A 2012 study concluded that 10% of all American adults (18 and older) answered “yes” to the question: “Did you once have a problem with drugs or alcohol, but no longer do?”
It is startling to consider that such a significant number of Americans have battled substance abuse. But it is reassuring that these same people do not feel that they still have a problem.
Substance abuse can be overcome!
All addiction is, to some extent, related to how the brain experiences ‘pleasure’ and ‘pain’ and how the brain regulates mood. Addiction is a treatable disease. That goes for heroin addiction as well, even as heroin routinely leads ominous lists of addictive substances.
The road to recovery for the heroin addict is not only initially difficult, but wrought with relapse. It’s important to remember that recovery is an ongoing process and not, necessarily, a permanent state. In that way, addiction, as a chronic and treatable disease, is not dissimilar from other treatable diseases such as diabetes, hypertension, and asthma. In all instances of relapse, the treatment protocols must either be reinstated, or adjusted to consider recent outcomes.
Heroin addiction recovery is possible, and even those who have abused a drug as dangerous and habit-forming as heroin can live a life free from addiction, given the correct, evidence-based approach to treatment.
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As of this printing, heroin addiction is still an incurable disease. There are a lot of incurable diseases, including Ebola, Alzheimer’s, Diabetes, and Cancer, to name a few. Just because a disease has no cure does not mean it cannot be successfully treated.
Recovery is clearly the goal of heroin addiction treatment. Here’s a definition for recovery provided by the Substance Abuse and Mental Health Services Commission (SAMSHA):
Recovery is a process of change through which individuals improve their health and wellness, live self-directed lives and strive to reach their full potential.
A recent survey of former addicts, recovery professionals, and the general population produced this recovery word cloud.
In any definition of recovery, it’s important to highlight how personal the recovery journey is for different individuals. It’s important to recognize that there is no cure for addiction. There is only a process that must remain a lifelong focus for the individual, if recovery from heroin use and addiction is to be sustained.
Heroin is an opiate, which means it has been derived from opium. It is actually a brand name given to diamorphine, a derivative of morphine.
Opium has been harvested from the opium poppy plant for centuries. It has been consumed both as a potent form of pain relief, and recreationally for the euphoric feeling it gives the user. Opium is highly addictive, and can cause death in the right quantity.
Heroin is a byproduct of morphine, another powerful opiate used to treat pain. Morphine is also considered the first active ingredient ever isolated from a plant. Like any other opiate, morphine is extremely addictive, as evidenced by the hundreds of thousands of soldiers who became addicted to morphine during the American Civil War.
The German company Bayer synthesized diamorphine in an effort to develop an alternative to morphine that was less addictive. Diamorphine turned out to be twice as potent as morphine. Bayer branded the product Heroin, after the German phrase heroisch (meaning heroic), to describe the effect it had on soldiers who took it. The chemical attributes of heroin that made it more potent than morphine turned out to make it even more addictive.
While heroin, and its non-branded form diamorphine, are still prescribed in some countries to treat severe pain, it is considered a Schedule I drug in the United States, and therefore illegal to possess without a DEA license.
Prolonged heroin use leads to difficulty in digesting food, and often nausea, vomiting, and constipation.
Other side effects include dizziness, fatigue, dry mouth, and blurred vision.
Complications can also occur from unsafe heroin abuse practices:
- needle sharing (HIV, hepatitis, or less severe bacterial or fungal infections)
- poisoning from contaminants used in heroin production/preparation
- effects of using alongside other drugs or alcohol
One of the side effects most likely to hurt recovery efforts in any substance abuse is withdrawal. When a person becomes dependent on a substance like heroin, missing that substance causes an often debilitating sickness. For heroin, withdrawal symptoms include anxiety, sweating, vomiting, and diarrhea.
Further complications can arise if the heroin use was masking chronic pain, or subsequent malnutrition.
Withdrawal from heroin abuse is rarely fatal. However, the anxiety and depression that can occur with withdrawal can result in dangerous or suicidal behavior. Most likely, withdrawal symptoms will at least cause a swift relapse.
Opioid use can interfere with the body’s ability to breathe normally (respiratory depression), and overdose can lead to death.
Associated deaths can come from aspiration of vomit during sleep, or complications from using other substances in conjunction with heroin.
Heroin is uniquely dangerous, in that the amount of heroin necessary for an overdose can be only slightly higher than the amount required for an initial ‘high.’ Those who develop a tolerance for heroin can accidentally overdose if the purity of the source is different than they are used to. And those who have relapsed may overdose on a relatively smaller amount of heroin due to a lower tolerance.
Opioid receptors are located in certain sections of the brain. Naturally occurring opioids are produced by the body in response to activity, and attach to these receptors. Some of these opioids are released to alleviate pain, and establish a consistent mood. Some chemical responses produce a pleasurable sensation, motivating the person to repeat the activity. These pleasurable opioid responses may occur when a person has sex, or eats certain foods.
When heroin is introduced into the system, the effect on the opioid receptors are similar to natural opioids. Only, heroin is quicker and more potent. The receptors become desensitized to heroin over time, causing the user to require more heroin to achieve the same high.
Withdrawal symptoms can set in quickly once a great enough chemical dependence is formed. Heroin becomes less an instrument for getting high, and more necessary just to achieve a normal state.
