woman struggling with heroin addiction

Treatment for Heroin Addiction: Where You Should Start?

Heroin is an opioid that comes from morphine, which is a substance that comes from opium poppy plants. It can be injected, sniffed, snorted, or smoked. Also called opioid use disorder, it is an illness that involves changes in the brain and behavior as a result of heroin use.

If you have a substance use disorder, like most people, you have probably been hiding it from yourself and others for quite a while now. Since you are reading this, you probably suspect that you (or a loved one) have a problem. So, let’s start with you.

Signs You May Already Be Addicted

Early in the use of heroin, there may not be any symptoms of a disorder, especially if the person is taking great measures to hide the use. As the use increases, it gets harder to hide. 

Signs of heroin use can include:

  • Agitation or drowsiness
  • Slurred speech
  • Constricted (smaller) pupils
  • Depression
  • Memory problems
  • Needle marks (if injecting heroin)
  • Runny nose or nose sores ( if snorting heroin)
  • Constipation
  • Reduced sense of pain
  • Changes in appearance or lack of personal hygiene
  • Changes in behavior like secrecy or aggression
  • Money issues such as missing money or needing more and more without a logical reason
  • Problems at school or work
  • Risky or dangerous behavior

One of the distinctive features of addiction is a person not being able to stop in spite of multiple attempts and the negative consequences associated with continuing. If you are using, you might be realizing that you need to use more and more heroin to get that same pleasant feeling you used to get initially.

Who Is Most At Risk?

Anyone who takes opioids runs the risk of developing an opioid use disorder. Some factors increase the risk of developing a drug addiction. According to the Mayo Clinic, some of the risk factors include:

  • Family or personal history of addiction to other substances.
  • Heavy tobacco use.
  • History of severe depression or anxiety.
  • Unemployment
  • Exposure to high-risk environments and people.
  • History of risk-taking behavior.

It needs to be mentioned, though, that even if you or someone you care for has one or many of the risk factors, it doesn’t mean they’ll necessarily develop a substance use disorder. Addiction has many facets. It includes genetic, psychological, and environmental factors.

Diagnosing Heroin Addiction

Diagnosing any substance use disorder, including opioid use disorder, is done through a complete examination and evaluation by a psychiatrist or psychologist. In some states, a licensed drug and alcohol counselor may make the diagnosis.

Lab tests, such as blood and urine tests, are used along with a clinical interview. If you have a suspicion that you or someone you care about has a heroin addiction, talk to a professional. A licensed drug or alcohol counselor, a social worker, a physician, or a psychiatrist will be able to answer questions and help you get the help you need.

Treatments for Heroin Use Disorder

There is no one perfect cure for any drug addiction, including heroin. There are several effective treatments available to help a person get into and through recovery. The kinds of treatment used depend on:

  • The individual
  • The substance used
  • Coexisting medical conditions

Both behavioral and pharmacological (medications) approaches help restore some degree of normalcy to brain function and behavior.

Although both treatments are useful when used alone, research shows that for most people, Combining both types of treatments, with the supervision of professionals, is the most effective method.

Pharmacological Treatment

Research has shown that medical treatment of heroin use disorder increases the likelihood of patients remaining in treatment programs, and decreases drug use, infectious disease transmission, and criminal activity.

Detox and Beyond

People addicted to opioids like heroin undergo withdrawal symptoms when they first quit, which may be severe. Medications help in the detoxification stage to ease craving and other physical symptoms that often cause a person to relapse. Symptoms include:

  • Pain
  • Diarrhea
  • Nausea and vomiting
  • Restlessness
  • Severe muscle and bone pain
  • Sleep problems

Lofexidine has been used to treat high blood pressure in the past but is now more commonly used to help with the physical symptoms of opioid withdrawal. It’s not a treatment for addiction but is a useful aid in detoxification when followed up by some evidence-based treatment.

The medications developed to treat opioid addiction work through the same opioid receptors in the brain as the addictive drug. The difference is that they are safer and less likely to create the same harmful behaviors characteristic of substance use disorders. There are three types of medications:

  1. Agonists—Agonists activate the opioid receptors in the brain. Methadone is a slow-acting opioid agonist. Methadone is only available through approved outpatient treatment programs and is dispensed on a daily basis. Lofexidine is also in this class.
  2. Partial agonists—Also activate the opioid receptors but produce a limited response. Buprenorphine is a partial agonist that relieves drug cravings without producing the “high” or dangerous side effects. The FDA has approved a 6-month buprenorphine implant and a once-monthly injection, which ends the need for daily dosing.
  3. Antagonists—They block the receptor and prevent the rewarding effects of opioids. Naltrexone is an opioid antagonist. It blocks the action of opioids, is not addictive or sedating, and doesn’t result in physical dependence. There is now a long-lasting injectable formula (Vivitrol) that is given once a month, eliminating the need for daily dosing.

Medications are selected based on the patient’s specific medical needs and other factors.

Behavioral Therapy

There are many behavioral treatments available for opioid use disorder, and they can be effective in outpatient and residential programs. Behavioral therapies include:

  • Individual and Group therapy—These therapies help the person identify their personal triggers for drug use, including any issues that might be causing emotional discomfort. Groups can help an individual build coping skills and develop ways to deal with a relapse.
  • Contingency management—Contingency management uses a voucher system where patients can earn points based on clean drug tests. The points earned can be exchanged for items that encourage healthy living such as gym memberships, dinner at a local restaurant, etc.
  • Cognitive Behavioral Therapy (CBT)—CBT is designed to help adjust the patient’s expectations and behavior as it relates to drug use. It also helps increase skills in coping with various life stressors.

