Overview

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This topic is about drug abuse and dependence in adults. For information about drug abuse in teens or children, see the topic Teen Alcohol and Drug Abuse. For information about alcohol abuse in adults, see the topic Alcohol Abuse and Dependence.

What is drug abuse and dependence?

Drug abuse is using drugs in a way that harms you or that leads you to harm others. You can abuse illegal drugs, prescription drugs, or over-the-counter drugs.

When you abuse drugs, you are not always able to meet work, home, or school duties. You may be late to work. You may use drugs in dangerous situations, such as when driving or operating machines, or drugs may cause problems in your relationships.

Drug abuse can lead to drug dependence, where you are addicted to a drug. The drug controls your life. Any of the following can happen:

• You take more of the drug over longer periods of time and need more of the drug to feel "high."
• You spend a lot of time trying to get the drug, and you give up other activities to do this.
• You try to quit using the drug, but you are not able to.
• You continue to use the drug even though it harms your relationships and causes you to develop physical problems.
• If you stop using the drug, you feel sick. This is known as withdrawal.

Drug dependence is a disease. It's not a weakness or a lack of willpower. It's your choice to begin using a drug. But as you use it more, your brain begins to change. This change can lead to a craving to use the drug, and this can influence how you act.

Which drugs might be a problem?

Drugs that are abused include:

• Marijuana, cocaine, and hallucinogens, such as LSD (lysergic acid diethylamide), mescaline, psilocybin, PCP (phencyclidine), and ketamine.
• Inhalants, such as glues, aerosol sprays, gasoline, paints, and paint thinners.
• Club drugs, such as ecstasy (MDMA).
• Methamphetamine, which is called meth, crank, or speed.
• Opiates, such as heroin, morphine, and codeine.
• Prescription drugs, such as diazepam (Valium), methylphenidate (Ritalin), hydrocodone and acetaminophen (Vicodin), and oxycodone (OxyContin). Nonprescription medicines, such as cough syrups or cold pills, also are abused.

What are the signs of drug abuse and dependence?

The signs of drug abuse and dependence depend on the drug and the person using the drug. Behaviors that may be signs of a drug problem include:

• Changes in sleeping or eating habits, less attention to dressing and grooming, or less interest in sex.
• Up and down moods, a mood or attitude that is getting worse, or not caring about the future.
• Anger toward others or treating others badly.
• Sneaky behavior, lying, or stealing.
• Poor family relationships, or relationships that are getting worse.
• New problems at work or school, or problems with the law.
• Dropping old friends and activities, finding new friends, and not wanting old friends to meet them.

Having these signs doesn't always mean a person is using drugs. The behavior could be because of work or school stress, or it could be a sign of depression or another medical problem. But behavior changes like these are common in people who abuse drugs.

Physical signs of drug abuse and dependence include:

• Red eyes, a sore throat, a dry cough, and feeling tired.
• Needle marks on the arm or other area of the body.
• Small, "pinpoint" pupils in the eyes.
• Losing weight without trying to, or not feeling like eating.
• Changes in sleep behavior, such as not sleeping as well.
• Seeing things that don't exist (hallucinations).

Why do people start using drugs?

Drugs can make you feel good for a while. They may make you feel energetic, self-confident, and powerful. You may take a drug to reduce stress or anxiety or to help you forget a problem. Or you may think drugs help you do better at work or school. You may take a drug because you are curious about it or because your friends use it.

How are drug problems diagnosed?

Drug problems may be diagnosed at a routine doctor visit or when you see your doctor for a health or social problem linked to drug use, such as anxiety, depression, or family conflict. If a partner or friend thinks you have a drug problem, he or she may urge you to see your doctor.

Your doctor will ask questions about your symptoms and past health, and he or she will do a physical exam and sometimes a mental health assessment. Your doctor also may ask questions or do tests to look for health problems linked to drug abuse.

If you think you or a loved one might have a drug problem, use this short quiz to check for drug use:

Drug abuse screening test(What is a PDF document?)

How are drug problems treated?

Treatment includes medicine, therapy, and self-help groups.

