Heroin can be injected, smoked, or snorted. Around 23 percent of people who use heroin become addicted to it, according to the National Institute on Drug Abuse. Heroin addiction carries numerous risks, including overdose, and it’s tough to beat. But with the right treatment, many people with even a severe heroin addiction recover successfully for the long-term.
If you or someone you love is addicted to heroin, there is hope. Examining heroin addiction and how treatment helps is beneficial in stopping the use of heroin and can empower you to improve your life on many fronts.
A Short History of Heroin in America
Heroin has a long history in America, starting with its synthesis in 1895. Bayer Company marketed this miracle drug as a cure for everything from a bad cough to menstrual woes. It was used in infant sleep aids and teething powders, headache cures and elixirs for nerves. It was also used to treat morphine addiction, which exploded after the Civil War. Touted as a safe substitute for morphine, heroin was widely considered to be non-addictive. That is, until it heroin addiction became a serious problem in the U.S., particularly in northern states.
In the early 20th century, opium and morphine addiction were rampant, and in 1914, the Harrison Narcotic Tax Act was passed and heavily taxed everyone who manufactured, imported, sold or distributed opioids. The law made it clear that opioid addiction was a moral issue rather than the medical condition it’s known to be today, and it barred physicians from using opioid medications to treat morphine and opium addiction.
In 1924, Congress passed the Heroin Act, which made heroin-laced over-the-counter drugs illegal. The heroin free-for-all ended, but that didn’t prevent use.
In the 1930s and 1940s, injecting heroin became hip among the Harlem jazz scene crowd, and then among the beatniks of the 1950s. This led to the country’s first heroin epidemic.
The second epidemic occurred between 1971 and 1977 when 15 percent of Vietnam War soldiers developed an addiction to it. After the Vietnam War, addiction was largely limited to large cities and primarily affected minority males.
The first two heroin epidemics largely resolved themselves through a lack of purity of heroin and the rising cost of the drug.
According to the National Institute on Drug Abuse, 80 percent of people who are currently addicted to heroin started out abusing prescription opioid painkillers like OxyContin and Vicodin. Several factors have led to the current heroin epidemic:
- The high cost of prescription opioids and the difficulty of obtaining them
- A government crackdown on “pill mills,” or physicians who prescribe them with abandon to users
- New formulations of opioid medications that make them harder to abuse
- The low cost of heroin and the ease of buying it on the street
- The glamorization of heroin abuse in film and TV
In 2015, 591,000 Americans were addicted to heroin, according to the 2015 National Survey on Drug Use and Health.
Why People Abuse Heroin
Addiction almost always has underlying causes that led to the substance abuse in the first place. Common underlying causes of addiction include a history of trauma, mental illness and chronic stress.
Trauma, especially when it occurs early in life, changes the brain in important ways. It increases activity in the brain region responsible for fear, stress and anxiety, and it reduces activity in the region associated with emotional regulation, decision making and memory formation. People with a history of trauma may develop post-traumatic stress disorder or PTSD. Symptoms of PTSD include nightmares, insomnia, anger, fear and flashbacks. Many people with a history of trauma -including sexual or physical abuse, surviving a natural disaster or being a victim of or witness to violence- use heroin to numb emotional pain, alleviate negative emotions, prevent nightmares or cope with fear and anger.
It’s common for people who have a mental illness to self-medicate their symptoms with drugs or alcohol. When this occurs, it’s known as co-occurring disorders or dual diagnosis. Around half of all people who abuse drugs or alcohol have a co-occurring mental illness. Sometimes, the mental illness led to substance abuse as a way to cope. Other times, the drug abuse led to the mental illness as the result of brain changes associated with heavy abuse.
Either way, when a mental illness like anxiety or depression co-occur with a substance use disorder, it requires specialized treatment, known as dual diagnosis treatment, which treats the mental illness in the context of the substance abuse and vice-versa.
How Heroin Hijacks the Brain: Addiction and Dependence
Heroin is highly addictive for two main reasons. First, it produces an intense euphoria that makes people want to keep using it. Secondly, it produces a high level of tolerance almost immediately, which means that you need larger doses to get the desired effects.
Heroin addiction and dependence aren’t the same thing, although they most often occur together.
Dependence is also the result of brain changes, which occur as the brain attempts to maintain normal function by altering its chemical function. These brain changes may begin to occur the first time you use heroin.
