With all of the media stories about how prescription painkiller abuse is driving the ongoing opioid epidemic, it is easy to forget about another deadly opiate – heroin.
Whether it is called “junk”, “horse”, “smack”, or even misspelled as “heron”, or “heroine”, the drug is killing thousands of Americans every year. And while the rates of abuse and overdose due to prescription opioid medications has slowed, the number of heroin addicts and deaths are skyrocketing.
How bad has the problem become?
According to a 2016 report from the American Society of Addiction Medicine, there were 591,000 people in the United States with an addictive disorder involving heroin in 2015, the most recent year available.
For perspective, a decade ago, there were “only” 340,000. That means that in just 10 years, the number of heroin addicts in this country increased by 70%.
Scarily, heroin-related overdose deaths are outpacing heroin addiction.
The Drug Enforcement Agency’s National Heroin Threat Assessment Summary says that heroin deaths went up over 427% between 2010 and 2015.
First Things First – Why Is Heroin So Addictive?
ALL substances of abuse – opioids, alcohol, tranquilizers inhalants, stimulants, hallucinogens, etc. – promote addiction because they profoundly affect the reward pathway of the brain. They do this by artificially increasing the production of dopamine.
Dopamine is the neurotransmitter that lets us feel pleasure. It is also associated with learning and memory. Whenever we perform an action necessary for survival – eating or sex, for example – dopamine levels rise, and we are rewarded with pleasurable sensations.
We LEARN and REMEMBER that the action means a REWARD, so we are MOTIVATED to repeat that action.
Because they also stimulate dopamine production, addictive substances trick the brain into recognizing drinking and/or drug use as a rewardable action.
Heroin does this to a much greater extent, causing in a faster, more harmful, and deeper addiction.
Heroin rapidly floods the body with dopamine. Within 8 seconds, levels jump 200%, resulting in a powerful, euphoric “high”. The feeling is so intense that 1 out of 4 people who even try heroin eventually become addicted.
But over time, chronic heroin abusers develop a tolerance to the drug. In other words, they need larger and larger amounts of the drug to experience the same effect.
This is what drives skyrocketing heroin deaths, because the amount of heroin that can cause a fatal overdose is just 5 times the amount necessary to get high.
Heroin Detox – The First Part of the Process
Long-term heroin abuse also results in drug dependence. This is when a person has been using heroin so long that natural dopamine production shuts down. A heroin-dependent person is completely unable to function without the presence of their drug.
But since functioning without heroin IS the goal, how can heroin dependence be overcome?
It’s simple, but not easy.
Stop using heroin, and your brain chemistry will slowly return to normal.
Whenever more heroin isn’t available, an addict can begin experiencing withdrawal in as little as 12 hours after their last dose. Typically, heroin withdrawal symptoms last between 5 days and 2 weeks, depending on the severity of the person’s addiction.
Unlike alcohol or benzodiazepine withdrawal, quitting heroin isn’t particularly dangerous. However, the harshly unpleasant withdrawal symptoms can be among the worst. The painful “dope sickness” of heroin withdrawal is what pushes many addicts back into active drug use.
Fear of being “sick” is why so many heroin addicts relapse. They just cannot suffer through withdrawal alone.
This is how a medically-supervised heroin detox program can be so beneficial. Withdrawal takes place in a private, controlled, and safe environment. Medical personnel ensure the person’s safety, while support staff makes them as comfortable as possible.
Because withdrawal takes place in a controlled setting, it reduces the likelihood of immediate relapse, simply because more heroin isn’t available. The risk of relapse is further reduced because the staff makes every effort to comfort and encourage patients during this difficult time.
Although some people believe that quitting heroin “cold turkey” is the only way to go, there is another option.
One of the best strategies to ensure successful heroin detox is the use of anti-craving medications such as buprenorphine or methadone. Not only do these doctor-prescribed medications reduce cravings to a more tolerable level, they also alleviate the worst withdrawal symptoms.
This way, it is easier for the person to successfully complete heroin detox.
Heroin detox is NOT recovery, but it IS an absolutely-critical preliminary step that sets up future success.
Only when the worst of the physical symptoms are over can a person’s mind be clear enough for them to move forward in their recovery.