Your doctor may decide you need detoxification, or detox, before you start treatment. Detox "flushes out" the drugs in your body. You need detox when you are physically addicted to a drug. Being physically addicted to a drug means that when you stop using the drug, you have physical withdrawal symptoms, such as feeling very sick to your stomach or feeling very anxious. So when you go through detox, you may need medicine to help with withdrawal symptoms.

After detox, you focus on staying drug-free. Most people receive some type of therapy, such as group counseling. You also may need medicine to help you stay drug-free.

When you have stopped using drugs, you have taken the first step toward recovery. To gain full recovery, you need to take steps to improve other areas of your life, such as learning to deal with your work, family, and living situation in healthy ways. This makes it easier to stay drug-free.

You will likely need support to stay drug-free and in recovery. This can include counseling and support groups like Narcotics Anonymous. Recovery is a long-term process, not something you can achieve in a few weeks.

What can you do if you or another person has a problem with drugs?

If you feel you have a drug problem, get help. You can visit a doctor or go to a self-help group. The earlier you get help, the easier your recovery will be for you and your family.

Helping someone with a drug problem is hard. If you are "covering" for the person, you need to stop. For example, don't make excuses for the person when he or she misses work.

You may be able to help by talking to the person about what his or her drug use does to you and others. Talk to the person in private, when the person is not using drugs or alcohol and when you are both calm. If the person agrees to get help, call for an appointment right away. Don't wait.

Frequently Asked Questions

Cause

People don't use drugs because they want to be addicted. Most of the time, drug abuse starts with casual use.

How does casual drug use turn into abuse or dependence?

Drug use changes your brain structure and how it works. If you continue to use the drug, you may develop strong cravings for the drug, and it may get harder to say "no" to further drug use. At the same time, you may begin to lose interest in activities you always enjoyed. This is because you may feel that they are not as enjoyable as using drugs. You may then become dependent on the drug.

Not everyone who uses drugs abuses them or becomes dependent. Other things that influence whether this happens include your genes, family, friends, and life situations. See the What Happens and What Increases Your Risk sections of this topic for more information.

Symptoms

When drug use, abuse, and dependence occur, you are more likely to have changes in your behavior than to have physical symptoms.

Changes in behavior

Behavior changes may include:

• Changes in sleeping or eating habits, less attention to dressing and grooming, or less interest in sex.
• Up and down moods, a mood or attitude that is getting worse, or not caring about the future.
• Anger toward others or treating others badly.
• Sneaky behavior, lying, or stealing.
• Poor family relationships, or relationships that are getting worse.
• New problems at work or school, or problems with the law.
• Not keeping up with old friends and activities, finding new friends, and not wanting old friends to meet them.

These signs don't always mean a person is using drugs. The behavior could be because of work or school stress, or it could be a sign of depression or another medical problem. But behavior changes like these are common in people who abuse drugs.

If you think you or a loved one might have a drug problem, use this short quiz to check your drug use:

Drug abuse screening test(What is a PDF document?)

Physical signs of drug abuse or dependence

Physical signs of drug abuse depend on the drug. They may include:

• Red eyes, a sore throat, and a dry cough.
• Needle marks on the arm or other area of the body.
• Small, "pinpoint" pupils in the eyes.
• Losing weight without trying to, or not feeling like eating.
• Changes in how well you sleep.
• Seeing things that don't exist (hallucinations).

For more information on commonly abused drugs, including signs of use, see:

• Marijuana.
• Cocaine.
• Inhalants.
• Ecstasy.
• Methamphetamine.
• LSD (lysergic acid diethylamide).
• Heroin.

Symptoms in older adults

Drug abuse in older adults may go unnoticed, since the signs may be similar to those of aging. Older adults often take more medicines, like sleep medicines and painkillers, that can lead to dependence.

Symptoms of withdrawal

When you are dependent on a drug and you stop using it, you may have physical symptoms known as withdrawal. These symptoms depend on the drug.

Common withdrawal symptoms include feeling sick to your stomach and vomiting and having belly pain, sweats, nervousness and shaking, and seizures. These symptoms may start the day you stop using the drug or start slowly and get worse over several days.

What Happens

You may not feel that using drugs is a problem. Maybe you feel that you are a casual user because you use drugs only now and then. You may feel that you can stop using drugs at any time.

