PRESCRIPTION

DRUGS

What are some 

of the commonly

abused prescription

drugs?

Although many prescription drugs can 

be abused or misused,

there are three classes of 

prescription drugs that are

most commonly abused:

■ Opioids, which are most

often prescribed to treat

pain;

■ CNS depressants, which

are used to treat anxiety

and sleep disorders;

■ Stimulants, which are

prescribed to treat the

sleep disorder narcolepsy,

attention-deficit hyperactivity disorder (ADHD),

and obesity.

Opioids

What are opioids?

Opioids are commonly 

prescribed because of

their effective analgesic,

or pain-relieving, properties.

Medications that fall within

this class—sometimes referred

to as narcotics—include morphine, codeine, and related

drugs. Morphine, for example,

is often used before or after

surgery to alleviate severe

pain. Codeine, because it is

less efficacious than morphine,

is used for milder pain. Other

examples of opioids that can

be prescribed to alleviate pain

include oxycodone (OxyContin),

propoxyphene (Darvon),

hydrocodone (Vicodin), and

hydromorphone (Dilaudid), 

from the director

Most people who take prescription

medications take them responsibly; 

however, the nonmedical use or

abuse of prescription drugs remains

a serious public health concern.

Certain prescription drugs—opioids,

central nervous system (CNS) depressants, and stimulants—when abused,

can alter the brain’s activity and

lead to dependence and possibly

addiction.

An estimated 9 million people

aged 12 and older used prescription

drugs for nonmedical reasons in

1999; more than a quarter of that

number reported using prescription

drugs nonmedically for the first time

in the previous year. We would like 

to reverse this trend by increasing

awareness and promoting additional

research on this topic.

The National Institute on Drug

Abuse (NIDA) has developed this publication to answer questions about

the consequences of abusing commonly prescribed medications. In

addition to offering information on

what research has taught us about

how certain medications affect the

brain and body, this publication also

discusses treatment options.

This publication was developed to

help health care providers discuss the

consequences of prescription drug

abuse with their patients. According

to a recent national survey of primary

care physicians and patients regarding substance abuse, 46.6 percent of

physicians find it difficult to discuss

prescription drug abuse with their

patients. 

Prescription drug abuse is not a

new problem, but one that deserves

renewed attention. We hope this 

scientific report is useful to the public,

particularly to individuals working

with the elderly, who because of the

number of medications they may take

for various medical conditions, may

be more vulnerable to misuse or

abuse of prescribed medications. 

Alan I. Leshner, Ph.D.

Director

National Institute on Drug Abuse

U . S . Department of Health and Human Services • National Institutes of Health

ResearchReport

NATIONAL INSTITUTE ON DRUG ABUSE

SERIES

AbuseandAddiction
as well as meperidine

(Demerol), which is used 

less often because of its side

effects. In addition to their

pain-relieving properties, some

of these drugs—for example,

codeine and diphenoxylate

(Lomotil)—can be used to

relieve coughs and diarrhea.

How do opioids affect 

the brain and body?

Opioids act by attaching to

specific proteins called opioid

receptors, which are found in

the brain, spinal cord, and

gastrointestinal tract. When

these drugs attach to certain

opioid receptors, they can

block the transmission of pain

messages to the brain. In 

addition, opioids can produce

drowsiness, cause constipation, and, depending upon 

the amount of drug taken,

depress respiration. Opioid

drugs also can cause euphoria

by affecting the brain regions

that mediate what we perceive

as pleasure.

What are the possible 

consequences of opioid

use and abuse? 

Chronic use of opioids can

result in tolerance for the

drugs, which means that users

must take higher doses to

achieve the same initial effects.

Long-term use also can lead 

to physical dependence and

addiction—the body adapts to

the presence of the drug, and

withdrawal symptoms occur 

if use is reduced or stopped.

Symptoms of withdrawal

include restlessness, muscle

and bone pain, insomnia, 

diarrhea, vomiting, cold flashes

with goose bumps (“cold

turkey”), and involuntary leg

movements. Finally, taking a

large single dose of an opioid

could cause severe respiratory

depression that can lead to

death. Many studies have

shown, however, that properly

managed medical use of opioid analgesic drugs is safe and

rarely causes clinical addiction,

defined as compulsive, often

uncontrollable use of drugs.

Taken exactly as prescribed,

opioids can be used to manage pain effectively.

Is it safe to use 

opioid drugs with 

other medications?

