Heroin Recovery, Rehabilitation and Treatment

Heroin addiction is a complex, multi-faceted, and maladaptive behavior with physical symptoms and long-term consequences which make unaided recovery all but impossible. The term maladaptive here indicates that the behavior is or has become more harmful than helpful. Heroin use is a solution to a problem that then becomes THE PROBLEM. While heroin withdrawal is not usually life-threatening, long-term use of heroin can cause underlying medical issues requiring medical detoxification. Long-term heroin use can also cause profound behavioral changes in which the individual’s entire existence is focused on finding more of the drug. Over time this can lead to extreme behavior and even mimic psychotic episodes. In order to be effective, rehabilitation programs for heroin must address all these aspects of heroin use.

Physical Recovery from Heroin

The first step in any recovery program designed to address heroin addiction is to get the person to stop using the drug. This may seem obvious, but heroin addiction has several aspects which make this step one of the hardest to take. In order to understand this, it’s important to understand that heroin is an opiate, just like the pain medication a dentist may prescribe for a tooth extraction.

Oxycontin painkillers.
Oxycontin painkillers. Image courtesy of the DEA.

Opiates and their synthetic derivatives, known as opioids, are a class of drug which creates a strong physical dependence. With every dose of this class of drug the body’s tolerance increases. As tolerance increases, more and more of the drug is needed to achieve the same effect. While prescribed for pain, opioids and opiates also cause a strong euphoric effect. This euphoric effect masks not only physical pain but also any mental and emotional pain a user might be feeling. It’s this euphoric effect which is the most devastating aspect of these types of drugs. The more a person experiences the effect the less able the individual is to solve problems without the drug. The body becomes dependent on the drug to function and the mind begins to use the euphoric effect as a way to avoid negative experiences, both from the past and in the present. This process quickly causes the user to look for not only larger doses of the drug, but stronger dosages. Often at this point, the doctor prescribing the drug will stop dispensing the it and the user will begin to buy first pills, then heroin on the street. Unfortunately, while many doctors will discontinue the prescription, relatively few will provide any form of treatment for heroin addiction.

In order to successfully treat the heroin addict and rehabilitate the person, the physical aspect of the addiction must first be addressed. Over the last 100 or more years there have been various approaches to treating heroin addiction.

Heroin itself was used as a treatment for opium withdrawal until its devastating effects were discovered. This approach—treating one addiction with another addictive substance—is unfortunately still used today. By giving a person addicted to heroin another opioid, withdrawal symptoms can be avoided. But as we have noted, withdrawal symptoms are not the only effect of heroin addiction and unfortunately, this is as far as many heroin addicts get. By replacing heroin with a controlled drug dispensed in a legal setting, proponents believe that they have solved the problem for society and they support these claims with statistics showing lower rates of criminality, overdose, and relapse. These social benefits fall into an approach called “harm reduction.” The reality, however, is that the addiction is not being treated, merely masked, and individuals on the drug are forced to take the drug for the rest of their lives, or until their next relapse.

There are other approaches to heroin rehabilitation that are not so grim. It is an unfortunate truth that the worst of the withdrawal symptoms of heroin reach their peak during the first 72 hours and subside completely in less than a week, and if a heroin user can get past this point, they will no longer be physically dependent and had they simply avoided replacement medication they would be largely free from the effects of physical dependence. In severe cases of heroin addiction and when underlying medical problems make withdrawal dangerous or likely to fail, the same drugs used as a replacement may be used to taper or ween a person off of heroin. While this approach may make the experience more comfortable for the individual, there is some research to suggest that, if medically possible, withdrawal without the aid of a taper may provide better results. In addition, the withdrawal my be further eased by light massage and mild physical activity. It’s important that after these initial withdrawal symptoms are addressed that the individual is provided further treatment options to address the underlying issues which created the dependence on heroin in the first place.

While the initial withdrawal is the main result of physical dependence, there are other physical symptoms which may last for months after this initial phase. These symptoms together are known as Post Acute Withdrawal Symptoms and may last for weeks or months after the initial withdraw has ended. Left unaddressed, these issues contribute to cravings and increase the risk of relapse. Medical attention for disease and malnutrition caused by prolonged heroin may also be needed.

Post-Acute Heroin Withdrawal Symptoms

The group of physical symptoms that persist after initial withdrawal from heroin is believed to contribute to the overall risk of relapse and has only recently been well understood by many drug rehabilitation programs. These symptoms may mimic symptoms which are normally treated by anti-depressants or other medications. This unfortunate effect may explain why these symptoms were not seen as an actual extension of the addiction.

