Heroin Addiction and Abuse
Heroin is a potent opiate with an intense effect on the brain reward system.
Heroin rigs this reward system by influencing the production of feel-good chemicals in the brain, such as dopamine and endorphins.
"Out of everyone who tries heroin for the first time, nearly one in four become addicted."
In normal circumstances, the brain releases these chemicals to reward behavior necessary for survival, like eating, and helping people cope with pain.
The brain quickly links heroin to the activation of these chemicals in the brain reward system. Eventually, the user becomes addicted and can’t function without the drug. This, along with the withdrawal symptoms of heroin, makes it hard for users to quit on their own.
The signs of heroin addiction are not immediately recognizable. Family members often dismiss strange behaviors in their loved ones as a result of fatigue, stress or the effect of having one drink too many. People rarely consider the possibility of heroin addiction.
If confronted, your loved one may simply not admit to a substance abuse problem. This makes it more difficult to make arrangements for recovery. So, what is heroin? How serious is its abuse, and how do you recognize the signs?
In this post, we discuss all you need to know about heroin addiction, including its effects, abuse symptoms and how to seek professional help. If you are suffering from the effects of substance abuse, or want to help someone you know, this information can help you get started with the right course of treatment.
Heroin is a highly addictive painkiller synthesized from morphine, which comes from the seeds of the poppy plant. Because poppy plants are used to make opium, any drugs derived from them are considered opiates. Both heroin and morphine are opiates.
Heroin is also known by names like junk, smack or “H.” Street heroin is often combined with dangerous additives like morphine or the powerful pain reliever fentanyl.
Approximately four million Americans have tried heroin at least once in their lifetime. Symptoms of prolonged heroin use can include severe itchiness, depression and collapsed veins.
Heroin has been described as "the hardest of drugs", "a serious community problem" and "a killer". The drug is illegal and difficult to obtain from any reputable source. However, people still find a way to access it.
Heroin addiction is total dependence on the substance itself. If you're addicted to heroin, it is almost impossible to function normally without taking it every few hours. This is because of its ability to alter the brain's reward pathway and change its structure and function. People who suffer heroin withdrawal are reacting to the absence of the drug because it has established itself in the brain's normal functions.
Recognising heroin addiction is key to getting help, for yourself or a family member. Heroin acts as a 'downer', which means it quickly induces a state of relaxation and euphoria. Like many opiates, it blocks the pain receptors in the brain and makes you unable to feel pain. If you use heroin, a common addiction test would be to see if you can go without the drug for 36 to 48 hours.
If you suspect a loved one or family member of heroin addiction, recognizing the following signs could provide some clues:
- Constricted (tiny) pupils
- Breathing difficulties
- Unnecessary outbursts and irritability
- Cycles of hyperactivity followed by suddenly sleeping
- Droopy appearance, as if their limbs are heavy
What Does Heroin Look Like?
Not all heroin looks the same. It comes in several different forms and can be abused in several different ways, including snorting, smoking and injecting.
- Fine white powder - This is the purest form of heroin.
- Brown or black powder - This form of heroin gets its color from additives and is more common than pure heroin.
- Black tar heroin - This form of heroin comes as a black sticky gel.
Uses of heroin
While morphine is a common choice for relieving mild or severe pains - or sedate patients before an operation - heroin is seldom used for medical reasons. In some countries, it can be administered as an effective analgesic. However, in other countries (like the US), it is banned as a drug of abuse and has no medicinal purpose whatsoever.
Heroin users have described the drug’s high as an intense feeling of well-being. When someone injects heroin, they often experience a “rush” from the drug reaching the brain so quickly.
The rush from intravenous heroin use lasts about two minutes. Intravenous users have likened the rush to orgasm in terms of pleasure. As heroin travels through the bloodstream, the high lasts for four to five hours.
The general effects of using heroin include:
- Reduced anxiety
- Relieved tension
The effects of heroin can seem harmless to those who are experimenting with the drug. Although it may produce some dizziness and drowsiness, these effects feel enjoyable. Unlike substances such as alcohol or ecstasy, there generally isn’t a hangover or comedown from initial heroin use, which is an attractive benefit to new users.
