A continued use of heroin, even when you’re experiencing negative effects, is a hallmark sign of substance use disorder. But recovery is possible.
With its powerful effects, heroin can be a challenge to quit once you’ve started using.
Over time, you may need more and more of it to experience the same effects.
Even with unpleasant reactions and a desire to stop using heroin, you may find it very challenging to stop on your own. This could be a sign of substance use disorder.
Heroin is an illegal substance in the United States. It belongs to a class of drugs called opioids.
It’s processed from an opiate called morphine.
Opioids and opiates are substances that affect opioid receptors in the brain and neutralize physical pain. They may also cause a relaxed and euphoric sensation.
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 naturally occurring opioids. The latter is what we call opiates.
Heroin works by binding to receptors in your brain called opioid receptors. These receive your body’s natural endorphins and regulate pain, reward, and some behaviors.
When heroin enters the body, it targets the opioid receptors and creates a flood of the feel-good neurotransmitter, dopamine.
This pleasurable, often euphoric, feeling can quickly reinforce the behavior of using heroin. The more you use heroin, the more your body may adjust to its presence.
“Dopamine is the molecule of pleasure and motivation,” explains Monty Ghosh, an addiction specialist in Alberta, Canada. “At baseline, 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 trick it into thinking it needs them to survive.
Your body can become so accustomed to functioning with heroin in its system that it becomes unregulated without it.
Long-term use of heroin can create potentially permanent changes to the structure of your brain. It may leave you with challenging hormonal and neuronal system imbalances.
Addiction is no longer considered a formal diagnostic term. It was removed from the Diagnostic and Statistical Manual of Mental Disorders in its fifth edition (DSM-5).
The symptoms you may associate with “addiction” are part of a complex neuropsychiatric condition that’s now officially known as substance use disorder.
According to the DSM-5, a reference handbook by the American Psychiatric Association (APA), substance-related disorders can be associated with 10 classes of drugs:
- sedatives, hypnotics, or anxiolytics
- unknown substances
According to the DSM-5, you may be living with a substance use disorder if you continue to take a drug even when it’s causing you negative outcomes.
Substance use disorder is not the same as process addiction, though these disorders can occur simultaneously.
Process addiction is based on repeat behaviors that trigger your brain’s natural reward system. Unlike substance use disorder, there’s no drug introduced into the body to create chemical imbalances.
“Process addiction focuses on the behavior a person does over and over again, but it is not necessarily substance-induced or related,” says Jacqueline Connors, a clinical therapist in Napa Valley, California.
“The person is most likely addicted to doing the behavior to relieve emotional discomfort from irrational types of thinking,” she adds. “Process addiction can include gambling, sex, shopping, and exercise.”
Both substance use disorder and process addiction can create a euphoric feeling and result in symptoms of withdrawal when the substance or behavior is stopped.
Heroin and other opioids may lead to substance use disorder because they do more than create a “high.” Unlike many other drugs, opioids have the ability to change your brain chemistry.
You may experience severe cravings and compulsions when you stop using.
Your susceptibility to substance use disorder can depend on your individual biochemistry, genetics, and any underlying health conditions.
Shalin Bhatt, a clinician at Mountainside Alcohol and Drug Addiction Treatment Center in Ramsey, New Jersey, explains trauma may play a large role.
“Current research in addictions confirms that the psychological wounds of trauma and other adverse childhood experiences (ACEs) also increase one’s likelihood of developing problems with substances later in life,” he says.
But this is not the case for everyone or for every opioid.
Other opioids can be used under the supervision of a medical doctor, unlike heroin, which is illegal in the United States.
Heroin use disorder is covered in the DSM-5 under opioid use disorder.