Opioids are safe to use 

with other drugs only under 

a physician’s supervision.

Typically, they should not be

used with other substances

that depress the central 

nervous system, such as 

alcohol, antihistamines, 

barbiturates, benzodiazepines,

or general anesthetics, as 

such a combination increases

the risk of life-threatening 

respiratory depression.

CNS depressants

What are CNS depressants?

C

NS depressants are 

substances that can slow

normal brain function.

Because of this property, some

CNS depressants are useful in

the treatment of anxiety and

sleep disorders. Among the

medications that are commonly

2NIDA RESEARCH REPORT SERIES

Approximately 4 Million Americans 

Reported Current Use of Prescription Drugs 

for Nonmedical Purposes in 1999

Source: Office of Applied Studies, Substance Abuse and Mental Health Services Administration. 

National Household Survey on Drug Abuse, 1999.

3.0

2.5

2.0 

1.5 

1.0

0.5

0 Stimulants Sedatives and

Tranquilizers

Pain Relievers

Millions of Americans
prescribed for these purposes

are the following: 

■ Barbiturates, such as

mephobarbital (Mebaral)

and pentobarbital sodium

(Nembutal), which are

used to treat anxiety, tension, and sleep disorders.

■ Benzodiazepines, such

as diazepam (Valium),

chlordiazepoxide HCl

(Librium), and alprazolam

(Xanax), which can be

prescribed to treat anxiety,

acute stress reactions, and

panic attacks; the more

sedating benzodiazepines,

such as triazolam (Halcion)

and estazolam (ProSom)

can be prescribed for

short-term treatment of

sleep disorders. 

In higher doses, some CNS

depressants can be used as

general anesthetics.

How do CNS depressants

affect the brain and body?

There are numerous CNS

depressants; most act on the

brain by affecting the neurotransmitter gamma-aminobutyric

acid (GABA). Neurotransmitters

are brain chemicals that facilitate communication between

brain cells. GABA works by

decreasing brain activity.

Although the different classes

of CNS depressants work in

unique ways, ultimately it 

is through their ability to

increase GABA activity that

they produce a drowsy or

calming effect that is beneficial

to those suffering from anxiety

or sleep disorders.

What are the possible 

consequences of CNS

depressant use and abuse?

Despite their many beneficial

effects, barbiturates and benzodiazepines have the potential for abuse and should be

used only as prescribed.

During the first few days of

taking a prescribed CNS

depressant, a person usually

feels sleepy and uncoordinated, but as the body becomes

accustomed to the effects of

the drug, these feelings begin

to disappear. If one uses these

drugs long term, the body will

develop tolerance for the

drugs, and larger doses will be

needed to achieve the same

initial effects. In addition, continued use can lead to physical dependence and—when

use is reduced or stopped—

withdrawal. Because all CNS

depressants work by slowing

the brain’s activity, when an

individual stops taking them,

the brain’s activity can rebound

and race out of control, possibly leading to seizures and

other harmful consequences.

Although withdrawal from

benzodiazepines can be problematic, it is rarely life threatening, whereas withdrawal

from prolonged use of other

CNS depressants can have 

life-threatening complications.

Therefore, someone who is

thinking about discontinuing

CNS-depressant therapy or

who is suffering withdrawal

from a CNS depressant should

speak with a physician or seek

medical treatment.

Is it safe to use CNS

depressants with other

medications?

CNS depressants should be

used with other medications

only under a physician’s

supervision. Typically, they

should not be combined with

any other medication or substance that causes CNS depression, including prescription

pain medicines, some overthe-counter cold and allergy

medications, or alcohol. Using

CNS depressants with these

other substances—particularly

alcohol—can slow breathing,

or slow both the heart and

respiration, and possibly lead

to death.

Stimulants

What are stimulants?

As the name suggests,

stimulants are a class of

drugs that enhance brain

activity—they cause an increase

in alertness, attention, and

energy that is accompanied by

elevated blood pressure and

increased heart rate and respiration. Stimulants were used

historically to treat asthma and

other respiratory problems,

obesity, neurological disorders,

and a variety of other ailments.

But as their potential for abuse

and addiction became apparent,

the medical use of stimulants

began to wane. Now, stimulants

NIDA RESEARCH REPORT SERIES3
are prescribed for the treatment

of only a few health conditions,

including narcolepsy, attentiondeficit hyperactivity disorder,

and depression that has not

responded to other treatments.

Stimulants may be used as

appetite suppressants for shortterm treatment of obesity, and

they also may be used for

patients with asthma.

