The National Center for Health Statistics reported that in 2016 more than 15,000 deaths in the United States were caused by heroin, which is a number that continues to grow at an alarming rate of 19% per year. It is this statistic, as well as the deaths related to prescription opioids that has led to what is currently labeled as the “Opioid Epidemic” or the “Heroin Crisis”. While these terms have been used to help influence policy change and impact change at a macro-level, they do little for the individual and the family suffering through a heroin addiction or trying to navigate various treatment options for heroin addiction. As scary as the alarming death rate from heroin overdose are the news articles describing corrupt “sober homes” and fraud stemming from illegal practices in unlicensed facilities that have tainted understanding of treatment. The alarming rates of overdose and reports of unethical treatment practices have caused seeking treatment to be a very difficult, overwhelming and scary time. At APEX Recovery, we can help you navigate the process.
Signs of Heroin Abuse
Even before seeking treatment, it is important to understand the signs of heroin abuse, whether you are concerned about yourself, a friend or a family member. Unlike alcohol, and in some states marijuana, which you can buy and enjoy legally and that many individuals use in moderation, heroin is a drug that is not only illegal but also extremely addictive. Despite the negative reputation associated with heroin as well as the high addiction and overdose risk, many individuals continue to be drawn to the substance due to the reported feelings of ecstasy and euphoria. Heroin users report immediate feelings of pleasure that are often described as a “rush”, an overwhelming feeling of calm, or an increased feeling of confidence and overall well-being. While these are the reported feelings of users, there are signs and symptoms of abuse that will be present and are often based on the amount and frequency of use as well as the length of time of heroin abuse.
It can be helpful to understand the signs of heroin intoxication if you are attempting to understand if your loved one is using. Short-term effects of heroin include flushing of the skin, dry mouth and a reported “heavy” feeling of arms and legs. Immediate symptoms may also include nausea, severe itching, and vomiting. Following the immediate intoxication, or high, an individual will be drowsy for multiple hours, have slowed breathing and a slowed heart rate and display what can be thought of as a foggy mental state. It is also common that a user will alternate between awake and asleep.
As a person develops a tolerance to heroin, which occurs after initial use, their use becomes more frequent with greater amounts to experience the same feelings. Because heroin affects the levels of dopamine in the brain, which helps us to feel good, long-term users begin to rely on the drug to feel normal. Once this develops, which is known as dependence, it becomes increasingly difficult to manage normal stress, emotions and experience, and engaging in normal daily life becomes increasingly difficult. Users that have developed both tolerance and dependence often report finding difficulty meeting basic daily needs as they become consumed with finding, buying and using heroin.
When to Seek Help
Heroin use is a slippery slope, with most individuals developing a tolerance and dependence immediately, which indicates the need for treatment. Furthermore, it is important to address the problem before it negatively impacts family relationships, work and school obligations and physical health. Common signs that heroin addiction has impacted psychosocial functioning include changes in behavior, which can commonly be observed as changes to eating and sleeping schedule, changes in friends and neglect of work obligations. Social effects could include loss of interest in family relationships and friendships, loss of job, financial stress and legal issues. It is highly likely that if you are concerned that you have a problem with heroin use, or you are concerned about a friend or family member’s use, that is already time to seek treatment.
Stages of Treatment
One of the largest barriers to getting off heroin includes withdrawing from the physical effects of heroin use. These symptoms can be both physically and psychologically challenging, with the user often seeking to return to use to endure the physical withdrawal symptoms. The physical withdrawal symptoms have been portrayed in Hollywood films including Traffic, Requiem For A Dream and Trainspotting, that while appear sensationalized depict a very accurate experience of this process. During the withdrawal process, as the substance begins to leave the body, the user will often experience nausea, vomiting and diarrhea, cold sweats and hot flashes, extreme muscle and body aches, agitation, anxiety and restlessness and strong cravings to use. It is recommended that detoxification occurs in a medically managed facility where not only support for physical symptoms can be provided, but also emotional support to prevent relapse in the midst of detox. Following completion of heroin detox, success increases exponentially when transitioning to residential treatment to address the emotional, social and psychological aspects underlying substance use.
Medication Assisted Treatment
Medication assisted treatment helps provide treatment for individuals with opiate dependency through combining behavioral therapy and counseling with the use of medical intervention as prescribed by a physician or psychiatrist. The prescribed medication can help relieve withdrawal symptoms and reduce the experience of cravings. Medication Assisted Treatment in conjunction with therapy and counseling can be an effective treatment option for heroin addiction. There are multiple types of medications that can be utilized in this option. Medication Assisted Treatment is thought of as a tool to slowly wean an individual off opiates and heroin to prevent the extreme symptoms related to “cold turkey” detox.
