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What Is The Most Addictive Drug?

Dr. Anna Pickering

Medically reviewed by

Dr. Anna Pickering

April 3, 2019

Drugs are powerfully addictive, and it takes more than a strong will to kick the habit. But, what does addiction even mean? What makes the most addictive drugs addictive? And, why are some people more at risk? The scope of addiction is troubling, and understanding it can lay the groundwork for recovery.

What Is Addiction?

Before considering the most addictive drug, it’s important to understand what addiction actually is. According to the latest research and science, drug addiction is a complex brain disease that is characterized by continued use despite harmful consequences. While people may initially choose to use drugs, prolonged use can turn into an addiction and take over a person’s life.

Criteria for addiction, which is also called a substance use disorder (SUD), is highlighted by the following symptoms:

  • Drug effects – prolonged use has lead a person to experience tolerance, or needing more a drug to achieve the desired high; when they stop use, they experience uncomfortable symptoms of withdrawal.
  • Impaired control – a person may try to stop, but can’t; they feel intense cravings and urges to use drugs.
  • Risky use – someone may use or obtain drugs in dangerous situations; they may continue to use a drug despite it causing health problems and other troubling issues.
  • Social problems – substance use leads to problems at work, home, or school; favorite activities are neglected in favor of substance use; relationships begin to deteriorate.

If someone identifies with any of the above criteria, they may suffer from a substance use disorder.

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What Is The Most Addictive Legal Drug?

Although legal, cigarettes are highly addictive. Nicotine, the addictive chemical in tobacco products, is why only 6% of smokers quit each year (over 30 million people smoke cigarettes). Out of all these people, most want to stop smoking. But, because of how nicotine affects the brain, many people struggle to quit.

When a person smokes a cigarette, dopamine levels in the reward center of the brain increase. Repeated exposure and the feelings of brief pleasure and euphoria reinforce taking a drag off a cigarette. Each inhales and exhale alters functioning in the brain related to learning, stress, and self-control. Before too long, the person is addicted to cigarettes and can’t quit because of uncomfortable symptoms withdrawal.

What Is the Most Addictive Illegal Drug?

While many illegal drugs are addictive, heroin is considered the most addictive drug because it enters the brain rapidly and stimulates areas related to pain and pleasure. Heroin is an opioid that’s derived from morphine, which is the natural substance taken from opium poppy plants. Due to its addictive properties and potential for abuse, heroin ranks as a DEA Schedule I controlled substance.

Usually snorted or injected, heroin causes an immediate surge of pleasure and euphoria. This euphoria, or high, is what pulls people into a vicious cycle of abuse. The effects may last for a few hours, but when the drug wears off, moods darken and intense drug cravings take hold. It’s estimated almost 25% of people who use heroin become addicted. Once addicted, most of a person’s time is spent using or looking for heroin.

Long-term heroin addiction can affect decision-making, behavior control, and responses to stressful situations. Heroin use has increased in the U.S. in recent years, and so have heroin-related overdose fatalities. Over 15,400 people died from a heroin overdose in 2016, an increase of more than 5 times the deaths in 2010.

Who Is Most At Risk Of Heroin Addiction?

Everyone can become addicted to heroin, but some may be more at risk than others. The Centers for Disease Control and Prevention predict the following people are most at risk of heroin addiction:

  • males
  • non-Hispanic whites
  • people addicted to alcohol or marijuana
  • people addicted to opioid pain relievers
  • people addicted to cocaine
  • people age 18-25
  • people enrolled in Medicaid or without insurance
  • people living in large metropolitan areas

There is no single factor to determine if a person becomes addicted to heroin or other drugs. But, a combination of biological, environmental, and developmental factors influence the risk of becoming addicted. People using heroin are particularly at risk because of how the drug affects the brain.

Heroin Tolerance, Dependence, And Withdrawal

Regular heroin use changes functioning in the brain. Repeated use is likely to lead to:

  • Tolerance – a person will need more and more heroin to reach the same high.
  • Dependence – the need to use heroin to avoid feelings of sickness, discomfort, and withdrawal.
  • Withdrawal – the period of adjustment when they stop using heroin, characterized by severe or unpleasant symptoms, which is likely to lead to further use.

Withdrawal symptoms can occur just a few hours after last use, which is one reason people routinely fall into the cycle of addiction. Symptoms of heroin withdrawal include:

  • cold flashes/goosebumps
  • diarrhea and vomiting
  • intense drug cravings
  • muscle and bone pain
  • restlessness
  • trouble sleeping
  • uncontrollable limb movement

When symptoms are severe, a medically supervised detox program can provide safety and support during the worst of withdrawal. Typically taking place in medical settings or rehab centers, detox programs can help alleviate uncomfortable symptoms and prepare a person for further treatment.

Treatment For Heroin Addiction

Heroin addiction is usually treated with a combination of medications and behavioral therapy. Medication-assisted treatment (MAT) is effective when used alongside therapy and counseling, and includes the use of medications like methadone, buprenorphine, and naltrexone. MAT has shown to:

  • alleviate unpleasant symptoms
  • decrease criminal activity and overdose
  • help people engage in and complete treatment
  • lessen dependence
  • reduce cravings

Effective behavioral therapies for heroin addiction include cognitive behavioral therapy (CBT) and contingency management. These therapies work to change a person’s thinking and attitudes towards drugs and reward them for positive behaviors, like remaining drug-free or engaging in therapy.

Inpatient rehab is likely a good option for those suffering from heroin addiction because they’ll have access to addiction medications, therapy, and peer and professional support. While heroin may be the most addictive drug, treatment can help people achieve fulfilling lives in recovery.

Centers for Disease Control and Prevention - Heroin

National Institute on Drug Abuse - Understanding Drug Use, and Addiction

National Institute on Drug Abuse: For Teens - Heroin

American Psychiatric Association - What Is Addiction?

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