980 saw the publication of an epochal document in psychiatry: Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition (DSM-III; American Psychiatric Association, 1980 ). The DSM-III provided clinicians and researchers with standardized definitions and diagnostic criteria for more than 200 psychiatric disorders, including substance abuse and dependence disorders. Prior to this publication, clinicians and researchers commonly used the same diagnostic terms to mean different things, and clinicians often disagreed on whether patients had specific disorders ( Spitzer, Endicott, and Robins, 1975 ; Spitzer and Fleiss, 1974 ). Substance abuse professionals engaged in semantic debates over the definition of addiction—even over the very existence of such a condition.

Following the publication of the DSM-III, diagnostic criteria were included in the mental disorders section of the International Classification of Diseases, 10th Edition (ICD-10; World Health Organization, 1993 ). The ICD-10 is widely used outside the United States to define psychiatric diagnoses.

Substance Use Disorders in DSM-IV

The current edition of the DSM, DSM-IV-TR, sets diagnostic criteria for two types of substance use disorder: dependence and abuse. Some patients seeking treatment report too few symptoms to meet the criteria for either diagnosis. In these cases, the specific symptoms, symptom clusters, and the severity of associated problems can inform effective strategies for intervention and management.

The ICD-10 criteria for substance dependence are similar to those of the DSM-IV. The ICD-10 counterpart to abuse is called “harmful use” and is less specific.

Substance Dependence

Drug or alcohol dependence is diagnosed by documenting that a patient has experienced at least three of seven criteria for a particular substance within a 12-month period. The criteria are:

• Substance often taken in larger amounts or over longer period than intended
• Persistent desire or unsuccessful efforts to cut down or control use
• Great deal of time spent in activities necessary to obtain, use, or recover from the substance
• Important social, occupational, or recreational activities given up or reduced
• Continued use despite knowledge of having a persistent or recurrent physical or psychological problem likely to have been caused or exacerbated by the substance

Although the DSM-IV provides no standards for dependence severity, clinicians may specify “with physiological dependence” or “with withdrawal” to indicate the presence of tolerance (i.e., the need for higher doses to achieve intoxication or other desired effects). Withdrawal, in particular, predicts medical problems and poor outcome ( Hasin et al., 2000 ; Schuckit et al., 2003 ). Alternatively, a symptom or criteria count can function as a measure of dependence severity ( Hasin et al., 2006 b ).

The DSM-IV lists substance-specific intoxication and withdrawal symptoms for most of the common classes of drugs. Two exceptions are hallucinogens and cannabis, neither of which had a known withdrawal syndrome at the time of the document’s publication. Planners for the DSM-V are considering the addition of a withdrawal syndrome for cannabis. In anticipation of such a potential change, the CIDI and AUDADIS interviews contain items related to possible marijuana withdrawal.

Test-retest studies have repeatedly shown good to excellent reliability for the diagnosis of substance dependence with the DSM-IV ( Bucholz et al., 1995 ; Chatterji et al., 1997 ; Easton et al., 1997 ; Grant et al., 1995 , 2003 ; Hasin et al., 1996 , 1997 a ; Horton, Compton, and Cottler, 2000 ; Williams et al., 1992 ). The DSM-IV substance dependence diagnosis also shows good validity in two forms of multi-method comparisons. One compares ICD-10, DSM-IV, and DSM-III-R diagnoses obtained from a single diagnostic interview ( Grant, 1993 ; Hasin et al., 1997 b ; Schuckit et al., 1994 ). The other compares diagnoses from a single system (such as DSM-IV) produced by different diagnostic interviews ( Cottler et al., 1997 ; Pull et al., 1997 ).

Studies of families with alcohol problems have validated the criteria for the substance dependence diagnosis. A family history of alcohol problems is strongly associated with DSM-IV alcohol dependence ( Hasin et al., 1997 c ; Hasin and Paykin, 1999 ). In addition, animal models support the validity of many elements of dependence ( Robinson, 2004 ; Tapper et al., 2004 ), and neuroscientists and geneticists are finding links to biological variations that increase or reduce the risk for dependence (e.g., Edenberg et al., 2004 ; Hogg and Bertrand, 2004 ).

Substance Abuse

Patients who do not meet the criteria for substance dependence may be diagnosed with substance abuse if they report experiencing one or more of four abuse symptoms repeatedly over a 12-month period. The symtoms are:

• Failure to fulfill major obligations at work, school, or home
• Recurrent use in situations in which it is physically hazardous
• Recurrent substance-related legal problems
• Continued use despite persistent social or interpersonal problems

Many clinicians have questioned the separation of substance dependence and substance abuse. Studies have shown that the DSM criteria for abuse are less valid than those for dependence. However, these studies diagnosed substance abuse hierarchically, meaning that an abuse diagnosis was considered to be redundant if dependence was present. Although DSM-IV stipulates this procedure, not everyone with dependence also meets the criteria for abuse ( Hasin and Grant, 2004 ). Women and minorities appear especially likely to experience dependence without abuse ( Hasin et al., 2005 ; Hasin and Grant, 2004 ). Studies that assessed abuse regardless of whether dependence was present showed better reliability for the criteria for abuse ( Bucholz et al., 1995 ; Canino et al., 1999 ; Cottler et al., 1997 ; Pull et al., 1997 ). In summary, the DSM-IV hierarchical status of abuse is problematic, but the criteria yield reliable diagnoses.

DSM-IV and Substance Use Comorbidity

Extensive comorbidity between substance use disorders and other psychiatric disorders has been reported consistently in patients ( Nunes, Hasin, and Blanco, 2004 ) as well as in the general population ( Grant et al., 2004 a , 2004 b ; Regier et al., 1990 ). Such comorbidity can be serious. For example, studies with acceptable response rates (70 percent or more) and reliable diagnostic assessments have consistently found an adverse effect of major depression on the outcome of substance use disorders ( Hasin, Nunes, and Meydan, 2004 ). Further, among patients with histories of substance dependence and major depression, the occurrence of a major depressive episode during periods of sustained abstinence predicts a higher number of suicide attempts ( Aharonovich et al., 2002 ).

To be accurate, assessments must address the fact that substance intoxication and withdrawal can mimic symptoms of depression, psychosis, or other independent psychiatric disorders. Accordingly, the DSM-IV distinguishes among “expected effects” of substance intoxication or withdrawal, “primary disorders,” and “substance-induced disorders.” A primary disorder is diagnosed if “the symptoms are not due to the direct physiological effects of a substance” ( American Psychiatric Association, 2000 ). Psychiatric disorders that co-occur with substance intoxication or withdrawal can be considered primary if (1) symptoms substantially exceed the expected effects of the substance in the amount that was used; (2) there is a personal history of psychiatric symptoms during periods of extended abstinence; (3) the onset of psychiatric symptoms clearly preceded the onset of substance use; and (4) symptoms persisted for at least a month after the cessation of intoxication or withdrawal. Symptoms that are not considered primary fall into the category either of expected effects of a substance or of a substance-induced disorder that exceeds intoxication or withdrawal effects and deserves independent clinical attention. Instrument developers have incorporated this information into some tools, in particular the SSADDA and PRISM.

The ASI’s psychometric properties have been tested extensively ( Alterman et al., 1994 ; Hodgins and el-Guebaly, 1992 ; Joyner, Wright, and Devine, 1996 ; Kosten, Rounsaville, and Kleber, 1983 ; McLellan et al., 1985 ; Rogalski, 1987 ). Several studies have demonstrated good to excellent reliability and validity for the instrument ( Butler et al., 2001 ; Hendriks et al., 1989 ; Leonhard et al., 2000 ; Weisner, McLellan, and Hunkeler, 2000 ). A 2004 summary of studies in multiple patient groups (Mäkelä) found that the reliability of composite scores varied from high ( Daeppen et al., 1996 ; McLellan et al., 1985 ; Peters et al., 2000 ) to low ( Drake, McHugo, and Biesanz, 1995 ; Zanis et al., 1994 ; Zanis, McLellan, and Corse, 1997 ). Three of the seven ASI domains (medical conditions, use of alcohol, and psychiatric disorders) have high internal consistency across studies, while the other four are more variable. Correlations between domains are usually low, except those between the drug and legal measures and those between the psychiatric and social impairment measures. The lack of across-the-board correlations is consistent with the ASI’s perspective, which is that impairment in some domains does not necessarily entail impairment in others.

The ASI, by itself, may not be a highly reliable screen for special populations, such as the homeless or dually diagnosed. For the latter groups, the ASI should be supplemented with instruments that assess comorbidity in greater depth, such as the PRISM or the SSADDA.

Interviewer training and experience enhance the validity of ASI results ( Mäkelä, 2004 ). Standardized training is available and consists of a 2-day classroom component and materials for independent study (see www.tresearch.org/training/asi_train.htm ).

Many community programs include the ASI in their initial assessment battery, but informal reports suggest that some look upon it as merely required paperwork and use its information minimally, if at all, in treatment. To remedy this situation, the NIDA/Substance Abuse and Mental Health Services Administration (SAMHSA) Blending Initiative has produced a curriculum on transforming ASI data into clinically useful information (see www.nida.nih.gov/Blending/ASI.html ).

Alcohol Tolerance Item From the World Mental Health Composite International Diagnostic Interview (WMH-CIDI)

Source: Kessler and Ustün, 2004 . Abbreviations: DK, don’t know; RF, refused.

Numbers are codes for recording the four responses.

The Composite International Diagnostic Interview

The CIDI, originally developed by the World Health Organization, assesses 22 DSM-IV diagnoses, including mood, anxiety, and substance use disorders (see “Alcohol Tolerance Item From the World Mental Health Composite International Diagnostic Interview (WMH-CIDI)”). For each substance use disorder, the CIDI elicits other information useful for treatment planning, such as the patterns and course of alcohol and drug use. The fully structured instrument takes approximately 120 minutes to administer in its entirety ( Kessler and Ustün, 2004 ).

Various versions and adaptations of the original CIDI have been developed. The University of Michigan version, the UM-CIDI, has been used in a large international epidemiological survey ( Wittchen and Kessler, 1994 ), but appears to produce lower prevalence estimates than other diagnostic instruments ( Wittchen et al., 1998 ). To address this problem and others related to earlier versions of the CIDI, the World Mental Health Survey Initiative Version, the WMH-CIDI, was developed ( Kessler and Ustün, 2004 ). A complete description of WMH-CIDI modifications is reported elsewhere ( Kessler and Ustün, 2004 ). The WMH-CIDI is available in paper and computerized forms for download or computer-assisted administration at www.hcp.med.harvard.edu/wmhcidi/instruments.php .

Programs or projects may use the CIDI substance use sections alone or combine them with other sections to achieve the desired range of assessment. To meet the particular needs of the substance abuse field, researchers have developed the CIDI Substance Abuse Module (CIDI-SAM), an expanded version of the original CIDI substance use section that elicits detailed information on such areas as the onset and history of substance abuse, withdrawal symptoms, common comorbidities, social consequences, and treatment history ( Cottler, Robins, and Helzer, 1989 ; Horton, Compton, and Cottler, 2000 ; epi.wustl.edu/epi/assessments/sam.htm ).

Test-retest studies of the original CIDI and the CIDI-SAM paper versions have demonstrated good to excellent reliability for DSM-IV diagnoses of any substance use disorder or substance dependence and fair to good reliability for abuse ( Rubio-Stipec, Peters, and Andrews, 1999 ; Wittchen et al., 1998 ). The reliability of the CIDI, version 3.0, was tested in the WHO World Mental Health Surveys by comparing CIDI-derived diagnoses to those derived with the SCID ( Haro et al., 2006 ). Concordance for alcohol dependence (with or without abuse) was excellent; concordance for drug dependence (with or without abuse) was fair; and concordance for alcohol abuse and drug abuse was good.

