Addiction: how it works and how people recover
Addiction is a health condition in which a person keeps using a drug or medicine despite clear harm, because repeated use has changed the brain's reward, stress and self-control systems. It is treatable. Recovery usually combines safe withdrawal, medicines such as methadone or buprenorphine for heroin dependence, counselling and family support. Stopping alcohol or sedatives such as alprazolam suddenly can cause fits and can be fatal, so withdrawal from them needs medical supervision. Relapse is common and is a reason to adjust treatment, not to give up.
Health writers · Aslam Clinic
is a health condition in which a person keeps using a substance even though it is clearly harming them, because repeated use has changed how their brain handles reward, stress and self-control. It is not a lack of willpower or a sign of bad character. Like diabetes or high blood pressure, it is a long-term condition that can be treated, and many people recover fully — though often after more than one attempt.
The World Health Organization and the UN Office on Drugs and Crime put it plainly: drug use disorders should be treated as health problems, in the health system, with the same dignity as any other illness. That matters in Pakistan, where shame often keeps families silent for years.
What addiction does to the brain
Everyday pleasures — food, friendship, success — release small bursts of the brain chemical in the reward circuit, which teaches us to repeat them. Drugs over-activate this circuit. The US National Institute on Drug Abuse describes three changes that follow with repeated use:
- The reward circuit turns down. The brain adapts to the drug, so ordinary life feels flat and the drug is needed just to feel normal. Needing more for the same effect is called tolerance.
- The stress system turns up. When the drug wears off, anxiety, irritability and unease — — drive the person to use again, now for relief rather than pleasure.
- The brakes weaken. The , which plans and controls impulses, loses its grip. It is also the last part of the brain to mature, which is why teenagers are most vulnerable.
Cues become powerful too. Places, people, money in the pocket or a bad mood can each become a that sets off intense craving, long after the last dose. This is why 'just stop' rarely works on its own.
Substances people use in Pakistan
The last national survey of drug use in Pakistan, carried out by the government with UNODC and published in 2013, estimated that about 6.7 million people aged 15 to 64 had used a controlled drug or misused a prescription medicine in the past year, and that about 4.25 million of them were dependent. The figures are now old, and the pattern has shifted since, but they show how common the problem is.
| Substance | Common names | Main dangers |
|---|---|---|
| Cannabis | Charas, hashish, bhang | The most used drug in the 2013 survey (about 4 million users). Dependence, poor memory and motivation, and a raised risk of psychosis with daily or strong use |
| Heroin and opium | Heroin powder, afeem | About 860,000 regular heroin users in 2013. Overdose, stopped breathing, HIV and hepatitis from shared needles |
| Methamphetamine | Ice, crystal | Barely detected in 2013, now a growing problem. Sleeplessness, paranoia, aggression and psychosis |
| Sedatives (benzodiazepines) | Alprazolam ('Xanax'), bromazepam ('Lexotanil'), clonazepam | About 1.5 million people misused tranquillisers or sedatives in 2013, and women more often than men. Dependence, and dangerous withdrawal if stopped suddenly |
| Opioid painkillers and cough syrups | Codeine-containing syrups, tramadol and other painkillers | About 1.6 million people used prescription opioids non-medically in 2013. Dependence and overdose, especially with sedatives or alcohol |
| Alcohol | Sharab, home-made 'kachi sharab' | Dependence, liver disease, dangerous withdrawal; home-made spirits can contain poisonous methanol |
| Tobacco and naswar | Cigarettes, naswar, gutka, shisha | The most common addiction of all — see the page on quitting tobacco |
Crystal meth deserves special mention. An audit at the addiction ward of Allied Hospital II in Faisalabad found that nearly a quarter of its admissions between July and December 2025 were for psychosis caused by methamphetamine. People on ice can become intensely suspicious, sleepless and aggressive, and the psychosis can persist after the drug has gone.
Addiction is not only to illegal drugs. such as alprazolam and bromazepam are sold far too loosely in Pakistan, often without a prescription, and many people become dependent after being given them for sleep or 'tension'. They are useful for short periods only. Codeine cough syrups are opioids too, and dependence on them is real.
