The young man sat down on my couch. He was twenty and already showed the telltale signs of heroin use. His eyes were myopic, meaning pupils were as tiny as pins. The young man’s weight was diminished, looking more like a POW than a college kid. I knew as a psychotherapist, I had a casualty of the growing epidemic in my office. “I’m not addicted” the young proudly announced. “I use heroin, but I never slam that stuff.” Slamming refers to the use of IV or “shooting up.” Many young people think that if they simply smoke or sometimes snort heroin, they are not at risk for dependence. Of course, after years in the field and hundreds of heroin addicts treated, I know better. Heroin addiction is insidious at first, but then grasps hold like a rebel force that is intent of leaving no survivors. “How long have you used” I asked. The young man responded for the last year he would use over a weekend, then stop. He readily admitted that his use had increased and that is was starting to be more painful to stop, a sign of withdrawal. He minimized this fact and stated “listen doc, I understand that people get hooked. In fact, I have lost a friend to overdose. Thing is, I am smarter” he exclaimed. “Why is that” I asked? He went on to rattle of his philosophy of how by not using every day, giving his body some rest, and not shooting up, would allow him to dance with the devil. It was no more than 6 months later this young man that was in my office, was living out of his car, shooting up heroin several times a day, and facing jail time from stealing from his family and ex-boss. Indeed, heroin addiction is real, very real. Then how come people struggle to realize this until it’s often too late?
History of Heroin Addiction
Heroin use has been around for some time. In reality, heroin use originated with the opium industry that was thousands of years old. In the late 1800’s heroin was first synthesized and then peddled as an elixir that suitable for many uses. Indeed, heroin is a substance with great anxiety relieving properties and pain blockers. This was popular for many people and it wasn’t until the 1920’s that the addictive nature of the drug led to the prohibition on the substance. As with many things, once it became illegal, organized crime began their sale and manufacture of the substance and the rest as they say, is history. During the 1960’s heroin addiction began to soar. This was in part with the popularity of the hippie movement and drug pervasive side culture, but also due to the fact that several wars including Vietnam had left many traumatized men open to the numbing effects and warm embrace of heroin. Drug addiction rates rose and the reality that heroin addiction could quickly slip in and take hold of emotionally and physically vulnerable users, was clinically evident. In 1971, then President Nixon, began to make policy against the use and spread of heroin. It was at this point that US society realized that heroin was no longer a closeted drug that only touched the fringes of population, but that an epidemic of a difficult addictive substance was no permeating many homes across the US. One of the most difficult components of this new addiction for society to deal with was the unbelievable and often fatal consequences of addiction to heroin that was not readily seen in many other drugs. Heroin addiction occurred so much faster than other substances and the body seemed to latch on and crave the substance like none other. Symptoms of withdrawal basically made users prisoners in their own bodies, making daily life impossible to live without “the fix” that brought users back to baseline. All the while heroin users would slip further and further into a hole that often-included joblessness, declining physical and mental health, and eventual heroin overdose and death. All hallmarks of addiction. So why do people start using a substance that is now known to be so addictive and deadly, and how do people know if they are addicted to heroin? First, it is nearly impossible to use heroin and not become addicted. The drug focuses on the dopamine system in such a way, that the unnatural release of dopamine and other neurotransmitters supply the brain with a calming, warm rush that is often 400% greater than sex, buying a new car, winning the lottery, basically anything that can be naturally pleasurable. The brain is so greatly hijacked with heroin, that it is nearly impossible for a brain to not be re-wired to a craving state. Additionally, because heroin is so easily metabolized and utilized in the human body, dependence -or addiction- occurs quickly and with severe withdrawal symptoms.
Heroin Addiction and Withdrawal
Withdrawal is often the telltale sign of heroin addiction. Addiction Specialists often state that is you are using heroin, you are addicted. This might not be 100% accurate, but the fact is that heroin use will within weeks, or sometimes days of use, turn into an addictive downward spiral. Dependence is felt when the body and mind are so intertwined in use, that the body goes through horrific cravings and withdrawal without use. These withdrawals include flu-like symptoms, vomiting, and severe diarrhea. The user also feels anxiety that is debilitating, sleeplessness and restlessness like the worst case of panic one can imagine. The body shakes and cramps from loss of heroin. People often can’t sleep, but also can’t get out of bed. The skin becomes clammy, dark circles are around the eyes, and weight is lost at a rapid rate. All these physical symptoms can last a week in acute state, and often for months in sub-acute withdrawal. Perhaps the most troubling part of heroin addiction is that of neuroplastic changes to the brain. If you are addicted to heroin, your brain is literally inoperable. Motivation is impossible. Anxiety is paramount, and depression and suicidal thoughts are almost always present. When one is addicted to heroin they feel like a slave to a master, literally incapable of separating reality from the life on the drug. These neuroplastic changes are often to the longest lasting aspect of heroin addiction, and it is not uncommon to see people that are still struggling with work and motivation two years after their last use. While the brain is creative in its ability to rewire, heroin addiction almost always leaves previous addicts with a mind that feels less interested, less motivated, and less happy than a brain that had never touched the substance. This altered state is often very depressing and frustrating for previous addicts and can create relapse triggers on their own. Many heroin addicts feel that they have damaged themselves so badly, that overdosing, and suicide are viable options. If they can’t be happy without the drug, can’t motivate or participate meaningfully with life due to damage, what is the point of trying? Fortunately, while heroin addiction is real and very problematic, there are good outcomes that can be found. Particularly with MAT, or medication assisted treatment, brain function issues can be greatly helped. Additionally, with long term heroin addiction treatment and support, many addicts return to a high quality of life. This is of course if they survive. Heroin is deadly, and it happens so frequently because a compromised brain on heroin often forgets about safety and reality. When one questions if they are even addicted and plays Russian roulette with their life, the outcome can often be poor. When anyone starts using heroin and thinks they will be an outlier, surviving occasional use and avoiding drug addiction, they are certain to lose. When one begins to use in any way, multiple times, surrounding themselves with like-minded users, it is only a short time until dependence creeps in. Physical deficits will be slight at first, but the mind will have already created the necessary feedback loop to keep the horse coming back to the watering hole. So, in short, if you are using heroin, you should consider yourself altered mentally and in process of becoming addicted. Heroin use is serious and not something that can be used recreationally. The consequences are usually most severe possible. So, in short, if you are considering if you are addicted to heroin, get help, support, treatment, and be honest with yourself. If you are not, it will be a short window of time before life altering consequences set in.