But drug use quickly can become a habit, and for many people it may lead to abuse and addiction. You may begin to use drugs without thinking about how drugs can harm you and those you care about. Drug use may become part of your routine, like a morning cup of coffee.

How do you become addicted?

Your brain links pleasure with activities that help you live. For example, you need food to live, so your brain tells you that eating feels good. Food becomes something that you want every day.

Drugs target your brain's limbic system, which allows you to feel pleasure. This causes your brain to release a lot of dopamine and other chemicals that make you feel good. Since the pleasure only lasts a short time, you crave more drugs to get the good feeling back.

Over time, your brain adjusts to drugs by making less dopamine and other chemicals. With less of these chemicals, your brain can't function as well, and it becomes harder for you to feel pleasure. You take drugs to get the good feeling back.

Drugs also affect the parts of your brain that deal with judgment, decision-making, problem-solving, emotions, learning, and memory. They change how the cells in your brain send and process information.

These changes in your brain make it harder to think and make good choices. You may be less able to control your actions.

Drugs and your health

Drugs can cause you to have health problems. These problems include:

• Heart disease.
• Stroke.
• Depression.

Drugs also can lead to problems with thinking and remembering.

Different drugs harm your body in different ways.

• Inhalants and other drugs can damage cells in your brain and nervous system.
• Marijuana can cause learning and memory problems and harm your lungs.
• Cocaine can lead to heart, lung, and other problems.
• Ecstasy can lead to thought and memory problems. Using it a lot could lead to liver damage.
• Methamphetamine can affect blood vessels in the brain, causing a stroke. It can make you think people are out to get you (paranoia) and believe things that are not true (delusions).
• LSD can cause drug-induced psychosis. This means you may no longer know what is real or be able to think straight. You may have flashbacks in which you "relive" part of an LSD experience you had many years ago.
• Heroin taken with a needle (injections) can cause infections of the blood vessels and heart and liver or kidney disease. Sharing needles to use heroin can give you hepatitis B or C or HIV.

Some people who use drugs also have mental health problems, such as depression or post-traumatic stress disorder (PTSD). When you have a drug problem and a mental health problem, it's called a dual diagnosis. You need to treat both the drug problem and the mental health problem.

Drugs can affect your whole life

Drug abuse and dependence harm you physically. Your drug use also can lead to problems with your partner or friends. You may begin doing poorly at work or in school, or you may even quit. You also can have legal problems, like being arrested for driving while on drugs or using or selling drugs.

If you're pregnant, drugs can pass into your uterus and harm your baby. This can cause problems with behavior, attention, and thinking as the child grows older. A child harmed by drugs may need special care and education.

Drug use also can change your behavior, making other problems more likely. Sharing needles to inject drugs makes you more likely to get or spread diseases, such as HIV or hepatitis B or C. You also are more likely to have unsafe sex when on drugs, and you may get and spread sexually transmitted diseases (STDs).

What Increases Your Risk

Not everyone who uses a drug develops a drug problem. Certain things make abuse and dependence more likely. These are called risk factors.

Risk factors include:

• Genes. People with drug problems often have a family history of drug use. Studies report that genes may influence whether you use drugs and whether you move from drug use to drug abuse and dependence.¹
• Gender. More men use drugs than women, but the rate of abusing prescription drugs is similar in men and women. Among people who use drugs, more women than men have serious mental health problems.²
• Your mental health. If you have a mental health problem, such as depression, post-traumatic stress disorder (PTSD), or an anxiety disorder, you are more likely to use drugs. Treating mental health problems makes drug use less likely, and if you're using drugs, treating mental health problems makes recovery more likely.
• Early use. The earlier you began to use drugs, the more likely you are to abuse them or become dependent.³ This may be because early drug use changes the developing brain.
• How you use. If you smoke a drug or inject it into a vein, you are more likely to become dependent.³ These methods give you a fast and intense "high," but you lose the high quickly and then feel low. This may make you use the drug more often.
• The drug you use and how strong the drug is. Some drugs, such as heroin and cocaine, are so strong that dependence is possible no matter how you use them. It doesn't matter if you inject them or snort them.
• Environment. If you live in an area where drugs are easy to get, people use drugs, or drugs are accepted as part of life, you are more likely to use drugs.
• Family. At early ages, your family plays a large role in how you feel about drugs. If your parents or older brother or sister used drugs or broke the law, you are more likely to use drugs.³ If a spouse or partner uses drugs, you are more likely to use drugs.³
• Friends. Your friends may influence you to use drugs by directly urging you to or by using drugs when you're around them.
• Problems with others. You may be more likely to use drugs when you are having problems in your family or with friends.
• Not having purpose or satisfaction in your life. If you have no activities that give you a sense of purpose, you may be more likely to use drugs. A satisfying job or schoolwork or volunteer activities can give your life purpose and meaning.