Inpatient Heroin Rehab—Structure and Care
After the detoxification process is over, successful recovery is further aided if the person follows up by checking into an accredited rehab program.
For people with a long personal drug history, or who have failed at previous attempts at recovery, an inpatient rehab program is often the best solution. During inpatient treatment, recovering heroin addicts live at a safe, therapeutic facility that is monitored and staffed 24/7.
People participating in a residential program are removed from the stresses and temptations of their normal daily lives. During treatment, their only real concern is getting better.
Inpatient – also called residential – programs are highly-structured and immersive. Virtually every daily activity adheres to a daily schedule and is in some way geared towards recovery. Keeping busy with wellness-focused therapies, education, and activities will fill the time that once was occupied by heroin addiction.
- Substance abuse disorder information—what it is, the progression, the effects, etc.
- One-on-one behavioral addressing individual issues
- Group therapy addressing issues common to most addicts
- Assessment and treatment for comorbid mental conditions
- Stress reduction
- Proper nutrition
- Positive recreation
- Medication-Assisted Treatment (MAT)— prescriptions to alleviate cravings, anxiety, or depression
- Avoiding triggers
- Relapse prevention and planning
- 12-Step meetings – Narcotics Anonymous, Alcoholics Anonymous, etc.
- Improving communication
- Building support systems
- Alternative holistic options – meditation, yoga, massage, art/poetry therapy, pet/equine therapy, etc.
That structure, the focus, and the around-the-clock monitoring are the biggest positives, especially for people who have been lost to the dysfunctional and chaotic lifestyle caused by active heroin addiction.
The Negatives of Inpatient Heroin Rehab
The biggest downsides to residential treatment are the time and the expense.
Inpatient rehab generally lasts between 30 and 45 days, although it can be extended for people with severe addictions. For some individuals, being away from home that long is a problem, because of other responsibilities and obligations – their children, family, job, school.
For most people, the expense of lengthy inpatient rehab can also be prohibitive, costing tens – or even hundreds – of thousands of dollars. Unless a person has a good insurance plan, that means money becomes a barrier to recovery.
Plus, even after “graduation” from an inpatient facility, many people new to recovery find that they still need ongoing support if they are going to stay clean and sober.
This need is supported by data.
Most addiction experts agree that for heroin rehab services to be effective, they need to last AT LEAST 90 days.
- A 2008 article in the Los Angeles Times reported over a third of individuals who quit rehab before 90 days will relapse within the first year.
- One study found that drug treatment of less than 90 days results in failure rates no better than treatment lasting only one or two days.
- However, when the drug treatment last 90 days or more, only 17% of people suffer a first-year relapse.
And here’s the best part – it doesn’t matter if the rehab program is inpatient, outpatient, or some combination of the two.
Outpatient Heroin Rehab – Flexibility During Recovery
Virtually all of the same kind of recovery services and activities provided by residential recovery facilities are also offered by accredited outpatient heroin rehab programs.
But while residential programs typically last several weeks, outpatient rehab generally lasts several months. In fact, some programs are open-ended, and can last as long as there is need.
Intensive Outpatient Programs – also referred to as IOPs – are the most comprehensive type of outpatient drug rehab. Typically, IOPs meet several times a week for 2-3 hours per session. Most programs offer both day and evening sessions, which is flexible enough to accommodate almost anyone’s schedule.
The main difference is that clients get to live at home during treatment.
This means that the recovering heroin addict can still receive daily support from their loved ones. This support can significantly improve the chances of successful recovery.
It also means that they can participate fully in their own lives while they recover – work, school, family obligations, church, etc.
But best of all, it means that they can apply what they learn in treatment to their daily lives – in real world situations. And, when there is an issue or a problem, it can be addressed at the next IOP class.
Obviously, outpatient drug rehab also means less supervision. But participants are still held to high standards to ensure compliance goals of the program. For example, IOPs require regular random drug tests, with varying degrees of frequency, depending upon a client’s progress.
There can also be homework, practical exercises, and other assignments, and outside attendance at 12-Step meetings, such as AA, NA, or Celebrate Recovery is a usual requirement.
Outpatient heroin rehab is so effective that many people who have just left a residential facility continue their recovery services with a local outpatient program. Not only does this have the benefit of extending the length of treatment, it also costs a fraction of inpatient drug rehab.
