Heroin Addiction in the United States

Heroin addiction has grown to epidemic proportions in recent years. Between 2002 and 2013, the number of Americans addicted to heroin increased from 100 to 200 people per 100,000, and between 2002 and 2014 fatalities from heroin-related overdose increased fivefold.

At one time, heroin was thought of as a drug only abused in big cities, but it is now found in small towns and rural communities all across the United States. A recent study from the University of Illinois at Chicago showed that heroin addiction cost the U.S. over 51 billion dollars in 2015. The cost accrues from a wide range of effects, including money spent to treat babies born to heroin-addicted mothers, lost job productivity, heroin-related crimes and imprisonment, heroin addiction treatment, treatment of diseases such as hepatitis and HIV contracted through IV heroin use, and heroin overdoses that lead to emergency room visits and death. The U.S. suffered almost 13,000 fatalities due to heroin overdose in 2015.

Why is This Happening?

The number one risk factor for heroin addiction is the abuse of prescription opioids like codeine, hydrocodone, and oxycodone. An addiction to prescription painkillers makes an individual 40 times more likely to develop a heroin addiction, and one in 20 Americans report the recreational use of prescription opioids.

Many people become addicted to pain medication while taking a prescription provided by their own doctor for a legitimate health reason, such as illness or injury, but responsible doctors will not continue to prescribe opioids indefinitely. When addicts find themselves no longer able to obtain their drug of choice through their local pharmacy and insurance coverage, they become vulnerable to transitioning to heroin, which is actually cheaper and easier to obtain illegally than prescription drugs.

From the 2000s to 2012, the amount of heroin seized at the Mexican border quadrupled. The rapidly increasing supply of heroin in the U.S. has not only made the drug cheaper and more readily available, it has made it more pure and more potent—a deadly combination.

With heroin now so cheap and widely available, people are more likely to try the drug on impulse, because it’s easy, and heroin addiction can occur from the very first use.

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Why is Heroin So Addictive?

One characteristic of heroin that makes it so dangerous is its chemical structure mimics that of neurotransmitters naturally found in the brain. These neurotransmitters are responsible for the brain’s ability to monitor and control actions, and send, receive and store information. Effective cognition requires healthy neurotransmitter function, particularly in the brain’s reward system. Heroin can easily “sneak” into the brain like it belongs there and attach itself to opioid receptors, where it hijacks the brain’s reward system and immediately begins to make changes.

Almost immediately after the drug is taken, heroin floods the user’s brain with dopamine, a neurotransmitter that regulates emotions, motivation, movement and pleasure. The release of dopamine is the brain’s way of reinforcing and rewarding survival behaviors such as eating, sleeping, and having sex. When released naturally, dopamine produces feelings of pleasure and contentment. When activated unnaturally via heroin abuse, the amount of dopamine released overwhelms the user with a rush of euphoria that immediately reinforces the act of using drugs as the brain automatically marks it as an “important” behavior. This trains the user to do heroin again, the same way our brains train us to eat when we’re hungry and sleep when we’re tired.

Unfortunately, the training effect of heroin abuse is much more intense than with the natural reinforcement of any normal survival behaviors, as illicit drugs can force the release of 2 to 10 times more dopamine than the brain uses to reward us for seeking out sex or food. In addition, the chemical reward happens almost immediately after taking heroin, and the effects last much, much longer than anything a human can experience in nature.

By hijacking the brain’s reward system in this way, heroin overwhelms and minimizes all past reward training in the brain, teaching the user to prioritize heroin abuse over all other behaviors.

But it Gets Worse

Heroin Addiction

The depression caused by heroin addiction fuels continued drug abuse.

Heroin addiction rapidly leads to tolerance, which forces the user to take increasingly larger and more dangerous doses of the drug to experience the same high. This is because the brain attempts to adapt to the massively unnatural levels of dopamine released via heroin use by reducing the number of functioning dopamine receptors and producing less dopamine overall.

As a result, the brain of a heroin addict soon has an abnormally underactive pleasure and reward center, which makes them unable to enjoy much of anything at all. They become depressed, and life starts to seem empty and pointless. Drug abuse transforms from a way to get high to a way to try and feel “normal” again, but, of course, further heroin abuse only exacerbates the problem.

In this way, heroin addiction causes addicts to keep using heroin, even after they suffer countless devastating consequences due to drug abuse, and even after deciding that they sincerely want to stop using. This is why the addiction is a chronic, relapsing disease of the brain that requires professional heroin addiction treatment to overcome.

Short and Long-Term Side Effects of Heroin Addiction

Heroin causes a variety of short and long-term side effects. Taking heroin causes an immediate rush of pleasure and suppression of pain as the drug enters the brain and binds to opioid receptors. Users become drowsy for hours with clouded thinking and difficulty focusing. Other short-term effects of heroin use include:

  • Skin flushing
  • Dry mouth
  • Nausea and vomiting
  • Severe itching
  • Slowed breathing that can lead to coma and brain damage

Long-term heroin use leads to imbalances in neurotransmitters and hormones, which impact brain function in profound ways that are difficult to reverse. It can also reduce the brain’s white matter, which affects the addict’s ability to monitor and regulate their behavior and make decisions. Heroin use swiftly leads to physical dependence and tolerance. Starting from just a few hours after the last dose, people suffering from a heroin addiction will experience withdrawal symptoms such as:

  • Muscle and bone pain
  • Restlessness and leg movements
  • Insomnia
  • Vomiting and diarrhea
  • Cold flashes
  • Arthritis and other rheumatologic problems
  • Liver and kidney disease
  • Collapsed veins
  • Bacterial infections
  • Abscesses
  • Infectious disease (e.g., HIV, hepatitis B and C)
  • Infection of heart lining and valves

Although withdrawal symptoms are at their worst 24 to 48 hours after the last dose of heroin, and usually fade away after about seven days, some individuals suffer symptoms for months afterwards. This is one of the reasons that medication-assisted withdrawal can be so helpful in heroin addiction treatment.

