Drug Addiction: A Clear, Evidence-Based Guide to Types, Symptoms, and Treatment (2025)
If you’re reading this because something about substance use feels off—yours or someone else’s—you’re in the right place. Addiction is a health issue, not a character flaw. People recover every day with the right mix of care, support, and time. This guide breaks big topics into everyday language: how addiction works, what to watch for, how to act in an emergency, and which treatments actually help in 2025. You can skim, jump to a section, or read end-to-end.
Use the Quick navigation to head straight to what you need—say, overdose response, screening tools, or proven therapies. And remember: legal status varies by jurisdiction; check local regulations if you’re unsure about the rules where you live.
How to use this guide
If you’re worried about yourself
- Start with Early signs and use the short checklist to get a clearer picture.
- Try a brief screen to gauge risk and decide on next steps you can take this week.
- Look at What works in 2025 for options that have strong evidence—no guesswork.
- Build a simple 24–72 hour plan so you’re not relying on willpower alone.
If you’re helping a loved one
- Use respectful language and healthy boundaries to keep conversations constructive.
- Review overdose basics—especially if opioids might be in the picture.
- Learn how to compare programs in Treatment in Thailand and what to ask any provider.
- Save the contact details in the CTA if you’d like a confidential consult with Siam Rehab.
This content is educational and not a substitute for seeing a clinician. In emergencies, call local services immediately.
What addiction is (plain language)
Substance use disorder (SUD) is a medical condition where a person keeps using a substance despite harm. It affects decision-making, mood, and day-to-day functioning, and it often comes with strong cravings. The APA and NIDA describe addiction/SUD as a chronic, relapsing brain condition because repeated substance exposure can change circuits involved in reward, stress, and self-control.
Tolerance means you need more for the same effect. Physical dependence means your body adapts and may go into withdrawal if you stop suddenly. You can have tolerance and physical dependence—from prescribed medicines, for example—without meeting criteria for a SUD. A SUD diagnosis focuses on behavior and impact on life, not just on withdrawal.
DSM-5-TR uses 11 criteria and groups severity by how many are present over 12 months: mild (2–3), moderate (4–5), and severe (6+). This helps match people with the right level of care.
Seven drug classes (according to DRE)
Clinicians and Drug Recognition Experts (DRE) talk about seven broad drug categories. It’s a helpful shorthand for patterns of effects, but many people use more than one substance, so real-life presentations can overlap.
| Class | Examples | What it does (typical) | Red flags | Do today |
|---|---|---|---|---|
| Cannabis | Marijuana, THC oils/edibles | Changes perception, coordination, reaction time | Daily use, unsuccessful cut-downs, falling behind at school/work; some develop cannabis use disorder | Marijuana risks |
| CNS Depressants | Benzodiazepines (e.g., alprazolam), barbiturates, some sleep meds | Calming, sedation; slows brain activity | Memory gaps, falls, combining with alcohol or opioids (breathing risks) | Benzo tapering |
| CNS Stimulants | Cocaine, methamphetamine, prescription stimulants (e.g., Adderall) | Euphoria, energy, alertness | Insomnia, fast heart rate, anxiety, binge/crash cycles | Cocaine help • Meth support • Adderall facts |
| Opioids | Heroin, tramadol, oxycodone; illicit fentanyl contamination | Analgesia, sedation; high overdose risk—especially with other sedatives | Pinpoint pupils, slowed breathing, “nodding”; withdrawal with aches and GI upset | Opioid therapy • Heroin help • Tramadol risks |
| Hallucinogens | LSD, psilocybin | Alters mood and perception | Panic, unsafe decisions; persistent anxiety in some | Seek a clinical consult if use causes distress or functional problems |
| Dissociative Anesthetics | Ketamine, PCP | Detachment, altered body awareness | Confusion, accidents, memory issues; higher risk when mixing with depressants | Discuss safety and screening; avoid combining with sedatives |
| Inhalants | Solvents, aerosols, nitrous oxide | Short-acting euphoria and disinhibition | Heart rhythm problems, injuries, brain/lung risks | Seek medical advice; reduce access; improve ventilation and safety |
Note: Legal status varies by jurisdiction; check local regulations.