There are a few caveats – outpatient heroin rehab may not be the right choice for anyone with a severe addiction, or who has had multiple failed attempts at recovery. Also, not all, outpatient programs are prepared to help people with certain co-occurring mental disorders, such as depression, anxiety, schizophrenia, or PTSD.
If you have a dual diagnosis of addiction and another mental condition, discuss this with your doctor or addictionologist to make sure which outpatient heroin rehab is right for you.
A Few Words about Opioid Replacement Therapy
Most people in outpatient heroin rehab also use MAT to help support their continued sobriety. In addition to antianxiety medications and antidepressants, many recovering heroin addicts also benefit from Opioid Replacement Therapy (ORT).
ORT is a treatment where the abused opiate – heroin – is replaced with a longer-acting and less-euphoric prescription opioid medication. This is done under strict medical supervision.
The treatment of heroin addiction with other, less-dangerous opioid medications is based on the fact that long-term heroin abuse significantly changes the user’s brain. Their recreational use becomes dependence, abuse, and addiction. The overpowering cravings triggered by their altered brain compel them into dangerous or self-destructive drug-seeking behaviors.
Many global health service organizations support ORT, including the Substance Abuse and Mental Health Services Administration, the World Health Organization, the Joint United Nations Program on HIV/AIDS, and the United Nations Office on Drugs and Crime.
Critics say the primary goal of ORT is not to help the person achieve a totally drug-free life, because it can go on for months or even years. Supporters of ORT say that replacing heroin with safer medications and dirty, used needles with prescription liquids and pills is a “harm reduction” strategy that protects the addict and society.
However, ORT does allow patients to regain a large degree of stability and normalcy.
And, when the recovering heroin addict personally decides to stop ALL drug use, their ORT medication can slowly be very gradually tapered and they can increase their participation in other kinds of heroin treatment.
The most commonly used ORTs (Opioid Replacement Therapies)
The two medications most-often prescribed are methadone and buprenorphine. When taken as prescribed, each medication is very effective at easing withdrawal symptoms and reducing cravings. But they also come with their own limitations.
Methadone has a high abuse potential. For this reason, it is usually only given dose-by-dose at a methadone clinic or a doctor’s office. This requires people in methadone maintenance programs to make daily trips. For some, transportation can be a problem.
Buprenorphine – also known as Suboxone – has a very low abuse potential, because its formulation gives it a “ceiling effect” that limits its euphoric effects. Because of this, it can be given in a take-home prescription.
However, methadone is considerably cheaper than Suboxone, and its effects last up to 50% longer. Additionally, research has shown that methadone patients are more likely to view their heroin use as a problem than those people who can simply take a “bupe” at home. Therefore, they are more likely to want additional treatment.
Ultimately, the need for ORT and which medications are right for you should be discussed with your doctor or addiction professional after you have been assessed.
How the Twelve Steps Fit In
Most drug and alcohol rehab programs incorporate the 12 Steps of Recovery in some way. The idea is that by following these Steps, even the most hopeless heroin addict can find the strength to make the mental and emotional changes necessary to successfully regain their sobriety.
Where does this strength come from?
As the 12 Steps say, “from the kinship of common suffering”.
When someone hoping for something better attends an Alcoholics Anonymous or Narcotics Anonymous meeting – even reluctantly – they will hear the stories of other addicts who were once just like them. Yet, somehow, those other people were able to get sober and stay that way.
Once they realize that lasting recovery is possible for SOMEONE ELSE, they will soon start to believe that it is possible for THEM. For the first time in a long time – maybe EVER – the heroin addict has hope.
And, when the outside world becomes too much to handle, strength and inspiration can be drawn from others in the group. That proves just enough to get through today.
It Sounds like A Lot of Work – Is It REALLY Possible to Recover from Heroin Addiction?
It IS a lot of work, make no mistake about it.
But it is MORE than possible. For inspiration, look at this list of famous people who recovered from their own battles with heroin and went on to lead successful lives:
- Robert Downey Jr.
- Samuel L. Jackson
- Tatum O’Neal
- Nicole Richie
- Russell Brand
- Steven Tyler
- Angelina Jolie