When to Call a Doctor

Call 911 or other emergency services right away if you or someone else:

• Has used or currently uses drugs and is having a hard time waking up or can't stay awake.
• Has abused a child or partner when using drugs.
• Has overdosed or has withdrawal signs. Be sure to tell the emergency workers that you are or someone else is using or trying to quit using drugs. Overdose or withdrawal signs may include:
  • Vomiting that doesn't stop, or vomiting blood.
  • A fever higher than 102°F (38.9°C).
  • Breathing more than 25 breaths a minute, or shortness of breath, such as gasping for air.
  • A heart rate over 120 beats a minute even when you are trying to calm down.
  • Sudden chest pain or severe stomach pain.
  • Seizure.
  • Shaking and chills.
  • Passing out.
  • Seeing or hearing things that aren't there (hallucinations).
  • Violent behavior, such as picking fights, harming yourself, or destroying property.
  • Being very confused, such as not knowing where you are.

Call your doctor if:

• Drug use is harming your relationships.
• You drive or operate machinery when using drugs.
• You have missed work or school because of drug use.
• Your family or friends have asked you to stop using drugs, or you feel you should.
• You use drugs or have used drugs and think you are pregnant.
• You say or do things while using drugs that you feel bad about.
• You have tried to stop using drugs but could not.

Who can treat a drug problem?

Health professionals who can diagnose, prescribe medicine for, and treat drug abuse problems include:

• General practitioners.
• Psychiatrists.
• Physician assistants.
• Nurse practitioners.
• Psychologists and drug counselors. These professionals cannot prescribe medicine.

Counseling usually is part of treatment. This can be done by:

• Psychiatrists.
• Psychologists.
• Social workers.
• Licensed mental health counselors.

Watchful waiting

Watchful waiting is a wait-and-see approach. If you get better on your own, you won't need treatment. If you get worse, you and your doctor will decide what to do next.

Watchful waiting is not a good choice for drug abuse and dependence. If you have a drug problem, or if you believe that your health or other areas of your life are being affected by drugs, you need to take steps to stop using drugs.

Watchful waiting also is not a good choice if you or other people are being hurt by another person's drug use. It is important to seek help for yourself and other people, even if the person who is using drugs does not seek treatment. Early treatment for all people affected by drug use makes recovery more likely.

If you have concerns about your drug use or the drug use of some you care about, talk to your doctor.

Exams and Tests

Drug abuse and dependence may be diagnosed during a routine doctor visit or when you see your doctor for a health or other problem linked to drug use, such as anxiety, depression, or family conflict. If your partner or a friend suspects a drug problem, he or she may urge you to see your doctor.

If you think you or a loved one might have a drug problem, use this short quiz to check for drug use:

Drug abuse screening test(What is a PDF document?)

Your doctor will ask you questions about your symptoms and past health and do a physical exam. If your doctor thinks you have a drug problem, he or she may ask about current and past drug use, your feelings toward drug use, and how drug use may have changed you. He or she also may ask you to take a drug assessment or ask if it's okay to give you a test to check for drug use, such as a urine or blood test.

Your doctor may ask to give you tests to look for health problems related to drug abuse. These may include tests for hepatitis B, hepatitis C, or HIV.

If you and your doctor agree that you have a drug problem, your doctor probably will refer you to a specialist in drug abuse or dependence.

Testing for mental health problems

People who use drugs also may have mental health problems. These include depression, anxiety disorders, or post-traumatic stress disorder (PTSD). If your doctor thinks this may be true for you, he or she may do a mental health assessment.

