Continued use of heroin, even when you are experiencing negative effects, is a hallmark of substance use disorder. But recovery is possible.
With its powerful effects, heroin can be a challenge to quit once you start using it.
Over time, you may need more and more to feel the same effects.
Even with unpleasant reactions and a desire to quit using heroin, it can be very difficult to quit on your own. This could be a sign of a substance use disorder.
Heroin is an illegal substance in the United States. It belongs to a class of drugs called opioids.
It is made from an opiate called morphine.
Opioids and opiates are substances that affect opioid receptors in the brain and counteract physical pain. They can also cause a relaxed and euphoric feeling.
Not all opioids are illegal. Some are used for medical purposes, under the supervision of a healthcare professional.
The term “opioid” is a catch-all used to describe synthetic, semi-synthetic and natural opioids. The latter is what we call opiates.
Approximately
Heroin works by binding to receptors in your brain called opioid receptors. These receive your body’s natural endorphins and regulate pain, reward, and certain behaviors.
When heroin enters the body, it targets opioid receptors and creates a flood of the feel-good neurotransmitter, dopamine.
This pleasant, often euphoric sensation can quickly reinforce heroin use behavior. The more heroin you use, the more your body can adapt to its presence.
“Dopamine is the molecule of pleasure and motivation”, explains Monty Ghosh, an addiction specialist in Alberta, Canada. “Initially, it gets us up on a Monday morning to start our day, but it is also essential for our human species to survive.”
Heroin and other opioids, Ghosh explains, “hijack” your brain’s pathways and make it think it needs it to survive.
Your body can become so used to working with heroin in its system that it will not be regulated without it.
Long-term use of heroin can create potentially permanent changes in the structure of your brain. This can leave you with difficult hormonal and neural imbalances.
Drug addiction is no longer considered a formal diagnostic term. It was withdrawn from the Diagnostic and Statistical Manual of Mental Disorders in its fifth edition (DSM-5).
Symptoms that you may associate with “addiction” are part of a complex neuropsychiatric disorder that is now officially known as substance use disorder.
According to DSM-5, an American Psychiatric Association (APA) reference manual, substance-related disorders can be associated with 10 classes of drugs:
- the tobacco
- stimulants
- opioids
- products to inhale
- sedatives, hypnotics or anxiolytics
- alcohol
- cannabis
- caffeine
- hallucinogens
- unknown substances
According to the DSM-5, you can be living with a substance use disorder if you continue to take a drug even though it is causing you negative effects.
Substance use disorder is not the same as process addiction, although these disorders can occur simultaneously.
Process addiction is based on repeated behaviors that trigger your brain’s natural reward system. Unlike substance use disorders, no medication is introduced into the body to create chemical imbalances.
“Process addiction focuses on the behavior that a person does over and over again, but it is not necessarily substance-induced or related,” says Jacqueline Connor, clinical therapist in Napa Valley, California.
“The person is most likely addicted to adopting the behavior to alleviate emotional discomfort from irrational types of thinking,” she adds. “Process addiction can include play, sex, shopping, and exercise. “
Substance use disorder and process addiction can both create a feeling of euphoria and lead to withdrawal symptoms when the substance or behavior is stopped.
Heroin and other opioids can cause substance use disorders because they do more than create “euphoria”. Unlike many other drugs, opioids have the ability to change the chemistry in your brain.
You may experience severe urges and compulsions when you stop using it.
Your susceptibility to substance use disorders may depend on your biochemistry, genetics, and any underlying health conditions.
Shalin bhatt, a clinician at the Mountainside Alcohol and Drug Addiction Treatment Center in Ramsey, New Jersey, explains that trauma can play a significant role.
“Current research on substance abuse confirms that psychological injuries caused by trauma and other negative childhood experiences (ACE) also increase the likelihood of developing problems with substances later in life,” he says.
But this is not the case for everyone or for all opioids.
Other opioids can be taken under the supervision of a doctor, unlike heroin, which is illegal in the United States.
Heroin use disorders are covered in DSM-5 under Opioid Use Disorders.