How do stimulants affect

the brain and body?

Stimulants, such as dextroamphetamine (Dexedrine) and

methylphenidate (Ritalin),

have chemical structures that

are similar to a family of key

brain neurotransmitters called

monoamines, which include

norepinephrine and dopamine.

Stimulants increase the amount

of these chemicals in the brain.

This, in turn, increases blood

pressure and heart rate, constricts blood vessels, increases

blood glucose, and opens 

up the pathways of the respiratory system. In addition, 

the increase in dopamine is

associated with a sense of

euphoria that can accompany

the use of these drugs.

What are the possible 

consequences of stimulant use and abuse?

The consequences of stimulant abuse can be dangerous.

Although their use may not

lead to physical dependence

and risk of withdrawal, stimulants can be addictive in that

individuals begin to use them

compulsively. Taking high doses

of some stimulants repeatedly

over a short time can lead to

feelings of hostility or paranoia. Additionally, taking high

doses of a stimulant may result

in dangerously high body 

temperatures and an irregular

heartbeat. There is also the

potential for cardiovascular

failure or lethal seizures. 

Is it safe to use stimulants

with other medications?

Stimulants should be used

with other medications only

when the patient is under a

physician’s supervision. For

example, a stimulant may be

prescribed to a patient taking

an antidepressant. However,

health care providers and

patients should be mindful

that antidepressants enhance

the effects of a stimulant.

Patients also should be aware

that stimulants should not be

mixed with over-the-counter

cold medicines that contain

decongestants, as this combination may cause blood

pressure to become dangerously high or lead to irregular

heart rhythms.

Trends in 

prescription 

drug abuse

S

everal indicators suggest

that prescription drug

abuse is on the rise in

the United States. According to

the 1999 National Household

Survey on Drug Abuse, in

1998, an estimated 1.6 million

Americans used prescription

pain relievers nonmedically

for the first time. This represents a significant increase

since the 1980s, when there

were generally fewer than

500,000 first-time users per

year. From 1990 to 1998, the

number of new users of pain

relievers increased by 181 percent; the number of individuals

who initiated tranquilizer use

increased by 132 percent; the

number of new sedative users

increased by 90 percent; and

the number of people initiating

stimulant use increased by 

165 percent. In 1999, an estimated 4 million people—almost

2 percent of the population

aged 12 and older—were 

currently (use in past month)

using certain prescription

drugs nonmedically: pain

relievers (2.6 million users),

sedatives and tranquilizers

(1.3 million users), and stimulants (0.9 million users).

Although prescription drug

abuse affects many Americans,

some trends of concern can

be seen among older adults,

adolescents, and women. In

addition, health care professionals—including physicians,

nurses, pharmacists, dentists,

anesthesiologists, and veterinarians—may be at increased

risk of prescription drug abuse

because of ease of access, 

as well as their ability to selfprescribe drugs. In spite of this

increased risk, recent surveys

and research in the early

1990s indicate that health care

providers probably suffer 

4NIDA RESEARCH REPORT SERIES
NIDA RESEARCH REPORT SERIES5

OPIOIDS

■ Oxycodone (OxyContin)

■ Propoxyphene (Darvon)

■ Hydrocodone (Vicodin)

■ Hydromorphone (Dilaudid)

■ Meperidine (Demerol)

■ Diphenoxylate (Lomotil)

Generally prescribed for

■ Postsurgical pain relief

■ Management of acute or chronic pain

■ Relief of coughs and diarrhea 

In the body

Opioids attach to opioid receptors in the brain 

and spinal cord, blocking the transmission of pain 

messages to the brain.

Effects of short-term use

■ Blocked pain messages

■ Drowsiness 

■ Constipation

■ Depressed respiration 

(depending on dose)

Effects of long-term use

■ Potential for tolerance, physical 

dependence, withdrawal, and/or addiction

Possible negative effects

■ Severe respiratory depression or death 

following a large single dose 

Should not be used with

Other substances that cause CNS depression, including

■ Alcohol 

■ Antihistamines

■ Barbiturates

■ Benzodiazepines

■ General anesthetics

CNS DEPRESSANTS

Barbiturates

■ Mephobarbital (Mebaral)

■ Pentobarbital sodium (Nembutal)

Benzodiazepines

■ Diazepam (Valium)

■ Chlordiazepoxide hydrochloride (Librium)

■ Alprazolam (Xanax)

■ Triazolam (Halcion)

■ Estazolam (ProSom)

Generally prescribed for

■ Anxiety

■ Tension

■ Panic attacks

■ Acute stress reactions

■ Sleep disorders

■ Anesthesia (at high doses)

In the body

CNS depressants slow brain activity through 

actions on the GABA system and, therefore, produce 

a calming effect.

