Is there a link between heroin abuse and alcoholism? Mounting evidence suggests just that—that these two highly-addictive substances share a connection that can jeopardize successful recovery through a dangerous disorder known as cross-addiction.
Heroin—The Most-Addictive Drug on Earth
“Heroin poses a serious public health and safety threat to the United States.”
~ The Drug Enforcement Administration’s 2017 National Drug Threat Assessment
First the bad news—recovery from heroin addiction is hard.
In fact, in 2007, a panel of experts determined that heroin is the most-addictive substance in the world.
This is of significant concern because in addition to being addictive, it’s also extremely deadly. Between 2002 and 2016, the number of heroin-related deaths in the United States increased by 533%.
But there is good news—Medication-Assisted Treatment can definitely aid in recovery from an addiction to heroin or other opioids. In fact, the combination of MAT, psychosocial counseling, and peer group support is the most effective way to realize a successful in lasting return to sobriety.
What is Opioid Replacement Therapy?
Opioid Replacement Therapy is a type of MAT that uses medications such as methadone or buprenorphine as substitutes for other more dangerous opioids like heroin or powerful painkillers.
Even though it is specifically recommended for opioid addiction, substitution therapy seems to be effective for both heroin and cocaine. After examining almost 9000 patients receiving ORT between 1998 and 2014, researchers learned that:
- Frequent heroin use—defined as at least 5 days a week—was cut to less than half, dropping from over 14% of patients to approximately 6%.
- Frequent cocaine consumption likewise saw a significant reduction, decreasing from 8.5% to under 5%.
Dr. Mary Jeanne Kreek, with Rockefeller University, says, “We wonder whether people who are dependent on both heroin and cocaine respond well to methadone because methadone reduces the number of mu-opioid receptors in the reward system of their brains, or whether they respond because cocaine depletes endorphins and methadone brings the endorphins back.”
Similarly, a small 1993 study published in The American Journal on Addictions reported that using buprenorphine to treat concurrent heroin and cocaine addiction lead to greater program attendants among patients (85%) and greater attention at the 90-day benchmark (91%).
- Cravings and use
- Needle use and sharing
- Addiction severity
Alcohol Consumption Increases During ORT
“Alcohol consumption, on the other hand, increased during the study period. It seems to mirror a general trend that this patient group drinks more alcohol.”
~ Dr. Marcus Herdener, Chief Physician, University Psychiatric Hospital
But a recently-completed long-term study conducted by the University of Zurich and the University Psychiatric Hospital has discovered that while ORT does reduce the consumption of illicit drugs, those same cannot be said for the drinking of alcohol.
At the commencement of ORT, patients will initially drink less alcohol. But as the ORT program continues, the chance of drinking goes up. By the end of treatment, nearly one-fourth of patients studied drink frequently.
Very often, this means that, at best, the person receiving ORT winds up swapping one abused substance for another—alcohol for heroin. This is known as cross-addiction.
What You Need to Know About Cross Addiction
“One truth for us addicts is that each time we move on to another addiction, our behaviors and consequences get progressively worse, never better.”
~ Charles Lease, Cross Addiction Anonymous
Cross addiction typically occurs in one of several ways–
- Without their usual way of getting high, addicts turn to other intoxicants.
This is especially true of alcohol. The Substance Abuse and Mental Health Services Administration estimates that approximately 1 out of every 8 people who abuse drugs also have a drinking problem.
- The addict may not see the harm in their new habit.
If a person’s primary addiction is to heroin, they may mistakenly feel that alcohol isn’t as dangerous. But the same risk factors that made them vulnerable to addiction to one substance places them just as much risk for others.
- The addict feels more “in control”.
At first, the person believes they are choosing to drink, rather than being compelled to use drugs. And, because drinking is legal and socially acceptable, they think they can imbibe just like “other” people. This is a serious case of denial and error in judgement that leads straight to relapse.
Why Do Drinking and Heroin Use Co-Occur?
“Addiction is when natural biological imperatives, like the need for food, sex, relaxation, or status, become prioritized to the point of destructiveness.”
~ Russell Brand, Recovery: Freedom from Our Addictions
Every substance of abuse alters the brain physically and chemically, affecting those areas involved in dopamine production. Dopamine is a neurotransmitter responsible for pleasure, motivation, and learning.
When you do something necessary for survival—eating or sex, for example—the brain “rewards” you with a flood of pleasure-causing dopamine. You learn to associate the pleasure with the action, so you are motivated to repeat the action.
Similarly, substances of abuse trick the brain into releasing massive amounts of dopamine—up to 10 times the normal amount. Initially, substance users choose to drink or use, in an attempt to feel good.
Because heroin and alcohol are both depressants, the effects are similar—euphoria, disinhibition, and sedation. Often, a heroin addict will drink excessively when their drug is unavailable. Alternately, they will drink while using to enhance their high. Between 50% and 70% of active heroin addicts also have an Alcohol Use Disorder (AUD).