The unnaturally massive dopamine rush produced by heroin leads the brain to compensate by reducing the production of dopamine or by reducing the number of dopamine receptors. This occurs with other neurotransmitters affected by heroin as well, and it produces tolerance, which means that increasingly larger doses of heroin are needed to get the desired effects. But the more use occurs, the more the brain continues to compensate.
At some point, brain function may shift so that it now operates more comfortably when heroin is present.
When you try to quit using heroin cold-turkey, normal brain function rebounds. Neurotransmitters that were suppressed now flood the brain, and those that were increased now slow down. This causes physical withdrawal symptoms, which can be extremely intense.
Heroin addiction is characterized by compulsive heroin abuse despite the negative consequences it causes in your life, such as relationship, legal, financial and physical and mental health problems. If you’re addicted to heroin, you’ll find it extraordinarily difficult to stop using on your own.
One of the neurotransmitters heroin acts on is dopamine, which is responsible for feelings of pleasure. Dopamine plays a key role in the memory, learning and reward centers of the brain. It’s designed to keep the species alive by making us want to engage in activities that feel good, like exercising and eating food. Heroin hijacks the brain’s reward system by producing a dopamine release 10 times bigger than what occurs with natural pleasures. This produces mind-boggling euphoria.
When you use heroin, your brain records a memory of the use and the pleasure it produces. It also records a memory of the environmental cues that are present when you use, such as people you use with, places you use or your mental state right before you use. These environmental cues become triggers for cravings once you develop an addiction.
Repeated heroin use causes the nerve cells in the brain’s reward center to begin communicating with the nerve cells in the areas of the brain responsible for planning and executing tasks. This leads the brain to equate liking heroin with wanting it, and the result is intense cravings and compulsive drug-seeking and using behaviors.
Addiction also leads to dysfunctional thought and behavior patterns. Even if heroin leads to serious problems in your life, once you develop an addiction, you’ll continue to use it anyway. You’ll likely minimize the problems or withdraw from them and avoid them. You may even be in denial that your heroin abuse is a problem. You may become paranoid, angry or anxious. But use may continue even if you want or try to cut down or quit.
Diagnosing Heroin Addiction and Dependence
Heroin addiction and dependence are diagnosed under the umbrella of “opioid use disorder,” or OUD. Eleven criteria are used to diagnose an OUD, which will be categorized as mild, moderate or severe, depending on how many criteria are met.
These are the criteria, which cover past-year use. Meeting two or three criteria indicates a mild OUD. Meeting four or five indicates a moderate OUD. An OUD is classified as severe if six or more criteria are met.
- Using for longer periods of time than you intended, or you use more than you planned on.
- Wanting or trying to cut down or quit, but finding you can’t.
- Spending an excessive amount of time seeking, using and recovering from using heroin.
- Experiencing intense cravings that make it difficult to think about anything else.
- Continuing to use despite the problems it’s causing at work, school or home.
- Continuing to use despite the relationship problems it’s causing with family, friends or co-workers.
- Losing interest in hobbies and other activities you used to enjoy.
- Repeatedly finding yourself in risky or physically dangerous situations as a result of using.
- Continuing to use even though it’s making physical or mental health problems worse.
- Developing a tolerance to heroin so that you need larger doses to get the effects a smaller dose once produced.
- Experiencing withdrawal symptoms when you quit using.
Signs of Use
Some of the signs that someone you love may be using heroin include:
- The presence of paraphernalia, including glass pipes, burnt spoons, syringes or the small baggies or balloons in which heroin is sold
- Needle marks on the arms, legs, hands, feet or between the fingers or toes
- Wearing long sleeves or pants to cover up needle marks, even on hot days
- Nodding off to sleep at odd times
- Withdrawal from friends or family
- Stealing money to buy heroin
- Dilated pupils or droopy eyelids
- Flushed skin
- Runny nose
- Slowed breathing
- Neglect of personal hygiene
- A loss of appetite
Many people with an addiction will become defensive and angry if you try to bring it up. They may lie about the extent of the problem, or they may be in denial that there is a problem. An intervention planned and executed with the help of a professional interventionist can help you help your loved one get the professional help that’s needed to end the addiction for good.
Treating Heroin Dependence
The withdrawal symptoms associated with heroin dependence can be excruciating, but they’re not particularly dangerous, with some rare exceptions. Not everyone will experience all of the withdrawal symptoms associated with heroin detox, and symptoms can range from mild to severe. The symptoms of heroin withdrawal are flu-like in nature and include:
- Runny nose
- Body aches
- Nausea and vomiting
- Abdominal cramps and diarrhea
- Agitation and anxiety
- Sleep disturbances
- Intense cravings
Most people who try to detox from heroin on their own go back to using very quickly, if only to end withdrawal. For people who are dependent on heroin, medical detox or medication-assisted treatment can ease or prevent withdrawal symptoms and restore brain function.