If you use drugs and have a mental health problem, it's called a dual diagnosis. A dual diagnosis can make treatment for a drug problem hard. If you don't get treatment, one problem can make the other one worse. If you treat only one problem, treatment may not work well. When you treat both problems, you have a better chance of a full recovery and less chance of using drugs again.

Treatment

Treatment for drug abuse or dependence usually includes group therapy, one or more types of counseling, and drug education. A 12-step program is often part of treatment and continues after treatment as part of your recovery.

Treatment doesn't just deal with drugs. It will help you manage problems in your daily life. It helps you take control of your life so you don't have to depend on drugs. You'll learn good reasons to quit drugs.

Treatment helps you overcome dependence, but it doesn't happen all at once. Staying drug-free is a lifelong process that takes commitment and effort. You may be in group therapy or counseling for a year or more.

Recovery helps you stay drug-free and adjust to life without drugs. It is important that you plan for a relapse, which happens when you slip up and use drugs again. Your doctor, family, and friends can help you avoid this. See the Recovery section for more information.

Getting started

How treatment begins can vary. You might start with your family doctor, or your doctor may recommend that you enter a treatment facility. A friend could bring you to a self-help group, such as Narcotics Anonymous, or you might walk into a clinic that deals with drug abuse.

No matter how you get into treatment, your main goal will be to stop using the drug. You can think more clearly and make better decisions when you keep drugs out of your system. If you tell yourself that using a little bit of the drug is okay, it will be very hard to break the drug habits.

You may have a treatment team to help you. This team may include a psychologist or psychiatrist, counselors, doctors, social workers, nurses, and a case manager. A case manager helps plan and manage your treatment.

You may be asked questions about your drug use, health problems, work, and living situation. Be open and honest to get the best treatment possible. Your treatment team may write a treatment plan, which includes your treatment goals and ways to reach those goals. This helps you stay on track.

Detoxification

Your doctor may decide you need detoxification, or detox, before you start treatment. Detox "flushes out" the drugs in your body. You may need detox when you are physically addicted to a drug. Being physically addicted means that when you stop using the drug, you have physical withdrawal symptoms, such as feeling very sick to your stomach or feeling intense anxiety.

People who are dependent on drugs often have to go to a hospital or treatment facility. Detox usually is done under the care of a doctor because detox without medical care can be dangerous. A doctor also may be able to prescribe medicines to help with detox and withdrawal symptoms. Detox can be done in an inpatient or outpatient setting, depending on the drug you are dependent on and other factors.

Detox helps get you ready for treatment. It does not help you with the mental, social, and behavior changes you have to make to get and stay clean.

Therapy

Treatment for a drug problem usually involves one or more types of therapy.

• In group therapy, you talk about your recovery with other people who are trying to quit. You can get support from others who have struggled with dependence.
• In cognitive-behavioral therapy (CBT), you learn to change thoughts and actions that make you more likely to use drugs. A counselor teaches you ways to deal with cravings and avoid going back to drugs.
• With motivational interviewing (MI), you resolve mixed feelings you have about quitting and getting treatment. A counselor helps you find personal motivation to change.
• Motivational enhancement therapy (MET) uses motivational interviewing to help you find motivation to quit and get you started toward recovery. It usually lasts for 2 to 4 sessions.
• Couples or family counseling can help you to stop using drugs, stay drug-free, and improve your relationships with your partner and family.

Treatment usually includes support group attendance, such as going to Narcotics Anonymous (NA) meetings. Your family members might also want to attend a support group such as Nar-Anon.

Medicines

You may take medicines to help you quit or to help you overcome withdrawal symptoms. Medicines often are used for addiction to opiate drugs like heroin or certain painkillers. Medicines that can help you include:

• Buprenorphine, such as Subutex. Buprenorphine works by targeting the same places in the brain that opiates do. This relieves drug cravings without giving you the same high or side effects as opiates.
• Methadone, such as Dolophine. It works on parts of the brain and spinal cord to block the "high" caused by using opiates. It also helps reduce cravings and withdrawal symptoms caused by opiate use.
• Naltrexone, such as ReVia. It blocks the effects of opiate drugs and helps reduce your craving.

Treatment programs

Treatment programs can be outpatient, inpatient, or residential. They offer similar therapies. Your treatment team can help you decide which type of program is best for you.