Effects of short-term use

■ A “sleepy”and uncoordinated feeling 

during the first few days, as the body 

becomes accustomed—tolerant—to the 

effects, these feelings diminish.

Effects of long-term use

■ Potential for tolerance, physical 

dependence, withdrawal, and/or addiction

Possible negative effects

■ Seizures following a rebound in brain 

activity after reducing or discontinuing use 

Should not be used with

Other substances that cause CNS depression, including

■ Alcohol 

■ Prescription opioid pain medicines 

■ Some over-the-counter cold and allergy 

medications

STIMULANTS

■ Dextroamphetamine (Dexedrine)

■ Methylphenidate (Ritalin)

■ Sibutramine hydrochloride monohydrate (Meridia)

Generally prescribed for

■ Narcolepsy

■ Attention-deficit hyperactivity disorder (ADHD) 

■ Depression that does not respond to other treatment 

■ Short-term treatment of obesity

■ Asthma

In the body

Stimulants enhance brain activity, causing an increase

in alertness, attention, and energy.

Effects of short-term use

■ Elevated blood pressure

■ Increased heart rate

■ Increased respiration

■ Suppressed appetite

■ Sleep deprivation

Effects of long-term use

■ Potential for addiction

Possible negative effects

■ Dangerously high body temperatures 

or an irregular heartbeat after taking 

high doses 

■ Cardiovascular failure or lethal seizures

■ For some stimulants, hostility or feelings 

of paranoia after taking high doses 

repeatedly over a short period of time 

Should not be used with

■ Over-the-counter cold medicines containing 

decongestants

■ Antidepressants, unless supervised by 

a physician

■ Some asthma medications

Some Commonly Prescribed Medications: Use and Consequences
from substance abuse, including alcohol and drugs, at a

rate similar to rates in society

as a whole, in the range of 8

to 12 percent.

Older adults

The misuse of prescription

drugs may be the most common

form of drug abuse among 

the elderly. Elderly persons

use prescription medications

approximately three times as

frequently as the general population and have been found

to have the poorest rates of

compliance with directions for

taking a medication. In addition, data from the Veterans

Affairs Hospital System suggest

that elderly patients may be

prescribed inappropriately

high doses of medications

such as benzodiazepines and

may be prescribed these medications for longer periods

than are younger adults. In

general, older people should

be prescribed lower doses of

medications, because the

body’s ability to metabolize

many medications decreases

with age.

An association between agerelated morbidity and abuse of

prescription medications likely

exists. For example, elderly

persons who take benzodiazepines are at increased risk

for falls that cause hip and

thigh fractures, as well as for

vehicle accidents. Cognitive

impairment also is associated

with benzodiazepine use,

although memory impairment

may be reversible when the

drug is discontinued. Finally,

use of benzodiazepines for

longer than 4 months is not

recommended for elderly

patients because of the possibility of physical dependence.

Adolescents and 

young adults

Data from the National

Household Survey on Drug

Abuse indicate that the most

dramatic increase in new users

of prescription drugs for nonmedical purposes occurs in

12- to 17-year-olds and 18- to

25-year-olds. In addition, 12-

to 14-year-olds reported psychotherapeutics (for example,

painkillers or stimulants) as

one of two primary drugs

used. The 1999 Monitoring the

Future survey showed that for

barbiturates, tranquilizers, and

narcotics other than heroin,

the general, long-term declines

in use among young adults in

the 1980s leveled off in the

early 1990s, with modest

increases again in the mid-to

late 1990s. For example, the

use of methylphenidate

(Ritalin) among high school

seniors increased from an

annual prevalence (use of the

drug within the preceding

year) of 0.1 percent in 1992 

to an annual prevalence of 

2.8 percent in 1997 before

reaching a plateau.

It also appears that college

students’ nonmedical use of

pain relievers such as oxycodone with aspirin (Percodan)

and hydrocodone (Vicodin) 

is on the rise. The 1999 Drug

Abuse Warning Network,

which collects data on drugrelated episodes in hospital

6NIDA RESEARCH REPORT SERIES

Illicit Drug Use Among Youths Age 12 to 14

6%

5

4 

3 

2

1

0

Age 12

Percent Using in Past Month

Age 13 Age 14

Marijuana

Psychotherapeutics

Inhalants

Hallucinogens

Source: Office of Applied Studies, Substance Abuse and Mental Health Services Administration. 