The 11 symptoms healthcare professionals look for to determine whether you’ve developed the disorder include:
- using larger amounts of a substance or using it for longer than intended
- feeling a desire to stop using but being unable to
- experiencing prolonged recovery times after substance use
- inability to manage commitments due to use
- continuing to use the substance despite negative effects on relationships
- giving up important activities because of use
- using the substance even if it puts you in danger
- continuing to use even if physical or psychological conditions are made worse by use
- tolerance (either by diminishing effects at the same dose, or the need for a higher dose to achieve effects)
- withdrawal symptoms or the use of the substance to alleviate withdrawal symptoms
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 the formal symptoms may include:
- warm flushing of the skin
- dry mouth
- heavy sensation in extremities
- severe itching
- clouded mental function
- lapses in consciousness
- reproductive cycle changes
- sexual dysfunction
- constipation and abdominal cramping
- lung conditions
- liver disease
- kidney disease
- mental health conditions
- slow breathing
- changes in brain structure
- hormonal and neural chemical imbalances
- cognitive changes, such as impaired decision making
- collapsed veins, heart-related infections, and abscesses from injecting
- damaged nasal tissue from snorting
Heroin use disorder is often marked by the need to take more heroin as your body develops a tolerance. Eventually, this could cause a potentially fatal overdose.
Signs of an overdose may include:
- loss of consciousness
- shallow breathing
- low blood pressure
- nausea and vomiting
- neuropsychiatric symptoms, such as hallucinations or anxiety
If you’re concerned you or someone else may have overdosed on heroin, calling 911 or local emergency services may ensure you’re evaluated as soon as possible.
The drug naloxone (Narcan, Evzio) can be used in the event of a heroin overdose. Taking it as directed can eliminate opioid intoxication and can reverse opioid overdose.
The nasal spray form of naloxone allows you and nonmedical caregivers to administer it.
Because naloxone only provides temporary relief, calling emergency services first is always recommended.
If you think someone may have overdosed on heroin, the
- Call 911 or local emergency services.
- Assess the scene to avoid exposure.
- If in the workplace or caregiving setting, call trained staff.
- Evaluate symptoms and try to keep or restore consciousness.
- Administer naloxone.
- Initiate other first aid interventions, such as rescue breathing.
- Monitor for condition changes or naloxone reactions.
- Establish post-overdose treatment services.
Good Samaritan laws
All 50 U.S. states plus Washington, D.C., have their own good Samaritan law.
If you stop using heroin after your body is used to it, you might experience these withdrawal symptoms:
- severe heroin cravings
- sleep disturbances
- cold flashes with goose bumps
- uncontrollable bodily movements
- severe bone and muscle pain
Treatment of heroin use disorder can be an individual process. Many people benefit from a combination of behavioral and medical treatments.
“For individuals who have developed a physical dependency to heroin, medically monitored withdrawal management (aka “detox”) in an outpatient or inpatient setting may be indicated,” Bhatt says.
Withdrawal management can help you get through any symptoms you experience while weaning off heroin.
During this phase of treatment, you may be prescribed another medication to minimize heroin withdrawal symptoms. While the medication selected depends on your unique needs, it may work to stimulate or block your opioid receptors.
Common medications used for different reasons during recovery from heroin use disorder include:
Naltrexone may be used after the detox process as a maintenance medication.
According to Connors, using therapies that help reprogram negative core beliefs at the heart of substance use disorder can be very helpful.
- eye movement desensitization reprocessing (EMDR)
- emotional freedom technique (EFT)
- neurolinguistics programming (NLP)
Behavioral therapies can also help you develop different coping strategies for stress and anxiety management.
Heroin is an illegal drug with a high potential for misuse. If you have heroin use disorder, it can be difficult to stop using it, even when you want to quit.
Professional help is highly advisable. You can recover from heroin use disorder when you receive the right treatment.
A combination of medications and psychotherapy can help you break the heroin use cycle.
If you or someone you know is living with heroin use disorder, additional resources can be found by:
- calling the SAMHSA National Hotline at 800-662-4357
- visiting the American Society of Addiction Medicine resources page