• In outpatient treatment, you regularly go to a mental health clinic, counselor's office, hospital clinic, or local health department for treatment.
• In inpatient treatment, you stay at a hospital and have therapies during the day or evening. This usually lasts around 6 weeks. You most likely will then go to outpatient therapy.
• Residential treatment provides a place for you to live for 6 months or more while you recover. You get therapy and 24-hour care. This may be a good option if you have a long history of drug abuse or crime or if you have an unstable work or home situation.

Most programs provide education about the causes and effects of drug abuse and dependence. Learning these things helps you and your family know how to overcome drug use. Some programs also offer job or career training.

Some treatment programs give rewards, called vouchers, when you stay off drugs. The rewards may get bigger when you go for a long time without drugs.

Many programs give regular drug tests while you go through treatment. Knowing that you will be tested can make you more likely to resist your cravings.

What to think about

People with drug problems often have other problems or are in unique situations. They may need other treatments, or other resources may be available to help them with the drug problem.

• If you have a drug problem and a mental health problem, you will need treatment for both problems. Doctors call this a dual diagnosis.
• Older adults also may have drug problems because of misuse of prescription medicines such as painkillers or sleeping pills. Learning more about the medicines might help the problem, but older adults also may need more extensive treatment.
• Drug abuse in the military is like drug abuse in the general population. But there may be other concerns, such as post-traumatic stress disorder or military sexual trauma.
• Some people are sent to drug treatment because of a court decision. This may happen if you have a drug problem and you commit a crime. A court may require treatment and then keep track of your progress. Treatment often is available in prison.

Medicines

Your doctor may prescribe medicine during detoxification to ease withdrawal symptoms or during treatment to help you move away from dependence. These medicines are mainly used for dependence on heroin or other opiates.

Medicines that can help include:

• Buprenorphine, such as Subutex. Buprenorphine works by targeting the same places in the brain that opiates do. This relieves drug cravings without giving you the same high or side effects as opiates.
• Methadone, such as Dolophine. It works on parts of the brain and spinal cord to block the "high" caused by using opiates. It also helps reduce cravings and withdrawal symptoms caused by opiate use.
• Naltrexone, such as ReVia. It blocks the effects of opiate drugs and helps reduce your craving.

Recovery

Recovery from drug abuse or dependence means finding a way to stay drug-free while changing your attitudes and behaviors. In recovery, you work to restore relationships with your family and friends and with people at your job or school. You seek to find meaning and happiness in a healthy lifestyle that doesn't include drugs.

Recovery is not a cure. It is a lifelong process. It begins in treatment, but it doesn't end when your treatment ends. There are 10 principles of recovery(What is a PDF document?) that can help you reach your goals and learn new things to help yourself. They help you gain self-confidence and respect for yourself. They make clear that you're in charge of your recovery. How far you go is up to you.

To help stay drug-free after treatment, find things to do, such as sports or volunteer work. Stay away from friends or family members who use drugs. Learn how to say no to alcohol and drugs.

Support

An important part of recovery is being sure you have support. You can:

• Develop and use social support and support groups. Support comes in many forms. You can find it in seminars and groups led by professionals, in 12-step groups made up of others who have drug problems, and in your relationships with family and friends. You can make support groups more helpful by being an active member.
• Connect with family and friends. Your family and friends can help you stop using drugs and stay drug-free by encouraging positive steps. But for them to do this, you have to be honest about your problems and help them by trying.
• Take part in recovery group activities. You may have used drugs to make friends or be with a social group. Your counselor or doctor can help you learn skills to make friends without using drugs. For example, your counselor may help you find a social skills training class.
• Find a sponsor and work with this person. A sponsor is someone who has been in recovery for a long time and helps you stay drug-free.

Lapse and relapse

Stopping drug use is very hard. It's normal to have setbacks, even years later. Very few people succeed the first time they try. A lapse or relapse is likely.

• A lapse is the first time you use a drug again after you have quit, or brief episodes of drug use later on.
• A relapse is not being able to stay drug-free over time. It can occur if you have a series of lapses close together or a lapse that leads to heavier drug use over a longer period. A relapse is most likely to happen a few months after you have quit using drugs.

