A pervasive need for pain management has led to the development of a variety of medications that relieve pain and improve function for millions of people. These powerful drugs are generally derived from opium or are chemically similar to it. Along with the benefits of using these drugs comes a risk: the problem of addiction.
Heroin was developed in the 1870s as an alternative to morphine, an opium derivative. Heroin was first thought to be less addictive than morphine, which was commonly used at the time for pain. However, the addictive qualities of heroin soon became apparent. Even as other drugs were developed, heroin continued to be abused for its powerful euphoric qualities.
Heroin addiction has become a widespread problem in the United States, with thousands of people at risk of serious physical illness, injury or death because of their drug use. These individuals often require in-patient treatment and aftercare over a period of time to allow them to overcome the addiction and rebuild their lives in sobriety.
Opioids and Opiates: What’s the Difference?
Individuals looking into the problem of heroin addiction may come across terms like “opiates” and “opioids.” Chemically, these are two different types of compounds.
Opiates are compounds made from opium, a drug extracted from the dried seedpods of the poppy plant. Opioid drugs, with “opioid” meaning “opium-like,” are synthetically produced in laboratories and manufacturing plants and, though similar in composition and effect, they are not the same. However, because of the similarity of these compounds, the term “opiate” is often used to denote any type of drug with opiate-like characteristics.
Opiate drugs include:
Opioid drugs include:
Abuse, Addiction and Dependence
A number of different terms are used to describe the involvement of an individual in the use of heroin or other substances. The primary terms used by therapists are abuse, dependence and addiction. Essentially, the terms are generally used to describe stages in the progression of substance use.
Substance abuse is when the person is involved in drug use on a regular basis, engages in reckless behavior, neglects everyday obligations such as work or school and continues to use despite personal problems or legal problems that result from use.
Dependence can be understood as physical reactions that occur because of heroin use, such as increased tolerance that makes the person use more of it over time and experiencing withdrawal symptoms when they do not continue using it. Withdrawal symptoms include fatigue, muscle pain, nausea, vomiting, fever, sweating, diarrhea, insomnia and intense cravings for the drug.
Addiction occurs when the individual is physically dependent on the substance and begins a pattern of problematical behaviors, such as being unable to stop, spending increasing amounts of time on acquiring the drug and continuing to use it despite deteriorating health.
The distinction between dependence and addiction is a fine one. Someone may be physically dependent on a substance without having a clearly defined addiction, which includes complete obsession with acquiring the substance—to the point of risking death. However, when dependence occurs, it is generally closely followed by addiction.
Statistics on Heroin
The National Survey on Drug Use and Health found that 669,000 individuals reported using heroin in 2012. About 156,000 reported using heroin for the first time, which was twice the number of people who reported first-time heroin use just 6 years earlier.
The greatest increase in heroin use was in the 18- to 25-year-old demographic. The number of total hospital admissions for heroin use in this age bracket rose from 11 percent in 2008 to 26 percent in 2012. Across the United States, heroin overdose deaths have quadrupled since 2002.
Prescription Painkillers and Heroin Addiction
The widespread use of prescription painkillers has had a direct effect on the prevalence of heroin addiction. Painkillers are used for a variety of treatments. They are often used after surgery to reduce pain and to reduce discomfort from dental procedures.
It is not uncommon for patients receiving these drugs to develop a dependency on them. Sometimes patients go on to deliberately abuse them for their euphoric effects, and sometimes a patient’s natural tolerance increases to the point that they abuse the medication in order to achieve the desired effect. The highly sought-after pills may even be diverted from their intended purpose and sold on the street.
Recently, legislatures in states across the country have tried to curb widespread over-prescribing and misuse of painkillers. As a result, many people who abused these drugs have turned to heroin, which is often cheaper and easier to acquire.