Narconon Drug Rehab - Step 1
An all-natural vitamin regimen
Narconon Drug Rehab - Step 2
Narconon Drug Rehab - Step 3

There are holistic solutions for these symptoms. Diet, exercise, and the treatment of underlying medical issues often resolve the symptoms. In addition, there are effective programs which relieve these symptoms with diet, light exercise, and low heat saunas. The New Life Detoxification Program at Narconon is one example of this type of program. Handling these symptoms is important so the person is not distracted by them while attempting to address underlying issues.

For more information about the signs of heroin use and the symptoms of withdrawal:

Heroin Rehabilitation and Social Skills

After the initial physical symptoms have been resolved and the former addict has stopped using the drug, the next phase of heroin recovery begins to address the behavioral effect the drug has had on the user. While the physical compulsion to use heroin may be gone, underlying emotional pain and further physical injury or personal loss can cause the individual to seek the strong euphoric effects of heroin or other opioids. In order to combat this, someone in recovery from heroin addiction must learn new skills to handle these situations.

Often people who have never suffered from addiction find it hard to understand why someone would turn to drugs. The reality is that drugs like heroin appear to solve problems. Most people don’t start with heroin, many start with alcohol, nicotine, marijuana or any other number of substances which seem to solve our immediate problems. While not everyone using these substances ends up using heroin, the underlying principle of addiction still exists. Anyone who has tried to quit smoking in a stressful situation will recognize how well nicotine seems to remove stress. The reality is, however, that it’s not removing stress, it’s amplifying it . The euphoric effect of nicotine is only apparent when one has not been smoking. The strong craving for nicotine amplifies the stress we are feeling and makes us think that it is providing a solution.

Many addicts can tell you when they actually got addicted. They remember when a substance appeared to make them feel invincible or comforted or whatever they needed to feel. While those who are not addicts learn skills to deal with these situations, if someone has been using drugs to regulate how they feel, then simply stopping the use of drugs will do little to ensure someone can recover from addiction. Another skill which addicts often lack is the ability to choose people who will support and validate them. Many addicts are used to choosing friends as a result of a need or desire for what that person can provide them or how they make them feel. Learning to choose healthy relationships and positive role models is a critical part of any recovery program.

Cognitive Changes During and After Recovery

Another aspect of recovery from heroin addiction involves not only learning new skills but addressing how individuals think so that they can take responsibility for their own actions. These cognitive changes are perhaps the most important aspect of heroin recovery. Instead of focusing on negative memories, unhealthy relationships or being the victim, rehabilitation programs must address these issues for true recovery.

Often individuals have collapsed into the belief that they are a victim and have no power to stop themselves from using heroin. This negative thinking can be addressed, and individuals can begin to accept responsibility for their actions once again. This approach is not universal, however, and some programs teach that the addict is powerless and will always be an addict. This is a commonly held belief in many 12-step recovery programs. While this approach may work for some, many individuals do not respond to this and are unable to trust a “higher power” to take away their addiction. For those where this approach does work, it allows them to change their negative thinking by accepting that they do not always make the best decisions, it allows them to accept that something greater than themselves exists. It’s this change in perspective which creates a similar cognitive change.

Part of the tragedy of heroin addiction is the negative self-image and social stigma that drug addiction creates. Even after someone is no longer addicted they may still face legal and social problems as a result of their addiction. Without tools that allow a person to deal with these situations, relapse may occur. These cognitive changes do not happen overnight. In fact, research has shown that the length of treatment is one of the leading indicators of ultimate success with any heroin addiction treatment program.

True Recovery from Heroin Addiction Is Possible

The stigma of heroin addiction is still difficult for many to overcome. Unfortunately, there is little public funding for treatment programs and the funding that does exist often favors the cheaper alternative of medications. While these medications may seem to reduce social problems attached to addiction, they do little to address the personal suffering created by the empty promise of a permanent solution provided by replacement drugs. While life-saving drugs such as naloxone and drugs used to ease withdrawal symptoms may have some efficacy, the only real solution to the addiction crisis is an effective, long-term drug rehabilitation program.

One way to help de-stigmatize addiction is through education. Understanding why individuals turn to drugs and alcohol as a solution allows others to empathize with those who are suffering. Educating individuals about the dangers of pharmaceutical pain medications can help all of us be on the lookout for situations that can quickly turn into an addiction. Learning to identify the signs of heroin addiction can help spot an addiction before it spirals out of control. For recovering heroin addicts, joining community groups which support drug education can help spread the word. There is no greater sign of recovery than the desire for others to have the same results. By giving back to the community and leading others by example, a single heroin user free from addiction can help hundreds of others. This is ultimately the goal of recovery.

True, lasting, effective recovery is possible.

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Reviewed by Claire Pinelli, ICAADC, CCS, LADC, MCAP, RAS