Prescription medicines: when “by the book” isn’t risk-free
Plenty of people first run into trouble with medicines they were given for a valid reason. Benzodiazepines and opioids can cause tolerance and withdrawal even when taken as prescribed. Using them together raises the risk of dangerous sedation and slowed breathing; guidance advises strong caution with this combination.
Gabapentinoids (gabapentin, pregabalin) are common for nerve pain and anxiety. Combined with opioids, they can further depress breathing, especially in people with lung problems or when other sedatives are on board. Regulators have issued safety warnings to both clinicians and the public.
Pregabalin (Lyrica) can also be misused and may lead to dependence. If a taper is needed, go slowly and under supervision to reduce withdrawal and relapse to higher doses.
Early signs & red flags
These signs don’t prove someone has a SUD. They’re clues that a conversation with a clinician could help—especially if several show up at once.
- Behavioral: using more than planned; failed cut-downs; secrecy; missing work or classes; risky use (driving, unsafe sex).
- Cognitive/emotional: strong cravings; planning life around supply; irritability, anxiety, or low mood between uses.
- Physical: needing more for the same effect (tolerance); withdrawal; sleep problems; weight or appetite changes.
10-item quick self-check
- Used more or longer than planned in the last 3 months?
- Tried to cut down and couldn’t?
- Spend a lot of time getting, using, or recovering?
- Cravings or strong urges?
- Use affecting school, work, or home roles?
- Keep using despite social or relationship problems?
- Given up activities because of use?
- Use in risky situations (driving, swimming, mixing sedatives)?
- Keep using despite health problems made worse by use?
- Notice tolerance or withdrawal?
If two or more items are “yes,” a brief clinical screen is a good next step. DSM-5-TR uses similar criteria to grade severity.
What happens in the brain and body
Addictive drugs boost activity in the brain’s reward system, often raising dopamine in areas like the nucleus accumbens. With repetition, the brain adapts in reward, stress, and self-control systems. That’s why “I’ll just stop” can feel fragile and why taking a break without support often slips. These changes can last, but they’re not destiny—medications, therapy, routines, and time help the brain settle toward steadier functioning.
Urgent help: overdose basics (opioids)
Opioid overdoses slow or stop breathing. If you suspect one: call emergency services, give naloxone if available, and start rescue breathing if the person isn’t breathing normally. Naloxone can restore breathing quickly, but it wears off; keep monitoring and redose as directed until help arrives.
- Recognize: slow or no breathing, blue lips, pinpoint pupils, unresponsive.
- Respond: call for help, give naloxone, provide rescue breaths if trained, place in recovery position, stay with the person.
- Access: in many places, naloxone is available without a prescription; brief training helps bystanders act fast.
Higher naloxone doses aren’t always better and can trigger brisk withdrawal. Follow local dosing and redosing guidance.
Screening (DAST-10 / ASSIST-Lite)
Brief screens estimate risk and point to the right level of support. Two common tools:
- DAST-10 (Drug Abuse Screening Test): ten yes/no items; scores suggest risk bands (0 none, 1–2 low, 3–5 moderate, 6–8 substantial, 9–10 severe). It’s a screen—not a diagnosis—and it guides referrals and care planning.
- ASSIST-Lite (WHO): a short version that flags low, moderate, or high risk by substance and recommends brief advice or a formal assessment.
Whatever you use, share results with a clinician who can interpret them and help you plan next steps, including safety if opioids, benzodiazepines, or alcohol are involved.
What works in 2025
Opioid Use Disorder (OUD)
Methadone, buprenorphine, and extended-release naltrexone are first-line, lifesaving treatments. When paired with counseling and recovery supports, they reduce overdose and keep people engaged in care. Policy updates in 2024–2025 expanded access—through modernized opioid treatment program rules and telemedicine pathways in many settings.
- Methadone: effective for cravings and withdrawal; newer rules allow more flexible take-home dosing where permitted.
- Buprenorphine: a partial agonist that lowers overdose risk and supports retention; access and prescribing rules vary by location and recent updates.
