Heroin Abuse, Addiction, and Treatment Options

Heroin is an extremely potent and highly addictive opioid that is made from morphine. Most individuals who experience the initial high from heroin describe feelings of intense euphoria and extreme calmness. After repeated and consistent use, however, these pleasant feelings turn to physical addiction. This physical addiction is so intense that an addicted individual will do things he would have never done to satisfy these cravings.

It poses a complex challenge to even the best of families and individuals from all backgrounds and life situations: mothers, fathers, sons, daughters, graduates and professionals. If you or your loved one is living with an addiction to heroin, here’s what you need to know about this devastating drug.

What is Heroin?

Heroin is an opioid drug derived from morphine, which is used to manage pain in hospitals. Morphine comes from the seed pods of “opium poppies”. While opium (which is also a dangerous drug) has been used for millennia in areas where opium poppies grow naturally, 20th Century technology gave the world the capability to refine and purify it into a much more potent and deadly substance.

It’s important for family members who suspect that a loved one may be using heroin to know that prescription opioid drugs are equally dangerous when abused and often lead to heroin or fentanyl (another opioid) use.
Heroin goes by many names, including but not limited to:

  • Brown Sugar
  • China White
  • Dope
  • H
  • Horse
  • Junk
  • Skag
  • Skunk
  • Smack
  • White Horse
  • When taken with OTC cold medicine and antihistamines they may call it “cheese”.

    What Does Heroin Look Like?

    Heroin at its purest is a whitish powder, but it may also be a brown powder or of a black, tarry consistency. Sugar, caffeine, powdered milk and other substances may be added to dilute the heroin, giving it an altered appearance.

    Pure heroin is snorted or smoked like cocaine, but the less pure, and more common forms, are typically injected into the lower layer for skin, muscles or straight into the veins.

    How Addictive Is Heroin?

    Heroin is highly addictive. Here’s why. Heroin can move very quickly to the brain so a person instantly feels it working. What is the heroin doing? To understand that, let’s briefly take a look at brain function.

    You have naturally-occurring substances in the brain called “neurotransmitters”, which are responsible for managing pain levels and generally how well you feel. These neurotransmitters control the levels of the hormone “dopamine”, which your body normally releases as a reward for good behavior. When someone praises you for a job well-done, dopamine is released, or when you do a favor for a friend, you feel good about it. That’s dopamine.

    Dopamine is also released when you’re in pain to ease the discomfort, which is why morphine is such an effective painkiller in hospitals, and it also greatly lowers inhibitions and slows the breathing and heart rate, having a calming effect.

    Heroin activates specialized receptors in the brain called MORs. When MORs get activated, it signals the neurotransmitters, which then tell the brain to increase dopamine levels. Heroin hijacks this natural system by making a person feel “rewarded” when they use it. It’s referred to as a “rush”. After the rush, the breathing and heart rate slow significantly, possibly to a dangerous or deadly level, and a person will generally feel very tired and want to go to sleep.

    With continued use, the brain becomes “dopamine-resistant”, meaning that a person will crave more and more heroin to get the same effect, and, additionally, things that should make a person feel good like a hug from a loved one no longer do. Being without the drug of choice can, therefore, lead to pain and depression because heroin becomes the only way the one living with a substance abuse disorder can feel any kind of pleasure.
    Heroin physically alters the brain, and that damage is not easily undone, so those who are addicted can’t “just quit” even if family members beg them to do so. The alterations in their brain generally make the cravings too strong to overcome without professional help.

    Signs and Symptoms of Heroin Abuse

    Because heroin impacts dopamine, it lowers inhibitions, which may lead to risky behavior like sharing needles or not caring for wounds properly. A person using heroin has a certain level of pain tolerance. So they may be able to endure festering sores that most people would find agonizing. This often leads to a sickly appearance, as the addiction progresses.

