Symptoms of Heroin Addiction, Use, and Abuse
For the mental health practitioner, the terms physical dependence and addiction are no longer accepted as clinically accurate. Rather, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) relies on the term substance use disorder. The DSM-5 is considered a main handbook for mental health purposes. The book is so important that if a disorder is not listed in it, insurance companies typically won’t cover claims for treatment.
The DSM-5 includes opioid use disorder in its sections on substance use disorders. Opioid use disorders include addictions to drugs such as heroin, the synthetic drug fentanyl, and prescription pain relievers (e.g., oxycodone, hydrocodone, and Percocet).
Per the DSM-5, in order for individuals to receive a diagnosis of an opioid use disorder, they must experience impairment or distress as a result of at least two of 11 symptoms within the same 12-month period. A selection of five symptoms, paraphrased, is as follows:
- Diminished engagement in significant areas, such as the social arena, at work, or in school because of heroin or other opioid use
- A persistent desire to use heroin or other opioids despite an awareness of its negative impact on critical spheres of life, such as family, work, and school
- Cravings to use heroin or other opioids
- The onset of tolerance: When the brain becomes accustomed to heroin or other opioids, it will naturally build a tolerance, which requires those who use the drug to consume more of it to receive the desired high.
- The experience of withdrawal symptoms when there is a lapse in use of heroin or other opioids: Although achieving the euphoria associated with a narcotic high provides the initial motivation to use the drug, over time, individuals may use heroin or other opioids mainly to avoid the uncomfortable experience of withdrawal.
Information about the diagnosis of an opioid use disorder provides insight for the individual who uses heroin as well as for concerned loved ones.
The explanation lies in how heroin operates in the brain.
When heroin reaches the brain, it is broken down into morphine, which bonds to opioid receptors in the brain. The morphine excites the opioid receptors in an extreme way, which causes a rush of dopamine and other neurotransmitters to flood the brain. This high amount of dopamine in the brain gives rise to the intense euphoria associated with heroin use. Over time, heroin can severely impair natural dopamine regulation in the brain. The changes to the brain environment of a person who uses heroin leads to perceptible physical, psychological, and behavioral signs and symptoms. The person who uses a drug experiences a symptom; people who witness this see a sign. For example, nausea is a symptom; vomiting is a sign.
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Physical Symptoms of Heroin Use
Individuals who use heroin have reported in different studies how it feels to do so. Although experiences differ, many say that in addition to experiencing euphoria, they have a warm feeling that removes all their worries. Some describe feeling as if they are in a dream-like state. These feelings can be especially desirous for people who are trying to self-medicate for a mental health disorder. According to one study, 75 percent of participants who used heroin had bipolar disorder, attention deficit hyperactivity disorder, and depression. Other studies have observed that there is a high correlation between heroin use and a co-occurring mental health disorder, also known as a dual diagnosis or co-occurring disorders.
Heroin is associated with a host of short-term side effects or symptoms. The National Institute on Drug Abuse notes that besides exhilaration, the following side effects may occur immediately or shortly after a person uses heroin:
- A warm flushing feeling on the skin
- Dry mouth
- A leaden feeling in the arms and legs
- A severe itching sensation
- Drowsiness (may persist for several hours)
- Clouded mental capacities
- Slowed heart rate
- Slowed breathing (can lead to permanent brain damage, coma, or death)
There are numerous long-term side effects associated with chronic heroin use. According to the National Institute on Drug Abuse, the following are some of the known long-term consequences:
- Brain damage, which may be permanent in some affected areas, can occur. For instance, some studies show that chronic heroin use affects the levels of white matter in the brain that can in turn affect a person’s decision-making abilities, ability to regulate behavior, and ways of responding to stress.
- Physical tolerance (also described in much of the literature as physical dependence, though again the DSM-5 has dispensed with this terminology) will likely develop.
- Due to physical tolerance, when an individual stops using heroin or significantly reduces the familiar intake, withdrawal symptoms begin. The most common heroin withdrawal symptoms are insomnia, muscular and bone pain, vomiting, diarrhea, goosebumps, involuntary leg movements, cold flashes, and restlessness. Typically, withdrawal symptoms peak 24-48 hours after the last time heroin was used. They may subside after a week to 10 days but can possibly continue for many months.
- The development of an opioid use disorder may occur. As noted earlier, a person who uses heroin and experiences a sufficient amount of clinically recognized symptoms is considered to have an opioid use disorder. All forms of heroin use, such as smoking, sniffing, or injecting, can lead to fast onset of an opioid use disorder.
In addition, there are other serious long-term effects of heroin use. A person with a history of heroin use may experience:
- Infections in the lining of the heart and valves
- Collapsed veins
- Infections in the skin, such as cellulitis and abscesses
- Contraction of hepatitis B, hepatitis C, or HIV
- Diseases that affect the lungs, such as tuberculosis or pneumonia
According to the US Substance Abuse and Mental Health Services Administration (SAMHSA), in 2014, an estimated 586,000 Americans were experiencing a heroin use disorder. (Note: heroin use disorder is not recognized in the DSM-5; it is used herein to denote an opioid use disorder that involves heroin.)
The most impactful physical side effect of using heroin is death. Per the National Institute on Drug Abuse, in 2014, there were more than 10,000 heroin overdose fatalities in the US. In all years from 2001 to 2010, the number of heroin overdose deaths stayed below 4,000. However, from 2011 to 2014, the number continued to climb. In 2011, there were more than 4,000 deaths. In 2012, there were almost 6,000, and in 2013, there were about 8,000.
Psychological Symptoms of Heroin Use
The psychological consequences of heroin use can include anxiety, depression, insomnia, and cravings for this narcotic. For some people, the cravings can last for years. There are, however, long-term heroin substitution therapies, such as methadone and Suboxone (buprenorphine), that can stem or end cravings and prevent relapse.
Mental health symptoms emerge at different times, including immediately after use, during withdrawal, and possibly after recovery. To the untrained eye, it may be difficult to distinguish between the mental health symptoms associated with heroin use versus a mental health disorder. Individuals who are concerned that a loved one may be using heroin can take different courses of action. If the individual is amenable to speaking with an addiction specialist, that’s typically the most effective thing to do. Otherwise, a concerned person may have a talk (i.e., an informal intervention) with the individual suspected of using heroin. If that is not effective, a formal intervention that includes an immediate treatment plan can be helpful, and interventions that are led by a professional are generally more successful.
There is overlap between the symptoms categorized here as physical, psychological, and behavioral. While mental health professionals rely on such distinctions, individuals who are concerned about a loved one’s behavior may see a host of warning signs and not know to which facet of heroin use they relate, but they will still sense that there is a problem.
One of the biggest signs of substance abuse is a very general one: a shift in the person’s attitude, appearance, and habits. Noticing that shift is the first step; the next step is developing a plan of action and making the necessary moves to get professional help. It’s important to know that there is help available. No matter how dangerous heroin addiction is, it is a treatable condition, and there is hope in recovery.
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