Heroin Addiction

What Causes Heroin Addiction?

When someone uses heroin, the drug binds with parts of cells that are specifically sensitive to opioids. The opioid receptors are present in cells throughout the body, but the drug’s most irresistible effects come from its interaction with opioid receptors in the brain. When heroin affects these cells, the level of a chemical called dopamine increases in the brain. Elevated dopamine levels produce the good feelings associated with the drug’s high.

The pleasurable effects of dopamine disappear when the drug isn’t present, so the user is driven to seek more of the drug. As the drug’s use continues, the brain becomes less sensitive to its effects, triggering the need for higher doses to achieve the same result. Eventually, changes in the user’s brain chemistry become so pronounced that abstinence from the drug produces physical withdrawal symptoms.

In addition to the drug’s physical addictiveness, some factors increase the likelihood that a given individual will abuse or become dependent on heroin. These risk factors include:

• Family or individual history of drug use or abuse
• Tobacco use
• Poverty or unemployment
• First drug use at a young age
• Criminal history
• Depression, anxiety, or other mental illness
• Exposure to environments where drug use is prevalent

Is Heroin Addiction Hereditary?

Addiction to heroin and other drugs does not stem from a single cause. In many cases, the most significant factors that lead to addiction are environmental. Users are moved to drug use because of situations surrounding them, and their continued drug use leads to addiction. There is, however, evidence to suggest that some people are more susceptible to becoming addicted to certain drugs after they begin to use them. That susceptibility seems to be, to some degree, determined by genetics and is likely inherited within families.

Scientists do not fully understand inherited addiction risk. In heroin addiction risk, research has focused on genes associated with opioid receptors, neurotransmitter creation, and the brain’s pleasure-and-reward circuitry. While studies have suggested several genes that may be involved, more research is needed.

How is Heroin Addiction Detected?

Heroin users stand the best chance of sustained recovery when they receive treatment as soon as possible. However, it can be challenging to detect when someone is using heroin because they will often attempt to hide their drug habit.

Warning signs that a loved one might be abusing or addicted to heroin include:

• Lethargy or sleepiness
• Unexplained and sudden weight loss
• Poor hygiene or changes in appearance
• Loss of interest in daily activities
• Constricted pupils or bloodshot eyes
• New, unusual problems at work or school
• Lying about or hiding their behavior

How is Heroin Addiction Diagnosed?

Heroin addiction can be formally diagnosed as a clinical disorder called opioid use disorder. To be diagnosed, the heroin use must cause significant impairment or distress, and at least two of the following symptoms must be present over 12 months:

• Heroin use is greater than the user intends, either in dosage or frequency.
• The user has a desire to quit or has unsuccessfully tried to quit.
• The user spends significant time acquiring, using, or recovering from the drug.
• The user has an intense craving for the drug.
• Drug use is interfering with the user’s obligations or responsibilities.
• Drug use continues despite the harm it does to the user, physically or otherwise.
• Drug use interferes with the user’s everyday activities and routines.
• The drug is used in dangerous situations.
• Tolerance for the drug develops, creating the need for higher doses or more frequent use to achieve the same effect.
• Abstinence from the drug causes withdrawal symptoms.

How is Heroin Addiction Treated?

Heroin addiction is tough to beat, and relapses are very common. Treatment approaches can include both medication-based treatments and behavioral therapies. These approaches are often used in combination, and treatment programs are most effective when tailored to best suit the individual patient.

• Buprenorphine and methadone. These drugs bind to the body’s opioid receptors the same way that heroin does. The medications, however, have a lesser effect than heroin, and they can be used to reduce withdrawal symptoms and cravings for heroin.
• Naltrexone. This medication blocks opioid receptors and stops heroin from affecting the user. Naltrexone is often used in combination with buprenorphine.
• Lofexidine and clonidine. These medications are used to relieve withdrawal symptoms.
• Contingency Management Therapy (CM). This type of therapy, also called motivational therapy, rewards patients for successfully abstaining from drug use. The rewards, monetary or otherwise, are given to patients when they successfully reach milestones of abstinence.
• Cognitive Behavioral Therapy (CBT). This type of psychotherapy helps drug users to recognize the triggers that prompt their drug use. The therapy also focuses on developing strategies and techniques for dealing with those triggers when they occur. CBT can be effective at preventing relapses once the patient has begun to abstain from drug use.

How does Heroin Addiction Progress?

Long-term heroin use can have severe, permanent, and sometimes fatal impacts on the user’s health. Effects of heroin use over a long time can include:

• Lung infections and disease
• Liver disease
• Kidney disease
• Heart infections
• Skin infections
• Loss of healthy brain tissue
• Depression
• Chronic constipation
• Sexual dysfunction
• Collapsed veins
• HIV or hepatitis from intravenous use

In addition to the long-term consequences, heroin-dependent users face a high risk of overdose. Heroin overdoses are often fatal because an excessive dose of the drug can reduce the user’s breathing rate to the point that the brain doesn’t get enough oxygen to survive.