National Household Survey on Drug Abuse, 1999.
emergency departments,

reported that mentions of

hydrocodone as a cause for

visiting an emergency room

increased by 37 percent

among all age groups from

1997 to 1999. Mentions of the

benzodiazepine clonazepam

(Klonopin) increased by 102

percent since 1992.

Gender differences

Studies suggest that women

are more likely than men to

be prescribed an abusable

prescription drug, particularly

narcotics and anti-anxiety

drugs—in some cases 48 percent more likely.

Overall, men and women

have roughly similar rates of

nonmedical use of prescription drugs. An exception is

found among 12- to 17-yearolds: In this age group, young

women are more likely than

young men to use psychotherapeutic drugs nonmedically. 

In addition, research has

shown that women and men

who use prescription opioids

are equally likely to become

addicted. However, among

women and men who use

either a sedative, anti-anxiety

drug, or hypnotic, women are

almost two times more likely 

to become addicted.

Preventing and

detecting prescription drug abuse

Although most patients

use medications as

directed, abuse of and

addiction to prescription drugs

are public health problems for

many Americans. However,

addiction rarely occurs among

those who use pain relievers,

CNS depressants, or stimulants

as prescribed; the risk for

addiction exists when these

medications are used in ways

other than as prescribed.

Health care providers such 

as primary care physicians,

nurse practitioners, and pharmacists as well as patients can

all play a role in preventing 

and detecting prescription

drug abuse.

Role of health care

providers 

About 70 percent of

Americans—approximately

191 million people—visit a

health care provider, such as 

a primary care physician, at

least once every 2 years. Thus,

health care providers are in a

unique position not only to

prescribe needed medications

appropriately, but also to

identify prescription drug

abuse when it exists and help

the patient recognize the

problem, set goals for recovery, and seek appropriate

treatment when necessary.

Screening for any type of 

substance abuse can be 

incorporated into routine 

history taking with questions

about what prescriptions and

over-the-counter medicines

the patient is taking and 

why. Screening also can be

performed if a patient presents

with specific symptoms associated with problem use of a

substance. 

Over time, providers should

NIDA RESEARCH REPORT SERIES7

Assessing Prescription Drug Abuse:

Four Simple Questions for You and Your Physician

■ Have you ever felt the need to Cut down on your use of

prescription drugs?

■ Have you ever felt Annoyed by remarks your friends or

loved ones made about your use of prescription drugs?

■ Have you ever felt Guilty or remorseful about your use 

of prescription drugs?

■ Have you Ever used prescription drugs as a way to 

“get going” or to “calm down?”

Adapted from Ewing, J.A. “Detecting Alcoholism: The CAGE Questionnaire.”

Journal of the American Medical Association 252(14):1905-1907, 1984.
note any rapid increases in 

the amount of a medication

needed—which may indicate

the development of tolerance—

or frequent requests for refills

before the quantity prescribed

should have been used. They

should also be alert to the 

fact that those addicted to 

prescription medications may

engage in “doctor shopping,”

moving from provider to

provider in an effort to get

multiple prescriptions for 

the drug they abuse.

Preventing or stopping 

prescription drug abuse is 

an important part of patient

care. However, health care

providers should not avoid

prescribing or administering

strong CNS depressants 

and painkillers, if they are

needed. (See box on pain 

and opiophobia.)

Role of pharmacists

Pharmacists can play a key

role in preventing prescription

drug misuse and abuse by

providing clear information

and advice about how to take

a medication appropriately,

about the effects the medication may have, and about any

possible drug interactions.

Pharmacists can help prevent

prescription fraud or diversion

by looking for false or altered

prescription forms. Many pharmacies have developed 

“hotlines” to alert other pharmacies in the region when a

fraud is detected.

Role of patients

There are several ways that

patients can prevent prescription drug abuse. When visiting

the doctor, provide a complete

medical history and a descripI

t is estimated that more than 50 million Americans suffer from

chronic pain. When treating pain, health care providers have

long wrestled with a dilemma: How to adequately relieve a

patient’s suffering while avoiding the potential for that patient to

become addicted to pain medication?

