Heroin Addiction: Signs, Symptoms, and Treatment 

In 2020, more than 900,000 individuals living in the United States used heroin.1 Additionally, the rates of individuals seeking treatment for heroin addiction increased by 5% from 2003 to 2013.2 Heroin is a Schedule I, highly addictive opioid that can be deadly if too much is taken or when it is mixed with other substances. Chronic use of the substance can lead to heroin addiction, which is a pattern of compulsive use despite negative consequences. However, knowing the signs and symptoms can help you know when to seek professional heroin addiction treatment.

In this article:

Signs of Heroin Addiction

Anyone who uses heroin is at risk of developing a use disorder due to heroin’s highly addictive qualities. Signs that suggest you may be addicted to heroin include:3

  • Performing poorly or differently in major roles (e.g., work)
  • Experiencing changes in your sleeping or eating habits
  • Getting in trouble with the legal system or your employer
  • Having problems getting along with others or your partner
  • Losing interest in things that you used to enjoy
  • Feeling less pleasure in things that used to give you joy
  • Missing work or no longer attending family events or other activities
  • Spending time with new friends who use substances or who may be involved in illegal activities
  • Spending less time with friends and family
  • Caring less about your hygiene and appearance

A medical or mental health provider follows the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for a diagnosis of an opioid use disorder, or heroin addiction. According to the DSM-5, you may have an addiction to heroin, if within the last 12 months, you have:4

  • Used heroin in a larger amount or have used it longer than you originally intended
  • Had a goal to cut down or control your heroin use and have been unsuccessful when you attempted to do so
  • Spent a significant amount of time trying to obtain heroin, use it, and/or recover from its effects
  • Experienced a strong desire to use heroin, also referred to as a craving for it
  • Failed to meet major role obligations, such as employment or family needs, due to your heroin use
  • Continued to use heroin despite it having harmful effects on social and interpersonal relationships
  • Given up or reduced recreational, social, or occupational activities
  • Been placed in physically hazardous situations due to heroin use (e.g., overdose)
  • Continued to use despite any other psychological problems, such as anxiousness or depression
  • Needing higher amounts of heroin to feel the desired effects (tolerance)
  • Experiencing heroin withdrawal symptoms when you suddenly quit (dependence)

If you have experienced at least two of these, you will have met the criteria for a “mild” substance use disorder. More symptoms will warrant a “moderate” or a “severe” heroin use disorder, depending on the amount of endorsed symptomatology.

Symptoms of Long-Term Use

If you have used heroin for a long time, common symptoms may develop as a result. Symptoms of long-term heroin use may include:5

  • Mental health disorders, such as depression
  • Insomnia
  • Infections of your heart, especially in the lining and valves
  • Constipation
  • Stomach cramping
  • Liver and kidney disease
  • Complications with your lungs, such as pneumonia
  • Sexual dysfunction
  • Irregular menstrual cycles
  • If you sniff or snort heroin, damaged tissue inside your nose
  • If you inject heroin, collapsed veins, scar tissue, or abscesses

Why is Heroin So Addictive?

For many, heroin can cause a calming effect and may even create a feeling of drowsiness. This effect is caused as heroin affects the brain’s various neurotransmitters.

Heroin can be taken in many forms, including intravenously (injected with a needle), nasally (snorted/sniffed), or inhaled (smoking). Heroin rapidly enters your body’s system and binds to opioid receptors throughout your brain.5 These cells are involved in your sense of feeling pain and pleasure and other functions, such as controlling your heart rate, breathing, and ability to sleep. When heroin is used, many people report a “rush” of pleasure or a sense of euphoria, as dopamine levels surge. This hijacks the brain’s reward system so that when the high fades and dopamine levels drop, the brain craves the substance and compels a repeat of the behavior to achieve the same high.

However, after repeated use, the user may develop tolerance, in which more heroin is needed to elicit the same high, or dependence, where the body becomes used to the presence of heroin and withdrawal symptoms occur without it. These can contribute to repeated use and the formation of an addiction to heroin.

Who is at Risk of Heroin Addiction?

Addiction can happen to anyone who uses heroin; however, you may be at increased risk of heroin addiction if you have become addicted or dependent to other opioids, such as those prescribed for pain. Opioid pain medications are chemically similar to heroin; as such, some people may progress to heroin use if they are unable to obtain or afford prescription pain medication through their doctors.5

Otherwise, general risk factors for becoming addicted to substances include:6

  • Early childhood problems (e.g., difficulties controlling emotions, lack of coping skills, and low self-esteem)
  • Other types of childhood vulnerabilities (e.g., learning disabilities, mental health problems, and physical disabilities)
  • Problems during adolescence (e.g., substance use at a young age)
  • Minority status (e.g., cultural/language barriers and racial discrimination)
  • Community and your environment (e.g., living in areas of high rates of crime and drug use)
  • Family environment (e.g., disruption in the family, abuse and/or neglect, and other forms of violence within the home)
  • Negative adolescent behavior or experiences (e.g., peer pressure, rebelliousness, and lack of bonding with society)

Heroin Addiction Treatment

Medical Detox for Heroin Withdrawal

Treatment usually starts with detox, or the process of ridding opioids from your body. When you stop taking heroin, you will likely experience symptoms of withdrawal. These symptoms can range from uncomfortable to dangerous, including:7

  • Agitation
  • Anxiousness
  • Body aches
  • Cravings to use
  • Increased blood pressure and heart rate
  • Insomnia
  • Irritability
  • Runny nose
  • Sweating

These symptoms can range in severity and duration, lasting from hours to days. The psychological symptoms can last even longer.