Methadone can help individuals function at a normal level while maintaining socialization, engagement in school and work and rebuilding relationships. Methadone does not provide the incapacitating side-effects associated with heroin use. Methadone can be used both as a maintenance program as well as helping taper individuals off heroin. While methadone is safer than heroin use, it remains highly addictive when not closely monitored and can lead to addiction or abuse. It should be noted that methadone is not a cure for heroin addiction and should be used as a short-term option for heroin addiction and will require a taper program when stopping to prevent withdrawal. Methadone treatment is provided in highly structured clinics and works most effectively when addressing underlying issues contributing to substance use.
Buprenorphine is also used as part of a comprehensive treatment that includes behavioral therapy and counseling and is used to treat heroin addiction. Unlike methadone which is dispensed in highly structured clinics, buprenorphine can be prescribed for home use. Buprenorphine works by lowering the physical dependency side effects associated with heroin and can ease withdrawal symptoms and cravings with lower risks of overdose. Additionally, buprenorphine can block the effects of heroin and is commonly referred to under the brand name Subutex and is often prescribed with naloxone under the brand name Suboxone. Suboxone is usually recommended as a longer treatment for addiction. Both methadone and buprenorphine are harm reduction treatment options as they relieve cravings and withdrawal symptoms, however, have continued addictive properties with potential for abuse, especially when not used in combination with counseling and therapy.
Naltrexone is an additional medication that can be used to help individuals maintain abstinence in recovery and is highly effective when used in outpatient treatment. Naltrexone can be used in both an oral pill form as well as in a long-acting injection that is given once a month and known by the brand name Vivitrol. Naltrexone in both forms stops the euphoric experience of heroin and opiates, which means that while a person is on the medication, they do not experience the high from heroin if they relapse. Additionally, Naltrexone can help manage cravings, with positive results in preventing relapse through multiple studies. It is noted that Naltrexone is not considered a “magic pill” to cure addiction, and as with other medication assisted treatment options, requires a combination of intensive psychotherapy, skills training, and family and social support.
Psychotherapy, or more commonly referred to as talk therapy, includes addressing underlying emotional and behavioral aspects to identify ways to overcome challenges and live a more fulfilling lifestyle. Psychotherapy as part of treatment for heroin addiction is the foundation of residential treatment and can be addressed in both individual and group settings. When engaged in psychotherapy, therapists will build relationships with clients based on support and positive regard and will work closely with each individual to improve insight regarding their substance use, build motivation for long-term changes and develop a skill set that assists with managing distressing emotions. Multiple modalities have been supported by research and are evidenced-based in supporting an individual in recovery. While the goal of therapy is always to improve well-being, it can be difficult to discuss and address emotions and trauma, however, our trained therapists will provide emotional support as you gain the skills to manage addiction.
Substance abuse affects the entire family, not just the individual, and family inclusion is important during the initial stages of treatment. Family therapy can lead to an opportunity to mend relationships, help family members develop an understanding of the addiction, and assist the family towards developing a plan that promotes sobriety. Research has shown that actively involving family members in treatment not only benefits the individual but allows a family to make a positive impact on sobriety and that when family is included, individuals are more likely to maintain abstinence. Family therapy includes opportunities to communicate while learning relationship skills as well as conflict resolution and problem-solving techniques to create a family system that will support all individuals towards living a more fulfilling life.
Outpatient therapy for heroin treatment is a necessary step in maintaining sobriety. The initial process of heroin treatment includes the physical withdrawal symptoms, with the second stage addressing immediate emotional regulation skills, however it is not until a person has reacclimated to their daily life that the biggest hurdles are presented. Clients completing treatment will often reference the day they left residential treatment as the true start date to their sobriety. This is because while in residential treatment, an individual in recovery is provided with daily structure as well as elevated levels of support and monitor, however as they begin to reintegrate to their daily lives, they often find themselves triggered by the same stressors, people, places and things that originally helped develop the addiction. Because of this, long-term outpatient treatment becomes important. At APEX, our outpatient programs incorporate daily group therapy, individual psychotherapy, drug, and alcohol counseling, and psychiatry or addiction medicine services. We utilize CBT, DBT, Motivational Interviewing, Coping Skills training and a variety of other didactic and process therapies to help individuals who have already finished a formal inpatient or residential treatment program, are currently sober, and need a continuation of care. In the initial stages of treatment and sobriety, having someone for guidance in the common life problems and challenges has an enormous impact on the positive outcome of the recovery process. During outpatient treatment, the goal is to help individuals move through the stages of change and move from early recovery, into living a more productive life, while adhering to personal goals and needs in the recovery process. Part of outpatient therapy includes a heavy focus on relapse prevention. Developing a comprehensive understanding of warning signs, triggers, and new coping skills is required to build a new life that is more satisfying and promotes sobriety. Developing long-term goals and identifying a value system that reflects new ways of managing stress, daily challenges, and struggles is all integral parts of the relapse prevention aspect. In the development of a relapse prevention plan, it includes incorporating new healthy habits, developing a new support system, changing unhealthy relationships and understanding when to ask for help. These tools help contribute to the long-term success of individuals that have effectively managed heroin addiction.