Many health care providers underprescribe painkillers because

they overestimate the potential for patients to become addicted

to medications such as morphine and codeine. Although these

drugs carry a heightened risk of addiction, research has shown

that providers’ concerns that patients will become addicted to

pain medication are largely unfounded. This fear of prescribing

opioid pain medications is known as “opiophobia.”

Most patients who are prescribed opioids for pain, even those

undergoing long-term therapy, do not become addicted to the

drugs. The few patients who do develop rapid and marked 

tolerance for and addiction to opioids usually have a history 

of psychological problems or prior substance abuse. In fact,

studies have shown that abuse potential of opioid medications

is generally low in healthy, nondrug-abusing volunteers. One

study found that only 4 out of about 12,000 patients who

were given opioids for acute pain became addicted. In a study

of 38 chronic pain patients, most of whom received opioids for

4 to 7 years, only 2 patients became addicted, and both had

a history of drug abuse.

The issues of underprescription of opioids and the suffering of 

millions of patients who do not receive adequate pain relief 

has led to the development of guidelines for pain treatment.

These guidelines may help bring an end to underprescribing,

but alternative forms of pain control are still needed. NIDAfunded scientists continue to search for new ways to control

pain and to develop new pain medications that are effective

but do not have the potential for addiction.

Pain and Opiophobia

8NIDA RESEARCH REPORT SERIES
tion of the reason for the visit

to ensure that the doctor

understands the complaint 

and can prescribe appropriate

medication. If a doctor prescribes a pain medication,

stimulant, or CNS depressant,

follow the directions for use

carefully and learn about the

effects that the drug could

have, especially during the

first few days during which

the body is adapting to the

medication. Also be aware 

of potential interactions with

other drugs by reading all

information provided by the

pharmacist. Do not increase 

or decrease doses or abruptly

stop taking a prescription

without consulting a health

care provider first. For example, if you are taking a pain

reliever for chronic pain and

the medication no longer

seems to be effectively controlling the pain, speak with

your physician; do not increase

the dose on your own. Finally,

never use another person’s

prescription.

Treating 

prescription 

drug addiction 

Years of research have

shown us that addiction

to any drug, illicit or 

prescribed, is a brain disease

that can, like other chronic

diseases, be effectively treated.

But no single type of treatment

is appropriate for all individuals

addicted to prescription drugs.

Treatment must take into

account the type of drug used

and the needs of the individual.

To be successful, treatment

may need to incorporate 

several components, such as

counseling in conjunction with

a prescribed medication, and

multiple courses of treatment

may be needed for the patient

to make a full recovery.

The two main categories of

drug addiction treatment are

behavioral and pharmacological. Behavioral treatments

teach people how to function

without drugs, how to handle

cravings, how to avoid drugs

and situations that could lead

to drug use, how to prevent

relapse, and how to handle

relapse should it occur. When

delivered effectively, behavioral treatments—such as individual counseling, group or

family counseling, contingency

management, and cognitivebehavioral therapies—also can

help patients improve their

personal relationships and

ability to function at work 

and in the community. 

Some addictions, such as

opioid addiction, can also be

treated with medications. These

pharmacological treatments

counter the effects of the drug

on the brain and behavior.

Medications also can be used

to relieve the symptoms of

withdrawal, to treat an overdose, or to help overcome

drug cravings. 

Although a behavioral or

pharmacological approach

alone may be effective for

treating drug addiction,

research shows that a combination of both, when 

available, is most effective.

NIDA RESEARCH REPORT SERIES9
Treating addiction to 

prescription opioids

Several options are available

for effectively treating addiction to prescription opioids.

These options are drawn 

from experience and research

regarding the treatment of

heroin addiction. They include medications, such as

methadone and LAAM 

(levo-alpha-acetyl-methadol),

and behavioral counseling

approaches.

A useful precursor to longterm treatment of opioid

addiction is detoxification.

Detoxification in itself is not 

a treatment for

opioid addiction.

Rather, its primary

objective is to

relieve withdrawal

symptoms while

the patient adjusts

to being drug free. 

To be effective,

detoxification must

precede long-term

treatment that

either requires

complete abstinence

or incorporates a

medication, such as

methadone, into 

the treatment plan. 

Methadone is a

synthetic opioid

that blocks the

effects of heroin

and other opioids,

eliminates withdrawal symptoms,

and relieves drug 

craving. It has been used 

successfully for more than 

30 years to treat people

addicted to opioids. Other

medications include LAAM, 

an alternative to methadone

that blocks the effects of opioids for up to 72 hours, and

naltrexone, an opioid blocker

that is often employed for

highly motivated individuals 

in treatment programs promoting complete abstinence.

