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   Isaac Yohanas MA, LCADC, LCPC

Links for Further Research

Department of Health and Mental Hygiene

National Institute on Alcohol Abuse and Alcoholism

Recovery Solutions Magazine

Baltimore Alcoholics Anonymous

Narcotics Anonymous

Drug Abuse




Drug addiction is a complex disease. It is characterized by compulsive, uncontrollable craving and use that persists even in the face of extremely negative consequences. For many people, drug addiction becomes chronic, with relapses possible even after long periods of abstinence. The words "drug addiction" calls up many different images and strong emotions. Any discussion about psychoactive drugs, particularly drugs like nicotine and marijuana, inevitably moves to the question is it really addicting? The conversation then shifts to the so-called types of drug addiction - whether the drug is "physically" or "psychologically" addicting. This issue revolves around whether or not dramatic physical withdrawal symptoms occur when an individual stops taking the drug, what we in the field call "physical dependence." The assumption that follows then is that the more dramatic the physical withdrawal symptoms, the more serious or dangerous the drug must be. Indeed, people always seem relieved to hear that a substance just produces psychological addiction, or has only minimal physical withdrawal symptoms. Then they discount its dangers. They are wrong. Marijuana is a case in point here, and I will come back to it shortly.


Defining Drug Addiction

What matter is whether or not a drug causes what we now know to be the essence of drug addiction: uncontrollable, compulsive drug seeking and use, even in the face of negative health and social consequences. This is the crux of how many professional organizations all define addiction, and how we all should use the term. It is really only this expression of addiction — uncontrollable, compulsive craving, seeking and use of drugs — that matters to the addict and to his or her family, and that should matter to society as a whole. These are the elements responsible for the massive health and social problems caused by drug addiction.


Essence of Drug Addiction

Drug craving and the other compulsive behaviors are the essence of drug addiction. They are extremely difficult to control, much more difficult than any physical dependence. They are the principal target symptoms for most drug treatment programs. For an addict, there is no motivation more powerful than drug craving. As the movie "Trainspotting" showed us so well, the addict’s entire life becomes centered on getting and using the drug. Virtually nothing seems to outweigh drug craving as a motivator. People have committed all kinds of crimes and even abandoned their children just to get drugs.


Rethinking Drug Addiction

Focusing on drug addiction as compulsive, uncontrollable drug use should help clarify everyone's perception of the nature of drug addiction and of potentially addicting drugs. For the addict and the clinician, this more accurate definition forces the focus of treatment away from simply managing physical withdrawal symptoms and toward dealing with the more meaningful and powerful, concept of uncontrollable drug seeking use. The task of treatment is to regain control over drug craving, seeking and use. Rethinking drug addiction also affects which drugs we worry about and the nature of our concerns. The message from modern science is that in deciding which drugs are addicting and require what kind of societal attention, we should focus primarily on whether taking those causes uncontrollable drug seeking and use. One important example is the use of opiates, like morphine, to treat cancer pain. In most circumstances, opiates are addicting. However, when administered for pain, although morphine treatment can produce physical dependence - which now can be easily managed after stopping use - it typically does not cause compulsive, uncontrollable morphine seeking and use, addiction as defined here. This is why so many cancer physicians find it acceptable to prescribe opiates for cancer pain. An opposite example is marijuana, and whether it is addicting. There are some signs of physical dependence or withdrawal in heavy users, and withdrawal has been demonstrated in studies on animals. But what matters much more is that every year more than 100,000 people, most of them adolescents, seek treatment for their inability to control their marijuana use. They suffer from compulsive, uncontrollable marijuana craving, seeking and use. That makes it addicting, certainly for a large number of people.

Reprinted from The National Institute on Drug Abuse (NIDA)


Drug Treatment Information

Problems associated with an individual's drug abuse can vary significantly. People who are addicted to drugs come from all walks of life. Many suffer from mental health, occupational, health, or social problems that make their addictive disorders much more difficult to treat. Even if there are few associated problems, the severity of addiction itself ranges widely among people.

