What Is the Most Addictive Drug?
How do you know what the most addictive drug is? The honest answer is, it depends on your personal physiology and any predisposition to addiction, however, there are a few things that seem to true for a large majority of people. First, for a behavior pattern to be considered an addiction, the person must meet specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), including impaired control, social problems, risky use, and experiencing certain physical and mental effects as a result of that use.
Of the legal drugs, nicotine appears to be highly addictive, based on the Centers for Disease Control and Prevention (CDC) findings. Among illicit (illegal) drugs, heroin takes the top rank as most addictive, in part because of the intense high it gives users. For people who are more predisposed to addiction, whether via biological or environmental factors, this rush can become irresistible and they spend increasingly more time trying to replicate it.
Overall, there are 5 main properties of drugs that influences how addictive they are:
Curiosity about drugs is nothing new. Yet legitimate information about how different drugs affect the body and how addictive each one is may not be common knowledge. Is one drug more addictive than another? How quickly does the average person become addicted to a given drug? We’ll explore the answers to these questions and more here.
What Is Considered Addiction?
First, we should clearly establish what addiction actually is. To properly define it, we turn to the Holy Grail of diagnostic criteria, the Diagnostic and Statistical Manual of Mental Disorders, or DSM for short. In it, you will find everything you’d ever want to know about mental health and substance use disorders.
The American Psychiatric Association (APA) publishes this manual, now in its fifth edition, and outlines addiction in terms of patterns of substance abuse related behaviors that fall into the following four categories:1
- Impaired control: you experience physical cravings and overwhelming urges to use; your attempts to cut down or stop use altogether fails despite a strong desire to do so.
- Social problems: significant problems at home, school, or work, including relationship problems; you stop doing activities you usually enjoy in order to use the substance.
- Risky use: you place yourself in settings or situations that could be or are dangerous just so you can continue to use.
- Drug effects: you experience physical signs of dependence, including needing more of the substance to achieve the same high as when you started (known as tolerance); you experience physical withdrawal symptoms when you try to stop using (which varies depending on the substance you use).
If you can check off something from each of these categories, then you meet the criteria for a moderate substance use disorder — in more common parlance, an addiction to your substance of choice.
A Totally Legal, Very Addictive Drug
Nicotine, the main active ingredient in cigarettes, e-cigs, and vapes, is legal and sold in grocery stores, drug stores, gas stations, and countless other locations — and is very addictive. Yet, although people smoke cigarettes or vape every day — several times a day, even — many do not consider nicotine a drug.
According to the Centers for Disease Control and Prevention (CDC), in 2014, 16.8% of all adults in the United States, or 40 million people, smoked cigarettes. 2 Smokeless tobacco (chewing tobacco, snuff, etc. — merely another form of nicotine) usage in the U.S. in 2012 was 3.6% in adults, or about 4 in every 100 people.3 Obviously a very popular, legal drug, nicotine is responsible for more than 480,000 deaths every year in the United States, yet it is the most preventable cause of death.2
So why are so many people addicted to something they know can kill them?
Nicotine goes straight to your brain and acts on its reward pathways by manipulating the neurotransmitter dopamine. Dopamine is released when you smoke and makes you feel good, relaxed, and is responsible for making you want to continue smoking.
Once nicotine dependence has set in, after you stop smoking, you may feel depressed, tired, and anxious, which are typically feelings you’d like to avoid. So you continue to smoke to feel better. Over time, this is how addiction evolves.
Some negative side effects of smoking include:4
- Skin discoloration.
- Stained teeth.
- More belly fat.
- Weakened immune system.
- High blood pressure.
- Blood clots.
- Fatty deposits in your arteries.
- Increased risk of heart attack or stroke.
- Increased risk of developing type 2 diabetes.
- Erectile dysfunction.
- Lung damage.
- Lung cancer.
- Mouth cancer.
- Other cardiopulmonary diseases.
The Most Addictive Illegal Drug
When it comes to illegal drugs, DrugWarFacts.org found that heroin is the most addictive drug.5 When comparing the elements of addiction in different drugs, heroin scored either a 5 or 6 (with 6 being the highest) in all key areas (see details below: Addictive Properties of Drugs). In addition, heroin is classified as a Schedule I drug, which means it has an extremely high potential for dependence and abuse.6
Heroin is derived from the seed pod of the Asian opium poppy plant. When it enters the body, it is converted to morphine, which then binds to opioid receptors in the brain.7 This gives you a quick and intense feeling of euphoria — and it’s this high that many people continue to chase as they fall into addiction.
Heroin can be addictive after only one use in some people. And it is easy to build up a tolerance to it quickly, meaning the body will continue to want more and more every time you use it. While the euphoric effects may diminish with each use, heroin will continue to depress life-sustaining processes such as breathing, which increases your risk of having an overdose since you’ll use increasingly larger doses of the drug over time to achieve a high.
According to the National Institute on Drug Abuse, heroin withdrawal symptoms can be quite severe, beginning within hours after the last dose.7 The side effects of heroin withdrawal are often likened to flu-like symptoms and may include:
- Muscle pain.
- Uncontrollable kicking movements.
Heroin withdrawal is extremely uncomfortable. When severe, it may be associated with other complications such as depressed mood and often compels people to immediately relapse, which is why having medical supervision while detoxing from heroin is beneficial to so many in early recovery.
Addictive Properties of Drugs
What makes one drug more addictive than another? It has to do with several properties of a drug, including:5
- Intoxication: The level of intoxication associated with different drugs corresponds to the amount of damage the drug can do on various levels.
- Reinforcement: The ability to make you want to continue taking the drug – in many cases, a function closely linked to the drug’s impact on the dopamine reward system.
- Tolerance: Requiring an increasing amount because the usual dose does not have the same effect. Chronic use can lead to tolerance as the mind and body become accustomed to the drug.
- Dependence: How easily a person develops a particular substance dependence, which can dictate how difficult it is for a person to quit the drug.
- Withdrawal: The magnitude of symptoms that occur when the person slows or stops taking the drug.
Whether the drug is legal or illegal, the pain it can cause in your life is the same. If you or someone you love has an addiction, help is available today.
- American Psychiatric Association. (2015). What Is Addiction?
- Centers for Disease Control and Prevention. (2016). Smoking & Tobacco Use: Fast Facts.
- Centers for Disease Control and Prevention. (2016). Smoking & Tobacco Use: Smokeless Tobacco Use in the United States.
- SmokeFree.gov. (2016). 18 Ways Smoking Affects Your Health.
- DrugWarFacts.org. (2016). Addictive Properties of Popular Drugs.
- Drug Enforcement Administration. (2016). Drug Schedules.
- National Institute on Drug Abuse. (2014). DrugFacts: Heroin.