How Did I Get Addicted?

No matter how you got it into your body, heroin gets to the brain quickly. After using it just one or two times, it can be difficult to stop yourself from using it again.

Heroin is an extremely addictive opioid that binds to receptors in the brain to release the chemical dopamine. Dopamine is used by your nervous system to send messages between nerve cells. Dopamine plays a role in how we experience pleasure and pain. You may think and walk slowly. The whole world slows down. Because it blocks you from getting pain messages and slows your heart rate and breathing, if you overdose, you may die.

Your body sends it along four pathways in the brain. Heroin enters the brain rapidly and increases the activity of the reward pathway by increasing dopamine transmission. Because heroin and other drugs activate the pathway for reward, they can be misused.  

Most people don’t start out to be heroin users. Often, an individual is prescribed opioid pain medication by their doctor. When the prescription runs out, and the doctor won’t prescribe more, the craving for pleasure and relief begins. Enter heroin—cheaper and stronger than prescription opioids and easier to get.

If a person takes an opioid repeatedly over time, the brain doesn’t naturally produce dopamine the way it used to. This results in the person taking higher and more frequent doses to achieve the same level of pleasure. You can now see that addiction is truly a disease of the brain.

Short- and Long-term Effects of Heroin Use

If you have been using heroin, you are aware of the surge of pleasure called a “rush.” There are other common effects, including short-term effects like:

  • Dry mouth
  • Warm flushing of the skin
  • Heavy feeling in the arms and legs
  • Nausea and vomiting
  • Severe itching
  • Clouded thinking
  • Going in and out of consciousness called “on the nod.”

For people who have been using heroin over the long term, these effects may develop:

  • Insomnia
  • Collapsed veins for people who inject the drug
  • Damaged tissue inside the nose for people who sniff or snort it
  • Infection of the heart lining and valves
  • Abscesses (swollen pus-filled tissue_
  • Constipation and stomach cramping
  • Liver and kidney disease
  • Lung complications, including pneumonia
  • Mental disorders such as depression and antisocial personality disorder
  • Sexual dysfunction for men
  • Irregular menstrual cycles for women

Further Complications

Because heroin often contains sugar, starch, or powdered milk, blood vessels leading to the lungs, liver, kidneys, or brain can become permanently damaged.

Sharing drug injection equipment and having impaired judgment from drug use increases the risk of contracting infectious diseases such as HIV and hepatitis.

Heroin Relapse

One of the most common complications you may face is a relapse after treatment. Addiction is a complex condition, and recovery often includes setbacks. Rates of relapse are between 40- to 60%. This is similar to relapse rates with other chronic diseases like asthma, hypertension, and Type 1 Diabetes.

People relapse for many reasons, but the major one is the person’s belief that he has gotten control of his addiction and wants to test it out. Other reasons include:

  • Thinking that one last time can’t hurt.
  • An inability to cope with stress
  • Difficulty managing physical or emotional pain
  • Substituting one drug for another
  • Difficulty addressing triggers

If you relapse, you are more susceptible to overdosing. A dose of heroin you once used regularly may now be fatal.

Overdose

A heroin overdose happens when a person uses enough of the drug to produce a life-threatening reaction or death. Heroin overdoses have increased in recent years. Overdose deaths doubled between 2010 and 2012. When a person overdoses, their breathing slows or stops. This decreases the amount of oxygen that reaches the brain. This can have short- and long-term mental effects as well as effects on the nervous system, including permanent brain damage.

Sometimes heroin is laced with other drugs. A rise in overdose deaths in 2014 is believed to be due to heroin being laced with the painkiller fentanyl. Even though it’s illegal, to meet the demand, traffickers have intensified their production and increased the amount smuggled into the U.S.

What’s My Outlook for the Future?

Heroin addiction is a serious condition but it doesn’t have to be permanent or even long term. It is treatable. There’s help out there if you want it. Or if someone you know needs it. Research shows that it is possible to have a successful recovery even if the individual doesn’t go voluntarily. Do not wait to “hit bottom.”

There is strong scientific evidence that the combination of medical and therapy-based interventions can give you the chance to recover a healthy life. To help eliminate the stigma placed by society on people, new federal rules have been enacted governing confidentiality and disclosure of substance use disorder patient records.

You already know that this is not something that can be handled at home. There is a recovery center in New Jersey with highly qualified, experienced, addiction specialists and medical professionals. Our professionals know that this is a chronic brain disease, not a moral failing or a character flaw. We focus on meeting the needs of each patient. Contact us now and our North Jersey Recovery Center specialists can help you get your life back.

Reviewed for Medical & Clinical Accuracy by Brian Ostertag

brian-ostertag-150x150Brian Ostertag, BA, MA, LCADC, CCS, is the Clinical Director for North Jersey Recovery Center. Brian is a compassionate leader with a desire to see others exceed, and who believes that people want to work hard at something they find meaningful and believe in. He is a strong addiction services professional with degrees in Psychology Addiction Studies, and Pastoral Counseling.