NIDA’s CTN adopted the CIDI after comparing five commonly used substance use disorder diagnostic instruments on 26 criteria, including psychometric properties, diagnostic time frames, time to administer, and training and financial considerations ( Forman et al., 2004 ). The CTN workgroup ultimately determined that only the CIDI met three crucial CTN requirements: it can be administered by trained research technicians with no prior clinical experience; it provides for DSM-IV, as well as International Classification of Diseases, 10th Edition (ICD-10; World Health Organization, 1993 ), substance use disorder diagnoses; and it provides for past-year and lifetime diagnoses. At this point, it is too soon to know whether CTN-related community-based programs will adopt the CIDI for clinical use.

Alcohol Use Screening From the Structured Clinical Interview for DSM (SCID)

Sources: First et al., 2002 ; Williams et al., 1992 .

The Structured Clinical Interview for DSM-IV

The SCID is available in different versions for researchers and clinicians. Additionally, the research version is available in formats for patients, nonpatients, and patients with psychotic disorders. The Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition ( First et al., 2002 ), provides lifetime and current diagnostic assessments for many DSM-IV disorders, including substance use disorders. The separate SCID for Axis II disorders provides the basis for diagnosing personality disorders ( First et al., 1997 ).

The semi-structured SCID is designed for administration by interviewers with clinical expertise, but research assistants having extensive experience with a population under study have sometimes learned to administer it successfully. After an open-ended overview and brief general screening, the interviewer takes the patient through the questions on the form, following up as needed (based on clinical judgment) to clarify responses. The alcohol and drug modules contain open-ended screening questions as well (see “Alcohol Use Screening From the Structured Clinical Interview for DSM (SCID)”). Administration can take up to several hours, depending on the complexity of the patient’s substance and psychiatric history. The instrument is modular, so clinicians can make use of only those sections that pertain to assessment aims. It contains a minimal number of nondiagnostic items to keep administration time as brief as possible.

In tests among substance-abusing populations, the SCID has demonstrated excellent reliability for diagnosing DSM-III-R substance dependence ( American Psychiatric Association, 1987 ; Ross et al., 1995 ). A small test-retest study of 52 patients with DSM-IV diagnoses showed excellent reliability for substance use disorders ( Zanarini et al., 2000 ). The SCID Web site ( www.scid4.org/index.html ) provides information on the different versions, psychometric properties, ways to obtain copies of the interview and training materials, and procedures for arranging on-site training. A user’s guide provides basic training in the use of the SCID. In addition, an 11-hour videotape training program is available with examples of interviews with actual patients. The instrument’s developers recommend at least 20 hours of training on the full SCID for most clinicians. A Spanish-language version of the SCID (research version), in which only the questions have been translated, and a computer-assisted SCID (for Axis I disorders, clinician version), developed by an outside source, can be obtained through the SCID Web site.

The Alcohol Use Disorder and Associated Disabilities Interview Schedule

The AUDADIS ( Grant et al., 1995 , 2003 ) provides for current (last 12 months) and lifetime DSM-IV diagnoses of major mood, anxiety, personality, and substance use disorders. Originally developed by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) for use in population-based epidemiological surveys, the fully structured AUDADIS functions as an economical tool that lay staff in treatment programs can administer for intake screening. Clinicians can use the detailed descriptive data obtained by the AUDADIS to structure treatment based on a patient’s specific substance-related behaviors. In addition to alcohol, tobacco, and other drug use, modules address treatment and family history. Numerous queries address the frequency and quantity of use of each type of alcohol (e.g., beer, wine, liquor) and each illicit drug during three time periods—that of heaviest use, the past 12 months, and the interviewee’s lifetime (see “Sample Item From the Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS)”).

The AUDADIS showed high reliability in a test-retest study in clinical settings where comorbidity was expected to be high ( Hasin et al., 1996 ). Its test-retest reliabilities for alcohol and drug consumption, abuse, and dependence, as well as those for other modules, were good to excellent ( Grant et al., 1995 , 2003 ). The AUDADIS interview can be downloaded (niaaa.census.gov/questionaire.html). The instrument’s developers recommend using the computer-assisted version.

The Psychiatric Research Interview for Substance and Mental Disorders

The PRISM ( Hasin et al., 1996 , 2006 a ; Hasin, Trautman, and Endicott, 1998 ) is a semi-structured diagnostic interview designed expressly for assessing comorbid psychiatric disorders in individuals who abuse substances. The instrument’s strength is in differentiating independent psychiatric disorders, such as depression, from the effects of intoxication and withdrawal. Along with abuse and dependence diagnoses for specific substance categories, clinicians and researchers can use the PRISM to make current and lifetime DSM-IV diagnoses of Axis I and Axis II disorders that commonly occur with substance abuse, such as mood, anxiety, and psychotic disorders.

The PRISM sections on substance use disorders are placed at the beginning of the interview and provide a background for the overall clinical picture. Periods of chronic intoxication (defined as “at least 4 days a week for a month”) or binge use (defined as “most of the day for 3 or more days”) and extended periods of abstinence are identified and charted on a timeline. The timeline is the only part of the PRISM that is conducted in an unstructured format, and timeline information is not coded for data entry. The purpose of the timeline is to assist in differentiating primary versus substance-induced symptoms in later diagnostic sections.

PRISM developers incorporated two features into the instrument to avoid the lengthy administration time associated with many standardized interviews. First, diagnostic sections are modular, so the instrument can be tailored to fit specific treatment or research needs. Second, consumption questions in the substance use module do not seek detailed information about patterns, but simply ask how often the interviewee has used the substance “in the last 12 months” or “ever” and whether the individual has ever experienced a period of chronic intoxication or binge use. If the response to any of these broad questions is “yes,” the interviewer moves on to the abuse and dependence diagnostic module.

A recent test-retest study of 285 heavy substance users showed good to excellent reliability for most dependence diagnoses, including alcohol, cocaine, heroin, cannabis, and sedative dependence ( Hasin et al., 2006 a ). An independently conducted validity study of a Spanish-language version of the PRISM with the Longitudinal, Expert, All-Data Diagnosis (LEAD) procedure ( Spitzer, 1983 ) as the “gold standard” and the SCID found that the concordance of the three assessments in substance dependence was good to excellent. However, PRISM/LEAD concordance was significantly better than SCID/LEAD concordance on current cannabis and cocaine dependence, as well as past alcohol abuse and dependence ( Torrens et al., 2004 ). The English version of the PRISM can be downloaded, together with training information ( www.columbia.edu/~dsh2/prism ). A computer-assisted version, which will include questions on marijuana withdrawal and modules for nicotine-related disorders, pathological gambling, and attention deficit hyperactivity disorder, will be available in 2008.

Sample Item From the Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS)

Sources: Grant et al., 1995 , 2003 .

The Semi-Structured Assessment for Drug Dependence and Alcoholism

The SSADDA ( Pierucci-Lagha et al., 2005 ) was developed for use in studies of genetic influences on cocaine and opioid dependence. Derived from the Semi-Structured Assessment for the Genetics of Alcoholism, the SSADDA provides extensive coverage of the physical, psychological, social, and psychiatric manifestations of cocaine and opioid abuse and dependence in addition to a number of related Axis I and Axis II disorders. A standout feature of the SSADDA is its inclusion of questions about the onset and recency of individual alcohol and drug symptoms, permitting a temporal assessment of symptom clusters. Information about the timing of symptoms is particularly helpful in distinguishing comorbid disorders from intoxication or withdrawal effects.

The reliability of individual dependence criteria in the SSADDA has been tested to determine the extent to which independent interviewers arrive at the same diagnostic conclusions. Overall, the inter-rater reliability estimates were excellent for individual DSM-IV criteria for nicotine and opioid dependence; good for alcohol and cocaine dependence; and fair for dependence on cannabis, sedatives, and stimulants ( Pierucci-Lagha et al, 2007 ). A computer-assisted version of the SSADDA is available free. Further information can be obtained by contacting Dr. Amira Pierucci-Lagha, Alcohol Research Center, Department of Psychiatry, University of Connecticut School of Medicine.

Zigy Kaluzny/© 2007 Getty Images

The publication of the DSM-III ushered in a period of standardized assessment and diagnosis in mental health research. Several widely used structured and semi-structured instruments for assessing dependence, co-occurring psychiatric disorders, and associated problems have shown good reliability, validity, and acceptance in clinical research settings. These instruments are now being used in community settings to inform treatment planning and case management.

Regardless of their original purposes, all of the measures described in this paper can be used for both research and treatment. The decision to use one instrument rather than another will depend on a number of practical considerations. Reliability and validity often vary considerably between specific drug categories. Thus, a review of the strength of the specific drug diagnoses of interest is important. Users will need to consider whether disorders other than substance use or other characteristics of interest are covered and, when necessary, if the instrument is available in a language other than English. Staff level of experience and training costs are also key factors in evaluating the appropriateness of an instrument for a particular research or treatment setting.

Most of the measures are in modular format. Substance disorder and other modules, along with a measure of problem severity like the ASI, can serve as the basis of a thorough intake interview and, as the patient progresses through treatment, can be used to assess changes in status systematically. Modules from different instruments can be combined, but this can be complicated if computer-assisted versions are used. In addition, even the most user-friendly computer-assisted instruments require staff with technical know-how, and computer and software costs and licensing fees can be high in relation to budget allowances. Conversely, paper-and-pencil versions consume additional staff time for data cleaning and data entry, require repeated printing, and can take up a great deal of storage space, depending on the sample or patient population size. Thus, a thorough cost estimate is needed before deciding whether to use a paper-and-pencil or computerized format.

ACKNOWLEDGMENTS

Support is acknowledged from NIAAA grants K05 AA014223 and R01 DA10919, NIDA grant U10 DA130350B2, and the New York State Psychiatric Institute. The authors wish to thank Ms. Valerie Richmond for editorial assistance and manuscript preparation.

