Scale of Addiction: A Drug by Drug Comparison

In most ways the “addictiveness” of a substance is highly subjective to the user. There’s no clear answer to the questions which drugs are more addictive than others.  The subject of addiction in general is frequently unclear with room for interpretation. What we do know with a fair amount of certainty is that there are both physical and psychological aspects to addiction.  Drugs and alcohol produce a pleasurable experience in the brain which, when abused over a long enough period of time, invariably leads to confusion in the brain’s reward/pleasure functioning. This- along with a person’s biology, environment, and development- factor into the development of addiction.  Since there’s no scientific method for us to measure how addictive a drug is the purpose of this post is to look at the “addictiveness” of different substances as objectively as possible. We’ll be looking at five factors to addiction: dependence, withdrawal, tolerance, reinforcement, and intoxication.  More specifically Sunrise House outlines these factors as: 

  1. Dependence: This is based on factors such as the relapse rate, the percentage of people who become addicted to the drug versus how many simply use it, self-reports of the need for the drug from addicted persons, how hard it is to quit, and the degree to which the drug is likely to be used despite knowledge of the drug’s harmfulness.
  2. Withdrawal: The severity of the symptoms that arise when addicted persons stop taking the drug.
  3. Tolerance: How soon users find that they need to take more of the drug to get the same effect and how much more they need to take.
  4. Reinforcement: This is based on human and animal experiments testing regarding how likely subjects are to seek out more of the drug given.
  5. Intoxication: This is how high people typically get on the drug.

Nicotine Addiction Score: 6

  • Dependence: 10

Simply put, cutting nicotine is bloody hard.  Nicotine is often considered one of the hardest substances to put down specifically with regard to dependence.  I’ve been told on numerous occasions that ending a cigarette habit is more difficult than quitting heroin.  Statistics back this up.  According to Drugfree.org “A new government study finds almost 70 percent of American smokers want to quit, and more than half tried last year, but only 6 percent succeeded.”  In comparison the success rate for booting heroin is around 10 percent. The fact that it’s widely available legally is probably the driving force behind these shocking numbers.

  • Withdrawal: 6

Nicotine withdrawal sucks but it’s mild compared to coming off of hard drugs.  More than anything you feel tense, are incredibly irritable, and possibly deal with headaches and moodiness.

  • Tolerance: 8IMG_5856

It doesn’t take long to begin building a tolerance to nicotine. Part of this comes from the high dependence rate and the frequency of use for the drug.

  • Reinforcement: 4

Nicotine’s reinforcement level is relatively low because it doesn’t give your brain the pleasure overload that comes from other drugs. Since there’s less of a reward in the form of pleasure from consuming less people pick up after their first cigarette. This is part of the reason why nicotine addiction sneaks up on you.

  • Intoxication: 2

To the habitual smoker nicotine intoxication is nearly unnoticeable.  However you will notice the absence of it. Overall it has subtly stimulating effects.

Marijuana Addiction Score: 4.2

  • Dependence: 3

Marijuana is generally associated with low dependence levels.  Over half the population of American adults have tried marijuana while just under 10 percent (7.2 percent or nearly 35 million) use it at least once a month.  This Healthline.com article claims, “it’s estimated that between 10 and 30 percent of individuals who smoke weed will develop dependency, with only 9 percent actually developing addiction.”  As you can see based on the statistics marijuana has far less a likelihood for dependence.

  • Withdrawal: 3  

While anything, including marijuana, can be psychologically addictive there’s some debate as to whether it is physically addictive.  Most people are able to stop using the substance without experiencing any sort of withdrawal. However, frequent marijuana users who attempt to stop use may experience irritability, mood and sleep difficulties, decreased appetite, cravings, and restlessness along with various forms of physical discomfort.  These seem to last no longer than two weeks.

  • Tolerance: 6

Marijuana tolerance builds relatively quickly.  In fact after prolonged use it may even feel impossible to get high.  However if you stop your brain returns to normal, generally within a couple of weeks, and use will result in the previously attained affects.

  • Reinforcement: 4

While marijuana intoxication produces an enjoyable feeling it does not have the euphoria that comes along with other drugs.  Furthermore, the comedown from pot is mild, far milder than other substances, so users aren’t in a rush to go back out for more.

  • Intoxication: 5

Marijuana isn’t anywhere near as intoxicating as alcohol or other illicit substances.  Users may appear drowsy or tired and could experience forgetfulness but the intoxicating potential of marijuana doesn’t result in a loss of control like some other substances.

Alcohol Addiction Score: 7.6

  • Dependence: 6

Alcohol is an interesting substance because it’s so much more widely used than anything else on this list.  Since alcohol is legal to consume and socially acceptable it’s hard to gauge the substance’s dependence scale on the societal level in comparison to other substances. According to the New York Times, “About 29 percent of the population meets the definition for excessive drinking, but 90 percent of them do not meet the definition of alcoholism.”  While those figures are likely true alcohol can be very hard to stop using. Alcohol should be considered relatively addictive based on dependence. With that being said, the easy accessibility of alcohol might play a big role in this.

