Heroin addiction: causes, effects, and treatment approaches

Heroin Addiction

Heroin is an illegal and addictive drug derived from certain varieties of poppy plants grown in South America, Mexico, Southeast Asia, and Southwest Asia. In 1874, heroin was first synthesized in the United States and in 1898 was initially used as pain medication. It was only in 1914 that heroin was regulated by the law (Gwinnell & Adamec, 2006). Modes of heroin administration include intravenous injection, intranasal or sniffing, and smoking. Intravenous administration is the fastest and most intense, with the user experiencing euphoria in 7 to 8 seconds. On the other hand, intranasal is relatively slow with its peak effects experienced within 10 to 15 minutes (Parker & Parker, 2002). Though the effect of intranasal heroin administration is slower than that of intravenous, it has been observed to be increasingly the primary mode by heroin users in New York, Connecticut, New Jersey, and Chicago in the past years (Sotheran, Goldsmith, Blasco, & Friedman, 1999). The effect of heroin or "rush" is a function of the mode of administration, dosage, body weight, time interval from last dosage, and individual pharmacokinetics (Aderjan et al., 1995, as cited in Darke & Zador, 1996). Though the intensity of "rush" may differ, it is generally similar across users - an overriding sense of "well being" that drives compulsive use and abuse. Heroin use does not only give a pleasurable sensation, but also a host of negative effects - both immediate and long-term. Immediate effects include nausea, vomiting, severe itching, slower cardiac function, depressed respiration, and clouded mental functioning. Long-term effects include addiction, bacterial infections, abscesses, heart lining and valves infection, and infectious diseases such as HIV and hepatitis C from reuse or sharing of infected syringes (Parker & Parker, 2002). Aside from diseases, heroin use may impact on the user's behaviors that risk imprisonment, interpersonal violence, social condemnation, and physical disfigurement (Humberto, 1998).

Parker & Parker (2002) defines addiction as "a chronic, relapsing disease, characterized by compulsive drug seeking and use, and by neurochemical and molecular changes in the brain." Heroin consumption is affected by its availability and price. In Australia, heroin use was observed to abate following the country's heroin shortage in January 2001 as suggested by reduced reported overdose deaths, declined Naloxene use, and decreased Canadian heroin seized (Wood, Stoltz, Li, Montaner, & Kerr, 2006). Heroin use is higher when its price is lower. Research by Bach & Lantos (1999) showed that when heroin is affordable, an increase in methadone the addicts receive is observed - suggesting greater heroin dependence. Treatments for heroin addicts have been developed for those who seek it. It is usually conducted in outpatient settings, though inpatient settings are preferred in other countries (European Monitoring Centre for Drugs and Drug Addiction 2008). The best treatment includes the right match of medication and cognitive-behavioral approach. Medication for heroin addiction includes Methadone, LAAM, Naloxone, Naltrexone, and Buprenorphine. Of these, methadone is the most widely used. Methadone is a legal drug that can only be obtained with a doctor's prescription. It allows the heroin addict to function normally, but its disadvantage comes with its being addicting as well (Simpson, 1997). In a study by Blanken, Hendriks, Koeter, van Ree, & van den Brink (2005), they found that patients who had previously participated in abstinence-orientated treatment responded significantly better to treatment with medically prescribed heroin plus methadone than to standard methadone maintenance treatment, while patients without experience in abstinence-orientated treatment did equally well in heroin-assisted or methadone maintenance treatment. Among the behavioral therapies for heroin addiction, two have emerged successful: Contingency Management Therapy, and Cognitive-Behavioral Interventions (Parker & Parker, 2002). The Contingency Management Therapy utilizes a voucher-based system in which the patient can earn points for each of his or her negative drug test. These points can be accumulated and exchanged for particular items promoting healthy living. On the other hand, Cognitive-Behavioral Interventions work by helping the patient modify his or her cognitive processes, and by assisting in learning skills needed in coping with various stressors.