• Aharonovich E, et al. Suicide attempts in substance abusers: Effects of major depression in relation to substance use disorders. American Journal of Psychiatry. 2002; 159 (9):1600–1602. [ PubMed ] [ Google Scholar ]
• Aharonovich E, et al. Postdischarge cannabis use and its relationship to cocaine, alcohol, and heroin use: A prospective study. American Journal of Psychiatry. 2005; 162 (8):1507–1514. [ PubMed ] [ Google Scholar ]
• Alterman AI, et al. Interviewer severity ratings and composite scores of the ASI: A further look. Drug and Alcohol Dependence. 1994; 34 (3):201–209. [ PubMed ] [ Google Scholar ]
• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3d ed. Washington, DC: American Psychiatric Association; 1980. [ Google Scholar ]
• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3d ed. Washington, DC: American Psychiatric Association; 1987. Text Revision; DSM-III-R. [ Google Scholar ]
• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 2000. Text Revision; DSM-IV-TR. [ Google Scholar ]
• Beck AT, et al. An inventory for measuring depression. Archives of General Psychiatry. 1961; 4 :53–63. [ PubMed ] [ Google Scholar ]
• Bucholz KK, et al. Reliability of individual diagnostic criterion items for psychoactive substance dependence and the impact on diagnosis. Journal of Studies on Alcohol. 1995; 56 (5):500–505. [ PubMed ] [ Google Scholar ]
• Budney AJ, et al. Marijuana abstinence effects in marijuana smokers maintained in their home environment. Archives of General Psychiatry. 2001; 58 (10):917–924. [ PubMed ] [ Google Scholar ]
• Butler SF, et al. Initial validation of a computer-administered Addiction Severity Index: The ASI-MV. Psychology of Addictive Behaviors. 2001; 15 (1):4–12. [ PubMed ] [ Google Scholar ]
• Canino G, et al. The Spanish Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS): Reliability and concordance with clinical diagnoses in a Hispanic y population. Journal of Studies on Alcohol. 1999; 60 (6):790–799. [ PubMed ] [ Google Scholar ]
• Chatterji S, et al. Reliability of the alcohol and drug modules of the Alcohol Use Disorder and Associated Disabilities Interview Schedule–Alcohol/Drug-Revised (AUDADIS–ADR): An international comparison. Drug and Alcohol Dependence. 1997; 47 (3):171–185. [ PubMed ] [ Google Scholar ]
• Cohen J. A coefficient of agreement for nominal scales. Educational and Psychological Measurement. 1960; 20 :37–46. [ Google Scholar ]
• Cottler LB, et al. Concordance of DSM-IV alcohol and drug use disorder criteria and diagnoses as measured by AUDADIS-ADR, CIDI and SCAN. Drug and Alcohol Dependence. 1997; 47 (3):195–205. [ PubMed ] [ Google Scholar ]
• Cottler LB, Robins LN, Helzer JE. The reliability of the CIDI-SAM: A comprehensive substance abuse interview. British Journal of Addiction. 1989; 84 (7):801–814. [ PubMed ] [ Google Scholar ]
• Crowley TK, et al. Cannabis dependence, withdrawal, and reinforcing effects among adolescents with conduct symptoms and substance use disorders. Drug and Alcohol Dependence. 1998; 50 (1):27–37. [ PubMed ] [ Google Scholar ]
• Daeppen JB, et al. Validation of the Addiction Severity Index in French-speaking alcoholic patients. Journal of Studies on Alcohol. 1996; 57 (6):585–590. [ PubMed ] [ Google Scholar ]
• Drake RE, McHugo GJ, Biesanz JC. The test-retest reliability of standardized instruments among homeless persons with substance use disorders. Journal of Studies on Alcohol. 1995; 56 (2):161–167. [ PubMed ] [ Google Scholar ]
• Easton C, et al. Test-retest reliability of the alcohol and drug use disorder sections of the schedules for clinical assessment in neuropsychiatry (SCAN) Drug and Alcohol Dependence. 1997; 47 (3):187–194. [ PubMed ] [ Google Scholar ]
• Edenberg HJ, et al. Variations in GABRA2, encoding the alpha 2 subunit of the GABA(A) receptor, are associated with alcohol dependence and with brain oscillations. American Journal of Human Genetics. 2004; 74 (4):705–714. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• First MB, et al. Structured Clinical Interview for DSM-IV Personality Disorders, (SCID-II) Washington, DC: American Psychiatric Press; 1997. [ Google Scholar ]
• First MB, et al. Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition, SCID-I/P. New York: Biometrics Research, New York State Psychiatric Institute; 2002. [ Google Scholar ]
• Fleiss JL. Statistical Methods for Rates and Proportions. 2d ed. New York: John Wiley & Sons; 1981. [ Google Scholar ]
• Forman RF, et al. Selection of a substance use disorder diagnostic instrument by the National Drug Abuse Treatment Clinical Trials Network. Journal of Substance Abuse Treatment. 2004; 27 (1):1–8. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Grant BF. Comparison of DSM-III-R and draft DSM-IV alcohol abuse and dependence in a general population sample. Addiction. 1993; 88 (12):1709–1716. [ PubMed ] [ Google Scholar ]
• Grant BF, et al. The Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS): Reliability of al alcohol and drug modules in a general population sample. Drug and Alcohol Dependence. 1995; 39 (1):37–44. [ PubMed ] [ Google Scholar ]
• Grant BF, et al. The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): Reliability of alcohol consumption, tobacco use, family history of depression and psychiatric modules in a general population sample. Drug and Alcohol Dependence. 2003; 71 (1):7–16. [ PubMed ] [ Google Scholar ]
• Grant BF, et al. Co-occurrence of 12-month alcohol and drug use disorders and personality disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry. 2004a; 61 (4):361–368. [ PubMed ] [ Google Scholar ]
• Grant BF, et al. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry. 2004b; 61 (8):807–816. [ PubMed ] [ Google Scholar ]
• Grant BF, Stinson FS, Harford TTC. The 5-year course of alcohol abuse among young adults. Journal of Substance Abuse. 2001; 13 (3):229–238. [ PubMed ] [ Google Scholar ]
• Hamilton M. A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry. 1960; 23 :56–62. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Haro JM, et al. Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. International Journal of Methods in Psychiatric Research. 2006; 15 (4):167–180. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Hasin DS, et al. Psychiatric Research Interview for Substance and Mental Disorders: Reliability for substance abusers. American Journal of Psychiatry. 1996; 153 (9):1195–1201. [ PubMed ] [ Google Scholar ]
• Hasin DS, et al. The Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS): Reliability of alcohol and drug modules in a clinical sample. Drug and Alcohol Dependence. 1997a; 44 (2–3):133–141. [ PubMed ] [ Google Scholar ]
• Hasin DS, et al. Nosological comparisons of alcohol and drug diagnoses: A multisite, multi-instrument international study. Drug and Alcohol Dependence. 1997b; 47 (3):217–226. [ PubMed ] [ Google Scholar ]
• Hasin DS, et al. Alcohol dependence and abuse diagnoses: Validity in community sample heavy drinkers. Alcoholism: Clinical and Experimental Research. 1997c; 21 (2):213–219. [ PubMed ] [ Google Scholar ]
• Hasin DS, et al. Differentiating DSM-IV alcohol dependence and abuse by course: Community heavy drinkers. Journal of Substance Abuse. 1997d; 9 :127–135. [ PubMed ] [ Google Scholar ]
• Hasin DS, et al. Withdrawal and tolerance: Prognostic significance in DSM-IV alcohol dependence. Journal of Studies on Alcohol. 2000; 61 (3):431–438. [ PubMed ] [ Google Scholar ]
• Hasin DS, et al. Co-occurring DSM-IV drug abuse in DSM-IV drug dependence: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug and Alcohol Dependence. 2005; 80 (1):117–123. [ PubMed ] [ Google Scholar ]
• Hasin DS, et al. Diagnosis of comorbid psychiatric disorders in substance users assessed with the Psychiatric Research Interview for Substance and Mental Disorders for DSM-IV. American Journal of Psychiatry. 2006a; 163 (4):689–696. [ PubMed ] [ Google Scholar ]
• Hasin DS, et al. DSM-IV alcohol dependence: A categorical or dimensional phenotype? Psychological Medicine. 2006b; 36 (12):1695–1705. [ PubMed ] [ Google Scholar ]
• Hasin DS, Grant BF. The co-occurrence of DSM-IV alcohol abuse in DSM-IV alcohol dependence: Results of the National Epidemiologic Survey on Alcohol and Related Conditions on heterogeneity that differ by population subgroup. Archives of General Psychiatry. 2004; 61 (9):891–896. [ PubMed ] [ Google Scholar ]
• Hasin DS, Grant BF, Endicott J. The natural history of alcohol abuse: Implications for definitions of alcohol use disorders. American Journal of Psychiatry. 1990; 147 (11):1537–1541. [ PubMed ] [ Google Scholar ]
• Hasin DS, Nunes E, Meydan J. Comorbidity of alcohol, drug and psychiatric disorders: Epidemiology. In: Kranzler HR, Tinsley JA, editors. Dual Diagnosis and Treatment: Substance Abuse and Comorbid Disorders. New York: Marcel Dekker; 2004. pp. 1–34. [ Google Scholar ]
• Hasin DS, Paykin A. Alcohol dependence and abuse diagnoses: Concurrent validity in a nationally representative sample. Alcoholism: Clinical and Experimental Research. 1999; 23 (1):144–150. [ PubMed ] [ Google Scholar ]
• Hasin DST, Trautman K, Endicott J. Psychiatric research interview for substance and mental disorders: Phenomenologically based diagnosis in patients who abuse alcohol logically or drugs. Psychopharmacology Bulletin. 1998; 34 (1):3–8. [ PubMed ] [ Google Scholar ]
• Hendriks VM, et al. The Addiction Severity Index: Reliability and validity in a Dutch addict population. Journal of Substance Abuse and Treatment. 1989; 6 (2):133–141. [ PubMed ] [ Google Scholar ]
• Hodgins DC, el-Guebaly Guebaly N. More data on the Addiction Severity Index: Reliability and validity with the mentally ill substance abuser. Journal of Nervous and Mental Disease. 1992; 180 (3):197–201. [ PubMed ] [ Google Scholar ]
• Hogg RC, Bertrand D. What genes tell us about nicotine addiction. Science. 2004; 306 (5698):983–985. [ PubMed ] [ Google Scholar ]
• Horton J, Compton W, Cottler LB. Reliability of substance use disorder diagnoses among African-Americans and Caucasians. Drug and Alcohol Dependence. 2000; 57 (3):203–209. [ PubMed ] [ Google Scholar ]
• Joyner LM, Wright JD, Devine JA. Reliability and validity of the Addiction Severity Index among homeless substance misusers. Substance Use and Misuse. 1996; 31 (6):729–751. [ PubMed ] [ Google Scholar ]
• Kessler RC, Ustün TB. The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) International Journal of Methods in Psychiatric Research. 2004; 13 (2):93–121. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Kosten TR, Rounsaville BJ, Kleber HD. Concurrent validity of the Addiction Severity Index. Journal of Nervous and Mental Disease. 1983; 171 (10):606–610. [ PubMed ] [ Google Scholar ]
• Kresina TF, et al. Addressing the need for treatment paradigms for drug-abusing patients with multiple morbidities. Clinical Infectious Diseases. 2004; 38 (Suppl 5):S398–S401. [ PubMed ] [ Google Scholar ]
• Leonhard C, et al. The Addiction Severity Index: A field study of internal consistency and validity. Journal of Substance Abuse and Treatment. 2000; 18 (2):129–135. [ PubMed ] [ Google Scholar ]
• Mäkelä K. Studies of the reliability and validity of the Addiction Severity Index. Addiction. 2004; 99 (4):398–410. discussion 411–418. [ PubMed ] [ Google Scholar ]
• McLellan AT, et al. An improved diagnostic evaluation instrument for substance abuse patients: The Addiction Severity Index. Journal of Nervous and Mental Disease. 1980; 168 (1):26–33. [ PubMed ] [ Google Scholar ]
• McLellan AT, et al. New data from the Addiction Severity Index: Reliability and validity in three centers. Journal of Nervous and Mental Disease. 1985; 173 (7):412–423. [ PubMed ] [ Google Scholar ]
• McLellan AT, et al. The Fifth Edition of the Addiction Severity Index. Journal of Substance Abuse and Treatment. 1992; 9 (3):199–213. [ PubMed ] [ Google Scholar ]
• Mertens JR, et al. Medical and psychiatric conditions of alcohol and drug treatment patients in an HMO: Comparison with matched controls. Archives of Internal Medicine. 2003; 163 (20):2511–2517. [ PubMed ] [ Google Scholar ]
• Nunes E, Hasin D, Blanco C. Substance abuse and psychiatric comorbidity—Overview of diagnostic methods, diagnostic criteria, structured and semi-structured interviews, and biological markers. In: Kranzler HR, Tinsley JA, editors. Dual Diagnosis and Treatment: Substance Abuse and Comorbid Disorders. New York: Marcel Dekker; 2004. pp. 61–101. [ Google Scholar ]
• Nunes EV, Levin FR. Treatment of depression in patients with alcohol or other drug dependence: A meta-analysis. Journal of the American Medical Association. 2004; 291 (15):1887–1896. [ PubMed ] [ Google Scholar ]
• Peters RH, et al. Effectiveness of screening instruments in detecting substance use disorders among prisoners. Journal of Substance Abuse and Treatment. 2000; 18 (4):349–358. [ PubMed ] [ Google Scholar ]
• Pierucci-Lagha A, et al. Diagnostic reliability of the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA) Drug and Alcohol Dependence. 2005; 80 (3):303–312. [ PubMed ] [ Google Scholar ]
• Pierucci-Lagha A, et al. Reliability of DSM-IV diagnostic criteria using the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA) Drug and Alcohol Dependence. 2007; 91 (1):85–90. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Pull CB, et al. Concordance between ICD-10 alcohol and drug use disorder criteria and diagnoses as measured by the AUDADIS-ADR, CIDI and SCAN: Results of a cross- DADIS-cross-national study. Drug and Alcohol Dependence. 1997; 47 (3):207–216. [ PubMed ] [ Google Scholar ]
• Regier DA, et al. Comorbidity of mental disorders with alcohol and other drug abuse: Results from the Epidemiologic Catchment Area (ECA) Study. Journal of the American Medical Association. 1990; 264 (19):2511–2518. [ PubMed ] [ Google Scholar ]
• Robinson TE. Addicted rats. Science. 2004; 305 (5686):951–953. [ PubMed ] [ Google Scholar ]
• Rogalski CJ. Factor structure of the Addiction Severity Index in an inpatient detoxification sample. International Journal of Addiction. 1987; 22 (10):981–992. [ PubMed ] [ Google Scholar ]
• Ross HE, et al. Diagnosing comorbidity in substance abusers: A comparison of the test-retest reliability of two interviews. American Journal of Drug and Alcohol Abuse. 1995; 21 (2):167–185. [ PubMed ] [ Google Scholar ]
• Rubio-Stipec M, Peters L, Andrews G. Test-retest reliability of the computerized CIDI (CIDI-Auto): Substance abuse modules. Substance Abuse. 1999; 20 (4):263–272. [ PubMed ] [ Google Scholar ]
• Schuckit MA, et al. A comparison of DSM-III-R, DSM-IV and ICD-10 substance use disorders diagnoses in 1922 men and women subjects in the COGA study: Collaborative Study on the Genetics of Alcoholism. Addiction. 1994; 89 (12):1629–1638. [ PubMed ] [ Google Scholar ]
• Schuckit MA, et al. Five-year clinical course associated with DSM-IV alcohol abuse or dependence in a large group of men and women. American Journal of Psychiatry. 2001; 158 (7):1084–1090. [ PubMed ] [ Google Scholar ]
• Schuckit MA, et al. A 5-year prospective evaluation of DSM-IV alcohol dependence with and without a physiological component. Alcoholism: Clinical and Experimental Research. 2003; 27 (5):818–825. [ PubMed ] [ Google Scholar ]
• Spitzer RL. Psychiatric diagnosis: Are clinicians still necessary? Comprehensive Psychiatry. 1983; 24 (5):399–411. [ PubMed ] [ Google Scholar ]
• Spitzer RL, Fleiss JL. A re-analysis of the reliability of psychiatric diagnosis. British Journal of Psychiatry. 1974; 125 (0):341–347. [ PubMed ] [ Google Scholar ]
• Spitzer RL, Endicott J, Robins E. Clinical criteria for psychiatric diagnosis and DSM-III. American Journal of Psychiatry. 1975; 132 (11):1187–1192. [ PubMed ] [ Google Scholar ]
• Tapper AR, et al. Nicotine activation of alpha 4* receptors: Sufficient for reward, tolerance, and sensitization. Science. 2004; 306 (5698):1029–1032. [ PubMed ] [ Google Scholar ]
• Torrens M, et al. Diagnosing comorbid psychiatric disorders in substance abusers: Validity of the Spanish versions of the Psychiatric Research Interview for Substance and Mental Disorders and the Structured Clinical Interview for DSM-IV. American Journal of Psychiatry. 2004; 161 (7):1231–1237. [ PubMed ] [ Google Scholar ]
• Weisner C, McLellan AT, Hunkeler EM. Addiction Severity Index data from general membership and treatment samples of HMO members: One case of norming the ASI. Journal of Substance Abuse and Treatment. 2000; 19 (2):103–109. [ PubMed ] [ Google Scholar ]
• Wiesbeck GA, et al. An evaluation of the history of a marijuana withdrawal syndrome in a large population. Addiction. 1996; 91 (10):1469–1478. [ PubMed ] [ Google Scholar ]
• Williams JB, et al. The Structured Clinical Interview for DSM-III-R (SCID). II. Multisite test-retest reliability. Archives of General Psychiatry. 1992; 49 (8):630–636. [ PubMed ] [ Google Scholar ]
• Wittchen HU, et al. Test-retest reliability of the computerized DSM-IV version of the Munich-Composite International Diagnostic Interview (M-CIDI) Social Psychiatry and Psychiatric Epidemiology. 1998; 33 (11):568–578. [ PubMed ] [ Google Scholar ]
• Wittchen HU, Kessler RC. Modifications of the CIDI in the National Comorbidity Survey: The development of the UM-CIDI [NCS Working Paper 2] Ann Arbor, MI: National, Comorbidity Survey; 1994. [ Google Scholar ]
• World Health Organization. ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research (Volume II) Geneva, Switzerland: World Health Organization; 1993. [ Google Scholar ]
• Zanarini MC, et al. The Collaborative Longitudinal Personality Disorders Study: Reliability of Axis I and II diagnoses. Journal of Personality Disorders. 2000; 14 (4):291–299. [ PubMed ] [ Google Scholar ]
• Zanis DA, et al. Reliability and validity of the Addiction Severity Index with a homeless sample. Journal of Substance Abuse and Treatment. 1994; 11 (6):541–548. [ PubMed ] [ Google Scholar ]
• Zanis DA, McLellan AT, Corse S. Is the Addiction Severity Index a reliable and valid assessment instrument among clients with severe and persistent mental illness and substance abuse disorders? Community Mental Health Journal. 1997; 33 (3):213–227. [ PubMed ] [ Google Scholar ]