- Extended-release naltrexone: a monthly injection that blocks opioid effects; best for people who can first reach opioid-free status.
Stimulant Use Disorders (cocaine, methamphetamine, prescription stimulants)
There are no FDA-approved medications yet. The best evidence supports contingency management (CM)—clear, structured rewards for meeting treatment goals—often combined with CBT or motivational interviewing. Newer real-world data suggest CM improves engagement and may lower mortality.
Benzodiazepines
With long-term daily use, dependence is common. Best practice is a slow, individualized, supervised taper (weeks to months), with support for anxiety/insomnia and psychotherapy where helpful. Abrupt stops are unsafe. A 2025 consensus guideline provides detailed tapering strategies.
Whole-person care
The right level of care depends on medical and psychosocial needs—ranging from outpatient to intensive outpatient to residential/inpatient. Updated criteria emphasize person-centered assessment, co-occurring mental health care, and individualized, recovery-oriented plans.
Action plans for the next 24–72 hours
If this is about you
- Safety check (today): If opioids, benzos, or alcohol are involved, avoid mixing sedatives; store medicines safely; if available and legal, keep naloxone at home and tell a support person where it is.
- Book a consult (today–tomorrow): Schedule a confidential assessment with an addiction-trained clinician. Ask about MOUD (for OUD), CM/CBT (for stimulants), and benzodiazepine taper plans if relevant.
- Plan your week (next 72 hours): Choose two doable goals (e.g., first appointment, safe storage, sleep routine). Name one supportive person you’ll text daily. Remove or secure high-risk substances and paraphernalia at home.
If you’re a family member
- Keep the door open: Use “I” statements (“I’m worried about your sleep and missed classes”) and offer options (“Would you talk to a counselor with me?”).
- Home safety: Reduce access to sedatives and opioids; lock medicines; learn overdose response and the recovery position; carry naloxone if legal.
- Boundaries + support: Be clear about limits (e.g., no driving after use). Encourage professional help and support groups; avoid threats you can’t keep.
Treatment in Thailand: when it makes sense
A change of setting can help some people step out of old patterns, focus on recovery, and access comprehensive care at a cost that’s often lower than in many Western countries. When comparing centers, ask:
- Medical oversight: Is there 24/7 nursing/medical coverage? What are the protocols for detox, withdrawal management, and emergency transfer?
- Evidence-based therapies: Do they provide or coordinate MOUD for OUD, CM/CBT for stimulants, and supervised benzodiazepine tapering?
- Dual-diagnosis care: How are anxiety, depression, PTSD, or other conditions integrated into the plan?
- Aftercare: What does relapse-prevention and follow-up look like (including telehealth where permitted)?
- Transparency: Are costs, staff qualifications, and outcomes tracking clear and accessible?
Relapse prevention & sustaining remission
- Trigger plan: List your top three triggers and what you’ll do in the first 10 minutes (text a support, brief walk, delay decision, breathing exercise).
- Sleep, stress, activity: Protect 7–9 hours’ sleep, add a short daily movement practice, and choose one stress-reduction skill (box breathing, progressive muscle relaxation).
- Medication adherence: If you’re on MOUD or other prescribed meds, set reminders and keep follow-ups.
- Peer support: Many people benefit from adding a peer or mutual-aid group alongside therapy.
- After a slip: Treat it as information, not failure. Reconnect with your plan the same day and update what didn’t work.
Myths & facts
- “Naloxone encourages use.” Research does not show increased substance use from take-home naloxone. Wider access is linked to better survival and fewer deaths.
- “Cannabis can’t be addictive.” Many use without problems, but a meaningful minority develop cannabis use disorder, especially with frequent, early, or high-potency use.
- “Detox cures addiction.” Detox stabilizes withdrawal. Ongoing care sustains recovery; for OUD, medications are first-line.
- “If a benzodiazepine causes problems, stop it right now.” Abrupt discontinuation is unsafe. Guidelines recommend a slow, supervised taper plus non-drug supports.
FAQ
How do tolerance, physical dependence, and SUD differ?