Withdrawal: when stopping suddenly is dangerous
Withdrawal is the body's reaction when a drug it has adapted to is taken away. For most drugs it is miserable but not dangerous. For two groups it can kill.
- Heroin and opioid withdrawal — aches, sweating, runny nose, diarrhoea, yawning and sleeplessness. It is very unpleasant but rarely dangerous in itself. The real danger comes afterwards: tolerance falls within days, so a person who relapses and uses their old amount can overdose and stop breathing.
- Meth and stimulant withdrawal — exhaustion, long sleep, hunger and low mood, which can be severe. Watch closely in the first weeks, and get help if the person talks of self-harm.
- Cannabis withdrawal — irritability, poor sleep, low appetite and craving, usually easing within a week or two.
What treatment involves
Good treatment is matched to the person and the substance, and it lasts longer than a few weeks. The main parts are:
| Part of treatment | What it does |
|---|---|
| Assessment | A doctor checks what is being used, how much, physical health (including HIV and hepatitis for people who inject), and any depression, anxiety or psychosis alongside |
| Withdrawal management ('detox') | Safe, medically supported withdrawal. On its own it is only a first step — without follow-up most people relapse |
| Opioid substitution treatment | For heroin dependence, a daily supervised dose of methadone or buprenorphine stabilises the brain, stops withdrawal and cuts overdose and injecting. WHO and UNODC note that people with opioid dependence generally do better on long-term maintenance than on detox alone |
| Talking therapy | to build the person's own reasons for change, and to handle cravings, triggers and high-risk situations |
| Family involvement | Family therapy and support for relatives, which improve the chance of staying in treatment |
| Mutual help | Groups such as Narcotics Anonymous and Alcoholics Anonymous, where people in recovery support each other |
In Pakistan, the psychiatry departments of teaching hospitals and many district (DHQ) hospitals can assess and treat addiction, and some have dedicated addiction wards. Availability of opioid substitution treatment varies by city, so ask the psychiatrist what is possible locally.
Choosing a rehabilitation centre
Private rehab centres vary enormously in quality. The international standards published by WHO and UNODC are clear that treatment must respect a person's dignity and rights: they must give informed consent and be free to leave, and punitive or humiliating practices — beatings, chaining, withholding food or treatment — should never be used. Confinement is not treatment.
How families can help: the CRAFT approach
Families often swing between anger and rescuing, and neither usually works. Community Reinforcement and Family Training (CRAFT) is a structured approach — one the WHO/UNODC standards list as an option when the person refuses treatment — that teaches relatives to change the situation around the person rather than trying to force them:
- Learn the pattern: when, where and with whom the use happens, and what sets it off.
- Reward sober time. Spend warm, enjoyable time together when they are not using; step back when they are.
- Stop cushioning the consequences. Do not pay drug debts, make excuses or clean up after them — let the natural results of using reach them, safely.
- Replace lectures and threats with calm, specific requests: 'I'd like you to come with me to see the doctor on Thursday.'
- Choose the moment. People are most open to help just after a bad episode, when they are regretful and sober.
- Protect your own health, and keep yourself and the children safe if there is violence — call 15 if anyone is in danger.
A 2025 study of caregivers in Islamabad described the heavy financial, social and legal burden families carry, with little support offered to them. Your own counselling is not a luxury; it helps you stay steady for the long haul.
Relapse is part of many recoveries
NIDA notes that relapse rates for addiction are similar to those for other long-term illnesses such as high blood pressure and asthma. A relapse does not mean treatment has failed or that the person does not care; it means the plan needs to be restarted or changed. What predicts lasting recovery is staying connected to treatment, support and a life with meaning — work, family, faith, sport — that gives the person something better than the drug.
What you can do today
- If you are the one using, tell one trusted person and book an appointment with a doctor or the psychiatry department of your nearest hospital.
- If you take alcohol or sedatives every day, do not stop abruptly — ask a doctor to plan a safe reduction.
- If you use heroin, never use alone, and be most careful after any break, when your tolerance is low.
- Remove easy access: delete dealers' numbers, avoid the places you used, and let someone else hold your money for a while.
- If you are family, start with the CRAFT steps above rather than a confrontation, and get support for yourselves.
Common questions
Still not sure what to do?
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