    In terms of behavior, watch for:

    • Lying or deceiving loved ones
    • Staring into the distance
    • Sleeping a lot
    • Withdrawal from family, friends, and activities they once loved
    • Stealing or constantly asking to borrow money
    • Wearing long sleeves even when it’s hot outside (to hide track marks)

    Any of these alone shouldn’t automatically suggest heroin use, but together they may show a pattern. A loved one may also notice:

    • Tiny pupils
    • Trouble breathing
    • Dry mouth
    • Sudden changes in behavior or actions
    • Feelings of being disoriented
    • A vicious cycle of hyper-alertness followed by suddenly going to sleep
    • Heavy extremities, which may cause a slumping, arm-dragging, foot-dragging appearance

    In addition to physical health signs, if you think your loved one may be using heroin, be on the lookout for heroin paraphernalia like:

    Burned metal spoons
    Missing silver. Silver spoons are preferred, when available.
    Aluminum foil or aluminum-lined gum wrappers with burn marks
    Burned straws
    Tiny plastic bags with an unknown powder or tarry substance
    A bong or pipe, which can be used for several types of drugs both legal and illegal

    Heroin Withdrawal and Detox

    Detoxing from heroin addiction is an intentional act in which a person allows the heroin to completely leave their system. Every detox experience is different, but during detox, a person will experience some kind of withdrawal symptoms like:

    • Nausea
    • Nervousness/Anxiety
    • Abdominal pain
    • Shaking
    • Sweating
    • Depression
    • Agitation
    • Muscle spasms

    Intense cravings and a feeling that the only way to end this agony is by using heroin again
    Withdrawal will typically last for up to three days before peaking and beginning to lessen. Some people experience drawn-out withdrawal-like symptoms for months, although the worst of it normally passes with a few days. Sadly, most people who attempt detox alone or even with a family member will find that the cravings are overwhelming. But they can find healing and hope through treatment.

    Treatment Options for Heroin Addiction

    When a person first begins the road to recovery, they’ll work with a professional to determine if medically-supervised detox or a medication-assisted program is the best way to overcome the addiction.

    Medically-Supervised Detoxification Vs Medication-Assisted Program

    During medically-supervised detox, the person who has the substance abuse disorder will stay in a facility under the care of a doctor. They may receive medications to ease symptoms. But detoxification is difficult no matter how you go about it.

    Alternatively, in some cases, a physician may recommend medication-assistance (MAT), also called “Opioid-Replacement” program. In this program, a person is given a heroin-substitute that is similar but less addictive in a clinic every so many days. The addiction specialist then reduces the dose slowly. The goal is to lessen dependence and reduce cravings until the individual is free of the drug.

    During MAT, a person must regularly attend classes and counseling while showing progress to remain in the program.
    If you choose the detox route, then you may go into either an extended inpatient stay or residential treatment program next.

    Inpatient Treatment Vs Residential Treatment

    The primary differentiator is the setting. One is in a hospital. The other is in a home-like setting. Residential treatment also tends to be longer, 30 days to a year.

    In both settings, a person will begin counseling and classes that support a life in recovery like:

    Dealing with tough emotions
    Managing cravings
    Handling peer pressure and avoiding triggers
    In residential treatment you might also do art projects, trust-building games and other activities to learn more about yourself and develop skills to prevent relapse.

    Outpatient Intensive Vs Outpatient Counseling

    Once you are ready to manage your addiction without constant supervision, your doctor will likely have you in one of these two programs. Outpatient intensive is generally a five-day-week of classes and counseling during which the person lives at home or in a home with others going through the program.

    Outpatient counseling is less rigorous and may involve meeting with your therapist once a week or more to talk about your ongoing challenges and working a plan at home to stay in recovery.
    Heroin Addiction Statistics

    Heroin addiction is far from uncommon. It can happen in the best of families. Nearly one million Americans report that they used heroin last year. Most people who use heroin are young adults 18-25, who are not likely to make it to their 30’s without help. Heroin use is on the rise, having doubled in the past 10 years, but on the bright side of things, fewer teens are trying heroin these days, perhaps because they’ve seen first hand what it can do to a person.