The 11 symptoms that healthcare professionals look for to determine if you’ve developed the disorder include:
- using larger amounts of a substance or using it for longer than intended
- feel the desire to stop using but be unable to
- experience prolonged recovery times after substance use
- inability to manage commitments due to use
- continue to use the substance despite negative effects on relationships
- abandon important activities due to the use
- use the substance even if it puts you at risk
- continue to use even if the physical or psychological conditions are worsened by use
- tolerance (either by reducing the effects at the same dose, or the need for a higher dose to obtain effects)
- withdrawal symptoms or use of the substance to relieve withdrawal symptoms
- cravings
If you have a substance use disorder, your symptoms can range from mild (two or three symptoms) to severe (six or more symptoms).
Physical signs related to formal symptoms may include:
- hot redness of the skin
- dry mouth
- nausea
- vomiting
- feeling of heaviness in the extremities
- severe itching
- disturbed mental function
- loss of consciousness
- insomnia
- changes in the reproductive cycle
- sexual dysfunction
- constipation and abdominal cramps
- lung conditions
- liver disease
- kidney disease
- mental health problems
- slow breathing
- changes in the structure of the brain
- hormonal and neuronal chemical imbalances
- cognitive changes, such as impaired decision making
- collapsed veins, heart infections and abscesses from the injection
- nasal tissue damaged by sniffing
Heroin use disorders are often characterized by the need to take more heroin as your body builds up tolerance. Ultimately, this could lead to a potentially fatal overdose.
Signs of an overdose may include:
- lethargy
- loss of consciousness
- shallow breathing
- Low blood pressure
- nausea and vomiting
- convulsions
- neuropsychiatric symptoms, such as hallucinations or anxiety
If you are concerned that you or someone else may have overdosed on heroin, call 911 or local emergency services to make sure you get assessed as soon as possible.
The drug naloxone (Narcan, Evzio) can be used in case of heroin overdose. Taking it as directed can eliminate opioid poisoning and may reverse an opioid overdose.
The nasal spray form of naloxone allows you and non-medical caregivers to administer it.
Since naloxone only provides temporary relief, it is always recommended that you call emergency services first.
If you think someone has overdosed on heroin, the
- Call 911 or local emergency services.
- Evaluate the scene to avoid exposure.
- If you are in the workplace or in a healthcare setting, call qualified personnel.
- Assess the symptoms and try to maintain or restore consciousness.
- Administer naloxone.
- Initiate other first aid interventions, such as artificial respiration.
- Watch for changes in condition or reactions to naloxone.
- Establish post-overdose treatment services.
If you stop using heroin after your body gets used to it, you may experience the following withdrawal symptoms:
- severe heroin cravings
- commotion
- sleep disturbances
- diarrhea
- vomiting
- cold flashes with goosebumps
- uncontrollable body movements
- severe bone and muscle pain
The treatment of heroin use disorders can be an individual process. Many people benefit from a combination of behavioral and medical treatment.
Medical treatments
“For people who have developed a physical dependence on heroin, medically supervised withdrawal management (aka ‘detoxification’) on an outpatient or inpatient basis may be indicated,” Bhatt explains.
Managing withdrawal can help you overcome any symptoms you experience while withdrawing from heroin.
During this phase of treatment, you may be prescribed another medicine to minimize the symptoms of heroin withdrawal. Although the medication you choose will depend on your unique needs, it may work to stimulate or block your opioid receptors.
Drugs commonly used for different reasons during recovery from a heroin use disorder include:
Naltrexone can be used after the detoxification process as a maintenance medication.
Behavioral therapies
According to Connors, using therapies that help reprogram negative core beliefs at the heart of substance use disorders can be very helpful.
She recommends:
Behavioral therapies can also help you develop different coping strategies for managing stress and anxiety.
Heroin is an illegal drug with a high potential for abuse. If you have a heroin use disorder, it can be difficult to stop using it, even when you want to quit.
Professional help is strongly recommended. You can recover from a heroin use disorder when you get the right treatment.
A combination of medication and psychotherapy can help you break the cycle of heroin use.
If you or someone you know has a heroin use disorder, additional resources can be found in:
- call the SAMHSA national hotline at 800-662-4357
- visit to the American Society of Addiction Medicine resource page
Comments are closed.