  • Withdrawal: 10IMG_5859

Alcohol is one of the absolute worst substances in regard to withdrawal.  In the most severe of cases alcohol withdrawal can even be deadly.  Some other symptoms include anxiety, headache, nausea, vomiting, and insomnia.  More than anything people coming off of alcohol will shake uncontrollably.  

  • Tolerance: 7

Alcohol tolerance builds at a moderate rate.  Even the casual drinker might find it necessary to consume a little more than previously needed to catch a buzz.  However this is mildly difficult to determine given that other factors come into play for example what a person ate that day.

  • Reinforcement: 6

Reinforcement rates for alcohol are not as high as other drugs because it doesn’t result in the intense euphoria associated with substances like heroin and cocaine.  However, alcohol intoxication can be very pleasurable and since it is very physically addictive it has a higher reinforcement score than drugs like marijuana.

  • Intoxication: 9

Consuming alcohol can get you very intoxicated even without reaching the threshold for overdose.  It results in slurred speech, impared motor skills, and lapses in thinking. You can tell when someone’s had too much booze.  Furthermore, alcohol lowers inhibitions, leading to the likelihood that alcohol binges increase addiction risks.

Heroin (IV Opioids) Addiction Score: 9IMG_5858

  • Dependence: 10

In 2016 about 948,000 Americans reported using heroin in the past year.  That same year the number of people meeting the criteria for heroin use disorder rose to 626,000.  In other words, just over sixty-six percent of heroin users become addicted. Heroin (IV opioids) have an outrageously high rate of dependency.  Almost one quarter (23 percent) of the people who try heroin become addicted.  Relapse among users is particularly concerning because so many people die from overdose after going back to the drug.  Chasing the effects of a user’s first high, along with concern over withdrawal, contribute to users’ opposition to quitting, and heroin cravings are generally considered the worst of any drug.

  • Withdrawal: 8

While heroin withdrawal generally doesn’t have the potential to be fatal, like alcohol and benzodiazepines do, it’s an absolutely miserable experience and the cause of many a relapse.  Addicts go through intense pain, terrible restlessness, a wide range of flu like symptoms, and the inability to control their bodily functions. It’s rare for someone to make it through these symptoms without medical assistance.  Without professional help the success rate for quitting is somewhere between five and ten percent, unfortunately the success rate for most programs isn’t much higher. This is why it’s important to recognize relapse as part of the journey into recovery, as few people get it there first try.

  • Tolerance: 10

Tolerance to heroin builds up so quickly that most users report that they’re never able to experience the same level of pleasure as their first high.  This is where the term “chasing the dragon” comes from.

  • Reinforcement: 9

Since heroin brings intense levels of euphoria reinforcement is also very high.  People often get hooked chasing this intense euphoria. Furthermore, in order to avoid withdrawal users often readminister the drug immediately after effects wear off.

  • Intoxication: 8

Heroin’s intoxication levels are topped only by alcohol, benzodiazepines, and hallucinogens.  Users are heavily sedated and frequently nod off, even during conversation.

Cocaine Addiction Score: 6.2

  • Dependence: 5

This score might come as a surprise given that cocaine is typically seen as very addictive, its dependency level is lower than nicotine or heroin.  Users do experience a rush of euphoria from the drug, however fewer users will actually develop addiction. In terms of relapse, rates are also considerably lower because of an easier withdrawal and less severe cravings.  With that being said, rates are higher for crack cocaine.  

  • Withdrawal: 7

Withdrawal from cocaine is considerably less severe in comparison to other “hard drugs”.  There don’t appear to be any physical characteristics of withdrawal. Users tend to experience intense fatigue, general discomfort, depression, agitation, and restlessness.  Cravings are still quite intense during the worst of the withdrawal. 

  • Tolerance: 5

Tolerance to cocaine seems to be lower than most other substances surprisingly.  This is likely a contributing factor to why its dependence levels are lower than expected.

  • Reinforcement: 9

While dependence and withdrawal are relatively low on addiction scales reinforcement rates for cocaine are considerably high.  Cocaine intoxication makes you feel invincible, give you bountiful energy, and makes you far more sociable in public settings. Furthermore, when you’re on cocaine all you can think about is doing more cocaine.

  • Intoxication: 5

Cocaine doesn’t have as intense intoxication when compared to other illicit substances.  Users typically experience a major increase in energy and often times become extremely talkative.  In fact they may simply appear to be in a really good mood.

Methamphetamine Addiction Score: 8.2

  • Dependence: 9

In 2017, approximately 1.6 million people (0.6 percent of the population) reported using methamphetamine in the past year.  During that same year an estimated 964,000 people had a methamphetamine use disorder. In other words, just over sixty percent of the people who used meth in the past year became addicted.  Meth is similar to cocaine, but three times more powerful, and it triggers dependency faster than most other substances other than heroin. 

