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What Are the Top 5 Most Addictive Drugs in the World?

According to one survey of experts, it was suggested that heroin, cocaine, nicotine, barbiturates, and alcohol are the most addictive drugs in the world. While the moniker of “most addictive” is debatable, it’s definitely true that these drugs all have significant abuse and addiction potential.

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What Is Drug Addiction?

In a medical context, drug addiction is a chronic, relapsing disorder in which a person feels compelled to use drugs despite experiencing adverse consequences as a result of that drug use. Drug addictions range in severity, with some people being relatively functional while addicted to drugs and others being crippled by their addiction, struggling to meet basic life needs.

Notably, drug misuse, even heavy misuse, doesn’t necessarily mean a person suffers from an addiction, although heavy drug use of any kind can still generally have serious health consequences. An important part of addiction is the compulsive element, where a person cannot control their drug use even if they want to or logically understand they need to stop using drugs or at least reduce the amount they’re using. 

Key Facts About Addictive Drugs

Key Facts

  • Different drugs have different mechanisms in which they might cause addiction, although the basic, broad strokes neurobiology of addiction generally remains similar between different drugs.
  • Addiction is generally caused by changes to the pleasure, learning, stress, decision-making, and self-control systems of the brain.
  • Addiction is not a moral failing. Addiction is a brain disorder, causing changes to the way a person thinks that make stopping drug use a complex and often challenging process.
  • Not all drugs have significant addiction potential, although that doesn’t necessarily mean they’re “safe,” as they may still cause serious health effects, especially in high doses.

Top 5 Most Addictive Drugs in the World

There isn’t a simple way to determine the “most addictive” drug in the world, as the metric one uses might vary. For example, is a drug the “most addictive” if the most people are addicted to it total or if the proportion of people who do use it and become addicted is the highest? 

Regardless, some experts have considered the issue and proposed five drugs that might be called the “most addictive,” even if the specifics are debatable. 

1. Heroin

Heroin is an illegal opioid and a significant contributor to America’s opioid epidemic. It is highly addictive and can significantly impact a person’s health. 

It also has a significant overdose risk, with a dose only five times higher than what it takes to get high being potentially fatal. Heroin becomes more dangerous when mixed with other drugs that may increase its effects on breathing and the heart, or that may suppress its effects and cause a person to take more than they normally would.

2. Cocaine

Talking about cocaine is complicated by the fact that crack cocaine has long been politicized and used as a tool to oppress various groups in the United States. At the same time, powdered cocaine is addictive, and crack cocaine is even more addictive, so they can’t be ignored, even if the way the discussion around these drugs has been shaped is misguided and needs to change. 

Cocaine causes spikes to a user’s dopamine levels. It’s estimated that about 21 percent of people who try cocaine become dependent on it at least once during their lifetime. 

3. Nicotine

Nicotine is the first drug on this list that is widely legal for adults to purchase and use. It is readily available, and it is most commonly found in tobacco products. 

While its easy availability makes it complicated to directly compare dependency rates to illegal drugs, nicotine is undeniably associated with dependence and addiction, with over two-thirds of people who have tried smoking reporting becoming dependent at some point in their lifetime. It’s been estimated that by 2030, tobacco will kill more than 8 million people a year.

4. Barbiturates

Barbiturates are a type of prescription anti-anxiety and sleep medication that work by suppressing certain regions of the brain. They can cause euphoria in users and also suppress important bodily functions like breathing, which can be dangerous if used at high doses or mixed with other drugs. These drugs used to be considered more destructive as they were widely available. They have been prescribed much less more recently, resulting in an overall lower rate of abuse and addiction.

5. Alcohol

Many people vastly underestimate alcohol’s potential to do harm, but the truth is that it is a depressant drug with significant abuse and addiction potential. Alcohol can also cause notoriously difficult withdrawal symptoms if a person develops physical dependence on it. In some cases, withdrawal can even be life-threatening if not done under medical supervision. 

Despite its wide availability, heavy alcohol use is dangerous, capable of suppressing breathing, damaging organs, and more. 

What Determines a Drug’s Addictiveness?

A drug’s addictiveness primarily has to do with neurobiology. As addictive drugs act on the brain’s reward systems, the brain adapts to their use. 

Over time and with repeated use, the brain essentially begins to act as though it is functioning “normally” when under the effects of the drug. This causes a person to develop withdrawal symptoms when their body has processed the drug out of its system, as the body’s natural state isn’t built for those adaptations. It takes time (and avoiding further drug use) for the body to readjust back to treating its sober, natural state as “normal.”

Substance use can also reduce the amount of pleasure a person feels from normally rewarding activities, such as eating, having sex, or accomplishing important tasks. Considering many people use drugs during hard times in their life, this can be especially troubling. It can cause a feedback loop where a person uses drugs to feel a sense of reward, but by using drugs, they feel less joy from their everyday life, which may cause them to repeatedly use drugs.

Drug use can also affect the judgment and decision-making circuits of the prefrontal cortex. If they do this, it can literally become more difficult for a person to make rational, long-term decisions. Because quitting drugs is often a difficult, long process, this can make it very challenging for a person to quit once addicted, even if they understand on some level that quitting would be a major improvement overall.

Treatment Options for Addiction

Addiction treatment generally requires the help of a medical professional. By talking to an addiction treatment expert, you can get access to a variety of treatments you simply cannot provide yourself at home as well as an expert’s opinion on the best treatment plan for your needs.

Addiction treatment usually involves some combination of the following approaches:

  • Behavioral therapy 
  • Medication
  • Care for withdrawal symptoms
  • Diagnosis and treatment of any co-occurring mental health conditions
  • Follow-up care to prevent relapse

Treatments may be provided through either inpatient or outpatient care. Inpatient care involves staying at an addiction treatment facility for multiple days or weeks, which can allow for focused, intensive treatment. Outpatient care involves going to therapy sessions but then continuing with your day as normal. Outpatient treatment is usually much cheaper than inpatient care, and it provides greater autonomy, but isn’t the best for everyone’s needs.

The right addiction treatment for you will depend on the severity and duration of your addiction as well as individual specifics like your home environment, the presence of any co-occurring disorders, and your support system. Many people begin their treatment with inpatient care and then transition to outpatient treatment once they gain a good footing in sobriety.

The specifics of any addiction treatment will depend on the drugs you struggle with. Some drugs, such as alcohol and opioids, have medications that can help to reduce cravings or otherwise reduce the likelihood that you will relapse. Other drugs don’t have these kinds of medications available, although research is ongoing into solutions like this for the drugs most commonly abused.

Updated April 25, 2023
  1. Drug Misuse and Addiction. (July 2020). National Institute on Drug Abuse.
  2. The Five Most Addictive Substances in the World. (June 2019). CNN.
  3. The Neurobiology of Substance Use, Misuse, and Addiction. (2016). U.S. Department of Health and Human Services.
  4. Treatment Approaches for Drug Addiction. (January 2019). National Institute on Drug Abuse.
  5. The Neuroscience of Drug Reward and Addiction. (September 2019). Physiological Reviews.
  6. The Mechanistic Classification of Addictive Drugs. (November 2006). PLOS MEDICINE.
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