Today, 1 in 12 Americans, or about 18.7 million, struggle with a substance use disorder. These addictions include a range of drugs including opiates, alcohol, prescription medication, and amphetamines, but all are characterized by compulsive seeking behavior, inability to quit, and physical dependence. Individuals can be addicted to nearly anything thanks to behavioral addictions (sugar, fitness, Internet), but addictions are significantly worse and harder to overcome when combined with physical addiction (caffeine, nicotine, alcohol).
Understanding why some drugs are harder to “kick” than others, and why some are more addicting can help you to make the right choices when seeking treatment. While the end-result is always in how those substances interact with the brain or the central nervous system, those answers will also help you understand that substance use disorder is, in fact, a disorder. The drug addictiveness scale is based on a 2007 study categorizing drugs based on ease of acquiring physical dependence, difficulty in quitting, and severity of physical withdrawal symptoms. These include the following drugs.
The 7 Hardest Drugs to Kick
Any drug will be difficult to quit. Any instance of chemical dependence will necessitate withdrawal, which can be painful and traumatic. And, any behavioral addiction, to a drug or otherwise, will require therapy, hard work, and consistent practice to get over. Even if you’re addicted to sugar (which is a behavioral addiction), you will experience cravings, phantom headaches, and seeking behavior. So, the fact that one drug is hard to quit doesn’t mean another one is easy.
These 7 drugs are the hardest to quit.
It might surprise you to learn that nicotine is one of the hardest drugs to quit. While nicotine users aren’t included in SAHMSA’s annual report, many are addicted and struggling to quit. In fact, of the 40 million smokers in the U.S., 35 million regularly want to quit. And, with the average person attempting to quit 35+ times before succeeding, with 85% of smokers never succeeding in quitting, Nicotine is undoubtedly difficult to quit. With just 6% of smokers successfully stopping in a given year, Nicotine has one of the lowest recovery success rates of any drug.
What makes nicotine so hard to quit? Nicotine hits the brain within just a few seconds, doesn’t get in the way of most life decisions and actions, and most users have no real strong motivation to quit. Plus, with most users simply trying to go cold turkey at home rather than seeking out behavioral therapy and counseling, people simply aren’t giving themselves the tools to do so.
10 years ago, benzodiazepines could be prescribed almost limitlessly with very little control regarding length or volume of prescriptions. Today, we know that benzodiazepines are highly addictive and most new prescriptions are limited to just 5 weeks. Yet, millions of people are still addicted to benzodiazepines, either through long-term prescriptions, abusing prescriptions, or using benzos recreationally. Benzodiazepines interact with GABA and dopamine receptors in the central nervous system, causing chemical dependence, emotional and psychological reliance, and eventually full substance use disorder. Most importantly, long-term benzodiazepine abuse is also linked to triggers for taking more of the drug, including anxiety, aggression, and panic attacks.
Benzos are difficult to quit because users often become heavily emotionally and psychologically reliant on them. In addition, it’s impossible to safely quit “cold turkey”, because GABA interaction means individuals will quite often simply go into seizures on quitting the drug.
What does this mean for people who want to quit a benzodiazepine like Xanax or Valium? Normally, it means either using medication assisted treatment to get off the drug more quickly, using a monitored tapering schedule to reduce the dosage to something you can safely quit, and seeking out intensive behavioral therapy to ensure you stay clean.
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Cocaine, or the product of the Coca plant, is abused by 20 million people worldwide, or about 1.5 in the U.S. according to the World Health Organization. While Cocaine and cocaine products like crack cocaine make the “hardest to kick” drugs list, it’s actually difficult to become addicted to the drug. In fact, most users never become fully dependent on cocaine. Instead, cocaine is a behavioral addiction, much like sugar. What makes it so hard to kick? Cocaine changes how the brain responds to the reward circuit by flooding dopamine receptors. When not high, these overstimulated receptors are unlikely to respond to the reward circuit producing dopamine in response to doing something good, a hug, or even sex. This process is called emotional blunting, because it blunts the individual’s ability to feel anything but the drug. So, users often continue using to feel something, to feel good, and to avoid withdrawal symptoms.