Symptoms of Heroin Addiction
Heroin addiction can occur very quickly, or it can develop over a period of time. Scientists have not yet found a way to pinpoint who is most vulnerable to addiction and who is not. Any exposure to the chemical disruption in the brain caused by heroin use can cause some people to become addicted. When addiction occurs, it is recognizable by a number of signs:
- Drowsiness, lapsing into sleep frequently
- Confused or unclear thinking
- Slowed breathing
- Track marks and bruising at injection sites
- Skin abscesses and infections
- Collapsed veins from repeated injections
- Heart, lung or kidney problems
- Deterioration in grooming and self-care
- Worsening performance at school or work
- Lying, deception or theft to pay for drugs
- Weight loss
- Hostile behavior when confronted or questioned about actions
- Runny nose
- Withdrawal symptoms when not taking drugs, such as nausea, vomiting, muscle pain, cold sweats and diarrhea
Any exposure to the chemical disruption in the brain caused by heroin use can cause some people to become addicted.
Effects of Heroin on the Body and Mind
When heroin enters the body, it is converted to morphine, which produces a strong, pleasurable sensation. The person feels a warm flush that spreads over the body, and the limbs feel relaxed and heavy. Some people feel nausea and may begin to vomit. Itching of the skin is common. The feeling of euphoria and warmth lasts for several hours after initiating a dose. The person becomes drowsy and mentally unfocused, and heart and breathing rates slow. An overdose of heroin can slow breathing so much that it stops, and the person may die as a result.
Over the long term, heroin use causes measurable changes in the physical structure of the brain. Heroin use also causes long-term changes in the hormone and neuronal systems that are needed for normal brain function. Scientists have charted loss of white matter in the brains of individuals who use heroin over a long period of time.
Heroin use also causes long-term changes in the hormone and neuronal systems that are needed for normal brain function.
These changes affect the person’s ability to make decisions, respond to stressful situations and regulate appropriate behavior. Returning addicted individuals’ brains to normal function can take time and significant effort on their part.
Addiction to heroin can have numerous negative physical effects. Individuals may suffer from collapsed veins or blood infections such as hepatitis B and C or HIV. Clogging in the arteries can lead to kidney, lung, liver or heart problems. Skin abscesses and other infections may frequently occur.
Psychiatric problems such as depression and anti-social behavior can result from heroin addiction. General poor health can leave the individual vulnerable to malnutrition, pneumonia and tuberculosis. Sexually transmitted diseases from reckless behavior can occur, and the individual is always vulnerable to the possibility of death from overdose.
Options for Treatment
Heroin addiction is one of the most difficult substance abuse problems to treat. Use of the drug causes changes in brain chemistry that must be overcome through hard work, time and habit. Finding the right treatment modalities to assist these patients has been a process based on evolving research that continues to provide new information.
- Addiction involves both brain function and behavior that treatment must address.
- No single treatment can be effective for every individual. Their unique needs must be considered when designing a treatment program.
- Treatment must be comprehensive, addressing other needs beyond the addiction, such as underlying mental health problems, economic issues and social concerns.
- Staying in a treatment program to completion is critical for success.
- Counseling and behavioral therapy are commonly used for helping individuals manage their behavior.
- Medications may be helpful for some patients in treating addiction.
- Treatment programs should be reviewed and revised as the patient’s needs change.
Treatment should also include testing for HIV, sexually transmitted diseases and other illnesses that often occur along with addiction.
Underlying mental health problems should be diagnosed and treated to aid in success in recovery.
Today, heroin treatment involves a number of different options:
- Detoxification – The addictive substance must be removed from the individual’s body in order for comprehensive treatment to begin. Medical assistance may be necessary to help relieve symptoms so that patients can begin the treatment process.
- Medications – Medications are sometimes used to assist patients with withdrawal symptoms and to allow patients to function normally while they continue to work on other aspects of their recovery. Methadone, buprenorphine and naltrexone are used to block the opiate receptors in the brain to prevent the effects of heroin if the individual tries to use it.
- Individual counseling – Many patients suffering from addiction have unresolved problems with anger, trauma, post-traumatic stress disorder, abuse or other issues that can be addressed in individual counseling sessions with a trained therapist.
- Group counseling – Group counseling sessions are used to help patients deal with their emotions and provide outside feedback on their thinking and their behaviors.
