What Are the Most Addictive Drugs?

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Many substances can be addictive, including prescription medications, alcohol, and illicit narcotics.

According to the most current data from SAMHSA (Substance Abuse and Mental Health Services Administration), drug addiction and alcoholism are on the rise in the United States. In 2021, 46.3 million U.S. over-12s met the DSM-5 criteria for addiction.

The clinical descriptor for addiction is substance use disorder. DSM-5-TR is the revised fifth edition of APA’s Diagnostic and Statistical Manual of Mental Disorders. DSM categorizes ten types of substance use disorder, including alcohol use disorder.

Addiction is defined as a chronic and relapsing brain condition. Central to all addictions is the compulsive use of substances in the face of clearly negative outcomes. The most addictive drugs cause tolerance and physical dependence to form rapidly, often leading to addiction in the form of substance use disorder.

While addiction is a progressive condition that typically gets worse if untreated, most addictions respond favorably to evidence-based pharmacological and behavioral interventions.

This guide highlights the most addictive drugs, but how is it possible to assess the addictive profile of a substance?

Determining the Most Addictive Drugs

In 2007, a group of pharmacologists, psychiatrists, and chemists at Royal College of Psychiatrists in the U.K. ranked the most dangerous drugs according to three factors:

  1. Physical harm
  2. Social harm
  3. Dependency

Results of their findings were published in The Lancet in an attempt to develop a scale to assess the harm and addictive profile of substances of abuse.

Of the above categories, dependency is most relevant to addiction. The researchers sub-categorized dependency as follows:

  • Pleasure: Drugs that trigger intense euphoria can cause the rapid formation of psychological dependence that may develop into addiction.
  • Physical dependence: If withdrawal from a substance triggers the presentation of physical and psychological withdrawal symptoms, this is a diagnostic criterion for addiction.
  • Psychological dependence: Acute cravings that manifest when the use of a substance is discontinued are indicative of its addictive potential.

What Drugs are the Most Addictive?

  • Heroin
  • Meth
  • Cocaine
  • Opioids
  • Alcohol


Heroin is an illicit Schedule I controlled substance. According to the DEA (United States Drug Enforcement Administration, heroin has no medical utility and a high potential for abuse, dependency, and addiction.

Ingesting heroin activates the brain’s opioid receptors, blocking feelings of pain, increasing relaxation, and producing a sensation similar to an out-of-body experience. Heroin also induces a powerful euphoria by triggering the overproduction of dopamine in the brain.

Tighter regulations and controls over prescription opioid painkillers like hydrocodone and oxycodone has led to a sharp increase in heroin abuse and addiction in the U.S. Data from NSDUH 2020 indicate that 690,000 over-12s met the DSM-5 criteria for heroin addiction (opioid use disorder) in 2020. The recently published NSDUH 2021 shows that over 1 million U.S. over-12s were addicted to heroin in 2021.

NIDA (National Institute on Drug Abuse) estimates that 23% of those who try heroin develop a subsequent opioid use disorder.

Dependence on heroin can develop rapidly with sustained use, and heroin withdrawal symptoms that occur during detox can be physically draining and emotionally challenging.

The most effective treatment for heroin addiction involves:

  • MAT: FDA-approved medications for the treatment of heroin addiction include methadone, naltrexone, and buprenorphine. Medication-assisted treatment is most effective when combined with psychotherapy.
  • Psychotherapy: Psychotherapy or talk therapy allows you to unpack the psychological component of heroin addiction.


Methamphetamine, also known as meth or crystal meth, is a fiercely addictive illicit stimulant and Schedule II controlled substance.

Data from NSDUH 2021 show that 2.5 million U.S. over-12s reported using meth in the previous year. 1.6 million people reported past-month meth use. The same data indicate that 1.6 million over-12s met the DSM-5 criteria for meth addiction in the same year.

Whether meth is smoked, snorted, or injected, the drug induces an intensely euphoric high. Tolerance to crystal meth can develop quickly, often leading to increased consumption. Abusive patterns of meth consumption will accelerate the development of physical dependence, often but not always leading to meth addiction (stimulant use disorder).

There are currently no pharmacological treatments for meth addiction approved by the FDA. Stimulant use disorders are typically treated with behavioral interventions like CBT (cognitive behavioral therapy) and contingency management.


Cocaine is a fiercely addictive Schedule II controlled substance. Like all substances under this schedule, cocaine has some medical utility, but a high potential for abuse, dependence, and addiction.

Powdered cocaine may be snorted or injected, while freebase rock cocaine (crack cocaine) is smoked in glass pipes.

All forms of cocaine trigger intense euphoria as the brain is flooded with dopamine. Dopamine is a neurotransmitter or brain messenger associated with positive mood. The effects of cocaine quickly set in and just as rapidly dissipate, often prompting abusive patterns of consumption in those seeking to recreate the euphoric high.

Research indicates that 21% of those who use cocaine will subsequently develop dependence. 1.4 million U.S. over-12s satisfied the criteria for cocaine addiction, according to SAMHSA.


An opioid epidemic has ravaged the United States since the late 1990s.

The epidemic was sparked by the aggressive marketing of opioid painkillers as non-addictive solutions for managing chronic pain. The claims made by pharmaceutical companies were false, leading to millions of U.S. citizens developing addictions (opioid use disorders) after taking the medication for legitimate medical purposes.

Tolerance and dependence can form very quickly with opioids, making them an especially addictive class of drug. As well as relieving pain, opioids also trigger intense euphoria, adding to their addictive potential.

NSDUH 2021 reports that 5.5 million U.S. over-12s used opioid painkillers in 2021.


Alcohol may be legal for over-21s in the United States but is also one of the most addictive substances.

29.5 million adults in the United States met the DSM-5 criteria for alcoholism (alcohol use disorder) in 2021, meaning that alcohol addiction continues to rise in the U.S. In 2019, by contrast, just 14.8 million people were addicted to alcohol.

Tolerance, dependence, and addiction to alcohol can all develop. Alcohol use disorder is the clinical term for alcoholism, and is diagnosed according to the criteria listed in DSM-5-TR as mild, moderate, or severe.

While there is no cure for alcohol use disorder, the FDA approves three medications for streamlining alcohol withdrawal and for promoting ongoing abstinence. Alcohol use disorder also responds positively to behavioral therapies like CBT or DBT.

Treatment for Drug Addiction and Alcoholism in Cincinnati, Ohio

Here at Ohio Community Health Recovery Centers, we specialize in the intensive outpatient treatment of all types of substance use disorders. Whether you are addicted to prescription drugs like opioids or benzos, alcohol, or illicit narcotics, we can help you move beyond substance use disorder.

Most people withdrawing from addictive substances benefit from a supervised medical detox. We can help you with this at Ohio Recovery Centers. Over a week or so, you will detox safely and comfortably, with access to medications, clinical care, and emotional care. You can then transition into one of the following treatment programs:

  • PHPs (partial hospitalization programs)
  • IOPs (intensive outpatient programs)
  • Dual diagnosis treatment programs (for co-occurring disorders)

All treatment programs offer individualized care that draws from the following evidence-based and holistic interventions:

  • MAT (medication-assisted treatment)
  • Individual counseling
  • Group therapy
  • Family therapy
  • Psychotherapy (talk therapy)
  • Aftercare

Initiate your sustained recovery from drug or alcohol addiction at Ohio Community Health Recovery Centers. Contact us online just here or call 513-757-5000.

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