During medical detox, you may be prescribed medications to help manage the symptoms of withdrawal. Medications used for heroin withdrawal may include:7

  • Methadone
  • Buprenorphine
  • Adrenergic medications (e.g., clonidine) as adjunctive medication
  • Over the counter (e.g., acetaminophen, anti-nausea) as needed

Treatment Settings

Addiction treatment services after detox will comprise the bulk of the work to help you achieve long-term recovery from heroin. These services can take the following forms:8

  • Inpatient rehabHighly structured, residential programs that are fully monitored by medical professionals in an environment solely focused on recovery.
  • Standard outpatient treatmentThese programs only require a few hours of therapy a week, whether it be in-person group therapy sessions or telehealth meetings with a doctor or counselor.
  • Partial hospitalization programs (PHPs)—Can often fill the gap between inpatient and outpatient rehab; these intensive programs typically require daily participation for several hours.
  • Intensive outpatient programs (IOPs) —Usually require nine or more hours a week of treatment, which can be broken up into meetings several days a week.

Medication-Assisted Treatment

Depending on your needs, medication-assisted treatment (MAT) may be used to help alleviate opioid cravings so you can fully engage in addiction treatment and prevent relapse. MAT is the term for medications that are approved by the Food and Drug Administration (FDA) to help treat effects of your heroin use disorder. These medications are intended to be used alongside behavioral therapies as a comprehensive approach to treating your addiction. Medications for opioids can include:

Qualities of Effective Addiction Treatment

Regardless of the level of services you choose, the most effective treatment includes:8

  • The approach and understanding that addiction is a complex illness that affects the brain, behavior, and ability to function
  • Treatment catered to you, as no single approach is effective and appropriate for everyone
  • A focus on you as a whole person, rather than focused solely on your substance use
  • An ability to remain in treatment for at least three months
  • Access to evidence-based behavioral therapies
  • Access to medications
  • Continuous monitoring of the treatment plan to ensure needs are being met
  • Treatment for co-occurring mental health disorders
  • Appropriate monitoring of substance use
  • Examination and treatment for medical conditions as needed

Aftercare and Ongoing Support

Recovery from heroin addiction is a long-term process and does not end immediately following detox or rehab. Involvement in aftercare has been shown to decrease the likelihood of readmission to treatment and improves the likelihood you will maintain your recovery gains.9 For individuals with co-occurring substance use disorders and mental health disorders, aftercare services were found to be effective in helping reduce the severity of psychiatric symptoms and improve functionality.

Recovery includes many aftercare services. These services are often types of standalone treatment themselves and were developed to help support progress and sustain recovery efforts.

Aftercare and ongoing support can also help you:9

  • Master living sober within your community
  • Develop constructive skills
  • Consolidate skills and values learned during earlier phases of treatment
  • Obtain employment
  • Resolve familial discord

Services that are offered as aftercare include:

  • Support groups—Most adhere to a 12-step model, such as Narcotics Anonymous, and can address substance use issues exclusively, mental health issues exclusively, or both issues simultaneously
  • TherapyThis can be on an individual basis or family or group therapy; may include cognitive behavioral therapy, motivational enhancement therapy, dialectical behavior therapy, holistic therapy modalities, etc.
  • Therapeutic communities—These are designed to help promote autonomy while focusing on maintaining abstinence as you return to the larger community. Many communities utilize sober living housing whereby individuals in recovery live together in a structured residency.

Furthermore, aftercare has a multitude of support services that can help your recovery from heroin addiction, including10

  • Outpatient counseling
  • Recovery monitoring by the use of urine drug screens
  • Family support
  • Education and job skills
  • Ancillary services with the use of a case manager to assist with things like housing

If you are interested in detox, treatment, or aftercare services for heroin addiction, call us at 800-662-HELP (4357) (Info iconWho Answers?) to speak with a treatment specialist who can help connect you to options.

Resources

  1. Substance Abuse and Mental Health Services Administration. (2020). Opioid overdose.
  2. Wu, L.-T., Zhu, H., & Swartz, M. (2016). Treatment utilization among persons with opioid use disorder in the United States. Drug and Alcohol Dependence 169, 117-127.
  3. National Institute on Drug Abuse. (2021). What are the signs of having a problem with drugs?
  4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  5. National Institute on Drug Abuse. (2021). Heroin.
  6. Hawaii Department of Health, Alcohol and Drug Abuse Division. (2022). Alcohol and drug abuse prevention.
  7. Substance Abuse and Mental Health Services Administration. (2015). Detoxification and substance abuse treatment.
  8. National Institute on Drug Abuse. (2020). Principles of drug addiction treatment: A research-based guide (Third edition)
  9. Substance Abuse and Mental Health Services Administration. (2020). Substance use disorder treatment for people with co-occurring disorders.
  10. Gonzales-Castaneda, R., McKay, J., Steinberg, J., Winters, K. C., Yu, C. H., Valdovinos, I. C., Casillas, J. M., & McCarthy, K. C. (2022). Testing mediational processes of substance use relapse among youth who participated in a mobile texting aftercare project. Substance Abuse, 43(1), 1-12.

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