- Behavioral therapies – Different modalities of behavior therapy have been found to be helpful in treatment for heroin addiction. Contingency management therapy works to increase self-control by offering rewards for negative drug tests in the form of vouchers that can be exchanged for desirable items of a healthy nature. This type of therapy encourages positive decisions and behaviors. Another type of behavioral management is called cognitive behavioral therapy. This type of therapy encourages individuals to monitor their own thoughts and emotions to recognize the sources of their negative behaviors. They are then encouraged to design actions for more positive outcomes.
- Family therapy – Family therapy is often necessary to overcome the distrust and angry feelings that have resulted from the addictive behaviors. In therapy, partners and family members can learn healthy ways to support the individual’s recovery.
- Relapse Prevention Training – Patients receive education about triggers that can lead to a relapse of drug use and what they can do to provide remedies that will help to prevent them from returning to substance abuse.
- Aftercare – Aftercare prepares patients for life after addiction treatment, with references to health agencies, counseling sources and support groups that can help them deal with the problems that occur in recovery.
Returning to Regular Life After Heroin Addiction Treatment
Participation in a treatment program is only the beginning of the journey back to normal life. Addiction wreaks havoc in people’s lives. It can destroy careers and undermine personal relationships, so that the person must work continuously to restore credibility with others. It is not always easy to regain trust in partner and family relationships. In some cases, addiction may have closed off a career option, and the person must develop new skills for employment.
Many treatment programs integrate family counseling and career counseling in their aftercare. The individual must be ready to do the work of restoring their lives in sobriety, utilizing the options that are available after a program has concluded to support their recovery and prevent the discouragement that can lead to relapse.
Dangers of Relapse
Effective programs include relapse prevention training that can provide the tools to resist temptation to return to drug or alcohol use and to minimize the damage when a relapse occurs. Participants in these programs learn a variety of strategies, including:
- Recognizing the individual triggers that cause them to consider drug or alcohol use.
- Understanding the stages of relapse and designing a plan to intervene before it occurs. These stages include:
- Intervening in the early stages of a relapse incident can prevent the relapse. If relapse does occur, the individual can immediately seek counseling or group support to allow them to get back on track.
- Setting up a support system to rely on when the danger of relapse threatens.
- Maintaining a state of mindfulness over thoughts and behaviors that can lead to relapse.
- Helping others to maintain their sobriety can often provide the motivation for individuals to stay drug-free.
Achieving Success in Recovery
Treatment is a process of learning new behaviors to replace the ones that lead to heroin addiction. This process occurs over time, and it only begins when the individual enters treatment. Many people must enter a treatment program several times before they learn to be completely successful in managing their illness.
Essentially, effective treatment for heroin addiction is a series of steps to learn the underlying problems that cause the person to engage in substance use, to understand addiction itself and how it holds them in the pattern of behavior, to develop techniques for transforming their behavior and to find new ways to engage with the wider world in a way that does not require reliance on substances to deal with stress, anger, frustration and other emotions.
The first year after treatment is the most dangerous time for individuals that are recovering from a heroin addiction. During this period, they may not yet be fully aware of the many triggers that can lure them back into drug use. Individuals may experience depression or anxiety over the difficulty of returning to normal life. They may face a number of challenges in returning to their work or to personal relationships. These situations often cause significant discouragement and stress that can lead them back into substance use.
Many people recovering from addiction find that support groups provide a safe place to air their feelings in the company of other people who are also struggling to rebuild their lives. At support group meetings, individuals in recovery can share their own experiences and learn from others who have experienced many of the same challenges in their own recovery. They can also receive encouragement and practical tips on dealing with the stress of recovery, continuing cravings and other problems. Other members of the group can also encourage those who are obviously having problems to seek additional counseling or treatment to help them stay drug-free.
Heroin dependence and addiction are serious conditions that require professional treatment and ongoing care to prevent a return to use. Patients in treatment often suffer relapses that cause a return to drug use, and sometimes the results are fatal. Some individuals require multiple attempts at treatment in order to overcome the powerful lure of the drug. However, as difficult as the path to recovery can be, many individuals have been successful in beating heroin addiction and have gone on to live happy, healthy lives.
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What Is the Scope of Heroin Use in the United States? (2014, November). Retrieved from https://www.drugabuse.gov/publications/research-reports/heroin/scope-heroin-use-in-united-states
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