Besides the chemical dependence, other aspects of heroin abuse can become addictive. These aspects include repeated needle use, or the community formed around heroin use. And the ‘high’ associated with heroin is uniquely attractive, in that it’s not generally possible without a similar substance.
Heroin is considered one of, if not the most addictive substances on earth.
In early August, the President of the United States declared the opioid crisis a national emergency. The declaration sets aside significant federal funding for use in combatting the opioid epidemic.
According to the National Institute on Drug Abuse, around 35,000 Americans died of heroin or opioid overdoses in 2015. But that number maybe significantly underreported.
The Center for Disease Control and Prevention (CDC) reports that heroin related fatal overdoses more than quadrupled between 2010 and 2015.
While heroin and legally prescribed opiates and opioids are often grouped for research purposes, it’s important to note that heroin can be cheaper than prescription opiates. For addicts with financial or health insurance challenges, heroin is a less expensive and often too easy to obtain high. And while the death rate of many legally prescribed opiates are leveling out, heroin overdose rates are not.
In the same, 2015 report, the CDC notes that, for the first time since the late 1990s, there were more heroin related deaths than deaths caused by traditional opioid painkillers.
During 2015, more people died due to heroin than in gun related homicides.
The heroin epidemic has been identified in one of the major culprits in a decline in overall life expectancy for Americans. This decline is the first of its kind since the 1990s, according to the National Center for Health Statistics.
Heroin use can start in many different ways, and can take on many different appearances. Because each heroin user will be unique, effective treatment will need to be personalized. Fortunately, there are many treatment practices supported by medical research. Taking an evidence-based approach to heroin addiction treatment ensures the strongest chance of long-term recovery.
Medically supervised detoxification programs provide a person battling heroin addiction with a safe environment during the most challenging withdrawal symptoms. The goal of heroin detoxification is to relieve the symptoms of withdrawal, while otherwise helping the addict cope with cravings as he or she is weaned off of chronic heroin use. Withdrawal symptoms peak during the first 48-72 hours of detox. Once withdrawal symptoms subside, powerful cravings can still linger.
Patients who successfully manage the heroin detox process must continue into a medically supervised residential program for as long as two weeks. While many patients will not proceed past this point in a clinical environment, it is generally accepted that this phase of the recovery process is only a first step, and more intervention will be necessary for long-term recovery.
Many medications have been successfully utilized in heroin addiction treatment. Medications can relieve some of the most difficult withdrawal symptoms. They can also provide a more gradual and safe recovery than a ‘cold turkey’ method, while making heroin less attractive and effective.
Here are some of the more commonly used medications in heroin addiction treatment:
- Methadone – One of the most historically used medications in heroin addiction treatment, methadone is another opiate, and is less potent than heroin. Methadone is a huge aid to curbing heroin cravings. It also has far fewer acute and long-term health effects. As a consequence, it becomes far easier to stop using methadone than heroin.
- Buprenorphine – This drug falls into the category of partial opioid antagonists. These drugs are still opiates, and contain many of the same dangers, but also block the opioid receptors, making opiates in general less effective.
- Naloxone – Commonly used in treating overdose, naloxone is also an opiate antagonist. It is considered a life-saving drug by many doctors and experts in the field. In some instances, naloxone use can prevent relapse.
Though pharmacological treatments should almost always be a part of the overall heroin addiction treatment plan, behavioral therapies will serve the patient in their long-term recovery. The goal of behavioral therapies include incentive for abstinence, improved life skills, and education in identifying triggers for relapse.
Two of the more common behavioral approaches to heroin addiction treatment include:
- Contingency management – This method rewards positive outcomes, such as negative drug tests
- Cognitive-behavioral – Education is provided in personal relapse triggers, and strategies are developed for avoiding dangerous behaviors, or coping with life stresses. Learning about the positive and negative consequences of drug use is a goal of cognitive-behavioral therapy.
Other behavioral interventions include:
Heroin addiction is, along with other chronic diseases, difficult to treat. Chronic diseases like addiction involve deeply imbedded behaviors, and require a personalized combination of medical and behavioral interventions. There is no cure for heroin addiction.
But heroin addiction can be successfully treated! And, like other chronic diseases, heroin dependence is best treated and managed through evidence-based treatment methodologies.
An often cited statistic for recovery is that only 3 in 10 who attempt addiction treatment will remain in recovery, long-term. About 40-60% of addicts that attempt treatment will relapse.
Relapse should not be considered failure. This is particularly important considering that a person in treatment for heroin addiction is more likely than not to suffer a relapse. A dedication to an evidence-based treatment plan can mitigate the consequences of a relapse. Relapse may also be a sign that the treatment may have missed an underlying cause of addiction, such as PTSD or some other co-occurring disorder. In this case, relapse is simply evidence that the treatment methodologies must be adjusted, not that the treatment is a failure.
It may also be useful to consider the relapse rate in other chronic diseases:
- 30-50% with Type I Diabetes
- 50-70% with Asthma
- 50-70% with Hypertension
Many studies have supported the concept that having a recovery plan, and sticking with the plan, can make a huge difference in the ability to maintain heroin abstinence. Conclusions drawn from institutions such as the British Journal of Psychiatry support this concept, especially the continued use of peer support groups.