What Does Prescription Drug Abuse Look Like?

Prescription drug abuse is cited as a major health concern in the United States. It should be noted that the vast majority of individuals who are prescribed medications do not abuse them, and a large number of prescription medications are not considered to be drugs/medications that have a significant potential for abuse. Much of the current media publicity concerns the abuse of controlled substances, prescription medications that have been categorized by the United States Drug Enforcement Administration (DEA) as having significant potentials for abuse and/or the development of physical dependence. The effects of abusing a number of controlled substances are rather striking. Understanding how prescription drug abuse generally presents is an important aspect in helping to resolve the situation.

Prescription drug abuse can be viewed in terms of its general overall presentation and then specific indicators that are associated with specific classes of prescription drug abuse.

The General Presentation of Prescription Drug Abuse

The terms drug abuse, addiction, and substance dependence have little clinical relevance, according to the American Psychiatric Association (APA). These terms, which are still used to some extent, are considered to have little diagnostic utility because the ever evolving research investigating the abuse and misuse of all different substances indicates that these terms do not describe mutually exclusive conditions.

Addictive behaviors are seen as occurring on a continuum from use, to abuse, to formal addiction, such that trying to separate mere abuse and addiction is futile as these designations are far more similar than they are different, and there are no definite lines that separate them. Instead, APA now prefers to use the clinical designation substance use disorder as a diagnostic category instead of older notions of abuse, addiction, and/or dependence. The specific substance of abuse can be identified in the formal diagnosis (e.g., an alcohol use disorder, a stimulant use disorder, an opiate use disorder, etc.), and this designation is believed to reflect a more complete understanding of this particular category of disordered behavior.

Substance use disorders, whether they involve the abuse of illicit drugs, prescription drugs, or other substances, show a number of similarities. In line with APA’s diagnostic criteria for substance use disorders in general, these similar characteristics can include:

• The person displays a pattern of frequent use that is inconsistent with prescribed use.
• The person’s use of the drug leads to noticeable impairment in aspects of their functioning and/or significant distress in life.
• The person frequently experiences cravings, or strong urges, to use the drug.
• The person gives up activities that were once important to them in favor of drug use.
• The person fails to meet important personal obligations as a result of their drug use.
• The person’s use of the drug indicates that they are experiencing difficulty controlling such use. Issues with control over drug use can occur in a number of different contexts that include but are not limited to one or more of the following situations:
• The person continues to use the drug in spite of knowing that such use is resulting in issues with emotional functioning or physical health.
• The person often uses more of the drug than originally intended or uses it for longer periods of time than originally intended.
• The person’s drug use continues despite significant negative ramifications as a result of use.
• The person frequently spends significant amounts of time using the drug, recovering from its use, or trying to get the drug.
• Even though the person has stated a desire to cut down or stop using the drug, they continue to use it in the same or increasing amounts.
• The person frequently uses the substance in situations where it is potentially dangerous to do so.
• The person develops tolerance to the drug.
• The person develops withdrawal symptoms when they either stop using the drug or cut down on use.

People who abuse prescription drugs will often not demonstrate all of the above symptoms. The formal diagnostic specifications indicate that an individual who displays two or more of the specific diagnostic criteria outlined by APA within a 12-month period has a diagnosable substance use disorder. The severity of the formal substance use disorder is determined by the number of symptoms that they display during the assessment process. This means that the symptoms are all given equal weight in terms of their diagnostic utility, even though on a practical level some symptoms are considered to be significantly more serious than others. Negative ramifications, such as a loss of one’s career, marriage, etc., are often considered to be more significant by both clinicians and patients than experiencing repetitive cravings for the drug of choice, even though in terms of their diagnostic utility, both are given equal weight.

It should be understood that individuals who only display physical dependence on prescription medications (the development of both tolerance and withdrawal) are not considered to have a substance use disorder if they are using the medication under the supervision of a physician and use it for its prescribed purposes. Physical dependence on any substance is neither necessary nor sufficient for the diagnosis of a substance use disorder. The person’s substance of abuse must result in negative ramifications for them, be associated with significant distress or impairment, and involve nonmedicinal use of prescription medications.

