6 Most Addictive Drugs

The National Survey on Drug Use and Health (NSUDH) estimated that more than 48 million Americans (aged 12 and older) battled a substance use disorder in 2023.¹ Substance use disorder, the clinical term for addiction, is a chronic disease characterized by drug seeking behavior and use that is compulsive or difficult to control despite harmful consequences.² A substance is deemed to be addictive based on the harms it can cause, the extent with which it impacts the brain’s “reward circuit,” the withdrawal symptoms caused if use of the substance suddenly stops or is drastically reduced, and how quickly someone becomes dependent—meaning their brain and body have become so used to having the substance present that without it, they cannot function.^2,3

Thus, some of the most addictive drugs include:

1. Cocaine.
2. Heroin.
3. Alcohol.
4. Fentanyl.
5. Nicotine.
6. Methamphetamine.

What is Drug Addiction?

As previously mentioned, drug addiction is considered a disease that impacts brain circuitry and behavior, and it is classified by an inability to control drug use. Addictive drugs act on the pleasure center in the brain, causing a shortcut to reward that, when repeated, can change the way a person processes information. A drug’s addictive qualities may be enhanced by how good they make a person feel when using them and how bad they may make them feel when the effects wear off. Chronic drug use can induce drug dependency, which leads to withdrawal symptoms and drug cravings without the drug’s presence.²

Cocaine

A stimulant drug derived from the coca plant that grows natively in South America, cocaine is illicitly manufactured in either a white powder or rock form (“crack”). Cocaine powder is snorted, smoked, or injected, while crack is generally smoked. Cocaine creates an intense high as it floods the brain with dopamine, the neurotransmitter involved in pleasure. The effects are quick, intense, and short-lived.

Cocaine increases euphoria, excitement, and alertness. It is highly addictive and may be regularly used in a “binge” pattern. Binge cocaine use refers to taking doses back to back in order to maintain the “high,” which is often followed by a “crash” that can cause physical and mental fatigue, depression, and severe drug cravings.⁴

The NSDUH estimates that about 1.3 million Americans aged 12 or older battled a cocaine use disorder in 2023.¹ Cocaine is classified as a Schedule II controlled substance by the U.S. Drug Enforcement Administration (DEA) because of its high potential for misuse and physiological dependence and limited medical use.⁵

Heroin

Heroin is an illegal drug that activates opioid receptors in the brain, serving to block feelings of pain, increase relaxation, and produce a kind of “out-of-body” sensation. It also induces euphoria by creating a backlog of dopamine in the brain.

Beginning in 2010, regulations and tighter controls over prescription opioid drugs like oxycodone (OxyContin), hydromorphone (Dilaudid), and hydrocodone (Vicodin, Percocet) caused heroin use and addiction to increase; however, heroin-related drug overdose deaths have been decreasing since 2018, according to the Centers for Disease Control and Prevention (CDC).⁶

Between 2010 and 2016, heroin-involved overdose deaths rose from 3,036 a year to 15,469. In 2022, there were 5,871 heroin-involved overdose deaths.⁷

Heroin is considered to be a highly addictive drug, as the American Society of Addiction Medicine (ASAM) estimates that nearly a quarter of those who try it become addicted to the drug. In 2023, approximately 587,000 Americans (aged 12 or older) were classified as having a heroin use disorder.¹ Dependence on heroin can manifest rather quickly with regular use, and the withdrawal symptoms that occur as the drug leaves the body can be difficult both physically and emotionally. Flu-like symptoms, depression, insomnia, and anxiety are common when heroin use is discontinued, after dependence is formed, thus encouraging individuals to keep taking the drug to avoid discomfort.

Alcohol

Alcohol is the most regularly used addictive substance in America, with nearly 29 million people aged 12 or older having a past year alcohol use disorder in 2023.¹

Legal for those of drinking age (aged 21 and older), part of many social activities and situations, and relatively inexpensive and easy to find, alcohol is used responsibly by millions of people; however, alcohol can be dangerous for some, who may be at a greater risk for developing an alcohol addiction.

Alcohol impacts the brain and central nervous system, slowing down certain functions. This can result in lowered blood pressure and heart rate. It also promotes sedation and impairs motor skills and cognition. When people are under the influence of alcohol, they are more likely to engage in risky behaviors as inhibitions are lowered. They may also be more talkative and sociable, and may experience mood swings and impaired decision-making and impulse-control abilities.

