What is Heroin Addiction?
Heroin is a drug derived from a natural substance found in the seed pods of the opium poppy plant. Heroin is classified as an opioid drug, and it is related to synthetic prescription drugs such as Vicodin and fentanyl.
Heroin is an illegal drug typically sold on the street in the form of a brown or white powder or a sticky black tar-like substance. The drug is consumed in a variety of ways, including smoking, snorting, or injecting.
The effects of heroin on the body are quick and intense. The drug binds directly to cells in the brain and elsewhere, producing feelings of well-being and blocking pain perception. Repeated use of heroin alters the user’s brain chemistry. It results in physical dependence, meaning that users consistently use the drug (in ever-increasing doses) to avoid unpleasant and potentially harmful withdrawal symptoms.
Symptoms of Heroin Abuse and Addiction
Along with the pleasant feelings of the high, short-term use of heroin often causes unpleasant side effects, including:
- Dry mouth
- Nausea and vomiting
- Mental confusion
- Unconscious or semi-conscious state
Long-term complications of chronic heroin abuse can include:
- Pneumonia and lung disease
- Collapsed veins
- Heart infections
- Skin conditions and infections
- Sexual impotence
Symptoms of heroin withdrawal for dependent users include:
- Intense craving for the drug
- Muscle pain
- Bone pain
- Extreme itchiness
- Cold flashes
- Uncontrollable movement of the legs
- Nausea and vomiting
Withdrawal symptoms begin a few hours after the drug is last used and usually peak within 48 to 72 hours. Symptoms often subside after about a week but may recur for months or years.
What Causes Heroin Addiction?
When someone uses heroin, the drug binds with parts of cells that are specifically sensitive to opioids. The opioid receptors are present in cells throughout the body, but the drug’s most irresistible effects come from its interaction with opioid receptors in the brain. When heroin affects these cells, the level of a chemical called dopamine increases in the brain. Elevated dopamine levels produce the good feelings associated with the drug’s high.
The pleasurable effects of dopamine disappear when the drug isn’t present, so the user is driven to seek more of the drug. As the drug’s use continues, the brain becomes less sensitive to its effects, triggering the need for higher doses to achieve the same result. Eventually, changes in the user’s brain chemistry become so pronounced that abstinence from the drug produces physical withdrawal symptoms.
In addition to the drug’s physical addictiveness, some factors increase the likelihood that a given individual will abuse or become dependent on heroin. These risk factors include:
- Family or individual history of drug use or abuse
- Tobacco use
- Poverty or unemployment
- First drug use at a young age
- Criminal history
- Depression, anxiety, or other mental illness
- Exposure to environments where drug use is prevalent
Is Heroin Addiction Hereditary?
Addiction to heroin and other drugs does not stem from a single cause. In many cases, the most significant factors that lead to addiction are environmental. Users are moved to drug use because of situations surrounding them, and their continued drug use leads to addiction. There is, however, evidence to suggest that some people are more susceptible to becoming addicted to certain drugs after they begin to use them. That susceptibility seems to be, to some degree, determined by genetics and is likely inherited within families.
Scientists do not fully understand inherited addiction risk. In heroin addiction risk, research has focused on genes associated with opioid receptors, neurotransmitter creation, and the brain’s pleasure-and-reward circuitry. While studies have suggested several genes that may be involved, more research is needed.
How is Heroin Addiction Detected?
Heroin users stand the best chance of sustained recovery when they receive treatment as soon as possible. However, it can be challenging to detect when someone is using heroin because they will often attempt to hide their drug habit.
Warning signs that a loved one might be abusing or addicted to heroin include:
- Lethargy or sleepiness
- Unexplained and sudden weight loss
- Poor hygiene or changes in appearance
- Loss of interest in daily activities
- Constricted pupils or bloodshot eyes
- New, unusual problems at work or school
- Lying about or hiding their behavior
How is Heroin Addiction Diagnosed?
Heroin addiction can be formally diagnosed as a clinical disorder called opioid use disorder. To be diagnosed, the heroin use must cause significant impairment or distress, and at least two of the following symptoms must be present over 12 months:
- Heroin use is greater than the user intends, either in dosage or frequency.
- The user has a desire to quit or has unsuccessfully tried to quit.
- The user spends significant time acquiring, using, or recovering from the drug.
- The user has an intense craving for the drug.
- Drug use is interfering with the user’s obligations or responsibilities.
- Drug use continues despite the harm it does to the user, physically or otherwise.
- Drug use interferes with the user’s everyday activities and routines.
- The drug is used in dangerous situations.
- Tolerance for the drug develops, creating the need for higher doses or more frequent use to achieve the same effect.
- Abstinence from the drug causes withdrawal symptoms.
How is Heroin Addiction Treated?
Heroin addiction is tough to beat, and relapses are very common. Treatment approaches can include both medication-based treatments and behavioral therapies. These approaches are often used in combination, and treatment programs are most effective when tailored to best suit the individual patient.
- Buprenorphine and methadone. These drugs bind to the body’s opioid receptors the same way that heroin does. The medications, however, have a lesser effect than heroin, and they can be used to reduce withdrawal symptoms and cravings for heroin.
- Naltrexone. This medication blocks opioid receptors and stops heroin from affecting the user. Naltrexone is often used in combination with buprenorphine.
- Lofexidine and clonidine. These medications are used to relieve withdrawal symptoms.
