Heroin Addiction: Treatment, Signs & Symptoms

The current heroin addiction epidemic in America is alarming and tragic, to be sure, however heroin itself is nothing new. It has been used for over 140 years and opiates have been used by humans for many thousands of years. As early as 3,400 B.C.E. Mesopotamian farmers were cultivating the Papaver Somniferum plant (opium poppy), which is the plant from which most opiates/opioids originate.

A 2015 study by the National Survey on Drug Use and Health found that over 5,000,000 Americans admitted to using heroin during their lifetime. Additionally, over 828,000 people admitted to use in the last year, while over 329,000 people admitted to use in the last month. Keep in mind that this study was self-reporting, so the actual numbers are higher in reality.

The number of people fitting the DSM-IV criteria for heroin use disorder or dependence has nearly tripled from 214,000 people in 2002, to 626,000 people in 2016. This trend has disproportionately affected the 18 to 25 year old age group, with there being significantly higher heroin use rates in this age demographic. Additionally, heroin use has transformed in the last few decades from being focused on urban areas to spreading far out into the suburbs and exurbs around major cities.

Why Is Heroin So Addictive?

Heroin is rendered in a hydrochloride salt for use by insufflation (snorting), intravenous injection (shooting up), and more rarely through smoking. It produces a mild to extreme euphoria, relieves pain and discomfort, and produces a great sense of calm or a feeling of enlightenment described as a “golden glow” by some. Also, many users report a feeling of warmth enveloping the body, typically spreading out from the spine and wrapping the user in a blanket of relaxed comfort. When snorted, the euphoria is produced within minutes and is mild to moderate, whereas when shooting up the euphoria is almost instantaneous and very intense. Some people can become psychologically addicted the very first time they use heroin, with the discovery of a way to feel this good overriding all else in the pursuit of it.

Heroin affects the natural opioid receptors in the brain which are used, among other things, to regulate mood, reward, and pain. The natural opioid peptides in the brain are released in situations of stress to reduce anxiety, depression, and sensitivity to pain. Alkaloid opioids such as heroin can be introduced into the body and will activate this system much more strongly that the natural opioids can. This overwhelms the brain with feelings of pleasure and after repeatedly doing this, the brain responds by adapting through a process called downregulation. This means that the brain reduces the amount of opioid receptors to compensate for the dramatic increase in opioid receptor stimulation in an attempt to balance itself out. The subsequent effect this produces is that the natural opioids have less of an impact since they are weaker than heroin and there are less receptors to sense them. Now, in the absence of heroin, a user will feel uncomfortable, anxious, depressed, and unfulfilled since the natural opioids are not regulating these feelings as they normally would. The only way to feel normal again is to abstain from heroin use long enough for upregulation to return the brain to normal, or to do more heroin.

Most, but not all, people use heroin for the first time by snorting it. The threat of needles and the lack of knowledge regarding hitting a vein keeps many people from trying the IV route right off the bat. Once addicted and having developed a tolerance however, the scariness and threat of needles can easily be overcome with the knowledge that a person can get much more high from a smaller amount of heroin when shooting it up. Once successfully performed, shooting up typically becomes the preferred route of intake as the euphoria and warmth is much more intense and is instant, although it does not last as long. Finally, since more heroin makes it into the brain through IV use, there will be a much more rapid downregulation and subsequently tolerance will be built up much more quickly.

IV drug use comes with its own set of risks, as people who do drugs in this manner will resort to sharing needles without much concern for the health risks or long term consequences. Additionally, the withdrawals from any drug used intravenously are much more severe than by other routes of intake, as much more of the drug makes it into the blood (and thus brain) by injection since it will not be subject to dilution via first pass metabolism. Finally, the risk of overdose is vastly increased for these same reasons, with a person able to inject a fatal dose in under a second.

Heroin Addiction

There are several distinct phases to heroin addiction. In the beginning, most people use heroin strictly to experience the rush and the high produced by using: The Honeymoon Phase. This often begins with users snorting heroin. After a tolerance has begun to develop and more of the drug is needed to produce the same effect, they may see the sense in shooting up since they can get much more high with less heroin.

This is a dangerous line to cross, as shooting up will introduce much more heroin into the brain at a time, which will have the blowback effect of causing the brain to reduce endogenous opioid production much more substantially than if it were being snorted. This means that withdrawal will set in quicker and much stronger through IV use of heroin.