How Is Heroin Addiction Prevented?

Heroin addiction is best prevented by total abstinence from the drug. Prevention programs aimed at reducing drug use among young people and at-risk populations are effective when they adhere to proven principles. Programs should focus on reducing risk factors and promoting positive behaviors. They should encompass all forms of substance abuse, not just heroin, and they should be tailored to the specific problems of the community they’re trying to reach.

Heroin Addiction Caregiver Tips

• Learn about addiction. Drug addiction has long been considered a social or psychological problem, but we know now that dependence on a drug like heroin is a disease driven by brain chemistry. When you understand the nature of addiction and what your loved one is struggling with, you’ll be best equipped to help them in their fight with the disease.
• Strengthen the bonds of family. Your loved one’s best chance of recovery comes when they are surrounded by a supportive community. So spend time together as much as possible, and be willing to participate in family therapy so that you can learn how to cope with the addiction together.
• Be prepared for setbacks. Heroin addiction is tenacious, and relapses are common even after prolonged periods of abstinence. Try not to be discouraged, and know that relapse does not mean that the battle is over.
• Protect yourself. Caregivers of people with addictions are susceptible to health problems, including substance abuse, themselves. Don’t neglect your own physical and mental health, and get help from a support group when you need it.

Many people with opioid use disorder (OUD) also suffer from other brain and mental health-related issues, a situation called co-morbidity. Almost half of the people with OUD have a co-existing mood or anxiety disorder. Here are a few of the disorders commonly associated with OUD:

• More than one in ten people with OUD also have an anxiety disorder, including panic disorder, social anxiety disorder, or post-traumatic stress disorder (PTSD). 
• Alcoholism and other substance use disorders are commonly comorbid with OUD. About one-quarter of people with opioid dependency also have an alcohol dependency.
• Approximately one in 20 people with OUD also have obsessive-compulsive disorder (OCD).
• Many people with OUD also suffer from depression.

Heroin Addiction Brain Science

Research into the biochemical sources of heroin addiction has focused, in part, on the role that opioid receptors play in the body’s response to the drug. Medications have been developed that either mimic heroin’s interaction with the receptors or block the receptors entirely.

The action of opioid receptors, however, might be only part of the problem of heroin addiction. Heroin-dependent users sometimes experience withdrawal symptoms when they stop taking the drug and when they’re exposed to environmental cues (situations, behaviors, sounds, smells, etc.) that they associate with withdrawal. When they encounter these cues, they begin to experience withdrawal and are driven to take more of the drug.

Researchers have attempted to identify the parts of the brain responsible for this cue-driven withdrawal, with the hope of developing new treatments to counter the effect.

Heroin Addiction Research

Title: Buprenorphine Stabilization and Induction Onto Vivitrol for Heroin-dependent Individuals

Stage: Recruiting

Contact: Kaitlyn Mishlen, MA

New York State Psychiatric Institute

New York, NY

Short-term treatment with buprenorphine before initiating treatment with naltrexone may increase the proportion of heroin-dependent patients successfully inducted onto Vivitrol.

Title: Combining Neuro-Imaging and Non-Invasive Brain Stimulation for Clinical Intervention in Opioid Use Disorder

Stage: Recruiting

Principal investigator: Kelvin Lim, MD

University of Minnesota

Minneapolis, MN

This project’s overarching goal is to expand the traditional expertise in non-invasive neuromodulation at the University of Minnesota towards developing novel paired-neuromodulation approaches using transcranial direct current stimulation (tDCS) for new addiction treatments that support long-term abstinence. This study will investigate whether the pairing of dorsolateral prefrontal cortex (DLPFC) stimulation and cognitive training can enhance functional connectivity between DLPFC and nucleus accumbens (NAcc). We have identified higher functional connectivity between DLPFC and NAcc in alcoholics that have successfully maintained abstinence for extended periods (7 years). This paired-neuromodulation approach can potentially be used as a therapeutic intervention to decrease substance use probability in addiction (e.g., opioid use disorder). The long-term goal is to develop new addiction treatments that support long-term abstinence in opioid use disorder. This proposal’s overall objective is to enhance functional connectivity between DLPFC and NAcc as a therapeutic intervention to enhance cognition and reduce substance use rates in opioid use disorder.

Title: Neuroimaging and CBD for Heroin Use Disorder

Stage: Recruiting

Contact: Yasmin Hurd, PhD

Icahn School of Medicine at Mount Sinai

New York, NY

The investigators propose an imaging study to investigate the neurobiological effects of CBD (vs. placebo) in abstinent subjects with heroin use disorder (HUD). The study aims to determine the neural circuits and transmitters associated with the effects of CBD on reducing craving and anxiety. The neuroimaging will be conducted in participants immediately following their first administration of CBD (800mg or placebo) and one week after the last administration (3 daily doses). This CBD administration protocol was shown in previous studies by the investigators to reduce craving and anxiety in abstinent heroin users.