Alcohol use, especially when alcohol is consumed frequently in heavy or binge drinking patterns, can lead to a dependency on the substance. When alcohol begins to leave the body, withdrawal symptoms can range from mild to life-threatening. When the effects of alcohol wear off on someone who has become dependent or addicted to alcohol, withdrawal symptoms can include anxiety, depression, insomnia, tremors, sweating, irregular heart rate, hypertension, nausea and vomiting, headaches, abdominal pain, and even psychosis and seizures. A desire to avoid these symptoms may lead an individual to use alcohol, which can therefore perpetuate alcohol addiction.

If you’re concerned about your alcohol use or that of a loved one, you can take our free, confidential, 5-minute alcohol use self-assessment questionnaire to help you examine the nature of your alcohol use and your behaviors surrounding it. It’s important to note that this is intended for educational purposes and should not be used to self-diagnose. This evaluation is not a substitute for advice from a medical doctor.

Fentanyl

In 2023, 5.6 million Americans aged 12 or older misused prescription fentanyl.¹ Fentanyl is addictive because if its potency; it’s an opioid, similar to morphine but 50 to 100 times more potent.⁸

Like heroin and other opioids, fentanyl works by binding to the body’s opioid receptors, which are found in areas of the brain that control pain and emotions. Repeated use can lead to the brain adapting to fentanyl’s presence, diminishing its sensitivity and making it hard to find pleasure in anything other than the drug.⁸ This is known as dependence, which means the body and brain become so used to having fentanyl in the system that without it, withdrawal symptoms surface.⁹

Withdrawal symptoms can range from mild to severe and may include:⁸

• Muscle and bone pain.
• Insomnia.
• Diarrhea and vomiting.
• Increased heart rate.
• Chills.
• Increased body temperature.
• Anxiety.
• Sweating.
• Uncontrollable leg movements.
• Severe cravings.

Individuals may take more fentanyl to avoid withdrawal symptoms and risk overdose as a result.⁸

Though fentanyl is available as a prescription, the majority of deaths are the result of individuals knowingly or unknowingly taking fentanyl that is illegally manufactured in labs. This synthetic is sold illegally as a powder, dropped onto blotter paper, put in eye droppers and nasal sprays, or made into pills to look like other prescription opioids.⁸ However, fentanyl’s potency increases the risk of overdose substantially. And while it’s dangerous on its own, it’s often found mixed with other substances such as heroin and cocaine, which amplifies the potency of these substances as well as the risk of overdose.

Nicotine

Nearly 29 million Americans aged 12 and older were daily cigarette smokers in 2023, according to the NSDUH.¹ Smokers may continue to smoke because of an addiction to nicotine, one of the primary active chemicals in tobacco smoke that is considered to be highly addictive.¹⁰

Nicotine acts on the reward circuitry in the brain after being absorbed through the mucosal lining of the mouth and nose, through the lungs, or through the skin. Its pleasant sensations and elevation in both mood and cognition may encourage smokers to keep smoking. Nicotine takes effect within 10 seconds of being smoked and wears off in a matter of hours, meaning that individuals may wish to have another cigarette not too long after the last one.¹¹

A dependency on nicotine can build up quickly when someone smokes regularly, and nicotine may be one of the toughest drugs to stop using without help. Withdrawal symptoms include irritability, increased appetite, anxiety, depression, trouble concentrating and focusing on things, and significant cravings. The legality and prevalence of nicotine may lead to its rampant use and high relapse rates.

Methamphetamines

Approximately 1.8 million Americans aged 12 or older had a methamphetamine use disorder in 2023, according to NSDUH.¹ Methamphetamine, or meth, is a powerful stimulant drug that is man-made in laboratories in either a powder or crystal (“crystal meth”) form to be smoked, snorted, or injected for an intense euphoric “high.” Meth can increase focus, decrease the need for sleep and appetite levels, and increase excitability and pleasure. In large amounts, it may also have psychotic side effects or cause aggression and/or violence.

Tolerance to meth can be developed rather quickly, prompting individuals who use it to want to take more in order to keep feeling its effects. Increased dosages can lead to drug dependence. Over time, meth can cause damage to the regions of the brain related to learning, memory, and emotional regulation as well as significantly deplete levels of dopamine and the way the dopamine receptors in the brain work.¹² Extremely low levels of dopamine and an inability for it to bind properly with receptors occur when meth leaves the body. This can result in severe depression, potential suicidal ideations, and significant drug cravings. These symptoms may facilitate compulsive drug-seeking behaviors and repeated meth use, which are hallmarks of addiction.

Get Help Quitting Drugs & Alcohol

If you or a loved one struggle with addiction to one of the substances mentioned here (or another substance), recovery is possible. American Addiction Centers (AAC) operates treatment centers throughout the United States, provides the complete continuum of care—including medically managed detox, inpatient care, and outpatient treatment options—and utilizes evidence-based therapies and interventions and individualized treatment plans to meet your unique needs. 

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