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How Can I Tell if Someone I Know is Using Heroin?

If someone you know is using heroin, they will probably show signs of heroin addiction such as skin infections, wounds, and needle marks from IV use. They will cycle through patterns of fatigue followed by alertness. While using, their pupils will become narrow and constricted, and they will seem drowsy and disoriented with a distant, staring gaze. They will have slurred speech and difficulty communicating, along with a lack of focus, memory problems, and a general disinterest in their life and surroundings.

Individuals suffering from heroin addiction will also exhibit behavioral signs of substance abuse, such as withdrawing from friends and family, failures at school or work, neglected appearance and hygiene, and lack of motivation. They often develop serious mental health issues such as depression and antisocial personality disorder.

Heroin Addiction Treatment

The only real way to recover from a heroin addiction is to seek professional heroin addiction treatment. Treatments for heroin addiction include both medical and behavioral interventions, which can be used separately or in conjunction, although their effectiveness is amplified when used together. These treatments combined with abstinence from heroin use can help the brain and body repair the damage done by heroin addiction while simultaneously helping addicts get their lives back on track.

What is Heroin Addiction Treatment Like?

Pharmacological Interventions

Studies have shown that pharmacological treatment (medications) decreases drug use and criminal activity while increasing retention in heroin addiction treatment programs. Medications can help transition addicts to sobriety by easing the intense cravings and severe withdrawal symptoms such as pain, nausea, vomiting and diarrhea, which will surface during detoxification. Counteracting these symptoms and ameliorating cravings will help the addict start off stronger in their recovery while also helping to prevent relapse.

Medications for heroin addiction also work on opioid receptors, but do so in safer, less extreme ways that help the addict avoid self-destructive behaviors. Some of these medications are:

  • Methadone has been used as an effective heroin addiction treatment since the 1960s. It is a slow-acting opioid agonist, which means it slowly works on the brain—partly because it is taken orally, and partly due to its chemical structure—preventing withdrawal symptoms and dampening cravings without producing the “high” that addicts used to achieve with heroin. It is dispensed daily through outpatient heroin addiction treatment programs.
  • Buprenorphine is a partial opioid agonist, which prevents drug cravings, also without producing the opioid “high.” It is often given in formulations that include naloxone, an opioid antagonist that will prevent withdrawal symptoms when taken orally, but will cause intense withdrawal symptoms if injected. Since 2002, buprenorphine has been approved by the FDA to be prescribed to patients by certified doctors without the patient’s having to visit a specialized clinic. This expands addicts’ access to heroin addiction treatment.
  • Naltrexone is an opioid antagonist. Non-addictive and non-sedating, it blocks the action of opioids. This makes it a useful treatment for heroin addiction, as it removes the temptation to use because the patient knows they will not be able to get high if they relapse and use heroin. The only problem with this treatment is compliance, as the medication cannot work if the patient stops taking it. As a possible solution, the FDA recently approved an injectable, long-acting formulation of naltrexone that can be administered once a month.
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Behavioral Interventions

Whether treatment for heroin addiction is received through an outpatient program, or while the addict is inpatient at a residential program, there are many useful, evidence-based behavioral therapies to facilitate recovery. Some of these therapies include:

  • Cognitive-behavioral therapy or CBT is a treatment used to free the patient from negative patterns of belief and behavior, replacing them with more useful perspectives and effective coping skills to help them respond well to conflict, stress and potential triggers.
  • Exposure therapy is a treatment that helps patients learn to respond calmly to trigger situations by exposing the patient to drugs or triggering environments in a safe way that will keep them from using, usually accompanied by their therapist. This allows the patient to directly experience how the intense anxiety and cravings that they feel when triggered will slowly pass if they resist the temptation to use.
  • Contingency management is a system that offers patients rewards to reinforce healthy behaviors such as abstinence. Voucher-based reinforcement gives patients a voucher or “points” for every negative drug test, which can be exchanged for items that encourage a drug-free lifestyle, such as movie tickets or food. Prize Incentives CM reinforces abstinence and positive activities such as attending counseling or reaching goals by allowing patients to enter drawings for a cash prize ranging from 1 to 100 dollars.

Solutions for Lifelong Recovery

Recovery is not something that you achieve, then forget. Giving up heroin and successfully completing a treatment program are wonderful accomplishments, but are not enough to permanently prevent relapse. Recovery needs to be fostered through ongoing effort. Some programs provide alumni services such as alumni group therapy or social gatherings to prevent an abrupt end to the treatment experience, and addiction support groups such as Narcotics Anonymous (NA) are a wonderful resource to support long-term abstinence. Taking good care of yourself physically through healthy food, regular exercise and quality sleep will also support ongoing abstinence from heroin and other drugs, as a healthy body is necessary to maintain a strong mental and emotional outlook.

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