Drug addiction: signs, treatment and how to get help in the UK

The NHS says charities and the NHS provide most drug treatment, with some private organisations too (private treatment must be paid for). Treatment depends on your personal circumstances and the drug you are using. Your keyworker works with you to plan the right treatment, which may include several treatments and strategies. NICE has separate guidelines for adults and young people over 16 on psychosocial interventions for drug misuse (CG51) and on opioid detoxification (CG52), and the UK clinical guidelines known as the Orange Book cover treatment for clinicians.

Talk to FRANK, the national drugs information service, sets out five steps: noticing something is wrong, getting expert help (via your GP or self-referral), being assessed, discussing a course of treatment, and changing your lifestyle. It says most treatment involves some form of talking therapy, and prescribed medication is needed for certain drug or alcohol problems.

The NHS says a GP can discuss your problems with you and help get you into treatment, usually by referring you to your local drug service. If you are not comfortable talking to a GP, you can approach your local drug treatment service yourself, and the FRANK website lists support near you. The NHS stresses that you are entitled to the same confidential care as anyone else who has a health problem, and that if you are not ready to stop you can still get help with staying safe and healthy.

At your first appointment staff will ask about your drug use and your work, family and housing situation. You may be asked for a urine or saliva sample to check what drugs you have been taking. They talk you through all your treatment options, agree a treatment plan with you, tell you about local support groups for drug users and their families or carers, and give you a keyworker who supports you throughout treatment. Treatment may be at home or, for intensive treatment like detox, as a hospital inpatient or in a residential rehabilitation service.

The NHS says that being addicted to something means that not having it causes withdrawal symptoms, or a "come down", and that often an addiction gets out of control because you need more and more to satisfy a craving. For cocaine, the NHS says you do not have to take it every day to be addicted and that a sign of addiction is that you have tried to cut down or stop but are unable to.

The Royal College of Psychiatrists lists signs of cocaine dependence that apply more widely to drug dependence: a strong desire to take the drug regularly, needing more to get the same effect, finding it difficult to stop, neglecting other interests in your life, continuing despite knowing it is harming you, and getting withdrawal symptoms if you stop.

Talk to FRANK describes the stage where you may have realised that you are not in full control of your drug use and that it is causing problems, such as with money, strained friendships, broken relationships, your job, or getting arrested. If you are developing a problem with prescribed or over-the-counter medicines, you may find you have been hiding the amount you are taking or lying about your symptoms.

The Royal College of Psychiatrists notes that continued cocaine use can cause long-term damage to physical and mental health: heart conditions, lung problems if smoked, nose and sinus problems if snorted, blood-borne infections if injected or shared equipment is used, and mental health problems such as depression, anxiety and psychosis.

The NHS defines addiction as not having control over doing, taking or using something to the point where it could be harmful to you. It is most commonly associated with gambling, drugs, alcohol and smoking. In the case of drugs, alcohol and nicotine, the NHS says these substances affect the way you feel, both physically and mentally; the feelings can be enjoyable and create a powerful urge to use again, which can become a habit that is very hard to stop.

The word covers a range of substances. The NHS has separate guidance on heroin and other opioids, on cocaine and crack cocaine, and on volatile substances such as glue, aerosols, petrol or lighter fuel. The Royal College of Psychiatrists says cocaine is the second most commonly used drug in the UK after cannabis.

The NHS says your keyworker helps you decide between two approaches to stopping heroin. Maintenance therapy is where you switch from heroin to a substitute such as methadone or buprenorphine and then stay on a stable dose. Detox is where you switch to a substitute before gradually withdrawing from the substitute so you are not taking either. You can switch from maintenance to detox at any time. Daily doses are supervised by a drugs worker or pharmacist for at least the first 3 months.

The NHS says you will usually only be offered detox as a hospital inpatient or in residential rehab if you need medical help for other physical or mental health problems, need to detox from alcohol or another drug such as benzodiazepines as well, or community detox has not worked for you before. After detox, your keyworker will carry on supporting you for at least 6 months, with help for issues such as housing, work or education. It also warns that detox lowers your tolerance, so overdose risk is higher if you use afterwards.

Talk to FRANK says there is very good evidence to support opiate substitution treatment as one part of a path to recovery, with the longer-term aim usually being to decrease the dose alongside talking treatments and other support when agreed in your care plan.

The NHS says effective treatments for cocaine addiction include talking therapies such as CBT (group or one to one with a specialist), couples therapy if you have a partner who does not use cocaine, and incentives such as vouchers for sticking with treatment. Unlike heroin, there are no medicines that work as substitutes for powder cocaine, crack cocaine and other stimulants, although you may be offered short-term medicines for related symptoms such as sleep problems. You normally stay living at home, and residential rehab is usually only recommended if your situation is particularly severe or complicated.

The Royal College of Psychiatrists says the withdrawal from cocaine is not itself fatal but can bring unpleasant symptoms such as low mood, anxiety, irritability and sleep problems.

The NHS says there are lots of reasons why addictions begin. Some studies suggest a person's risk of becoming addicted is partly genetic, and environmental factors, such as being around other people with addictions, are also thought to increase the risk. Substance misuse can be a way of blocking out difficult issues, and unemployment, poverty, stress and emotional or professional pressure can trigger addiction.

The Royal College of Psychiatrists adds, for cocaine, that people with a family history of dependence on drugs or alcohol, easier access to the drug, or childhood trauma are more likely to become dependent.

NHS inform (Ready Steady Baby) says taking drugs when you are pregnant, even in small quantities, can put your baby's health at serious risk, and that babies are more likely to be born early, be underweight, have feeding and breathing problems, get infections and have problems with development. Some prescribed or illegal drugs that cause physical dependency can pass through the placenta, and after delivery a baby may show signs of withdrawal known as neonatal abstinence syndrome.

It advises talking to your midwife or GP as soon as you can after finding out you are pregnant, and not stopping prescribed medication suddenly, because that could be harmful to you and your baby. Drug support services are private and confidential.

NHS inform says injecting drugs such as heroin and cocaine increases the risk of injuries, wounds, bacterial and viral infections and overdose. It advises using new sterile supplies, only your own equipment, and regular testing for blood-borne viruses such as hepatitis C and HIV, and says sharing equipment can spread infections. It advises contacting your GP if a wound is getting bigger, not getting better, or you feel unwell, and phoning 111 if your GP is closed.

NHS inform also says the risk of overdose is higher if injecting, and to always carry naloxone, a medicine that can temporarily reverse the effect of an opioid overdose.

The NHS says families often play an important role in helping someone come off drugs, and getting help for yourself puts you in a better position to support them. Your GP can give details of local support groups. It lists FRANK, Adfam, Addiction Family Support, Families Anonymous, SMART Recovery (with a Family and Friends Programme) and Release (for advice on drugs law) as places to find help.

Call 999 if someone has taken drugs and is unresponsive, struggling to breathe, having a seizure, has chest pain, or you suspect an opioid overdose. Give naloxone if you have it and it is available. For other situations, such as withdrawal that is making you very unwell, thoughts of self-harm, or a wound that is spreading, contact your GP or NHS 111.

On the NHS the route is through your GP or a self-referral to a local drug treatment service, many of which are run by charities on behalf of the NHS. The NHS says private drug and alcohol treatment organisations also exist and must be paid for. Whichever route you choose, it is sensible to check the service is registered and to keep your GP informed so that medicines, physical health and mental health are looked after together.