Drug abuse is a treatable disorder. Through treatment that is tailored to individual needs, patients can learn to control their condition and live normal, productive lives. Like people with diabetes or heart disease, people in treatment for drug abuse learn behavioral changes and often take medications as part of their treatment regimen. Behavioral treatment can include counseling, psychotherapy, support groups, or family therapy. Treatment medications offer help in suppressing the withdrawal syndrome and drug craving and in blocking the effects of drugs. In addition, studies show that treatment for heroin drug abuse using methadone at an adequate dosage level combined with behavioral therapy reduces death rates and many health problems associated with heroin abuse. In general, the more treatment given, the better the results. Patients who stay in treatment longer than 3 months usually have better outcomes than those who stay less time. Patients, who go through medically assisted withdrawal to minimize discomfort but do not receive any further treatment, perform about the same in terms of their drug abuse as those who were never received treatment. Over the last 25 years, studies have shown that drug abuse treatment works to reduce drug abuse and crimes committed by drug abusers. Researchers also have found that drug abusers who have been through treatment are more likely to have jobs.

The ultimate goal of all drug treatment is to enable the patient to achieve lasting abstinence, but the immediate goals are to reduce drug use, improve the patient's ability to function, and minimize the medical and social complications of drug abuse. There are several types of drug abuse treatment programs. Short-term methods last less than 6 months and include residential treatment, medication treatment and drug-free outpatient treatment. Longer term treatment may include, for example, methadone maintenance outpatient treatment for opiate addicts and residential therapeutic community treatment.

Drug treatment programs in prisons can succeed in preventing patients' return to criminal behavior, particularly if they are linked to community-based programs that continue treatment when the client leaves prison. Recovery from the disease of drug abuse is often a long-term process, involving multiple relapses before a patient achieves prolonged abstinence. One of the more well-developed behavioral techniques in drug treatment is contingency management, a system of rewards and punishments to make abstinence attractive and drug use unattractive. There are many addictive drugs, and treatments for specific drugs can differ. Treatment also varies depending on the characteristics of the patient.


The Drug Addict

How quickly a potential drug addict does become addicted to a drug depends on many factors including the biology of their body. All drugs are potentially harmful and may have life-threatening consequences associated with their use. There are also vast differences among individuals in sensitivity to various drugs. While one person may use a drug one or many times and suffer no ill effects, another person may be particularly vulnerable and overdose with first use. There is no way of knowing in advance how someone may react.
Here are four questions to help determine if someone is at risk of becoming an addict.

  1. Have you ever felt you ought to cut down on your drug use?
  2. Have people ever annoyed you by criticizing your drug use?
  3. Have you ever felt bad or guilty about your drug use?
  4. Have you ever had a drink or taken a drug first thing in the morning to steady your nerves?

If a person is compulsively seeking and using a drug despite negative consequences, such as loss of job, debt, physical problems brought on by drug abuse, or family problems, then he or she is probably an addict. The physical signs of being an addict can vary depending on the person and the drug being abused. For example, someone who abuses marijuana may have a chronic cough or worsening of asthmatic conditions. THC, the chemical in marijuana responsible for producing its effects, is associated with weakening the immune system which makes the user more vulnerable to infections, such as pneumonia. Each drug has short-term and long-term physical effects; stimulants like cocaine increase heart rate and blood pressure, whereas opioids like heroin may slow the heart rate and reduce respiration.

Drug addiction is a complex brain disease. It is characterized by compulsive, at times uncontrollable, drug craving, seeking, and use that persist even in the face of extremely negative consequences. Drug seeking becomes compulsive, in large part as a result of the effects of prolonged drug use on brain functioning and, thus, on behavior. For most addicts, drug use becomes chronic, with relapses possible even after long periods of abstinence. There is no easy answer for the addict.

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Mr. Yohanas is a very special person and a wonderful therapist. He is very patient and willing to listen. he is very knowledgeable about drugs, alcohol, anger issues, relapse traps, and DUI / DWI's. I learned so much from him and I am now on the road to maintaining my sobriety. Thanks so much.


Mr. Yohanas just made me feel so comfortable and I could discuss any topic with him. His knowledge of drugs, alcohol and issues relating to DWI / DUI's are amazing. I am so glad he was my counselor when I needed one. A very good professional.


I was very apprehensive about my latest DUI charge. When I spoke to Mr. Yohanas I could tell that he cared about my situation. He took the time to talk to me about the steps I needed to take and has been very helpful to me and has now involved my entire family as part of my overall treatment. I just want to thank you, Mr. Yohanas, for handling my situation with great professionalism and confidentiality.


Mr. Yohanas help me to recognize and deal with my underlying depression, which came up when I was seeing him for a DUI charge. He explained information to me and helped me along the way. Because of him I have been better able to cope with and learn about my problems. Thank you













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