Addressing the collateral damage of heroin addiction

Heroin has a long history of use and misuse, dating back to the late 1800s. Like many other opioids, heroin is a derivative of morphine, which is found naturally in opium poppies. Opioids are still measured against morphine to assess their strength for use in medicine. Compared to morphine, heroin is twice as strong but shorter in acting. Generally, shorter-acting drugs are more addictive – they enter the system and leave it faster, meaning one of the first signs of heroin addiction is the need to take more of it quickly to maintain a high.

The story of heroin will be familiar to anyone who has witnessed the rise and fall of other opioids, such as oxycodone, in the last century. Initially hailed as a wonderdrug and considered safe, heroin began to be produced on a mass scale in 1898. Quickly, its addictive qualities became apparent. Morphine users switched to the stronger drug and enhanced its effects by injecting it, leading to heroin addiction becoming widespread. After the introduction of restrictions on its production and distribution, heroin entered the black market, and rates of use rose quickly.

In the UK, prevalence stabilised after peaking in the 80s and 90s, with fewer young people using it. In 2021/2022, the mean age of heroin users was 43.69% of people in treatment for opiates said they first used heroin before 2001, with only 9% saying they first used heroin in 2011.

Physical, mental and emotional toll

Heroin is extremely addictive, both physically and mentally, causing a rush of pleasurable feelings, a sensation of release and a reduction in physical pain. It is easy to overdose on heroin, as bags may be inconsistently dosed or cut with adulterants and other drugs. Taking too much causes dangerously low heart rate, lowered body temperature, shallow breathing and, if the dose is severely misjudged, death.

The availability of naloxone has helped to reduce overdoses in the UK, but solid data is hard to come by. There are even suggestions that the distribution of naloxone reduced overdoses by 6.6%, and there are calls to make it more available. However, this small reduction shows that naloxone is not a magic bullet for preventing overdose and that while making it more available is the right thing to do, it doesn’t address the underlying causes or consequences of addiction to heroin.

Heroin addiction is progressive, and over time, the body becomes more compromised and open to infections if injection is the preferred route of administration. When taken orally, opioid addicts, while still at risk of overdose, circumvent many of these risks. However, injection is the fastest-acting and most cost-effective way of taking heroin, and this massively increases the risk of complications. There is a severe and long-term risk of bacterial infections in people injecting heroin, and needle-sharing increases the risk of contracting HIV, hepatitis B and hepatitis C.

Genetic, trauma-based and adverse childhood experience-based explanations have all been put forward as factors increasing the likelihood of heroin addiction. Early life experiences are known to alter gene expression, meaning a combination of nature and nurture-based causes is possible. A Chinese study on 341 heroin users reported an 80% prevalence of childhood trauma. While the causes are uncertain, trauma and emotional dysregulation are commonly reported.

Unfortunately for the user, heroin addiction itself is extremely traumatic. Heroin withdrawal symptoms, while not usually life-threatening, are intense and unpleasant to go through. In rare cases, heroin withdrawal has been fatal, from dehydration due to vomiting and diarrhoea, but supervised heroin detox significantly reduces this risk.

Heroin users can risk death for their addiction, and interactions with communities and society at large become more stressful, fraught and dangerous. The physical, mental and emotional toll on the user is intense. People can remain trapped in this cycle, finding relief only in heroin while the experience of heroin addiction keeps them trapped in traumatic circumstances for many years.

Community and Society

Public services are often not equipped to deal with serious addiction. In the UK, the financial cost of heroin was calculated as £37,864 per user every single year. These costs were incurred by numerous factors – cost of interventions, crime and violence, health, housing, homelessness, employment, education, public health outcomes and maternal and infant care. This makes it clear that heroin addiction touches on a huge number of issues – but heroin users often fall between the cracks on all of them.

The criminalisation of heroin and the need for the user to obtain money for heroin by any means necessary increases the likelihood of users being involved with law enforcement, with poverty, unemployment and social exclusion being both causative and the result of heroin addiction.

Family dynamics and relationships

Heroin misuse, like many substance use disorders, increases the disruption of attachments, rituals, roles, communication, social life and finances within relationships and families. When a parent is suffering from a substance use disorder, the family dynamic is often secretive and marked by loss, conflict, violence and fear. Role reversal can occur, such as parentification, when the child takes on responsibilities greater than appropriate for their age.

Support groups and education for families of heroin users play an important role. When family members have the right information, they can play a significant role in getting a loved one to recognise they have a problem and accept treatment.

However, it is important to note that families are also gravely affected by a loved one’s heroin addiction, and they need support, too. Setting, defining and keeping boundaries are ways families can protect themselves in a way that isn’t punitive, defining what behaviours they will and will not tolerate. This helps them support their loved ones while protecting their physical and mental health.

Treatment for heroin addiction – admitting you have a problem

As we touched on earlier, many people addicted to heroin have been so for a long time, which makes admitting addiction complicated. Drug addiction means that drug use has spiralled beyond a person’s control, and denial is a powerful tool in suppressing this fact.

A study of recovered and non-recovered heroin users over 30 years found two major factors in recovered users – increased self-efficacy, and the addressing of underlying psychological factors. This self-efficacy allows users to feel less powerless in the face of addiction and cravings, and addressing the psychological problems that led to the addiction removes some of the reasons why a user may return to using heroin.

This means that while addressing the addiction itself is important – and being supported through the process of heroin detox and rehab can be a lifeline – incorporating therapy is critical for addressing underlying psychological factors and building adaptivity and coping skills. That’s why a holistic approach, which addresses the addiction, helps users confront psychological stressors and gives them new tools that promote self-actualisation, which can increase the effectiveness of heroin rehab and prevent relapse.

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