Withdrawal symptoms are also harsh. Cocaine is snorted, reaches the brain in a few minutes, and leaves the body quickly. Withdrawal is typically characterized by a crash, complete with depression, anxiety, agitation, and mood swings. How can individuals quit this difficult-to-kick drug? Cocaine abusers should seek out medically supported detox to ensure they stay safe while in detox and then go through an intensive behavioral therapy program to build coping mechanisms and behaviors that support living drug free.
Prescription aids like Adderall and Myadis are used to treat depression, anxiety, ADHD, obesity, and a range of other symptoms. Unfortunately, they’re also incredibly addictive and difficult to kick once you become hooked. Amphetamines mimic the effect of dopamine and norepinephrine, resulting in adrenaline and increased energy, happiness, and euphoria.
Like cocaine, amphetamine users typically experience strong crashes after use, harsh and sometimes dangerous withdrawal, and strong emotional blunting. This can result in long depressive periods where users feel little motivation to do anything at all except use more of the drug, because they struggle to feel anything outside of the amphetamine. Most amphetamine users can kick the habit by seeking out a medical detox program, tapering the amphetamines under medical supervision, and then moving into a rehab program.
Methamphetamine and crystal meth are illegal in the United States and only available as a recreational drug on the street. Both are stronger than most prescription amphetamines, meaning their effects and side-effects are considerably worse. Methamphetamine is also often smoked, giving a different high, and more impact to the central nervous system through the GABA receptor. This means that addiction can happen more quickly, individuals experience worse withdrawal symptoms, and cravings are stronger. Here, it is extremely important to seek out medical attention when attempting to withdraw.
Morphine is considered to be one of the most addictive drugs on the planet, despite being approved for medical use in sedation and pain relief. At one point in United States history, it was available over the counter and used in everything from cough and cold medication to alcohol use disorder treatment. Today, it’s a Schedule I controlled drug and only available through prescription. Millions of people become addicted through both prescription medication abuse and through recreational use. And, while it’s difficult to say exactly how many are morphine related, 20 million people are addicted to opiates. Plus, with over 70,000 opioid related deaths in the United States in 2018 alone, morphine and similar drugs are incredibly dangerous.
Morphine causes an intense high, dreamlike state, and sedation. Individuals who try to quit experience depression, cold and flu symptoms, strong cravings, muscle pains, mood swings, anxiety, paranoia, and stress. Individuals who want to quit often require a medically monitored detox program, ongoing behavioral therapy, and often, medication assisted treatment to improve outcomes.
Diamorphine, colloquially known as heroin, is morphine’s “Big brother”. While less strong than modern opioids like fentanyl, heroin us as much as 200 times the strength of morphine. Because it’s typically produced in illicit conditions, without FDA approval, and typically illegally, it’s also manufactured to significantly lower standards and less quality control, making it significantly more dangerous than prescription counterparts. This increases the risk of overdose, medical complications, and withdrawal symptoms, making it more difficult to quit as well.
Heroin is responsible for nearly 10% of all opioid related deaths in the United States.
Why are Some Drugs Harder to Kick?
While it’s a truth that any drug addiction is difficult to quit, some are undoubtedly more addictive than others. This typically interplays with various factors such as the person and their vulnerabilities to the substance, including social, economic, and genetic factors. It can also interplay with behavior and habits, how and where the individual seeks out help, and what kinds of tools the individual uses when attempting to quit the drug. For example, it’s extremely common for alcohol drinkers to simply try to put alcohol down and go cold turkey. They make it through the first 3-10 days, or the worst of the withdrawal symptoms, and then start drinking again. Despite getting through the hardest part, they still slip up, because they don’t have the tools or structure to support staying sober.
Other factors that influence addiction include how the drug interacts with receptors such as dopamine and serotonin, opioid, or GABA in the body. For example, substances that interact with GABA receptors tend to be very difficult to quit. Substances that interact with dopamine receptors tend to result in emotional blunting. The severity of withdrawal symptoms also plays a large part. If withdrawal symptoms are too heavy to allow an individual to function normally when coming off the drug, they often have to continue taking it to meet social or work responsibilities. Physical damage to the brain and body are also important because they affect cognition, cravings, and the individual ability to function.
Many substances are physically and behaviorally addictive, which makes them difficult to quit by simply removing the physical cause. Drug addiction treatment therefore heavily focuses on behavioral therapy and counseling to teach coping mechanisms, behaviors that don’t involve drugs, and skills that function as support as you live a life without drugs.