What may seem like “harmless” or occasional heroin use often devolves into addiction because tolerance builds quickly. Eventually, the user cannot feel normal without taking the drug because their brain cannot produce natural amounts of dopamine on its own. As the user increases their doses, they are at a greater risk of a fatal heroin overdose.
Signs of a heroin overdose include:
- Shallow breathing
- Dry mouth
- Tongue discoloration
- Very small pupils
- Slow pulse
- Bluish lips
Pharmacology of heroin
Why do people inject heroin? Among other abused street substances, heroin is most associated with injection. This is because of the instant impact the user experiences. Being a Class-A drug, heroin is highly addictive and the withdrawal effects are more severe than most drugs. Continuous usage can eventually lead to death if you don't cease usage.
Overdosing on heroin is potentially fatal and requires quick medical attention. This occurs when you ingest more heroin than your body can metabolise.
Signs and symptoms of overdose may vary according to:
- The quantity and purity of the heroin used
- Additional substances consumed
- Age and weight of the user
Common warning signs of an overdose include bluish nails or lips, labored breathing, pinpoint pupils, weak pulse, delirium, extreme drowsiness, vomiting, loss of consciousness and coma.
Heroin Addiction Defined
Heroin addiction is one of the most dangerous addictions in the world. Although a recent survey reported that the number of young addicts in the UK had reduced by 79% in the past few years, it remains a disturbing problem amongst families with affected people.
Being able to spot a heroin dependency in your family member or friend can save their life. Heroin addiction is simply the inability to perform regular tasks because of total dependence on heroin. Sooner or later, withdrawal sets in, forcing you to abandon all activity and seek the drug.
If you're addicted, you will have trouble socializing with a new crowd or group of friends. Isolation is a common behavior among most addicts. Before long, personal and legal problems will become a regular feature in a person's life.
Why is Heroin So Addictive?
Among street drugs, heroin is famous for its powerful addictive properties. People who use the drug recreationally often discover that they rapidly transition to compulsive usage that is almost impossible to control. So, why is it so addictive?
The reason can be traced to the brain. Addiction is characterized by the psychological need for drugs that exceeds your ability to control the intake of drugs. The changes begin in the brain cells and research has shown that heroin affects major areas of the brain, altering the reward pathway and the ways in which we seek instant pleasure.
Heroin is so powerful, its presence in the brain leads to the secretion of large quantities of dopamine (the reason for euphoria). Eventually, this stresses the brain cells. If used continuously, the cells tend to burn out, forcing you to take more heroin to feel the initial 'euphoric effect'. Over time, tolerance is built and the absence of heroin triggers withdrawal symptoms.
Why Is Heroin Addiction So Hard to Treat?
Overcoming addiction is difficult, but overcoming heroin addiction is a challenge that can break even the strongest individuals. That said, it is not impossible to beat dependence, but it will take all your will and commitment, along with the right treatment procedures.
Heroin has become famous for the hold it has on its victims. This can be attributed to the physically dependent nature of the drug. Most substances either have physical or psychological withdrawal symptoms attached.
For heroin, withdrawal leads to severe physical effects that make addiction treatment very difficult. When a user stays off the drug (for some hours), the painful effects of withdrawal set in, which leads to them taking the drug for relief.
Physical withdrawal effects include:
- Muscle spasms and joint pain
- Nausea and vomiting
- Increased heart rate and blood pressure
- Stomach cramps
There are also psychological effects of withdrawal, such as anxiety, depression, anger, paranoia and restlessness.
Famous Heroin Addicts
Heroin is often described as the scourge of poor neighbourhoods, because of its popularity in areas with high crime rates. On the contrary, it is also used by the wealthy and educated. Even celebrities have fallen victim to heroin addiction.