Tolerance is needing more for the same effect; physical dependence means withdrawal when stopping. SUD is a behavioral health diagnosis based on impact and loss of control. You can be tolerant or dependent (e.g., after long-term prescriptions) without meeting SUD criteria.
Do I need inpatient care or can I go outpatient?
It depends on medical and social factors. Many start with outpatient or intensive outpatient. Others need residential/inpatient for safety or stability (e.g., complicated withdrawal, unstable housing). Clinicians use standardized criteria (like ASAM) to match you to the level of care.
Are there proven medications for stimulant addiction?
Not yet. The best-supported approach is contingency management, usually paired with CBT or motivational interviewing. Some combinations are under study, but CM remains the standard in 2025.
Can I taper benzodiazepines at home?
Only with a prescriber’s plan. Tapers are slow and individualized, with monitoring and supports for anxiety and sleep. Sudden stops are risky.
When should I call emergency services?
Right away if someone is unresponsive, breathing abnormally, or you suspect an opioid overdose. Give naloxone if available, start rescue breathing if trained, place the person on their side, and stay until help arrives.
Is naloxone legal to carry?
In many places, yes—but rules vary. Public health agencies increasingly recommend wider access and training for people likely to witness an overdose. Check your local regulations.
Does cannabis use always lead to addiction?
No. Most people do not develop a disorder, but a significant minority do—especially with frequent, early, or high-potency use. Watch for impaired functioning and trouble cutting down.
What about mixing medicines?
Mixing opioids with benzodiazepines or other sedatives increases overdose risk. Avoid unprescribed combinations and talk to a clinician about any changes.
What changed in 2024–2025 for opioid treatment access?
Rules modernized opioid treatment programs (e.g., more flexible take-home methadone where appropriate) and finalized telemedicine pathways for buprenorphine in many contexts. Implementation varies by location.
Authors & medical review
Prepared by a multidisciplinary team (addiction medicine specialist and counseling psychologist). Clinically reviewed prior to publication.
Contributors
References
- American Psychiatric Association. What Is a Substance Use Disorder? (accessed 2025). https://www.psychiatry.org/patients-families/addiction-substance-use-disorders/what-is-a-substance-use-disorder
- EBSCO Research Starters. DSM criteria for substance use disorders (explains 2–3 mild, 4–5 moderate, 6+ severe). https://www.ebsco.com/research-starters/health-and-medicine/dsm-criteria-substance-use-disorders
- Centers for Disease Control and Prevention. 2022 CDC Clinical Practice Guideline at a Glance. May 7, 2024. https://www.cdc.gov/overdose-prevention/hcp/clinical-guidance/index.html
- National Institute on Drug Abuse. Drugs, Brains, and Behavior: Drugs and the Brain. https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drugs-brain
- World Health Organization. Opioid overdose: Fact sheet. Aug 29, 2025. https://www.who.int/news-room/fact-sheets/detail/opioid-overdose
- National Institute on Drug Abuse. Medications for Opioid Use Disorder Are Effective and Save Lives. Updated 2025. https://nida.nih.gov/research-topics/medications-to-treat-opioid-addiction/medications-opioid-use-disorder-are-effective-save-lives
- American Society of Addiction Medicine. Joint Clinical Practice Guideline on Benzodiazepine Tapering. 2025. https://www.asam.org/quality-care/clinical-guidelines/benzodiazepine-tapering
- American Society of Addiction Medicine & American Academy of Addiction Psychiatry. ASAM/AAAP Clinical Practice Guideline on the Treatment of Stimulant Use Disorder. 2024. https://www.asam.org/quality-care/clinical-guidelines/stimulant-use-disorders
- Substance Abuse and Mental Health Services Administration. 42 CFR Part 8 Final Rule: Medications for the Treatment of Opioid Use Disorder. Jan 31, 2024. https://www.samhsa.gov/substance-use/treatment/opioid-treatment-program/42-cfr-part-8
- American Journal of Psychiatry. Real-World Mortality Associated With Contingency Management for Opioid Use Disorder. 2025. https://psychiatryonline.org/doi/10.1176/appi.ajp.20240788
