Beyond the needle: Addressing the root causes of heroin addiction

There are several factors proposed as root causes of heroin addiction – social, psychological, biochemical and genetic causes. These all overlap and affect each other, and heroin addiction arises from a complex interplay of some or all of them. None of this alone guarantees that a person will become addicted to heroin – but they increase the risk, especially when more than one is present.

Some of these causes can’t be changed – your genes, for instance. However, some causes can be addressed and may offer a path out of addiction. Social groups can be changed, trauma can be unpacked in therapy, and mental health problems can be treated in counselling, heroin rehab or with medications.

We’re going to give an overview of these four causes and how they overlap, dispel some persistent myths and look at routes out of addiction.

Social causes

The people around us, the place we grew up in and the things that happen to us are all powerful factors in addiction. Social causes include many things: our families, our neighbourhoods, our access to resources, and things that happened to us in the past.

Environment and socioeconomic status

Heroin use is correlated with poverty, and poverty is significantly associated with stress, poorer health outcomes, worse living conditions and unemployment – all factors that can drive a person to drugs. Heroin is also cheaper. People with more money may become addicted to pain pills, while poorer people are more likely to become addicted to heroin.

Peer pressure and social groups

Drug use itself is often a social behaviour, and social groups matter. Heroin abuse is more embedded in poor communities, and its higher availability can mean use is more normalised and people are more likely to encounter it, increasing the risk.

Trauma and adverse childhood events

There is a huge overlap between addiction and trauma, particularly childhood trauma. One paper found that 80% of heroin users surveyed in their study had experienced at least one childhood trauma.

Psychological causes

Heroin addiction is a psychologically distressing situation and is also frequently a response to psychological distress. These can form a symbiotic relationship, with both making the other worse.

Mental health problems
Many people struggling with heroin addiction have a dual diagnosis. This means the presence of at least one mental health condition and a substance addiction – there is a major overlap. Trauma is also associated with mental health problems, an example of how causes can overlap and influence each other.
Stress and coping mechanisms

Stress is a risk factor in developing an addiction and susceptibility to relapse. People with poorer coping mechanisms become caught in a cycle, with a diminished capacity to cope with stress, which leaves them vulnerable to addiction and relapse.

Biochemical causes

Biochemical causes are the effects of heroin itself, the addictive nature of the substance and what it does to the brain. They overlap with genetic factors, as people with certain genes experience drugs differently from other people – the field that studies this is called pharmacogenetics.

Brain chemistry
Heroin alters your brain chemistry, releasing dopamine and activating your mesolimbic reward system. One of the common signs of heroin addiction is seeking these pleasurable changes in your brain more and more, which reinforces its use.
Dependence and withdrawal
Like the carrot and the stick, the pleasurable effects of heroin are counteracted by the horrors of withdrawal symptoms, which are frequently severe. Avoiding the withdrawal symptoms of heroin addiction can become as important to the user as maintaining the high.

Genetic causes

Genetic causes are the ways our genes influence our susceptibility to addiction. This overlaps with other causes in complex ways. Genes can alter how users experience heroin biochemically. There is a genetic component to mental health problems. Also, different genes can be ‘switched on’ by experiences, positive and negative, and by your environment. The field that studies this is called epigenetics.

Genetic predisposition

It has been said that about half of a person’s susceptibility to addiction is likely genetic. Studies have found that people who have a lower number of certain dopamine receptors are more likely to become addicted to heroin. This makes sense – dopamine is a feel-good chemical and an intrinsic part of our reward system. If it is harder for us to feel good, drugs that help with that deficit become more tempting.

Studies have found fewer similarities in susceptibility to addiction in non-identical twins than in identical twins, who are more genetically similar, which is further evidence of a genetic component. Interestingly, it’s been found that a lot of genes that predict addiction aren’t specific to one substance but multiple ones. This highlights the role of environmental factors in determining which substance people become addicted to.

Family history

Substance misuse disorders can be inheritable – if a family member has struggled with substance misuse, this increases your risk.

Myth – Addiction is a choice

In 1979, Robert Salmon from the Hunter College School of Social Work in the US said this; ‘Bias, myths and prejudices have influenced our policy stance and have made heroin addiction a more serious problem than it otherwise would have been…contrasted with the British system which in attitude and practice tends to view the addict as ill rather than evil’.

Framing addiction as a disease acknowledges that, like physical diseases, it has many causes that are beyond the control of the user, instead of cruelly and reductively framing it as a choice, which places the blame solely and squarely on the user’s head.

Framing it as a choice makes draconian measures to reduce heroin use more socially acceptable – but these measures don’t work. Heroin use skyrocketed after it entered the black market, and punitive rather than rehabilitative drug laws do not decrease usage. America has strict laws and even had a ‘War on Drugs’, but heroin-related deaths in America are still increasing – by 248% in 2010-2014 alone with few signs of stopping.

It’s important to recognise heroin addiction is complicated and has many causes, and also not to consign users to complete helplessness – trapped in their circumstances and unable to get out. Recovery is a choice – and an extremely brave one. Supporting a user in following the path to recovery after they’ve chosen to stop using means empowering them to keep making the right choices for themselves.

This is called self-efficacy, and it’s one of the key traits found in users who manage to get off and stay off heroin. However, lack of self-efficacy isn’t a simple lack of willpower – it’s not being taught or equipped with the right tools. Self-efficacy and coping techniques are skills taught in therapy, and they are a critical part of the recovery process.

Treatment for heroin addiction

Effective treatment regimens should understand the complexity of heroin addiction and its causes so that they can be both compassionate and effective.

At UKAT, we offer comprehensive, knowledgeable and understanding heroin detox, rehab and aftercare services. Once you’ve made that choice to leave heroin behind, we’ll be with you every step of the way.

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