Famous heroin addicts include:
- Steven Tyler (Lead vocalist of rock band, Aerosmith)
- Philip Seymour Hoffman (Actor)
- Courtney Love (Singer, Actress)
- Tom Petty (Country singer)
- Janis Joplin (Singer)
- Billie Holliday (Jazz singer)
- Russell Brand (Actor, comedian)
- Corey Feldman (Actor)
- Chris Farley (Actor, comedian)
There is nothing glamorous about heroin. Some of the aforementioned celebrities were able to clean up. However, a few like Janis Joplin and Chris Farley died of an overdose. Spotting the warning signs in time could have prevented their deaths.
Symptoms, Signs and Side Effects of Heroin Abuse and Addiction
You can save yourself or someone you love by identifying signs of heroin abuse. Perhaps you have noticed rapid mood changes or secretive behaviour in a family member? If they've started lying or staying isolated from colleagues to indulge in their habit, this is a bad sign.
Are they spending time with a suspicious new group of friends? There are common physical signs that reveal heroin addiction, such as:
- Mumbled speech
- Severe scratching
- Sexual dysfunction
- Sudden mood swings: excitement to disinterest to depression
- Constricted pupils
- Neglecting responsibilities: school, work and family
Common health signs may include injection scars, regular nosebleeds (from snorting) and frequent respiratory problems.
These are symptoms that can be observed immediately after taking heroin. At first, the user feels the 'rush' of euphoria, which may last for a few hours. When it wears out, a sudden feeling of dread and depression follows. During this time, they will act out or exhibit violent mood swings, irritability and fatigue.
The chronic use of heroin leads to health complications such as cardiac arrest, liver failure, kidney disease, skin abscesses, respiratory tract infection, HIV and so on.
Heroin and Other Drugs
People who abuse painkillers have a higher risk of experimenting with and becoming addicted to heroin. Painkillers like OxyContin are classified as opioids because they are synthetic, opiate-like substances activating the same receptors in the brain as heroin.
Painkillers have similar effects to heroin, but these pills can be expensive and hard to acquire. Many people who become addicted to painkillers turn to heroin because it is cheaper and more accessible.
The way painkillers are abused can lead to future heroin abuse as well. Some people crush up painkillers to snort or inject, which introduces them to methods of administration commonly used in heroin abuse.
"Close to 50 percent of young people who use heroin reported abusing painkillers before moving on to heroin. Some speculate that heroin may be easier to obtain than painkillers."
It is not uncommon for people to mix heroin with other drugs to heighten its euphoric effect. One commonly abused combination is heroin and cocaine, otherwise known as a speedball. Although it's not fully understood why this poly-drug is more popular, users have said that the concurrent cocaine use leads to a rush that serves as a relief for the downing effect of heroin use.
Besides cocaine, heroin is often mixed with substances such as alcohol, meth, MDMA, GHB or opioids.
The rate of poly-drug usage has increased due to the following factors:
- 'Normalization' of illicit drug abuse
- Prevalence of illicit substances in mainstream channels
- Wilful disbelief of the possible risks
People combine heroin with other drugs for many reasons, but by doing so, they increase their exposure to risk and dependence on other drugs. It also raises the chances of a drug overdose.
Prescription Opioids and Heroin
Opioids are a class of drugs that are derived from opium. Heroin is a common example. However, there are prescription opioids used by physicians to treat pain. Examples of prescription opioids are Oxycodone, Hydrocodone, Morphine, Fentanyl, Methadone and Oxymorphone.
Fentanyl or any other prescription opioid (such as methadone or oxymorphone) is used to amplify the effect of opioid in a person's system. Like any other poly-drug combination, the consequences can be dangerous.
It can increase the severity of opioid side effects, such as nausea, disorientation, and respiratory collapse. This may cause breathing problems and raise the risk of falling into a coma.
The relationship between Heroin Addiction and HIV/Hepatitis
If you use heroin, there is a high risk of contracting HIV, viral hepatitis and other infectious diseases transmitted through body fluids (saliva, semen) or blood. This is because heroin addicts tend to share injection apparatus that may have become contaminated by infected users.