Follow Us x

• Core Concepts
• Our Intensive Outpatient Program
• Powerpoints
• In The News
• Take the Test
• Referral Forms
• Addiction Resource Guide
• Client Portal

Contact Info x

• Active Recovery
• Phone: (318) 946-8157
• FAX: (318) 216-5868
• Direct: (318) 584-7133
• Fax: (318) 584-7135
• Phone: (318) 377-1072

20 Cheap Things To Do

Anger as a drug, calendar and daily schedule, core concepts worksheet, defense mechanisms worksheet, forgiveness exercise, getting organized, gratitude journal, identifying triggers worksheet, is my anger due to feeling threatened, is my anger due to unmet expectations, who am i really.

• Copyright © 2024 Active Recovery , all rights reserved.
• 3821 Southern Avenue,,  Suite 510 C,   Shreveport ,  LA   71106    (318) 946-8157

India's #1 Addiction & Recovery Online Resource

Drug addiction explained — a comprehensive guide.

The following blog has been reviewed by an expert. For more information, please see our editorial policy .

Drug addiction, also known as substance use disorder, is a condition which has become a concern all over the world. Many people don’t understand what drug addiction is and how someone gets addicted to drugs.

They think that people who get addicted to drugs are either not willing to quit or lack the willpower to do so.

But in reality, it is a more complex problem than that. Drugs change the brain chemistry of a person in such a way, it becomes very difficult to quit, even if you want to.

In this guide, you will learn about the following —

• What is drug addiction?
• Causes of drug addiction
• Types of drug addiction
• Signs of drug addiction
• Effects of drug addiction
• Prevention from drug addiction
• Drug addiction in India
• Drug addiction treatment

What is Drug Addiction?

Drug addiction is a complex neurobiological disorder , which affects a person’s brain and behaviour in a way that they lose the ability to resist the urge to use drugs.

It isn’t just about illegal drugs like heroin and cocaine. You can get addicted to substances like medication drugs, alcohol , nicotine , marijuana and other legal drugs as well.

Drug dependence usually starts with an experiment. Initially, you take drugs because you like the way it feels. You think it’s a one-time experience and you can handle it.

Also, many people start using drugs as self-medication or to cope with stress.

But repeated misuse of drugs physically changes how your brain works. It makes you lose self-control and messes with your ability to avoid the desire to take drugs. These changes in the brain can be long-lasting.

People who are in recovery from drug abuse are likely to return to drug use even after years of being in recovery from drug addiction. This is called drug relapse.

Causes of Drug Addiction

The reaction of drugs on a human mind varies widely from person to person.

Each person’s body and mind works differently. Some people love to use drugs, and others hate it after their first try.

Rather than a single factor, multiple factors contribute to the addiction to drugs.

• Genetics & Family History – Your genes may mean a greater predisposition to addiction. Your body and brain react to a particular drug the way your ancestors reacted to it. If your parents or their parents had a history with drug abuse, your chances of being addicted to drugs increase drastically.
• Abuse of drugs among friends and peers
• Lack of social support
• Troubled relationships
• Stress in life
• Low socioeconomic status
• Psychological Cause – Although genetics and environment play a significant role in drug addiction, psychological factors also contribute to the problem. Sexual or physical abuse, negligence from parents and peers, domestic violence, everything can lead to psychological stress. And people turn to drugs to let off this stress. Over time, this misuse of drugs can become an addiction.
• Mental disorder such as depression
• Lack of friends in school or any social setting
• Huge academic pressure
• Traumatic events

Types of Drug Addiction

There are different types of drugs in the market, and each type of drug causes different kinds of effects in your body.

Opioids, also called narcotic drugs, are often used as a pain reliever. They work by lowering the pain signals received by your brain. They also change the way your brain responds to pain.

Opioids are usually safe to use. But if consumed in an uncontrolled way, opioids can become very addictive. Opioid drugs alter brain chemistry by influencing dopamine release and hijacking the reward pathway. Dopamine is a neurotransmitter (chemical messenger) that makes you feel good.

After too much use of opioids, your brain starts to depend on it and stops producing its own.

Commonly Abused Opioids

• Hydrocodone
• Hydromorphone
• Oxymorphone

Short-Term Effects of Opioids

• Nausea, vomiting
• Physical agitation
• Slurred Speech
• Shallow breathing
• Anxiety attack

Depressants

Common depressants are prescribed to help with symptoms like insomnia, anxiety, panic and acute stress reactions. It works by slowing down the activities of the brain and putting the body in a state of relaxation.

Depressants can build up drug tolerance quickly. And because of the way it affects brain chemistry, if consumed regularly without a doctor’s prescribed guideline, it can lead to addiction.

Commonly Used Depressants

• Barbiturates
• Benzodiazepines

Short-term Effects of Depressants

• Enhanced mood
• Reduced anxiety
• Reduced reaction time
• Weakness, headache and lightheadedness
• Impaired judgment
• Slurred speech
• Slowed breathing

Stimulants are a category of substances which include both medical drugs, illegal street drugs and commonly used substances such as caffeine and nicotine.

