Heroin addiction: causes, treatment and patient management

By Cristiano Antonino On Apr 15, 2023

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Heroin addiction is unfortunately still quite widespread. There are different types of heroin that differ in quality, type of impurities and cutting substances that have been added during or after production

The most common types are white heroin and heroin base (‘brown sugar’).

The former is the ‘purest’ of those on the market, while the latter is the basic brown heroin.

The ‘white’ is much stronger than the ‘base’, which, due to its characteristics, is more suitable for smoking.

Heroin can be taken by injection, inhaled, aspirated or smoked

The most common method of administration remains injection.

The other methods of administration are usually chosen to avoid the risks of infection associated with injections, sometimes in the mistaken belief that they are less likely to lead to heroin addiction.

The effects of heroin depend on the mode of intake

Intravenous injection produces greater intensity and a rapid onset of euphoria (7 to 8 seconds), while intramuscular injection produces a relatively slow onset of euphoria (5 to 8 minutes).

When inhaled or smoked, the strongest effect is generally obtained between 10 and 15 minutes.

It has to be said that the perceived effects of this substance then depend on the characteristics of the person taking it, the specific time at which he or she does so and the level of structuring of the use behaviour into a real heroin addiction disorder.

Euphoria, or ‘rush’, is one of the reasons why heroin is an addictive substance.

The rush (described by some as similar to orgasm) lasts from a few seconds to a minute.

Once the rush has passed, the state that follows is one of semi-vigilance. In this there is a detachment from reality and a sedative effect on the central nervous system: coordination and concentration are reduced and speech is confused and slow.

Mental functions are clouded for a few hours. A state of strong well-being, extreme inner tranquillity or deep satisfaction is achieved.

The long-term effects of heroin abuse can be devastating: addiction generates physical, mental and social consequences.

In the long term, the heroin addict develops a variety of physical problems that include: immunodeficiency, exposure to all kinds of infectious diseases (HIV/AIDS, TB, hepatitis B and C); liver, respiratory and heart disorders; venous collapse, severe skin abscesses, venous thrombosis; chronic constipation; menstrual irregularity and infertility in women, impotence in men; unhealthy eating habits, weight loss; severe emotional and cognitive disturbances.

The heroin addict quickly experiences physical dependence on heroin, characterised by increased tolerance to the drug and the onset of withdrawal syndrome.

Tolerance is defined as an increasing need over time for higher doses of the drug to achieve the desired euphoric effect.

In the case of heroin addiction, there comes a point where the euphoric effect disappears, but the body has become accustomed to the presence of the drug in its system and needs it in order to function normally.

Psychological dependence on heroin is manifested by a constant desire to take the substance, followed by a negative mood

The patient’s behaviour is often irrational, as it is aimed only at achieving the goal, i.e. the substance.

Physical abstinence can last up to 12 days.

Although it is usually not life-threatening, it is a painful and very stressful condition, making it difficult for many to free themselves from addiction.

Common symptoms of physical withdrawal include: mydriasis (dilation of the pupils); pain in the muscles, spine, legs and joints; nausea and vomiting; stomach cramps; dysentery; chills; sweating, watery eyes; yawning; extreme restlessness and insomnia.

Within a week the patient usually experiences residual weakness and emotional pain characterised by a sense of guilt and shame.

Typical complaints are mood swings, irritability, sleep disturbances, night sweats.

In heroin addiction, emotional suffering in the withdrawal phase is often so significant that it is considered the most common cause of relapse.

From a treatment perspective, the indications in the literature emphasise the importance of a multidisciplinary intervention involving at least three phases: detoxification, intensive treatment and relapse prevention.

Taking charge of the heroin addicted patient must therefore first of all provide specialist medical support of a toxicological and psychiatric nature (where there are no infectious diseases requiring specific activation), then psychological and psychotherapeutic intervention.

Cognitive-behavioural psychotherapy, the elective treatment for substance addiction, focuses on identifying situations ‘at risk of use’ for the patient and implementing strategies to cope with craving and the negative states (thoughts, emotions and situations) generally associated with abuse, at least in the preliminary phase of the disorder.

Within the Cognitive-Behavioural framework, there are also treatments based on acceptance and non-judgement (such as Mindfulness-based approaches) which aim to work on the approach people have with their thoughts and emotions, in order to limit automatic/impulsive acts and allow a different reaction to anxiety, stress, psychic or physical pain, etc. (Childress et al., 1986; Hayes et al., 1996; Gross, 2007).

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