You can also be infected by having sexual intercourse or making intimate contact with an infected person. Snorting or smoking heroin doesn't eliminate the risk of infectious diseases like HIV/AIDS/hepatitis, because people who use heroin often engage in risky sexual encounters that can expose them to these infections.
The Use of Methadone for Heroin Addiction
The use of methadone in treating heroin addiction remains a controversial method. Although methadone is a prescription opiate, the choice to use it as heroin detox medication draws mixed reactions because of its tendency to create a poly-drug-type effect.
The Western Journal of Medicine has defended this approach by stating that methadone is a preferred drug because unlike heroin, it is a long-acting opioid. Therefore, it doesn't have the immediate sedative effects of heroin, a short-acting opioid.
Who is using Heroin?
The figures for heroin consumption appear to be dropping, so who is using it? In the past, people believed that heroin use was confined to a small area of inner cities (so-called poor neighborhoods), but it has transcended those places to the suburbs and even the countryside.
A study revealed the consumption of heroin to be along racial lines. According to the results, about 90% of participants who began using the drug in the past decade were white. Gender-based differences were also observed; while men accounted for 80% of users in the 1960s, the figures for both men and women were approximately equal by 2010.
The report also showed that heroin users are getting older. The average age of heroin users has increased from 16 years old in the 1960s to 23 years old in 2010.
Heroin Abuse Statistics
According to a national statistics report, the number of 18 to 24-year olds in England seeking treatment for Heroin addiction dropped 79% in the last decade. This was attributed to the stigma surrounding the use of heroin and users' changing preferences for intoxication.
In March 2015, 2,367 people from the same age group presented cases of heroin and opiate addiction at about 900 drug treatment services in England. This pales in comparison to the 11,351 patients in 2005, according to statistics from the National Drug Treatment Monitoring System (NDTMS).
They made up a small fraction of the 149,807 opiate addicts who sought help for treatment during the year - a number that is itself down by 12% from a 170,032 peak in 2009 -2010.
Treatments for heroin addiction
Treatment begins with talking to someone you trust. It could be your partner, family member or close friend. They should provide support in seeking professional help. If you don't have someone to talk to, our helplines are always available.
Treatment is usually a two-pronged process; the detox stage and rehab therapy. While you can undergo detox at any hospital, some rehab centers also provide detox services on site.
What you or your loved one will need from a rehab center will vary according to:
- The quantity of heroin used before commencing treatment for addiction
- The duration of abuse prior to the time you begin treatment
Based on the answers to these questions, the addiction specialist will categorize your situation under a low-dose/short-term addiction or a high-dose/long-term addiction. The categorization will determine whether you require an inpatient addiction treatment, an outpatient addiction one or a bit of both.
Throughout the UK, there are accredited rehab centers built to provide both treatment options.
Pharmacological Treatment (Medication)
Detoxing from heroin addiction can feel unbearable due to the effects of withdrawal, but if you are in a proper facility with access to qualified physicians, you'll be treated with medication that can help alleviate the pain.
Each person is different, and your individual needs make it necessary to choose a rehab with access to good medicine. Naturally, the use of medicine begins at the first stage of treatment with other modalities, as the physical effects of withdrawal begin to manifest.
In rehab, depending on the type of program, you'll receive therapy aimed at treating specific problems. The first step is usually to identify the underlying cause of your addiction. What event made you start using the drug? Some people resort to heroin to overcome grief, while others use it to ease physical pain from an injury or accident. When an underlying reason is identified, the addiction therapist helps you to overcome it.
Therapies may also be used to help you fight cravings by initiating certain behavioral changes.
Examples of behavioral therapies are:
- Cognitive behavioural therapy
- Cognitive behavioural play therapy
- System desensitisation
- Aversion therapy
Aversion therapy is a form of treatment aimed at helping you develop a strong dislike for the addictive substance. Its application is performed using various techniques.
Heroin is one of the most addictive substances in existence, and an addiction to this drug is hard to overcome without help. If you or someone you care about is suffering from a heroin addiction, find treatment and support that can help.
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