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NOPE Task Force – Narcotics Overdose Prevention & Education

For Students

What Is Substance Use Disorder?

Drug addiction also known as Substance Use Disorder (SUD)  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 on behavior. For many people, drug addiction becomes chronic, with relapses possible even after long periods of abstinence.

How Quickly Can I Become Dependant on a Drug?

There is no easy answer to this. If and how quickly you might become dependant to a drug depends on many factors including your genes (which you inherit from your parents) and the biology of your 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.

What Are the Physical Signs of Substance Use Disorder (SUD)?

The physical signs of Substance Use Disorder (SUD) can vary depending on the person and the drug being abused. In addition, each drug has short-term and long-term physical effects. For example, someone who abuses marijuana may have a chronic cough or worsening of asthmatic conditions. Stimulants like cocaine increase heart rate and blood pressure, whereas opioids like heroin may slow the heart rate and reduce respiration.

I'm concerned about my drug and alcohol use and I'm not sure where to turn. There's no way I'm talking to my parents. What should I do? Sometimes you may think it seems pointless to talk to parents. You suspect that they'll just react poorly by getting mad, worried - or both. But as hard as it may seem, your parents were your age once. They also had to deal with many questions about drugs. They may not be as out of it as they seem to you at times, and you can open their eyes about what you are experiencing so they can understand and help. Ask for their support. Also, your parents might have some ideas that you haven't thought of before. They might have some ideas about figuring out whether you should be concerned about your drug use. And let's face it, hiding stuff from your parents always backfires because more often than not, they find out about your drug use anyway and then there's a huge fight about lying to them and then they can't trust you at all. They'll trust you more if you start the conversation, and if you are worried or stressed about it, you can use adult help and support.

How do I talk to my parents about getting help? What should I say?

One of the hardest things in this world is to live in fear. And remember - our fears are much bigger than what actually happens when we try something new. So challenge yourself - think of talking to your parents as an act of courage, of toughness. Some kids are closer with one parent and not the other and there's no rule that you have to talk to both parents together. Start with one if that feels better to you. Also, you might start by expressing your fear and ask your parent not to be angry with you. You might say, "You know, Mom (or Dad), I want to talk to you about something that's hard to talk about but I'm scared you'll just get mad." See how that introduction feels and then, "I'm wondering if I might have a problem with drugs."

Is it possible to talk to my parents about getting help -- without admitting anything about my drugs or alcohol use? Sure, it's possible. You may just not be ready to talk to your parents, but you might want to talk to a psychologist about it. You can say to your parents that you need to talk to someone professionally, a therapist, but you are not ready to talk to them about it. You want them to respect that for the moment and that maybe in the future you can talk to them, but you know you need to explore some stuff with a neutral person - someone who will be objective. You need that safety for the moment. You might even ask for just one session with the therapist and see how that goes.

I've tried talking to my parents about my drug and alcohol use but they're rigid about their views and out of touch with what's going on out there. They just won't listen to anything I have to say. Who can I talk to about my real feelings and concerns? It's unfortunate that you can't talk to your parents. This usually suggests a serious problem with communication, which must be addressed. But for now, try talking with a school counselor, clergy, family doctor, older relative, or close friend's parent - just make sure it's someone you can relate to. Hopefully, this person will be knowledgeable about the issue and can provide you with accurate information and another point of view. You can also call a teen help hotline and talk (anonymously, if you wish) with a person trained to discuss these matters. Most young people report that they feel much better after finally "spilling their gut" to someone.

Are There Effective Treatments for Substance Use Disorder?

Yes. Substance Use Disorder can be effectively treated with behavioral-based therapies and, for addiction to some drugs such as heroin or nicotine, medications. Treatment may vary for each person depending on the type of drug(s) being used and the individual's specific circumstances. In many cases, multiple courses of treatment may be needed to achieve success.

Isn't Drug Addiction a Voluntary Behavior?

Yes and no. A person may start out taking drugs voluntarily. But as times passes, and drug use continues something happens that makes a person go from being a voluntary drug user to a compulsive drug user. Why? Because the continued use of addictive drugs changes your brain - at times in dramatic, toxic ways, at others in more subtle ways, but often in ways that result in compulsive and even uncontrollable drug use.

Isn't Becoming Addicted to a Drug Just a Character Flaw?

No, most scientists now consider addiction a brain disease. Using drugs repeatedly over time changes brain structure and function in fundamental and long lasting ways that can persist long after the individual stops using them.

Every type of drug of abuse has its own individual mechanism for changing how the brain functions. But regardless of which drug a person is addicted to, many of the effects it has on the brain are similar: they range from changes in the molecules and cells that make up the brain, to mood changes, to changes in memory processes and thinking, and sometimes changes in motor skills such as walking and talking. And these changes have a huge influence on all aspects of a person's behavior. A drug can become the single most powerful motivator in a drug abuser's existence. He or she will do almost anything for the drug. This comes about because drug use has changed the individual's brain, their behavior, their social and other functioning in critical ways.

Shouldn't Treatment for Drug Addiction be a One-Shot Deal?