How Does Drinking Lead to Heroin Relapse?
“When they were looking for a fix, they looked desperate and panicky.”
~ Julie O’Toole, Heroin: A True Story of Drug Addiction, Hope, and Triumph…
But over time, this artificial over-stimulation burns out the brain’s dopamine receptors and disrupts normal production, to the point that the only way the person can experience any feelings of pleasure or even feel “normal” is when they are under the influence of intoxicants. Now, they can no longer choose—they are compelled out of a need to keep from feeling bad.
During recovery, their disrupted dopamine production gradually returns to normal. During this period—which can last several weeks or even months—the person often suffers from prolonged depression or anxiety
Trying to feel better, some recovering addicts will self-medicate with other substances—most frequently, readily-available alcohol. And, because both substances affect the same regions of the brain, their addiction continues. The person in heroin recovery has just relapsed, by swapping addictive substance for another.
What Are Some of the Specific Dangers of Alcohol Abuse During Heroin Recovery?
“Anything and everything, as much as possible. I had a serious problem… Considering everything I’ve gone through, I feel like I’ve already been there and done that lifestyle to the nth degree. It’s not interesting to me anymore.”
~ Corey Monteith, star of Glee
Shortly after Monteith died at the too-young age of 31, the coroner confirmed that the official cause of death was due to a “mixed drug toxicity” of heroin and alcohol. Specifically, that corner wrote that “after a period of cessation from opioid drug use, a previously tolerated drug concentration level may become toxic and fatal.”
Monteith’s tragic death highlights several of the specific hazards of combining heroin and alcohol.
- Both heroin and alcohol are central nervous system depressants, each individually affecting heart rate, blood pressure, and especially respiration. But when used in combination, the effects are magnified to a deadly degree. 75% of all drug overdoses—and 98% of those that prove fatal—involve more than one substance.
- An individual’s tolerance for intoxication grows faster and is retained longer than their ability to safely handle that dosage physically.
Of special relevance, that overdose threshold drops rapidly during any period of abstinence—during ORT for example.
Denial is a Large Part of Cross-Addiction
“One aspect of denial is thinking that if we bury our guilt by pushing it out of our awareness, we will be free of it… Ultimately, denial comes from, and reinforces, fear.”
~ Lee J. Jampolsky, Healing the Addictive Personality: Freeing Yourself from Addictive Patterns and Relationships
A person who swaps one substance for another is also in denial about the nature of their illness. Changing the drug of choice doesn’t get rid of the specific problem. Addictive disorders have less to do with specific substances and more to do with dysfunctional compulsive behaviors that cause harm.
The main purpose of denial is to preserve the addiction. After all, the longer someone can deny that a problem even exists, the longer they can avoid dealing with it.
In a related way, denial also protects the person’s self-esteem. No one wants to admit they are an addict. The illusion of choice, rather than compulsion, keeps the addiction going.
Additionally, denial helps addicts avoid confrontation with loved ones—those concerned family members and friends who might be able to intervene and exert some influence over the addict. Without that confrontation and intervention, the addiction continues.
Finally, denial shields the addict from the natural consequences of their actions. If they can pretend there’s no problem, they can avoid shouldering any responsibility.
To that end, an addict in denial will employ several strategies:
- Anger – Using hostility to push other people away.
“Who are you to tell me how to live?”
- Blaming – Negatively focusing on others to avoid responsibility.
“I drink because of YOU!”
- Minimalizing—Playing down the gravity of the situation.
“So what if I drink a little? It’s legal.”
- Rationalizing—Justifying substance use.
“I NEED something to take the edge off.”
- Self-deception—Lying to one’s self.
“I can stop anytime I want to.”
Guarding Against Cross-Addiction
For all practical purposes, once someone has been addicted to ANY substance, they forevermore lose the ability to casually use any OTHER addictive substance. Being addicted to one intoxicant means being potentially addicted to ALL intoxicants.
To guard against relapse, an addict in recovery must make a conscious decision to be overly-cautious concerning the use of any potential substance of abuse. This includes legal substances – alcohol, recreational marijuana, and even certain prescription drugs.
Some people in recovery even find it necessary to avoid seemingly-innocuous products, such as mouthwashes containing alcohol or cough medicines containing codeine or dextromethorphan.
A person with a personal history of substance abuse must ALWAYS be completely open and honest with their doctors and other health service providers. For example, someone in ORT should tell their recovery supervisor if they are finding it hard to refrain from drinking during their maintenance program.
The old adage says that “an addict is an addict is an addict”, and the dangers of untreated addiction are largely the same, regardless of what a person’s particular drug of choice is.
But with self-honesty, specialized professional counseling, peer group support, necessary medication assistance, and a willingness to make the required lifestyle changes, it IS possible to overcome any addiction and return to a healthier and happier sober life.