Stimulants affect the brain by temporarily increasing functions like awareness, alertness, energy and mood. Stimulants also increase the level of dopamine inside the mind. It gives you a sensation of euphoria. This sensation makes it more difficult to stop the harmful pattern of stimulant abuse.

Commonly Used Stimulants

• Amphetamine (e.g. Adderall)
• Methamphetamine(e.g. Desoxyn)
• Methylphenidate (e.g. Ritalin, Concerta)

Stimulant users tend to develop rapid drug tolerance. Tolerance occurs when people have to take more of a substance to achieve the same level of high. This type of behaviour also increases the risk of overdose.

Short-Term Effects of Stimulants

• Increased energy, sociability
• Increased vigilance
• Reduced appetite
• Rapid heart rate
• Increased blood pressure
• High body temperature
• Muscle shake or tremors

Hallucinogens

Hallucinogens are a type of drug which alters the perception of reality and causes hallucinations. There are two types of hallucinogens: classic hallucinogens (psychedelics) and dissociative hallucinogens.

Hallucinogens are sometimes considered less dangerous than other kinds of drugs like heroin. But hallucinogens can cause dependency, addiction, and long term adverse side effects.

Commonly Used Hallucinogens

• Psilocybin (mushrooms)
• Mescaline (peyote)
• PCP (phencyclidine)

Hallucinogens cause people to see and hear things that feel real but don’t exist. For some people, these cause intense anxiety, panic attack and terrifying thoughts.

Short-Term Effects of Hallucinogens

• Altered perceptions
• Sense of relaxation, well-being
• Unclear thinking
• Excessive sweating
• Elevated heart rate
• Increased body temperature

Most commonly known as “weed” or “marijuana”, cannabis can be a mixture of leaves, flowers or stems from cannabis plants. THC (tetrahydrocannabinol) is the main active component of cannabis that leads to drug abuse.

Cannabis produces relaxation sensation, mild euphoria, increased appetite and distorted perception of space and time. If used for a prolonged time, you can develop an addiction to cannabis. Research has also shown that excessive use of cannabis can cause brain damage and memory impairment.

Commonly Used Forms of Cannabis

• Marijuana (dried flowering tops and leaves)
• Hashish (dried cannabis resin and compressed flowers)
• Hash oil (extracted THC from hashish)

Short-term Effects of Cannabis

• Relief from stress
• Increased appetite
• Bloodshot eyes
• Altered judgment
• Poor coordination
• Impaired memory

Signs of Drug Addiction

The signs and symptoms of drug addictions vary, and some drugs have a higher risk of getting addicted to them than others. Here are some of the symptoms of drug dependence:

• Feeling an intense urge to use drugs or medication frequently. Maybe several times a day.
• You need more substance to get the same effect because you built a tolerance for the drug.
• You feel alive when you are on the drug. When the drug wears off, you feel shaky, depressed, and confused. You may not feel hunger and may have headaches or run a fever.
• You can’t stop yourself from taking the drug.
• You are doing everything you can to make sure you get drug supplies, even if you can’t afford it.
• Your social life is a wreck. You have a hard time bonding with co-workers, friends or family.
• Your personal health declines. For example, you may start to gain or lose weight. You have bad breath or red eyes.
• You start to steal money to buy drugs.
• You experience withdrawal symptoms when you stop taking drugs.

Effects of Drug Addiction

Drugs are chemicals which affect the brain and body. Different drugs have different compounds and affect the human body differently. Effects of drug abuse also depend on the way you consume it. There are few ways a drug can be consumed, like injection, inhalation and ingestion.

If the drug is injected into the bloodstream, it works almost instantaneously. But when ingested, it takes time for the drug to get into the bloodstream. According to the WHO, around 31 million people worldwide have drug abuse disorder, and among them, 11 million consume drugs by injecting it.

Effect of Drug Addiction on the Brain

All types of drugs affect the brain’s reward system. Drugs physically change how your brain functions and interfere with the ability to make decisions. Misuse of drugs can also lead to various behavioural changes and problems, both short-term and long-term.

Here are some effects of drug addiction in your brain:

• Altered brain functions
• Loss of rational decision-making
• Loss of self-control
• Drug viewed as necessary to survival
• Inability to feel pleasure without drugs

Effect of Drug Addiction on the Body

Prolonged use of drugs not only affects your mind, but it also affects many other organs in the human body. Here are some common effects of drug misuse on the human body:

• Drug abuse damages the immune system and makes you vulnerable to infections.
• It causes heart conditions, including abnormal heart rates, heart attacks and the collapse of veins.
• Drugs cause nausea, abdominal pain and vomiting.
• Some drugs increase the risk of liver failure due to the excessive strain on the liver.
• Misuse of drug abuse causes permanent brain damage, including memory loss, and problems with decision-making and focus.

Social Effects

Apart from these, there are social effects of drug abuse that are also damaging:

• Damaged relationships with family and friends
• Financial trouble
• Sexual abuse
• Accidents and injuries
• Legal consequences (e.g. going to jail).

Prevention From Drug Addiction

When it comes to prevention from drug abuse, there is no foolproof way. But you can certainly do some things that will help you protect yourself and your loved ones from becoming addicted to drugs.

• Educate yourself – Learn about the physical, biological, and social effects of drug misuse. Evaluate the risk factors like losing a job, isolation from society, dropping out of college. No one sets out to be addicted to drugs, so be careful in thinking using a drug “just once” will not be harmful.
• Learn healthy ways to cope with stress – Stress is one of the primary reasons that drive people to drug misuse.
• In this fast-paced world, stress is inevitable – And sometimes to escape from stress, people turn to alcohol and drugs. In the end, this can make life more miserable and stressful. To avoid this, you should learn to handle stress without using drugs. Take up exercising, read a book, volunteer for a good cause, create something. Anything positive that will give you a sense of fulfillment and take your mind away from using drugs to relieve stress.
• Develop close bonds with family – Research has shown that people who have a close relationship with their families are less likely to abuse drugs. A loving family works as a support system and helps you deal with your pressures in life. It helps you to keep a distance from addictive substances.
• Choose your friends mindfully – Teenagers and young adults are easily influenced by others. Often they start to explore different addictive drugs to impress their friends and portray themselves as “cool”. Find friends who won’t force you to do harmful things or be okay with possibly facing rejection when you turn down drugs.
• Develop a healthy lifestyle – There is no better prevention of drug problems than adopting a healthy lifestyle. Being active and fit makes it easier to manage stress. This, in turn, helps to reduce the urge to use drugs or any other harmful substances to manage stress.

These are some of the preventive measures one can take to avoid drug addiction. But if you already developed an addiction, it is advisable to seek professional help and treatment for your drug problem.

Drug Addiction in India

The problem of drug addiction is on the rise in India. Read our comprehensive blog on drug addiction in India to learn more about this problem.

Drug Addiction Treatment

There is no cure for drug addiction. But there are some treatment procedures which can help you to overcome addiction and stay clean.

The first step towards treatment is acknowledging that you have a drug abuse problem in the first place. Once you recognise the problem, there is a wide range of treatments that can be possible.

Most people go through a combination of different types of treatments.

Detoxification

Detoxification is typically the first step of treatment. The goal is to stop the drug, while managing withdrawal symptoms. Sometimes this may be a taper, or reducing drug intake slowly and eventually stopping it.

While in detoxification, it is natural to see withdrawal symptoms.

Withdrawal symptoms are different for different kinds of drugs and require different approaches. It is best to reduce the dose of the drug gradually or have a medication that helps mitigate withdrawal symptoms.

Behavioural Therapy

Behavioural therapy is the standard treatment for drug addiction after detoxification. It can be done by one-on-one sessions, in a group, or family basis, depending on the requirements.

Here are the different types of behavioural therapies.

Cognitive-behavioural therapy (CBT)

It helps the individual to recognise and change thinking towards drug abuse.

Multidimensional family therapy (MDFT)

This kind of treatment is designed to help the family, particularly in addressing youth problems and disorders.

Motivational interviewing (MI)

It helps to encourage the individual to resolve ambivalent feelings and find internal motivation for change.

Self Help Groups

Being a part of a self-help group is very beneficial in recovering from drug dependence. It involves meeting with other individuals with similar addictive disorders and sharing experiences with each other. It boosts motivation and reduces the feeling of loneliness.

These self-help groups also become a great support system for its members.

Medication is not a standalone treatment for drug addiction. However, it may help during the detoxification to manage withdrawal symptoms.

A person may take medication to prevent drug relapse and reduce cravings in the long-term. But it should always be coupled with other methods such as behavioural therapy or rehabilitation.

Drug addiction has become a serious concern worldwide. It affects not only the victim but also their family, friends, and entire society. Drug addiction treatment is possible. Treatment is challenging but effective.

However, do not try to do it alone. Whether you take rehab, join a self-help club, or go to therapy, always reach out to someone, with whom you can find support in overcoming this problem in your life.

Featured Rehabilitation Centres

Sukoon Recovery Centre

Delhi, New Delhi

Jagruti Rehabilitation Centre – Ahmedabad

Ahmedabad, Gujarat

Jagruti Rehabilitation Centre – Chennai

Chennai, Tamil Nadu

JRC – Mumbai

Abhasa Rehabilitation and Wellness Home Coimbatore – Thondamuthur

Coimbatore, Tamil Nadu

Mulshi, Maharashtra

Jagruti Rehab Gurgaon

Gurgaon, Delhi

Abhasa Rehabilitation and Wellness Home – Maharashtra

Karjat, Maharashtra

Abhasa Rehabilitation & Wellness Home – Exclusive Women Center

Alpha Healing Center

Gujarat, India

Lotus Wellness and Rehabilitation Center – Coimbatore

Sanctum Wellness and Healing

Chatterpur, New Delhi

Part of the Recovery.com network. Helping families and individuals worldwide find hope from addiction and mental illness.

• Recovery.com (Global)
• Luxury Rehabs
• Rehabs.africa
• Recovery.co.uk

RehabPath ©2024 | Sky Loft, 2nd Floor, Creaticity Mall, Shastrinagar, Yerawada, Pune 411006, India

Drug Addiction

Introduction:

In recent years Drug Addiction has significantly increased in Bangladesh. This agent of human devastation has spread its tentacles worldwide and also in our country. Every intelligent and humane person in the world, society and international organizations such as the UN and WHO are alarmed by the present rate of addiction. In our country the regular seizures of stocks of heroin and other hard drugs by the police and narcotics department gives us an indication of the extent of addiction in our country. Nowadays nearly ten per cent of outpatients in our hospitals are cases of drug addiction involving heroin, ganja and phensidyl. These are generally youths and young men between 15-30 years of age and come from all strata of the society. But there are adolescents below 15 years of age and men and women over 30. Hospital surveys show that average age of drug addicts is 22. The addicts are students, professionals, businessmen, laborers, rickshaw pullers and from other professions. Students are most affected and drugs have caused deterioration in standards of education and students have also given up going to schools and colleges. These addicts are turning to various criminal activities, in order to procure drugs.

 Generally speaking drugs are substances that affect the physical and mental condition of persons significantly and adversely. Any substance that can lead to addiction, misuse and dependence is a drug. Addiction level of drugs increase with each day of use. If drugs are not available, the patient shows critical withdrawal symptoms when immediate medical care is needed to prevent physical and mental deterioration, even death.