Medical detox helps people get through the entire detox process relatively unscathed. It’s supervised by medical and mental health personnel who administer medications as needed to reduce the severity of withdrawal symptoms and shorten the time it takes to detox.
During medical detox, you’ll enjoy a high level of support from staff and peers in recovery. A variety of holistic therapies are offered in high-quality programs and help reduce stress and increase feelings of well-being. These include restorative yoga, massage therapy, acupuncture and nutritional therapy.
It can take anywhere from a few days to a few weeks or longer before symptoms subside. How long it takes for you depends on a number of factors:
- The severity of the heroin abuse
- Your age
- Your general state of physical and mental health
- Your unique biological makeup
Detox gives you an opportunity to unplug from the stressors in your life and begin the healing process in a calm, nurturing environment. You’ll work with your treatment team to identify your own personal motivations for wanting to recover and develop an individualized recovery plan that will help you end the addiction once and for all.
Medication-assisted treatment, or MAT, is the gold standard for treating opioid use disorders. MAT is a combination of medication and therapy that has been shown to be effective for helping people recover from an opioid addiction for the long-term. According to the Substance Abuse and Mental Health Services Administration, research shows that MAT:(5)
- Increases engagement in treatment
- Increases social functioning
- Improves the chances of finding and maintaining employment
- Improves birth outcomes for pregnant women
- Reduces illegal opioid use and associated criminal activity
- Reduces HIV and hepatitis C infections
- Reduces the risk of fatal overdose
- Reduces the risk of relapse
The medications used with MAT have a variety of functions, including:
- Reducing cravings
- Preventing withdrawal
- Blocking the effects of opioids
- Improving brain function
Approved MAT Medications
Three medications are approved for use with MAT: Methadone, buprenorphine and naltrexone.
Methadone has been used in MAT since the Narcotic Addict Treatment Act of 1974 allowed for the establishment of federally licensed methadone detox and maintenance clinics. A synthetic opioid agonist, methadone acts on the same receptors that painkillers and heroin do, but its effects are more gradual and less intense than those of other opiates. It prevents withdrawal from setting in, including the intense cravings that can drive you to distraction and back to using.
Since methadone has a high potential for abuse, it’s only available as a daily dose that must be administered at a licensed facility. For this reason, it can be hard to stay on methadone. But if you miss a dose, withdrawal will begin, and relapse is highly likely once symptoms start.
Buprenorphine is a semi-synthetic opiate approved by the FDA in 2002 to use with MAT. A partial opioid agonist, buprenorphine will produce the same effects as full agonists like methadone and heroin, but the effects are far weaker.
Buprenorphine has a ceiling effect, so larger doses won’t increase its effects. For this reason, it can be prescribed by a physician and taken at home, precluding the need for a trip to the clinic.
Suboxone is the most commonly used buprenorphine drug. It’s a combination of buprenorphine and naloxone, the overdose reversal drug. If Suboxone is taken in larger doses than prescribed, or it’s crushed and snorted, the naloxone will kick in and prevent the euphoric effects and send you into withdrawal.
Naltrexone has been used since 2010, when it was approved by the FDA for MAT. Naltrexone is an opioid antagonist, which means that it blocks the effects of opioids if you take them while on naltrexone. It also reduces cravings.
Naltrexone can be taken as a daily pill or a monthly injection. Unlike buprenorphine and methadone, which can be started at any time in the recovery process, naltrexone can’t be taken until all traces of opioids are out of your system. Therefore, MAT with naltrexone requires that you go through detox before starting on it.
The Duration of MAT
The medication component MAT can last for as long as it’s needed.
The purpose of MAT is to reduce cravings and help restore normal brain function so that you can focus on treatment and develop the skills, strategies and lifestyle changes that support long-term recovery.
Some people will stay on their medication for just a few months, while others will stay on it for years. Some will take medication for the rest of their lives.
The counseling component of medication-assisted treatment should last at least 90 days, according to the National Institute on Drug Abuse.
While some treatment centers may offer shorter programs, such as four- and eight-week programs, anything less than 90 days is of limited effectiveness.
That’s because addiction is far more complex than dependence, and effectively treating it takes time.