Like many other illnesses, drug addiction typically is a chronic disorder. To be sure, some people can quit drug use "cold turkey," or they can quit after receiving treatment just one time at a rehabilitation facility. But most of those who abuse drugs require longer-term treatment and, in many instances, repeated treatments.

(Source: National Institute on Drug Abuse and Check Yourself)

Your Brain

Introducing... Your Brain

The brain is the command center of your body. It weighs about three pounds, and has different centers or systems that process different kinds of information.

The brain stem is the most primitive structure at the base of your brain. The brain stem controls your heart rate, breathing, and sleeping; it does the things you never think about.

Various parts or lobes of the brain process information from your sense organs: the occipital lobe receives information from your eyes, for example. And the cerebral cortex, on top of the whole brain, is the "thinking" part of you. That's where you store and process language, math, and strategies: It's the thinking center. Buried deep within the cerebral cortex is the limbic system, which is responsible for survival: It remembers and creates an appetite for the things that keep you alive, such as good food and the company of other human beings.

(Source: National Institute on Drug Abuse. The Brain: Understanding Neurobiology Through the Study of Addiction Pub. No. 00-4871. National Institute on Drug Abuse. Brain Power! The NIDA Junior Scientists Program( Pub. No. 01-4575. Bethesda, MD: NIDA, NIH, DHHS. 2000.

The cerebellum is responsible for things you learn once and never have to think about, such as balance when walking or how to throw a ball.

How Does Your Brain Communicate?

The brain's job is to process information. Brain cells called neurons receive and send messages to and from other neurons. There are billions of neurons in the human brain, each with as many as a thousand threadlike branches that reach out to other neurons.

In a neuron, a message is an electrical impulse. The electrical message travels along the sending branch, or axon, of the neuron. When the message reaches the end of the axon, it causes the release of a chemical called a neurotransmitter. The chemical travels across a tiny gap, or synapse, to other neurons.

(Source: National Institute on Drug Abuse. The Brain: Understanding Neurobiology Through the Study of Addiction Pub. No. 00-4871. National Institute on Drug Abuse. Brain Power! The NIDA Junior Scientists Program( Pub. No. 01-4575. Bethesda, MD: NIDA, NIH, DHHS. 2000.

Specialized molecules called receptors on the receiving neuron pick up the chemical. The branches on the receiving end of a neuron are called dendrites. Receptors there have special shapes so they can only collect one kind of neurotransmitter.

In the dendrite, the neurotransmitter starts an electrical impulse. Its work done, the chemical is released back into the synapse. The neurotransmitter then is broken down or is reabsorbed into the sending neuron.

Neurons in your brain release many different neurotransmitters as you go about your day thinking, feeling, reacting, breathing, and digesting. When you learn new information or a new skill, your brain builds more axons and dendrites first, as a tree grows roots and branches. With more branches, neurons can communicate and send their messages more efficiently.

(Source: National Institute on Drug Abuse. The Brain: Understanding Neurobiology Through the Study of Addiction Pub. No. 00-4871.)

What Do Drugs Do to the Brain?

Some drugs work in the brain because they have a similar size and shape as natural neurotransmitters. In the brain in the right amount or dose, these drugs lock into receptors and start an unnatural chain reaction of electrical charges, causing neurons to release large amounts of their own neurotransmitter.

Some drugs lock onto the neuron and act like a pump, so the neuron releases more neurotransmitter. Other drugs block reabsorption or reuptake and cause unnatural floods of neurotransmitter.

(Source: National Institute on Drug Abuse. The Brain: Understanding Neurobiology Through the Study of Addiction Pub. No. 00-4871.)

All drugs of abuse, such as nicotine, cocaine, and marijuana, primarily affect the brain's limbic system. Scientists call this the "reward" system. Normally, the limbic system responds to pleasurable experiences by releasing the neurotransmitter dopamine, which creates feelings of pleasure.

What Happens if Someone Keeps Using Drugs?

Think about how you feel when something good happens-maybe your team wins a game, you're praised for something you've done well, or you drink a cold lemonade on a hot day-that's your limbic system at work. Because natural pleasures in our lives are necessary for survival, the limbic system creates an appetite that drives you to seek those things.

The first time someone uses a drug of abuse, he or she experiences unnaturally intense feelings of pleasure. The limbic system is flooded with dopamine. Of course, drugs have other effects, too; a first-time smoker may also cough and feel nauseous from toxic chemicals in a tobacco or marijuana cigarette.

(Source: National Institute on Drug Abuse. The Brain: Understanding Neurobiology Through the Study of Addiction Pub. No. 00-4871.)

But the brain starts changing right away as a result of the unnatural flood of neurotransmitters. Because they sense more than enough dopamine, for example, neurons begin to reduce the number of dopamine receptors. Neurons may also make less dopamine. The result is less dopamine in the brain: This is called down regulation. Because some drugs are toxic, some neurons may also die.

(Source: National Institute on Drug Abuse. The Brain: Understanding Neurobiology Through the Study of Addiction Pub. No. 00-4871. National Institute on Drug Abuse. Mind Over Matter: The Brain's Response to Drugs Teacher's Guide (

How Many Times Does Someone Have To Take a Drug To Become an Addict?