 Drug addiction beings on rapid erosion of educational and cultural, moral and family values. The addicts lose their professional and educational capabilities, self-dignity, and get involved in serious or petty criminal activities. The sole aim in life of an addict becomes the procurement and use of drugs. Other aims and objectives in life are thrown by the roadside. Besides, dread diseases such as Hepatitis, HIV/AIDS can easily attack drug addicts through use of injectable drugs.

 In our country, heroin is mostly smoked within aluminum foil or cigarette paper, but in other countries this is injected. Intravenous injection of pathedine/ morphine and now tadigesic brand of riknomar penic. These are extremely dangerous drugs and increases addiction manifold. Injections through infected needles can cause diseases of the liver, brain, heart, lungs and spinal cord. Normal medication also interacts with heroin and cause many complications, which many addicts do now know about. Such interactions may also cause e death.

 Heroin addiction lowers mental enthusiasm and efforts and physical ability The addict loses contact with normal society and becomes self and drug-centered. He engages in all types of activities to obtain money to buy drugs. A Heroin addict may need about Taka 500 worth of the drug a day. He neglects the needs of the family, and those are non-earning may sell off family assets. They also go out on the streets for mugging and robbery.

  Justification of the study:

Nurses could be the important and experienced key informants about drug addiction because they have been dealing a lot of drug addicted patients while working in the hospitals. Most of the time the drug addicted patients are admitting for a long time for getting cure based on the nature of addiction. During the admitting time the nurses have the opportunity to talk with the patients even beyond the medical boundary and become a good interpersonal relation between the patients and nurses. Due to this fare interpersonal relation the addicted patients most often discuss their life history with the staff nurses especially how they have been felt into this addiction. Sometimes the nurses could get enthusiastic to know about the personal life of the patients that is relevant with their addiction. The nurses have the scope to go through the personal history form of the patients which is the another information source for them to know about drug addiction. During counseling of the addicted patients the staff nurses accompany the counseling process and during leaving hospitals staff nurses theirselves counsel the patients. The counseling process depends on the personal history of the patients, their life style, economic status, nature and type of addiction. So, the nurses should be the sources of information depot about drug addiction. If the experiences of the nurses are gather through a scientific process it could get new window to serve for the sector of drug addiction. So, this study could be conducted by following the scientific process.

Literature Review:

Copyright 1992 Blackwell Science Ltd

Caring for patients in pain is a pivotal function of nursing practice In particular, pain control is a primary concern of hospice nurses in order to ensure comfort in the terminal phase of the person’s life, and also for nurses in intensive therapy units caring for patients who may have substantial pain related either to pathologic conditions or treatment interventions and who have difficulty communicating their pain This paper reports on a study which aimed to identify and compare the knowledge and the perceived adequacy and acquisition of knowledge of intensive therapy and hospice nurses pertaining to the theoretical, pharmacological and non-pharmacological aspects of pain and its management using multiple-choice, short-answer and open-ended questions The sample consisted of 52 intensive therapy and 48 hospice nurses who were further divided into beginners and experts The findings indicated that although the hospice nurses received higher knowledge scores than the intensive therapy nurses, both groups demonstrated lack of knowledge in specific content areas In addition, the findings demonstrated few differences between the beginners and experts

The subjects, in general, were not confident about their knowledge of analgesics, nor did they believe that their basic nursing education had prepared them adequately to care for patients in pain The working environment and clinical work in hospital since qualification were perceived by the subjects to be the most influential experiences in learning about pain and its management.

 To determine the extent to which nurses are able to correctly identify drugs as narcotics and to ascertain their perception of the addiction potential of opiates when used for pain management. Methods: A questionnaire was administered to 86 nurses who attended palliative care workshops in India. Findings: Only morphine (95%), heroin (71%) and codeine (75%) were correctly identified as narcotics by the majority of participants. Imipramine (34%), diazepam (20%) and phenobarbitone (39%) were wrongly classified as narcotics by many nurses. Dextropropoxyphene (11%), pentazocine (21%), buprenorphine (15%) were correctly classified as narcotics by fewer than half the participants. Only 14% knew that that the frequency of psychological dependence due to use of morphine for cancer pain was less than 1%.

A lack of knowledge about common pharmacological agents used in pain control, and exaggerated fears about the likelihood of psychological dependence lead to poor pain management in clinical practice. Studies have demonstrated that many health professionals have a poor understanding about pain assessment and treatment. Cohen’s (1980) questionnaire survey of 121 nurses also revealed that nurses had inadequate knowledge about use of opioid analgesic drugs and were overly concerned about the possibility of opioid addiction. When asked to estimate the number of persons with pain who become addicted as a result of being treated with narcotic drugs in the hospital, only 31.5% of the nurses correctly thought it was 1% or less. 13% of this sample estimated the chance of addiction at 26% or greater.

A survey was carried out by Weis et al (1983) among house staff and nurses involved with postoperative care to assess their knowledge of analgesics and their attitudes toward postoperative analgesic care. Only one-fifth of the respondents prescribed adequate analgesics for complete pain relief. There were some misconceptions about adding other drugs to narcotic analgesics, as well as fear of the addictive properties of these narcotics. The incidence of addiction after use of opioid drugs for pain relief was correctly identified as <1% by only 15.8% of physicians and 11.4% of nurses.

McCaffrey et al (1990) analyzed data obtained from workshops on pain to determine the nursing knowledge of pharmacological management of pain. Results indicated that nurses lack knowledge in classification of opioids with correct responses ranging from 23 to 98% across seven analgesic drugs. Less than 25% of nurses correctly identified the frequency of psychological dependence. These above studies indicate that nurses and other health professionals have inaccurate knowledge about common pharmacological agents used in pain control, and they have exaggerated fears about the likelihood of psychological dependence on opioids as a result of the use of narcotics for pain control. This study was conducted to understand the perception and knowledge of nurses about narcotics in Indian setting. The data was collected from pretest surveys during two workshops conducted by the author (SKC). The participants had varying years of experience in nursing, and oncology. These workshops were conducted in the year 1999 and 2000. These were conducted at two large cancer centers in South India. The procedure used by the workshop leader was to distribute the questionnaire at the beginning of the session and to tabulate the results during the day to share the results with the attendees. Consent for using the findings for further teaching and reporting in a journal was obtained from the participants. The tool, included two sections. The first section assessed knowledge of drug classification by asking the subjects to identify ten drugs as narcotic or nonnarcotic. Subjects were given choices of “narcotic”, “nonnarcotic”, and “don’t know”. The drugs listed were cocaine, codeine, heroin, morphine, Fortwin (pentazocine), Proxyvon (dextropropoxyphere), Tidigesic (buprenorphine), imipramine, calmpose (diazepam), and luminol (phenobarbitone). The second section was a single item assessing knowledge of narcotic addiction. Subjects were asked to identify the frequency (by percent) of addiction in patients treated with narcotic drugs for pain. Ten possible choices were given ranging from <1% to 100%. A definition of the term “narcotic addiction” was included on the tool. It was defined as the behavioral pattern of drug use, characterized by overwhelming involvement with the use of drug, the securing of its supply, and a high tendency to relapse after withdrawal. It is not used interchangeably with physical dependence (Jaffe 1985). Data was analyzed using the statistical package SPSS tenth version.

 There were a total of eighty-six respondents. (N=86). All participants were female. The median age was 31. The median number of years of experience in nursing was 9 years. The median duration of experience with cancer patients was 2 years. The results of the narcotic classification questionnaire are presented in. Correct answers for individual drugs ranged from 95% for morphine to 17% for cocaine. The majority of participants correctly identified only morphine, heroin and codeine as narcotics. Imipramine, phenobarbitone and diazepam were wrongly judged as narcotic by 40%, 45% and 23% of nurses respectively. Fewer than half the participants correctly classified dextropropoxyphene, pentazocine, and buprenorphine as narcotics. None of the participants could give all correct responses. Seven nurses gave 8 or 9 correct answers and 52 gave four to six correct responses. 19 had fewer than four correct answers. An attempt was made to examine the association between the correct scorers and years of experience in nursing. It was found that nurses who had fewer years of experience had better knowledge about narcotic substances, as compared to those who had more than ten years of experience. This difference was found to be statistically significant (p < 0.05). Knowledge about the frequency of drug addiction is presented in. Only 14% of nurses correctly identified the frequency of addiction among cancer patients on opiates as <1%. 32% of the nurses thought the frequency of addiction was more than 50%.

 Nurses are integral to palliative care delivery and it is important that they have a clear understanding of the nature of the drugs prescribed. In our study nurses had a poor knowledge about the classification of narcotic drugs and about the low potential of addiction in patients using opiates for pain relief. Similarly, McCaffrey et al (1990) found in pain management workshops that many nurses had inadequate knowledge about the pharmacological management of pain. When asked to classify analgesics, the percentage of correct responses for seven drugs ranged from 17% for cocaine 95% for morphine.

On examining the association between the knowledge about narcotics and years of experience in nursing, it was found that nurses who had fewer years of experience had better knowledge, as compared to those who had more than ten years of experience. This implies that those trained recently have a better knowledge about narcotic drugs rather than those trained more than ten years back. This trend is positive, and it is hoped that present nursing training would give more attention to cancer pain and use of morphine for pain relief.

Confusion regarding opioid analgesics probably results from multiple factors. The term narcotic has been used to refer to morphine related strong analgesics. The media often refer to all substances of abuse as ‘narcotic’ drugs and some health professionals also use the term loosely.

Less than a quarter of the nurses in McCaffery’s study correctly identified the frequency of psychological dependence. Marks and Sachar (1973) reported that only 60% of physicians correctly identified the chance of addiction from use of narcotic drugs for pain relief as <1%. 16% thought that addiction occurred in between 1 and 5% of patients; and 22% thought the incidence of addiction was greater than 6%. Chart review of 37 patients in their hospital showed that physicians underprescribed analgesics and nurses compounded the problem by administering less opioid medication than was prescribed. Concern about iatrogenic addiction was probably a significant factor in the under use of analgesics.

In India, legal and administrative obstacles to the use of opioids drugs for pain control can easily convey the message that such drugs are better avoided. The present study indicates that many nurses have fears about patients developing psychological dependence on opioid drugs. Consequently nurses may fail to play an active role in titrating opioids and in administering analgesics for breakthrough pain. If this is to improve, it is imperative that staff and student nurses in India have adequate opportunities to learn about the properties of commonly used analgesics, and the scientific use of opioids for pain management.

  Study design

• Research question
• Broad objective
• Specific objectives

Methods and Materials

• Study population
• Inclusion criteria
• Exclusion criteria
• Data Collection, Management & Analysis
• Ethical consideration
• Informed Consent
• Operational definition

Research Question:

The problem of the research was concerned with understanding about the Knowledge level of nurses about drug addiction arisen from handling the drug addicted patients working in Barisal Medical College Hospital.

  Research Objective

General Objective

To assess the knowledge level of nurses about drug addiction working in the Barisal Medical College Hospital.

 Specific Objectives

• To assess the level of knowledge of the nurses working in the Barisal Medical College Hospital about drug addiction.
• To know the socio demographic background of the drug addicted patients, source of abusive drug and nature of addiction from the respondents.
• To explore the consequence of drug addicted patients through the respondents.

 Operational definition:

Drug addiction: In this study drug addiction included all types of chronic addiction in any drug except smoking.