How Heroin Addiction Treatment Works
Detox and medication alone won’t do much to address an addiction, which is far more complex than dependence. Without treatment, the risk of relapse after detox or during MAT is very high. One study, published in the Irish Medical Journal, found that 91 percent of patients relapsed after detox- 59 percent of them within a week. Those who participated in a short treatment program after detox either didn’t relapse or had significantly delayed relapse.
Many people, including many of those who are addicted to heroin, believe that relapse is a sign of a lack of willpower. But the National Institute on Drug Abuse stresses that good intentions and willpower are rarely enough to end an addiction for good. That’s because heroin addiction almost always:
- Has underlying causes that need to be addressed to end the addiction.
- Causes serious life problems that need to be solved for a successful recovery.
- Leads to dysfunctional patterns of thinking and behaving, which must be changed to prevent relapse.
Ending an addiction is about more than simply quitting using. It’s about addressing underlying causes and developing the skills and strategies you need to cope with physical or mental pain, negative emotions, cravings, stress and other powerful relapse triggers. It’s about helping you identify your strengths and values and find purpose and meaning in life. These are what lead to successful recovery because they remove the need and desire to use heroin.
A holistic treatment program that addresses issues of body, mind and spirit offer the best possible outcomes of treatment, according to the Substance Abuse and Mental Health Services Administration. A holistic approach to treatment involves a variety of traditional complementary therapies along with other services and interventions that address all of an individual’s unique needs and issues. These help people in recovery:
- Identify dysfunctional thought and behavior patterns and develop healthier patterns of thinking and behaving.
- Develop coping skills for dealing with stress, cravings and other relapse triggers.
- Address underlying problems behind the addiction.
- Improve self-esteem, self-confidence and self-awareness.
- Find purpose and meaning in a life without heroin.
- Learn to relax and have fun without heroin.
- Repair damaged relationships.
- Restore function to all corners of life.
Traditional therapies are research-based therapies known to be effective for treating addiction. They mostly consist of psychotherapies, or “talk” therapies.
Dialectical behavior therapy helps you develop emotional coping skills and reduce conflicts in your relationships.
Art of music therapy helps you express difficult emotions and experiences and improves self-awareness, reduces stress and feelings of shame and increases engagement in treatment.
Yoga promotes mental and physical balance, flexibility and strength. It reduces stress, increases mindfulness and fosters emotional healing.
Biofeedback teaches you to reduce stress on the spot through techniques like meditation, deep breathing and progressive relaxation.
The most effective and commonly used traditional therapy used to treat addiction is cognitive-behavioral therapy, which helps individuals evaluate their thoughts and behaviors, address underlying issues and develop essential coping skills.
Acceptance and commitment therapy helps you develop psychological flexibility and learn to accept, rather than avoid or suppress, negative emotions and experiences.
Complementary therapies used in addiction treatment are research-based therapies that have been shown to be effective for treating addiction when they’re used along with traditional therapies.
Family therapy helps to restore function to the family system by improving communication among family members and repairing damaged relationships.
Other Services and Interventions
Addressing the individual’s multiple needs is essential for successful recovery. A variety of services and interventions are used as needed to help restore function to every aspect of your life. These include:
Housing assistance helps you to find safe, stable housing once treatment is complete.
Psychoeducational classes help you better understand addiction and how it’s treated. Psychoeducational classes are also used to inform clients about subjects like co-occurring mental illnesses, relapse prevention and medications used in treatment.
Life skills classes
Life skill classes help you develop the essential life skills you need for successful recovery. These may include domestic, financial, parenting or relationship skills.
Medical care helps to address any medical issues and get them under control.
By attending to your multiple needs, issues and challenges, treatment helps to remove the need -and the desire- to use heroin.
Legal assistance to help you navigate the legal system.
Vocational or educational assistance
Vocational or educational assistance help you find and maintain a job or return to school.
There is Hope
Hope is the foundation of recovery, according to the Substance Abuse and Mental Health Services Administration. Hope is the belief that a better life is possible. And it is possible. Many people recover from a heroin addiction -even a severe one- and go on to live happy, productive lives.
Recovery isn’t easy, but neither is being addicted to heroin. Treatment can help you end a heroin addiction for the long-haul while improving your life on every front. A better life is possible, and treatment can help you live it.
- What is Heroin?
- Prescription Opioids and Heroin
- Overdose Deaths Involving Opioids, Cocaine, and Psychostimulants
- The terrible toll of the opioid crisis is even worse for women
- Medication and Counseling Treatment
- Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)
- Lapse and relapse following inpatient treatment of opiate dependence.
- Understanding Drug Use and Addiction
- SAMHSA Working Definition of Recovery