No one knows how many times a person can use a drug without changing his or her brain and becoming addicted.

A person's genetic makeup probably plays a role. But after enough doses, an addicted teen's limbic system craves the drug as it craves food, water, or friends. Drug craving is made worse because of down regulation.

Without a dose of the drug, dopamine levels in the drug abuser's brain are low. The abuser feels flat, lifeless, depressed. Without drugs, an abuser's life seems joyless. Now the abuser needs drugs just to bring dopamine levels up to normal levels. Larger amounts of the drug are needed to create a dopamine flood or high, an effect known as tolerance.

By abusing drugs, the addicted teen has changed the way his or her brain works. Drug abuse and addiction lead to long-term changes in the brain. These changes cause addicted drug users to lose the ability to control their drug use. Drug addiction is a disease.

(Source: National Institute on Drug Abuse. The Brain: Understanding Neurobiology Through the Study of Addiction ( /highschool.htm):NIH Pub. No. 00-4871.)

If Drug Addiction Is a Disease, Is There a Cure?

There is no cure for drug addiction, but it is a treatable disease; drug addicts can recover. Drug addiction therapy is a program of behavior change or modification that slowly retrains the brain. Like people with diabetes or heart disease, people in treatment for drug addiction learn behavioral changes and often take medications as part of their treatment regimen.

(Source: National Institute on Drug Abuse. NIDA InfoFacts: Drug Addiction Treatment Methods ( Bethesda, MD: NIDA, NIH, DHHS. Retrieved June 2003.)

How To Talk To Your Friend

Discussing a friend's drug or alcohol use isn't an easy thing to do. It's very normal to worry about how a friend or sibling will respond to your concerns. If you're at a loss about how to start this type of discussion with someone you care about, here's a list of steps which may help with your approach and delivery.

Make a Plan

Before you engage your friend in a conversation, you'll need to prepare yourself. Go for a walk, sit where you can't be disturbed, and think. Reflect on the facts of the situation. Organize your thoughts. Decide what you want to say to your friend. Focus on a tone that is assertive, but not aggressive. Think about what resources you might need: a parent, a counselor, your faith leader, a school counselor, etc. Once you start the conversation, remain calm and supportive.

Discuss your concerns and identify some of the changes that you've seen in your friend. For example, you were at a party and saw your friend using drugs or acting in a way that you find inconsistent with their "normal" behavior; their grades have slipped or they're missing classes; your friend has changed from being "the person you know" to someone who is getting into trouble at home, or school, or in the community; or simply, you have noticed your friend has become quiet and secretive. Tell them you miss them and that you're concerned about them and that's why you want to talk. You may also decide that writing a note to your friend might be an appropriate first step.


After presenting your side of the story, ask your friend for his/her response to the information you've presented. Listen to your friend. Hear what he/she is saying. Offer your help or ask them if they think they need a professional's help.

Continue the Conversation

Determine a time when you and your friend will follow up about the discussion. Talking to your friend about drugs may be a continuous process -- not a one-time event. Let your friend know that you'd like to touch base about the situation again in the near future because you care about them. And, for you, don't be afraid to ask an adult who you can trust for help.

Key Talking Points

  • I don't want anything to happen to you or for you to hurt yourself.
  • We all count on you. Your brothers/sisters (if applicable) look up to you/care about you, as do I. What would they do if you were gone?
  • Look at all the things that you would miss out on. Drugs and alcohol can ruin your future and chances to... keep your drivers' license, graduate, go to college and get a job.
  • What can I do to help you? I am here to support you.
  • Are there other problems you want to talk about?
  • Are you feeling pressure to use? Let's talk about it.
  • I love you and I won't give up on you.
  • If you need professional help or you need an adult to talk to, I can help you find someone. I will be here to help you and support you every step of the way.

Tell Someone

Talking to a Parent or Supportive Adult

If you decide that your friend's problem is bigger than both of you, it may be time to bring the issue up with your parents, your friend's parents, or another supportive adult (coach, doctor, etc.). Keep in mind that only you know the people and relationships involved. Talking to a counselor about this decision may also be a good idea if you're not sure how your parents or your friend's parents will react.

It's Not Your Fault

Helping a friend with a drug or alcohol problem is hard work and can be a very difficult experience for you as well as your friend. You may feel a great deal of pressure to get your friend to stop drinking or doing drugs. Or you may get discouraged if your efforts to convince your friend to stop using drugs or alcohol don't work. But it is important to know that your friend's drug or alcohol use is NOT your fault. Remember that it's ultimately up to your friend to make that change and you can't do that for him. Sometimes, as much as you may try to get your friend to quit or seek help, you just can't seem to make it happen. If this becomes the situation you are in, you should do one of the following:

  • Seek support from other friends or trusted adults - your friend is not the only one who needs help in this situation.
  • Limit the time you spend with your drug or alcohol-using friend. Remember your friend's use may also be putting you at risk.
  • Start thinking about yourself-get out and participate in activities that you enjoy to take your mind off of the situation.


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