Signs of Heroin Use:

Some of the noticeable signs of heroin addiction are:

  • Frequently Nodding Off (briefly falling asleep in public or at work)
  • Frequent Itching and Scratching
  • Frequent Vomiting (some people tend to vomit repeatedly when first doing heroin, while some people do not)
  • Hoarse Voice
  • Very Small Pupils
  • Nosebleeds (from snorting)
  • Wearing Long Sleeves Regardless of the Weather (for IV users this is to cover track marks)
  • Bite Marks on Belt (for IV users a belt can be used as a tourniquet or ligature)

After some weeks of using heroin on a daily basis, the highs are less intense and the user will begin to feel as if they need heroin in order to feel normal. This is the beginning of full blown heroin addiction: The Maintenance Phase.

Symptoms of Heroin Addiction

Heroin use has now become a serious preoccupation and a person in the phase will typically make plans around acquiring or doing heroin. At this point, their brain has begun to be unbalanced in the absence of heroin and the normal AN signals reaching their brain from your body, which have been severely dampened through regular heroin use, will begin to make them feel unpleasant when not high.

 Some behavioral symptoms of heroin addiction include:

  • Isolation from Friends and Family (not answering phone calls/texts and avoidance behavior)
  • Frequent Appeals to Borrow Money (with the reasons becoming more outlandish, or even repeated over time)
  • Frequent Unexplained Absence from Work or Social Gatherings
  • Lack of Personal Hygiene (failing to shower, shave, or brush teeth)
  • Lack of Motivation in General

In addition, without daily heroin use, the depression of descending pathway neuron traffic is no longer present so the GI tract will begin to reawaken as well as motor neurons returning to full signalling strength. This is the beginning phase of heroin withdrawal and worsening addiction. Finally, after months of use you will enter the final phase of heroin addiction: The Withdrawal Prevention Phase.

Signs of Worsening Heroin Addiction

Some of the signs exhibited by someone in this phase of heroin use may include:

  • Frequently Selling Their Own Valuables
  • Theft or Robbery of Valuables or Cash
  • Open Hostility Towards Friends or Family
  • Almost Total Absence from Work and Pre-Heroin Social Life
  • Wounds or Illnesses such as Abscess, Botulism, or Necrosis¹ (due to IV use)

At this point, the heroin addict will find that they need heroin to do anything. The thought of withdrawal becomes anxiety inducing and terrifying. They will do anything they can to get more heroin to avoid withdrawal. 

Every time they use again, the cycle will become more vicious. The symptoms of withdrawal will continue to escalate the longer and more that they use heroin.

They may find themselves spending any and all money that they have to get more. After their available money is exhausted they may find themselves borrowing money or selling whatever they can to get more money. Once they’ve sold and borrowed everything they can, theft or robbery becomes a very appealing prospect.

Heroin use has transformed from a luxury to an absolute necessity. The thought of going to work or having to deal with people in any regard while in withdrawal is appalling and it is very common for a heroin addict to miss work, social events, family gatherings, or school when they are in withdrawal. 

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Heroin Treatment and Recovery

Because of the long term effects of heroin withdrawal and the intensity of heroin addiction, it is highly recommended to attend treatment after you have finished acute detox, as relapse is a very strong possibility without professional support. Heroin relapse is especially dangerous, as relapse overdoses are fairly common, especially these days with extremely potent adulterants like Fentanyl commonly found in heroin.

Staying sober and relapse prevention should now be your main objectives, and there are several ways you can get help in this regard. Short or long term rehab is recommended, as these can provide clinical and psychological support and services to help you cope with life after heroin. Counseling or therapy is also recommended as having an outlet for your thoughts, frustrations, or fears can be of great benefit. Also, there may be underlying issues in addition to heroin addiction which may need to be dealt with. Some examples of rehab types include:

In order to maximize the likelihood and quality of sobriety, it’s strongly recommended that individuals participate in an addiction support group along with committing to heroin addiction treatment. 12 Step programs have a remarkable success rate with regards to helping people achieve long term sobriety. There are many such groups which can be attended free of charge – including Alcoholics Anonymous, Narcotics Anonymous, SMART Recovery and Dharma Recovery.

Another such group is Heroin Anonymous, which begun in 2004 and has gained more and more popularity among heroin addicts - especially young adults.  Heroin Anonymous has adoptied the same literature and 12 Step framework as Alcoholics Anonymous, simply substituting the word heroin for alcohol in the readings at the meeting. With different lifestyles being attributed to different drugs, it can be very helpful to be around people who have shared your particular experience, and have come out the other side and remained sober. There are currently meetings in England and 35 of the United States (as of October 2019). You can use the Heroin Anonymous Meeting Finder to find one close to you.

Author Information:

Michael Smeth
Michael Smeth
Michael Smeth is the Director of Online Marketing at The Summit Wellness Group. He has been involved in the addiction recovery community for over 18 years. In addition to actively attending at least five 12-Step meetings a week and sponsoring others, he's a huge advocate of the healing power of therapy. He has over a decade of experience in content strategy and online marketing, which he uses to spread the message of hope that recovery has brought him and countless others.
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