Buprenorphine, another effective medication, is awaiting

Food and Drug Administration

(FDA) approval for treatment

of opioid addiction. Finally,

naloxone, which counteracts

the effects of opioids, is used

to treat overdoses.

Treating addiction to 

CNS depressants

Patients addicted to barbiturates and benzodiazepines

should not attempt to stop

taking them on their own, as

withdrawal from these drugs

can be problematic, and in the

case of certain CNS depressants,

potentially life-threatening.

Although no extensive body

of research regarding the treatment of barbiturate and benzodiazepine addiction exists,

patients addicted to these

medications should undergo

medically supervised detoxification because the dose 

must be gradually tapered off.

Inpatient or outpatient counseling can help the individual

during this process. Cognitive

behavioral therapy also has

been used successfully to 

help individuals adapt to the

removal from benzodiazepines.

Often the abuse of barbiturates and benzodiazepines

occurs in conjunction with 

the abuse of another substance

or drug, such as alcohol or

cocaine. In these cases of

polydrug abuse, the treatment

approach must address the

multiple addictions.

10NIDA RESEARCH REPORT SERIES

Many Physicians Have

Difficulty Discussing Substance

Abuse With Patients

Over 40% of physicians report having difficulty discussing 

substance abuse, including abuse of prescription drugs, 

with their patients. In contrast, less than 20% have difficulty

discussing depression.

National Center on Addiction and Substance Abuse at Columbia University

(CASA). Missed Opportunity: National Survey of Primary Care Physicians and

Patients on Substance Abuse. New York: CASA, 2000.

50%

40

30 

20 

10

0 Depression

Percent of Physicians

Alcohol

Abuse Prescription

Drug Abuse
Treating addiction to 

prescription stimulants

Treatment of addiction to 

prescription stimulants, such

as Ritalin, is often based on

behavioral therapies proven

effective for treating cocaine

or methamphetamine addiction. At this time, there are no

proven medications for the

treatment of stimulant addiction. However, antidepressants

may help manage the symptoms of depression that can

accompany the early days of

abstinence from stimulants.

Depending on the patient’s

situation, the first steps in

treating prescription stimulant

addiction may be tapering off

the drug’s dose and attempting to treat withdrawal symptoms. The detoxification

process could then be followed

by one of many behavioral

therapies. Contingency management, for example, uses a

system that enables patients to

earn vouchers for drug-free

urine tests. The vouchers can

be exchanged for items that

promote healthy living. 

Another behavioral approach

is cognitive-behavioral intervention, which focuses on

modifying the patient’s thinking, expectations, and behaviors while at the same time

increasing skills for coping

with various life stressors.

Recovery support groups may

also be effective in conjunction with behavioral therapy.

NIDA RESEARCH REPORT SERIES11

Glossary

Addiction: A chronic, relapsing disease, 

characterized by compulsive drug seeking 

and use and by neurochemical and molecular

changes in the brain.

Barbiturate: A type of central nervous 

system (CNS) depressant often prescribed 

to promote sleep.

Benzodiazepine: A type of CNS depressant

prescribed to relieve anxiety; among the most

widely prescribed medications, including

Valium and Librium.

Buprenorphine: A new medication awaiting

FDA approval for treatment of opioid addiction. It blocks the effects of opioids on the

brain. 

Central nervous system (CNS): The brain

and spinal cord.

CNS depressants: A class of drugs that 

slow CNS function, some of which are used to

treat anxiety and sleeping disorders; includes

barbiturates and benzodiazepines.

Detoxification: A process that allows the

body to rid itself of a drug while at the same

time managing the individual’s symptoms of

withdrawal; often the first step in a drug 

treatment program.

Dopamine: A neurotransmitter present in

regions of the brain that regulate movement,

emotion, motivation, and feelings of pleasure.

LAAM (levo-alpha-acetyl-methadol):

An approved medication for the treatment of 

opioid addiction, taken 3 to 4 times a week.

Methadone: A long-acting synthetic 

medication that is effective in treating opioid

addiction.

Narcolepsy: A disorder characterized by

uncontrollable episodes of deep sleep.

Norepinephrine: A neurotransmitter 

present in some areas of the brain and the

adrenal glands; decreases smooth muscle 

contraction and increases heart rate; often

released in response to low blood pressure 

or stress.