A lapse or relapse doesn't mean you or your treatment has failed. It may mean that you just slipped up. If this is true for you, accept the mistake and move on. Try to find out why you relapsed and make changes in your life so that it won't happen again. You also may need more treatment, another type of treatment, or more time in support groups such as Narcotics Anonymous.

A relapse is most likely to occur in the first few months after you stop using drugs. It's smart to plan for a relapse before it happens. Your doctor, family, and friends can help you do this.

A healthy lifestyle

When you use drugs, you often get away from some of the basics of good health. Part of recovery is finding your way back to a healthy lifestyle.

• Exercise and be active. This may give you something to do instead of thinking about drugs, and it also can help reduce stress. People who are fit usually have less anxiety, depression, and stress than people who aren't active.⁴
• Relieve stress. Stress can trigger a relapse. If you learn how to manage your stress, you can help prevent a relapse. Stress-relief exercises can help.
• Get enough sleep to help your mood and make you feel less stressed.
• Eat a balanced diet. This helps your body deal with tension and stress. Whole grains, dairy products, fruits, vegetables, and protein are part of a balanced diet.
• Meditate. Meditation helps you feel calm and can give you a clearer awareness about your life.

Family and Community

Drug abuse and dependence can harm your family and friends. You and your family may feel you have turned against each other. You may be angry at your family and friends, and they may be angry at you.

If you can, talk with your family about your drug problem and recovery. Your family and friends need to know that they did not cause your drug problem but that they can help you during recovery.

• Try to be open and honest with loved ones about your drug use. This will help them understand what you're going through and how they can help. Many treatment programs offer counseling for families to help you solve problems at home.
• Talk about what may cause a relapse, and share your relapse plan.

For family and friends: Encourage treatment

It's hard to get someone who uses drugs into treatment if he or she doesn't want it. You may be able to help the person get treatment by:

• No longer making excuses, such as covering up for missed work or missed activities with children. Don't lie or stretch the truth to help the person.
• Finding a good time to talk to the person. Say clearly how the person's drug use is harming you and that you will take action if he or she doesn't seek help. For example, you could say that drug use is causing money problems and that you will cancel credit cards if it continues.
• Being ready and able to help when a decision is made to get treatment.

For family and friends: Help with treatment and recovery

If someone you care about has had a drug problem, you know how hard it can be. You know how living or dealing with someone who has a drug problem can change and even destroy your life.

After the choice for treatment has been made, you play an important part. You can help your loved one stop using drugs and help repair the damage done to your family or relationship.

• Make sure the home contains no drugs or items that help people use drugs (drug paraphernalia).
• Be involved and patient. Attend recovery meetings with your loved one and be supportive. Know that it may take a long time for you to trust and forgive the person and for the person to forgive himself or herself.
• Be aware that your loved one may seem a different person once he or she is drug-free. You may find it hard to get used to this person. You may need to build a new relationship.
• Understand that you have the right to know how recovery is going, but you should ask about it in a respectful way.
• Help your loved one plan for a relapse. Most people relapse after treatment. This doesn't mean the treatment failed. Try to help your loved one see relapse as a chance to do better and keep working on skills to avoid drug use.
• Focus on the positive actions your loved one is making.

For family and friends: Take care of yourself

Taking care of yourself while you help your loved one is important. You probably will feel relief and happiness when the person decides to get help. But treatment and recovery mean changes in your life too. Your emotions may become more complicated. You may:

• Resent what the person did to you in the past.
• Not trust the person. You may not want to give the person the house key, the car key, or money. You also may feel guilty about not trusting the person.
• Find it hard to give up or share your family role. For example, if you took over child-rearing when your partner was using drugs, you may resent him or her becoming involved again. If you managed money, you may resent having to make shared decisions on how to spend money.
• Resent that the person is spending more time at meetings or with others in recovery than with you.
• Worry so much about relapse that you avoid anything you feel may upset the person. You also may resent this feeling.

These feelings are normal. You've been through a bad period of your life, and what happened is not easy to forget. Nor is it easy to forgive the person. Keep in mind that recovery is the road to a better life, and that you can help your loved one get there.

Find your own support. Nar-Anon and similar programs are for people with family members or friends with drug problems. They help you recover from the effects of being around someone who was addicted. You also may try family therapy.