 Knowledge on drug addiction: In this study knowledge of the respondents include

• Emergency management of drug addicted patient
• Counseling of drug addicted patient
• Supporting the admitted drug addicted patient
• Behaviour with the drug addicted patient
• Common syringe using and its consequences
•  Consequences of f drug addiction

 Consequences of drug addiction : This study includes the knowledge of the respondents about the fate of drug addicted persons so far their knowledge.

 Key variables

The study constitutes 2 types of variables, whereby knowledge of the staff nurses was dependent upon several variables.

 Independent Variable

Knowledge of the staff nurses on drug addiction.

 Dependent variables

• Training received
• Duration of service
• Knowledge of handling drug addicted patients
• Source of addicted drug
• Nature of addiction
• Nature of treatment provided
• Nature of counseling

Materials and methods

Type of study

This study was a cross sectional study conducted among the nurses to assess the level of knowledge about drug addiction, at Barisal Medical College Hospital.

Study Place

This study was basically carried out in Barisal Medical College Hospital, Barisal.

Study Period

The study was conducted over the period of June 2011 to December 2011

Study Population

Staff nurses of Barisal Medical College Hospital, who are working across different wards.

Inclusion criteria:

• Nurses working in the Barisal Medical College Hospital
• Nurses willingness to participate in the study.

Exclusion Criteria:

• Nurses, who decline to participate in the study

  Sample Size

The sample size for the study was 100 nurses who were selected purposively.

 Sampling Technique

Purposive sampling technique was followed in the study, so that, multiple respondent and responses could be ensured.

 Data Collection Tools

For smooth conduction of the study, a structured questionnaire was developed. The questionnaire was divided into several parts. The first part focused on nurses socio demographic information’s, second part on their knowledge on drug addiction, third part on attitude towards drug addicted patients and fourth part focused on recommendations for the drug addicted patients.

 Data Collection Procedure

After explaining the purpose of the study data was collected through face to face interview using /English structure questionnaire.

 Conduction of the study, quality control and monitoring

Data was collected from selected hospital by the investigator. The collected data was checked and verified at the end of the work every day. Any inaccuracy and inconsistency was corrected in the next working day. However, cross checking of the collected data was done randomly.

 Data Processing and data analysis

The data entry process just started immediately after the completion of data collection. The collected data was checked, verified and then entered into the computer in analyzable format. Only fully completed datasheet was entered into the computer for the final analysis and incomplete or inconsistent sheets were revisited. The data analysis process was carried out with the help of SPSS (Statistical Package for Social Science) Windows software program.

 Ethical consideration

Prior to the commencement of this study, the research protocol was approved by the research committee (Local Ethical committee). The aims and objectives of the study along with its procedure, risks and benefits of this study was explained to the respondents in easily understandable local language and then informed consent was taken from each patient. Then it was assured that all information and records will be kept confidential and the procedure will be used only for research purpose and the findings will be helpful for developing policy to increase the knowledge on managing drug addicted patients by the nurses.

  Informed Consent

A well and clearly understood inform consent form was filled in up by the respondents and interviewer in case of each interview. However, translations and clarifications were carried out the according to the need of the respondents. This ensures that each of participants got the information they need to make an informed decision and provide their opinion freely.

Findings and Results

Background Characteristics

Table 1: Age of the Respondent

 Descriptive Statistics

 It was observed from the study that, the study was conducted among the respondent nurses, whose age was in between 32 to 56 years, with an average age of 39.61 years. It was also observed from the study that, most of the respondents were from the age group of 36 to 40 years. 52% of the respondents were from this age group. It was notable from the frequency distribution that, only 8 respondents were aged more than 50 years. It was found that 19 respondents were below the age of 36 years.

Table 2: Marital status of the respondents

 To know about the marital status of the respondents, it was found that, almost 97% of the respondents were married, whereas only 3% of the respondents mentioned that they were either separated or unmarried.

Table 3: Academic background

To assess the academic background of the respondents, it was found that, 89 of the respondents have Diploma in Nursing qualification, and 11 respondent were reported to have BSC in Nursing degree.

Table 4: Position of the respondents

 To have an overview on the respondents working position, it was observed from the study that, 91% of the respondents were senior staff nurses, while only 4% of the respondents were nursing superintendents. At the junior level, only 2% of the respondents were staff nurses and 3% of the respondents were assistant nurse.

Table 5: Descriptive Statistics of Duration working in hospital

 It was observed from the descriptive status that, all of the respondents have experience in working at hospitals. The minimum duration of working at the hospital was 5 years, whereas, maximum experience or duration of working was found 31 years.

Table 6: Where the respondents works

 To know about the place of working about the respondents, it was found from the study that 96 respondents works at the indoor units whereby only 4 of the respondents were engaged in outdoor services.

Table 7: Have roster duty

 In order to know whether respondents have to perform roster duty, all respondents urged that, they have to work according to the roster duty.

Table 8: How long work in a day

 All of the respondents mentioned that, they have to work 8 hours in a day. Some respondents mentioned that, they may have to work for more working hours when required.

Table 9: Have heard about drug addition

In response to the query of respondent’s knowledge and familiarity with drug addiction, the study find that, all of the respondents have heard about drug addiction and they know about drug addiction.

Figure 1: Type of drug available in Bangladesh

While mentioning about the types of drugs available in Bangladesh, 30% of the respondents identified availability of Heroine as a significant observation. Besides, 20% of the respondents also mentioned about the availability of Ganja/Marijuana. In line with these, 13% of the respondents also mentioned about the availability of Fencidyle and 17% respondents mentioned about the Wine. It was noteworthy that, only 11% of the respondents mentioned about the availability of Tobacco, whereas, Globat Adult Tobacco Survey in Bangladesh notified more than 37% of the Bangladesh in using tobacco products. 9% of the respondents demonstrated about the availability of other drugs in Bangladesh.

Figure 2: Who are usually involved in drug addiction

For identifying the major population groups, who are usually involved in drug addiction, it was alarming one to find that, more than 75% of the respondents identified the Frustrated children to be the drug addicted. Hereby, the polarity in income status also significantly contributes toward drug addiction, which is due to societal problems. 45% of the respondents urged that members of very rich families are usually involved in drug addiction, whereas, 30% respondents mentioned drug addiction is prevalent in very poor families. Nonetheless, respondents also demonstrated about a present problem like inattentiveness to studies as a basic reason for drug addiction and 26% respondents were in favor of this opinion. 29% respondents also agreed that, those who have no job also used to take drugs. 27% Respondents also demonstrated about the children who did not receive any care from their parents, are often addicted to the drugs.

Table 10: Know about physical consequence of drug addition

 While assessing the knowledge of the respondents about the physical consequences, all of the respondents noted that they are familiar to physical consequence of drug addiction.

Figure 3: Physical consequences of drug addiction

In order to know about the physical consequences about the drug addiction, most of the respondents (31%) mentioned that drug addiction can even result in respiratory diseases. Besides, 24% of the respondents believe that as a measure of damaging the lever.18% of the respondent’s claims drug addiction to be the basic reason for losing weight while 14% mentioned the drug addiction to be a cause of loss of appetite. Moreover 13% of the respondents believe that drug addiction can even lead toward death.

  Table 11: Know how a person can involve in drug addiction

 In response to the question, whether respondents know that how a person can be involved in drug addiction, all respondents unanimously informed that, they knows about the ways of involvement toward drug addiction.

Figure 4: how a person can be involved in drug addiction

While examining the reasons of drug addiction, and how a person can be involved in drug addiction, the study finds that, it starts with mostly Fun with friend (15%). Sometimes pressure from the friends (17%) can also lead them to drug addiction. 21% of the respondents have notified that, frustration remains the  reason for involvement in drug addiction. Being very rich constitutes topmost risk for drug addiction with a percentage of 32. 15% of the respondents also noted that, lack of parental care lies at the core of drug addiction for the young.

 Table 12: Know about social consequences of drug addiction

In response to the query of respondent’s knowledge and familiarity social consequences of drug addiction, the study find that, all of the respondents know about social consequences of drug addiction.

Figure 5: Social consequences of drug addiction

In order to know about the social consequences of drug addiction, most of the respondents (46%) argue that, it results in loss of money, which includes wastage and treatment for the addicted. 20% the respondent’s increased social insecurity of respondents as the social consequences. 20% respondents believed that this series of consequences can promote Illegal activities in the society. 14% of the respondents also identified that, drug addiction even consequences on misbehaving with the parents.

Table13: The roles of parents to overcome the situation

Respondents were asked about the role of the parents to overcome from the drug addiction, whereby respondents mentioned that, behaving friendly with the children (31%) can help the addicted to overcome. Most of the respondents also noted that, taking proper care of the mental health (43%) of the addicted children can help healing the situation. 26% of the respondents believes that Regular care of child and counseling them can help in recovery of the children from the consequence of drug addiction

Table 14: Service providers have the responsibilities to overcome the situation

 Whether service providers have the responsibilities to overcome the situation or not, it was received from the respondents end that, all of the service providers have their own responsibility for overcoming from the situation.

Figure 6: Respondents of service providers for ensuring services

The respondents have identified two type of responsibilities required to be provided by the service providers. 73% of the respondents have identified providing treatment to the drug addicted can be the foremost responsibility of the service providers, whereas, 71% uses to believe that, counseling is the primary responsibility of the service providers.

Table 15: Country has the responsibilities

 Respondents were unified about the question states responsibility for drug addicted. All respondents urged that, country has its own responsibility and have the responsibility for the special vulnerable group like drug addicted.

Figure 7: Role of the state for drug prevention

While mentioning about the role of the state in preventing drug addiction, it was found that, 26% of the respondents claimed for ensuring proper education and 20% respondents claimed for job for preventing drug addiction. 21% of the respondents demonstrated about the necessity of ensuring social security as a measure for prevention of drug addiction, whereas, most respondents emphasized upon stopping the drug trafficking (33%).

Table 16: Parents has role to reduce drug addiction

While responding to the query of role of parents in reducing drug addiction, all of the respondent urged that, they have a significant role in this.

Figure 8: Role of the parents for reducing drug addiction

While identifying the role of parents in reducing drug addiction, the respondents mostly emphasized upon the regular care of the children (98%). Besides, supervise continuation of studies (27%) by the parents can play a vivid role. 69 of the respondents also demonstrated to care for the friends, with whom, the children mixes with  needs to be taken care of. Respondents also mentioned about respecting the opinions of the children as a negligible but mentionable component.

Figure 9: Service available for drug addicted

It was found in the study that, respondent mainly mentioned about 3 types of service available for drug addicted. Whereas, 36% of respondents emphasized upon social counseling, 29% of the respondent also mentioned about counseling for drug addicted. Other 35% of he respondents mentioned about the medical treatment for the patients.

Table 17: Service providers support to drug addicted people

Whether the service providers provide support to the drug addicted people, 100% of the respondents noted that, service provider’s support is necessary for the prevention of drug addiction.

Figure 10: Why support is necessary for drug addicted

The respondents have identified the various form of support to be an essential part of the patient’s rehabilitation and proper survival. 54% respondents mentioned the necessity of support or better health, whereas 70% respondents noted it necessary for social improvement of the drug addicted and come out of the devastating cycle.