  • Withdrawal: 9

Methamphetamine withdrawals last an incredibly long amount of time.  They can last for up to forty weeks and come in three sections: the crash, the cravings, and the recovery.  The first stage of meth withdrawal, the crash, accounts for the first three to ten days after stopping use. During this stage the user goes through a major decrease in energy and cognitive functioning.  Depression is also very common in this phase. Stage two, the cravings, begins after the initial crash. Users will crave the intense euphoria that meth brings. This lasts for up to ten weeks and is accompanied by insomnia and depression.  Stage three, the recovery, is when cravings for meth begin to disappear. They become less frequent and less intense. After 30 weeks the cravings, insomnia, and depression are mostly gone and this stage can last for as long as the user wants to remain active in recovery.

  • Tolerance: 7

Tolerance to meth can develop rather quickly, within a few uses.  Like all drugs tolerance depends on the individual as well as how the drug is being administered.

  • Reinforcement: 9

Reinforcement rates are very high given that methamphetamine floods the brain with euphoria.  This is further reinforced given that users struggle with debilitating fatigue in the absence of the drug.

  • Intoxication: 7

Meth users experience heightened concentration and increased energy so it’s not uncommon that they don’t appear intoxicated at all.  Some signs of meth use include picking at skin or hair, dilated pupils, rapid eye movement, and tweaking. Since users stay awake, sometimes for days at a time, the lack of sleep is more easily detectable than the actual drug use.

Amphetamine/Adderall Addiction Score: 6.0

  • Dependence: 6

Amphetamine dependence can occur even with using the substance as prescribed.  With that being said it does have a lower likelihood of dependence when compared to other substances.  While the drug does have a high potential for abuse, there are a number of people who take the medication as prescribed who do not experience the adverse effects of amphetamine dependence. 

  • Withdrawal: 7IMG_5861

Amphetamine withdrawal usually isn’t life-threatening. However, it can be incredibly unpleasant and lead to relapse.  Withdrawal from amphetamine is similar to meth withdrawal as the two substances are similar, however it is less intense.  General fatigue and a significant increase in sleep is the most common symptom of amphetamine withdrawal, other symptoms include increased appetite, unintended bodily movements and twitches, and depression.

  • Tolerance: 5

Tolerance to Adderall and other amphetamines builds relatively slow when compared to other drugs.  When the drug is taken as prescribed t can take a significant amount of time to notice a slow reduction in its efficiency. Tapering off the dosage can bring on extreme lethargy and the mind feels foggy as dopamine levels are obstructed.

  • Reinforcement: 7

Since amphetamines don’t bring on intense feelings of euphoria it has moderate reinforcement score when compared to other drugs.  Another contributing factor to lower reinforcement scores is that the drug makes sleeping very difficult for new users. On the other hand, users find positive reinforcement in the effectiveness as well as the easy accessibility of the drug. 

  • Intoxication: 5

Most of the time there aren’t clear signs of amphetamine intoxication making it difficult to determine if someone is using the drug.  Some users will tweak, engage in frantic and compulsive behavior, similar to meth users.  

Benzodiazepines (Xanax, Ativan, & Valium) Addiction Score: 8

  • Dependence: 6

More than one in eight Americans (12.6 percent) have used benzodiazepines in the past year. According to a study published in American Psychiatric Association misuse of the drugs make up over 17 percent of total use.  In a lot of ways benzodiazepines are very close in efficiency to alcohol.  They have even been referred to as “freeze dried alcohol.” Benzodiazepines are considered to have a relatively moderate rate of dependence.  Since the drug isn’t accompanied by feelings of euphoria it has a lower dependency score than other illicit substances.

  • Withdrawal: 10

Like alcohol, withdrawing from benzodiazepines can be fatal depending on the length of use.  Generally speaking most withdrawal symptoms start within 24 hours of a person’s last use and they can last anywhere from a few days to several months.  They are very similar to alcohol withdrawal symptoms and can include irritability, agitation, anxiety, panic attacks, insomnia, and tremors. About ten percent of recovering benzo addicts report still feeling withdrawal symptoms years after stopping the drugs.

  • Tolerance: 9

There’s a reason why benzodiazepines are not intended to be prescribed for long periods of time.  Tolerance to the drugs builds rapidly, the sedative effects of the drug quickly diminish after two weeks of regular use.

  • Reinforcement: 6

The reinforcement rates of benzodiazepines are relatively low compared to other illicit substances because the drug doesn’t create feelings of euphoria.  With that being said benzodiazepines have reinforcing characteristics for some individuals especially in people that have drug-seeking behavior.

  • Intoxication: 9

Benzodiazepines are highly intoxicating with users experiencing a lack of total recall.  When taken above the therapeutic level the intoxicating effects are similar to alcohol. These effects include slurred speech, blurred vision, and a lack of motor skills.

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