According to sources, such as the American Society of Addiction Medicine, there are other general signs and symptoms that are indicative of potential abuse of prescription medications that are not associated with formal diagnostic criteria. These include:

• Frequent attempts to illegally procure prescription medications
• Individuals who have prescriptions to the drug using it in manners inconsistent with its prescribed instructions or purposes, such as frequently using the drug in greater amounts than prescribed or using it in conjunction with other drugs that are not prescribed and go against the prescribed uses of the substance
• Individuals with prescriptions to the drug engaging in “doctor shopping” in an attempt to get more of the drug
• Finding numerous empty prescription bottles on an individual’s person or in their room, car, clothing, etc.
• Financial issues associated with the need to purchase drugs for nonmedicinal use
• Recurrent legal issues associated with the use of prescription medications
• Frequent use of prescription medications in manners that are more associated with abuse of the drug, such as grinding up pills and snorting them, mixing them in water and injecting them, etc.
• Frequent use of prescription medications to deal with the normal stresses of life
• Attempting to borrow, steal, or even buy prescription medications from individuals who have prescriptions
• Forging or selling one’s prescription
• Frequently losing prescriptions so physicians must write additional prescriptions
• Sudden increases or decreases in the need for sleep
• Issues with judgment and decision-making
• Uncharacteristic mood swings, irritability, hostility, and/or periods of lethargy
• Often appearing to be unusually sedated, energetic, and/or under the influence of some substance

In addition to general signs of prescription drug abuse, there are some specific signs that may be present in individuals who abuse specific classes of prescription medications.

Specific Signs of Prescription Medication Abuse

There are some specific signs associated with the general classes of prescription medications in addition to the signs and symptoms mentioned above. The information below is based on information from the book Concepts of Chemical Dependency.

For opioid medications (medications designed to deal with pain, such as Vicodin, OxyContin, Lortab, codeine, etc.), some specific signs that may indicate abuse include:

• Significant issues with constipation
• Significant sedation or drowsiness
• A noticeably slow rate of breathing
• Periods of confusion
• Significantly slowed or slurred speech
• Issues with balance or motor coordination
• Nausea
• Increased sensitivity to pain

Some specific issues that may be observable in individuals who use sedatives or medications designed to treat anxiety, such as benzodiazepines (e.g., Xanax, Klonopin, Valium, etc.), include:

• Lethargy and drowsiness
• An unsteady gait
• An inability to concentrate
• Noticeably slowed breathing
• Confusion
• Dizziness
• Forgetfulness
• The appearance of being intoxicated without the smell of alcohol (e.g., issues with walking, slurred speech, giddiness, mood swings, etc.)

Some specific issues that may be observable in individuals who abuse prescription stimulants (e.g., Ritalin, Adderall, diet aids, etc.) include:

• Periods of increased energy, talkativeness, and sociability interspaced with periods of lethargy, irritability, and depression
• Significantly reduced need for sleep that may be interspaced with periods where the individual sleeps excessively
• Periods of significantly reduced appetite
• Periods of increased body temperature (may present as increased perspiration)
• Uncharacteristic periods of anxiety or suspiciousness
• Experiencing hallucinations without a history of having some other mental health disorder, such as schizophrenia, bipolar disorder, etc.

The development of any substance use disorder associated with prescription medication abuse is a serious issue. Many of these medications are controlled substances; when they are used indiscriminately for long periods of time, they can produce significant damage to internal organs and the central nervous system. When taken in excessive amounts, they can result in significant issues, including damage to vital organs and even death. Prescription medications require the authorization of a physician in order to be obtained because of these potential issues associated with their misuse.

Anyone who suspects that they, or someone they know, are abusing prescription medications should consult with a licensed mental health clinician regarding treatment for their potential substance use disorder.