Opioids: Controlled drugs or narcotics most

often prescribed for the management of pain;

natural or synthetic chemicals based on

opium’s active component—morphine—

that work by mimicking the actions of painrelieving chemicals produced in the body.

Opiophobia: A health care provider’s

unfounded fear that patients will become

physically dependent upon or addicted to 

opioids even when using them appropriately;

can lead to the underprescribing of opioids 

for pain management.

Physical dependence: An adaptive physiological state that can occur with regular drug

use and results in withdrawal when drug use 

is discontinued.

Polydrug abuse: The abuse of two or more

drugs at the same time, such as CNS depressant abuse accompanied by abuse of alcohol.

Prescription drug abuse: The intentional

misuse of a medication outside of the 

normally accepted standards of its use.

Prescription drug misuse: Taking a medication in a manner other than that prescribed

or for a different condition than that for which

the medication is prescribed.

Psychotherapeutics: Drugs that have an

effect on the function of the brain and that

often are used to treat psychiatric disorders;

can include opioids, CNS depressants, and

stimulants.

Respiratory depression: Depression of 

respiration (breathing) that results in the

reduced availability of oxygen to vital organs.

Stimulants: Drugs that enhance the activity

of the brain and lead to increased heart rate,

blood pressure, and respiration; used to treat

only a few disorders, such as narcolepsy and

attention-deficit hyperactivity disorder.

Tolerance: A condition in which higher doses

of a drug are required to produce the same

effect as experienced initially.

Tranquilizers: Drugs prescribed to promote

sleep or reduce anxiety; this National

Household Survey on Drug Abuse classification

includes benzodiazepines, barbiturates, and

other types of CNS depressants.

Withdrawal: A variety of symptoms that

occur after chronic use of some drugs is

reduced or stopped.
12NIDA RESEARCH REPORT SERIES

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1997.

CSAT. Substance Abuse Among Older Adults

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Pub. No. (SMA) 00-3394. SAMHSA, 2000.

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Ruddon, R.W.; and Gilman, A.G., eds.

Goodman & Gilman’s The Pharmacological

Basis of Therapeutics 9th Ed. New York:

McGraw-Hill, 1996.

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Abuse. Cleveland Clinic Journal of Medicine

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Results on Drug Use, 1975-1999, 2 Vols. 

NIH Pub. No. 00-4803. National Institute

on Drug Abuse (NIDA), NIH, DHHS, 2000.

Joransson, D.E.; Ryan, K.M.; Gilson, A.M.; and

Dahl, J.L. Trends in medical use and abuse of

opioid analgesics. Journal of the American

Medical Association 283(13):1710-1714,

2000.

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61:2121-2131, 2000. 

Longo, L.P.; Parran, T.; Johnson, B.; and Kinsey,

W. Addiction: Part II. Identification and 

management of the drug-seeking patient.

American Family Physician 61:2401-2408,

2000.

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Missed Opportunity: National Survey of

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1999.

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15(1):12-13, 2000.

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(SMA) 97-3162. SAMHSA, 1997.

Office of Applied Studies. Summary of Findings

from the National Household Survey on Drug

Abuse. DHHS Pub. No. (SMA) 00-3466.

SAMHSA, 2000.

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Patterson, T.L., and Jeste, D.V. The potential

impact of the baby-boom generation on 

substance abuse among elderly persons.

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Medical Association 284(4):428-429, 2000.

Simoni-Wastila, L. The use of abusable prescription drugs: The role of gender. Journal of

Women’s Health and Gender-based Medicine

9(3):289-297, 2000.

Snyder, S.H. Drugs and the Brain. New York:

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Wilford, B.B; Finch, J.; Czechowicz, D.J.; and

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Access information 

on the NIDA web site

■ Information on 

prescription drugs and

other drugs of abuse

■ Publications and 

communications 

(including NIDA NOTES)

■ Calendar of events

■ Links to NIDA 

organizational units

■ Funding information 

(including program

announcements 

and deadlines)

■ International 

activities

■ Links to related 

Web sites (access to 

Web sites of many 

other organizations in

the field)

NIDA Web Sites

www.drugabuse.gov

www.steroidabuse.org

www.clubdrugs.org

National Clearinghouse

for Alcohol and Drug

Information (NCADI)

Web Site: www.health.org

Phone No.: 1-800-729-6686

References

NIH Publication Number 01-4881

Printed July 2001

Feel free to reprint this publication.