- Contingency Management Therapy (CM). This type of therapy, also called motivational therapy, rewards patients for successfully abstaining from drug use. The rewards, monetary or otherwise, are given to patients when they successfully reach milestones of abstinence.
- Cognitive Behavioral Therapy (CBT). This type of psychotherapy helps drug users to recognize the triggers that prompt their drug use. The therapy also focuses on developing strategies and techniques for dealing with those triggers when they occur. CBT can be effective at preventing relapses once the patient has begun to abstain from drug use.
How does Heroin Addiction Progress?
Long-term heroin use can have severe, permanent, and sometimes fatal impacts on the user’s health. Effects of heroin use over a long time can include:
- Lung infections and disease
- Liver disease
- Kidney disease
- Heart infections
- Skin infections
- Loss of healthy brain tissue
- Chronic constipation
- Sexual dysfunction
- Collapsed veins
- HIV or hepatitis from intravenous use
In addition to the long-term consequences, heroin-dependent users face a high risk of overdose. Heroin overdoses are often fatal because an excessive dose of the drug can reduce the user’s breathing rate to the point that the brain doesn’t get enough oxygen to survive.
How Is Heroin Addiction Prevented?
Heroin addiction is best prevented by total abstinence from the drug. Prevention programs aimed at reducing drug use among young people and at-risk populations are effective when they adhere to proven principles. Programs should focus on reducing risk factors and promoting positive behaviors. They should encompass all forms of substance abuse, not just heroin, and they should be tailored to the specific problems of the community they’re trying to reach.
Heroin Addiction Caregiver Tips
- Learn about addiction. Drug addiction has long been considered a social or psychological problem, but we know now that dependence on a drug like heroin is a disease driven by brain chemistry. When you understand the nature of addiction and what your loved one is struggling with, you’ll be best equipped to help them in their fight with the disease.
- Strengthen the bonds of family. Your loved one’s best chance of recovery comes when they are surrounded by a supportive community. So spend time together as much as possible, and be willing to participate in family therapy so that you can learn how to cope with the addiction together.
- Be prepared for setbacks. Heroin addiction is tenacious, and relapses are common even after prolonged periods of abstinence. Try not to be discouraged, and know that relapse does not mean that the battle is over.
- Protect yourself. Caregivers of people with addictions are susceptible to health problems, including substance abuse, themselves. Don’t neglect your own physical and mental health, and get help from a support group when you need it.
Many people with opioid use disorder (OUD) also suffer from other brain and mental health-related issues, a situation called co-morbidity. Almost half of the people with OUD have a co-existing mood or anxiety disorder. Here are a few of the disorders commonly associated with OUD:
Heroin Addiction Brain Science
Research into the biochemical sources of heroin addiction has focused, in part, on the role that opioid receptors play in the body’s response to the drug. Medications have been developed that either mimic heroin’s interaction with the receptors or block the receptors entirely.
The action of opioid receptors, however, might be only part of the problem of heroin addiction. Heroin-dependent users sometimes experience withdrawal symptoms when they stop taking the drug and when they’re exposed to environmental cues (situations, behaviors, sounds, smells, etc.) that they associate with withdrawal. When they encounter these cues, they begin to experience withdrawal and are driven to take more of the drug.
Researchers have attempted to identify the parts of the brain responsible for this cue-driven withdrawal, with the hope of developing new treatments to counter the effect.
Heroin Addiction Research
Title: Buprenorphine Stabilization and Induction Onto Vivitrol for Heroin-dependent Individuals
Contact: Kaitlyn Mishlen, MA
New York State Psychiatric Institute
New York, NY
Short-term treatment with buprenorphine before initiating treatment with naltrexone may increase the proportion of heroin-dependent patients successfully inducted onto Vivitrol.
Title: Combining Neuro-Imaging and Non-Invasive Brain Stimulation for Clinical Intervention in Opioid Use Disorder
Principal investigator: Kelvin Lim, MD
University of Minnesota
This project’s overarching goal is to expand the traditional expertise in non-invasive neuromodulation at the University of Minnesota towards developing novel paired-neuromodulation approaches using transcranial direct current stimulation (tDCS) for new addiction treatments that support long-term abstinence. This study will investigate whether the pairing of dorsolateral prefrontal cortex (DLPFC) stimulation and cognitive training can enhance functional connectivity between DLPFC and nucleus accumbens (NAcc). We have identified higher functional connectivity between DLPFC and NAcc in alcoholics that have successfully maintained abstinence for extended periods (7 years). This paired-neuromodulation approach can potentially be used as a therapeutic intervention to decrease substance use probability in addiction (e.g., opioid use disorder). The long-term goal is to develop new addiction treatments that support long-term abstinence in opioid use disorder. This proposal’s overall objective is to enhance functional connectivity between DLPFC and NAcc as a therapeutic intervention to enhance cognition and reduce substance use rates in opioid use disorder.
Title: Neuroimaging and CBD for Heroin Use Disorder
Contact: Yasmin Hurd, PhD
Icahn School of Medicine at Mount Sinai
New York, NY
The investigators propose an imaging study to investigate the neurobiological effects of CBD (vs. placebo) in abstinent subjects with heroin use disorder (HUD). The study aims to determine the neural circuits and transmitters associated with the effects of CBD on reducing craving and anxiety. The neuroimaging will be conducted in participants immediately following their first administration of CBD (800mg or placebo) and one week after the last administration (3 daily doses). This CBD administration protocol was shown in previous studies by the investigators to reduce craving and anxiety in abstinent heroin users.