  Comments and General findings:

Respondents argued that the target group has to be made aware and fully informed about drugs, its misuse and horrifying consequences. Educational institution, student and youth organizations should be involved in group discussion and meetings, with advocacy and awareness programs through posters, slogans, radio and TV programme and various mass communication agenda, including the print media. Community leaders, politicians, sport and movie personalities can take active part in the campaign against drug addiction. Organizations to resist drug addiction must be built up by the students and youths

 Alternative Programmes: The inherent strengths of the youth in society have to be put to constructive work. Monotony, idleness, unemployment cause despair and frustration in the patient, and to seek solace elsewhere the target group look to drugs for comfort and to forget the trouble and tension of everyday life. Monotony and frustration may be eliminated through sports and games, physical training and competitive games, social work which make the youth adjust to the environment. Student life exposes the youth to many social pressures which leads to despair and tensions and the need for drugs to forget the stresses of modern life. Counseling of students on mental and physical health and tackling of various problem at school and college is required. Medical care is extremely and urgently necessary for the addicts. Withdrawal symptoms hinder the giving up of the habit. The first step in treatment is to stop drugs and treat for the withdrawal symptoms. Various physical symptoms of withdrawal have to be treated at this stage. Stopping the taking of heroin has to be under the supervision of a specialist. To get the patient to agree to treatment for addiction is the first step in the treatment. The patient will try to make excuses to avoid treatment. Sometime the patient stops taking requisite medication. The giving up of heroin without specialist advice is a waste of time, energy and money.

 Once the addiction is removed from the human body, the patient and his/her family has to cooperate in a courses of long-term treatment prescribed by the specialist which include considerations of the patient’s depression, social environment, recreation and other aspects. The preferred treatment mode is psychotherapy. The patient and his family must be convinced of the fact that giving up drug is not the end of the treatment course, but just the end of the beginning of the treatment. Long-term follow-up treatment is the only cure to this terrifying problem. The patients who cannot or do not undergo follow-up treatment, may again revert to addiction.

Discussion:

It was observed from the study that, the study was conducted among the respondent nurses, whose age was in between 32 to 56 years. The academic background of the respondents was mostly Diploma in Nursing qualification, some have BSC in nursing degree. 95 % of the respondents were found working at senior staff nurses level where 4% respondents were the juniors. The minimum duration of working at the hospital was 5 years, whereas, maximum experience or duration of working was found 31 years. Iit was found from the study that 96 respondents work at the indoor units whereby only 4 of the respondents were engaged in outdoor services. All respondents urged that, they have to work according to the roster duty and they have to work 8 hours in a day.

All of the respondents have heard about drug addiction and they know about drug addiction, while mentioning about the types of drugs available in Bangladesh, respondents identified availability of Heroine, Ganja/Marijuana, Fencidyle, Wine, Tobacco and other drugs to be available in Bangladesh.

For identifying the major population groups, who are usually involved in drug addiction, it was alarming one to find that Frustrated children are to be prone the drug addiction. Hereby, the polarity in income status also significantly contributes toward drug addiction, which is due to societal problems and differences. Members of very rich and very poor families are usually involved in drug addiction; recently, inattentiveness to studies is working as a basic reason for drug addiction. Frustrated people, who have no job also used to take drugs. Respondents also demonstrated about the children who did not receive any care from their parents, are often addicted to the drugs.

The physical consequences about the drug addiction, is so serious. Drug addiction can even result in respiratory diseases, damaging the lever, losing weight, loss of appetite and can even lead toward death.

 While examining the reasons of drug addiction, and how a person can be involved in drug addiction, the study finds that, it starts with mostly Fun with friend, sometimes pressure from the friends, frustration remains the reasons for involvement in drug addiction. Being very rich constitutes topmost risk for drug addiction. Respondents also noted that, lack of parental care lies at the core of drug addiction for the young.

 In order to know about the social consequences of drug addiction, most of the respondents noted that it results in loss of money, which includes wastage and treatment for the addicted. Increased social insecurity and illegal activities in the society are also the footnotes in the case. Some respondents also identified that, drug addiction even consequences on misbehaving with the parents.

 Behaving friendly with the children can help the addicted to overcome. Most of the respondents also noted that, taking proper care of the mental health of the addicted children can help healing the situation and regular care of child and counseling them can help in recovery of the children from the consequence of drug addiction.

 Most of the respondents have identified providing treatment to the drug addicted can be the foremost responsibility of the service providers, whereas, others uses to believe that, counseling is the primary responsibility of the service providers. All respondents urged that, country has its own responsibility and have the responsibility for the special vulnerable group like drug addicted.

 While mentioning about the role of the state in preventing drug addiction, it was found that, the respondents claimed for ensuring proper education, job, ensuring social security as a measure for prevention of drug addiction, whereas, most respondents emphasized upon stopping the drug trafficking.

While identifying the role of parents in reducing drug addiction, the respondents mostly emphasized upon the regular care of the children. Besides, supervise continuation of studies by the parents can play a vivid role. Respondents also demonstrated to care for the friends, with whom, the children mixes with needs to be taken care of. Respondents also mentioned about respecting the opinions of the children but mentionable component.

It was found in the study that, 3 types of service available for drug addicted whereby respondents emphasized upon social counseling. They also mentioned about counseling for drug addicted and medical treatment for the addicted patients.

 Whether the service providers provide support to the drug addicted people, 100% of the respondents noted that, service provider’s support is necessary for the prevention of drug addiction.

 The respondents have identified the various form of support to be an essential part of the patient’s rehabilitation and proper survival. The support for the drug addicted is necessary because it can help to ensure better health and social improvement of the drug addicted and come out of the devastating cycle of addiction to drugs.

Limitation of the study:

The study was conducted with the objective of investigate the knowledge of drug addiction among the nurses in AGM Osmai Medical College Hospital in Barisal. It was intended to know the major causes drug addiction, side effect of drug addiction, and practices of nurses to provide services to drug addicted people. It was good if the study compare other hospital in a wide perspective. But due to time and cost constraint the study only conducted in one hospital and only with 100 respondents. The limitation of the study was the sample size. It used 100 respondents only which is not enough to generalize the findings. At the same time it used only quantitative data. If this study uses more qualitative data for in-depth information the report would be more informative and reliable.

Recommendations:

• Nurses knows about drug addiction, drug availability while mentioning about the types of drugs available in Bangladesh, respondents identified availability of Heroine, Ganja/Marijuana, Fencidyle, Wine, Tobacco and other drugs to be available in Bangladesh and even knows about the drug addicted group which consists of basically the very rich or poor families, frustrated, inattentive persons. Thus, more training have to be provided to the nurses for understanding the signs, cares, recovery of drug addicted patients.
• The physical consequences about the drug addiction, is so serious as drug addiction can even result in respiratory diseases, damaging the lever, losing weight, loss of appetite and can even lead toward death. So nurses should carry out the message among the patients who are drug addicted
• Nurses can help in treatment, social counseling process. Thus, more information towards the parents and caregiver’s group of the drug addicted should be informed for recovery and survival of the drug addicted.
• As drug addicted comes from different strata of the society, while examining the reasons of drug addiction and social and other consequences, the core of drug addiction should be understood properly and disseminated through the nurses.
• There is no alternate of counseling with drug addicted. Thus, behaving friendly with them can help the addicted to overcome. Most of the respondents also noted that, taking proper care of the mental health of the addicted can help healing the situation and taking regular care and counseling them can help in recovery of the addicted from the consequence of drug addiction, whereby, nurses play the role of caregiver as a change agent.

Conclusions:

The main elements in combating Drug addiction include measures to control availability and use of drugs, treatment of withdrawal symptoms, and restoration of social moral and religious values. To prevent re-addiction in patients, innovative treatment containing medical, social and religious aspects have to be put in place. The patient should be treated in a hospital or clinic under supervision of doctors and nurses. The patient’s history has to be known and understood in detail by the health professionals and then medication and course of treatment may be prescribed. The patient’s personality and mental make-up has to be understood by the doctor along with the patient’s physical and mental disabilities. Easy availability of treatment will ensure the elimination of this socially and physically dreaded disease. Treatment of addiction in our country is still not in a hopeful stage. Its is time that experienced and qualified health professionals, nurses come to the aid of the addict in our society, and give genuine and prolonged treatment and care.s and nurses medication choices, Pain.

Computer Aided Hospital Management System

Prevalence of Cross Infection Among the Patients

Pregnancy and Delivery Risk Among Bangladeshi Women

Internship Report on Marketing Performance Analysis of Crystal Agencies

Thanks Letter Format to Principal on Granting Fee Concession

Paravauxite – Properties and Occurrences

Sample Proposal Letter to Bank Authority

Problem of Capital City of Bangladesh

Female Education In Bangladesh

Medical Coding Services

Latest post.

Magnesium Orotate

Magnesium Malate

Study Indicates Recommended Exercise for Type 1 Diabetic Patients

ADHD Stimulants may Raise the Risk of Heart Disease in Young People, a study finds

Bismuth Ferrite – an inorganic chemical compound

Terbium Monoselenide – an inorganic compound

Drug Abuse: Your Assignment

• Your Assignment
• Understand Your Topic
• Find Articles
• Kanopy Videos
• Find Websites
• Works Cited
• Write Your Paper
• Video Tutorials
• Off-Campus Login

Drugs in the United States

What you need to know.

Understanding Your Assignment

Before you begin looking for information you should make sure you understand your assignment. Some good questions are:

• How many pages?
• How many sources?
• What format?

Your professor is your best resource to answer these questions.

Controversial Issue Paper

What to do:

• Select your topic
• Research the issues surrounding the topic
• Read other writers’ arguments for and against
• Take a stand
• Present supporting evidence in favor of your position
• Defend your position against opposing points of view
• Anticipate and deflect arguments against your position
• Make your case persuasively 

Research Basics - Step by Step

Breaking Down The Research Process  

The following outline gives a simple and effective strategy for finding information for a research paper and documenting the sources you find. Depending on your topic and your familiarity with the library, you may need to rearrange or recycle these steps. Adapt this outline to your needs. We are ready to help you at every step in your research.

• Choose a topic - or have one assigned
• Background reading
• Consider a main focus
• Refine your topic
• Make a list of your keywords and concepts
• Write your paper - Informative, Analytical, Argumentative, Critical
• Cite your sources

Related Guide

• Legalizing Marijuana
• Substance Abuse and Addition

Talk to a Librarian

The Cerritos College Librarians can help you with your research in a variety of ways:

Librarians are available during library hours to answer your questions by phone or chat. (562) 860-2451 x 2425

• Next: Understand Your Topic >>
• Last Updated: Jun 10, 2024 5:09 PM
• URL: https://libraryguides.cerritos.edu/drug_abuse

An official website of the United States government

Here’s how you know

Official websites use .gov A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

Lesson Plans and Activities

Search for free lessons and activities on the science and consequences of drug use. All lessons are based on national science and education standards and were developed by scientists from leading universities and the National Institute on Drug Abuse.

Cannabis: The Facts You Need to Know

Can Too Much Screen Time Harm You?

Toxicity Testing: The Effect of Chemicals on Radish Seeds

Is This Legit? Accessing Valid and Reliable Health Information

Opioids: What You Need to Know

What You Need to Know About Prescription Stimulants

Stressed Out?

Nurturing My Mental & Emotional Health

Mind Matters: Drugs and the Brain

Mind Matters: The Body's Response to Prescription Stimulants

Mind Matters: The Body's Response to Opioids

Mind Matters: The Body's Response to Nicotine, Tobacco and Vaping

Mind Matters: The Body's Response to Methamphetamine

Mind Matters: The Body's Response to Marijuana

Mind Matters: The Body's Response to K2/Spice and Bath Salts

Mind Matters: The Body's Response to Inhalants

Mind Matters: The Body's Response to Cocaine

How Nicotine Affects the Teen Brain

NDAFW Activity Ideas: Community, School-wide, and Online