Heroin is derived from opium, which is why it is referred to as an opiate or opioid. Users experience a brief pleasant rush and then a long drowsy, disconnected feeling. With continued use, chemical changes in the brain cause the body to become accustomed to and dependent upon the drug. The body also becomes tolerant of the chemicals in the drug, meaning that the user must constantly increase the amount of the drug used in order to feel another high. This dual physical and psychological addiction makes recovery particularly difficult. Treatment for Heroin addiction may employ either medication or behavioral therapy alone, but research shows that combining the two is the most effective approach.
Detoxification from Heroin addiction is a period of waiting until the drug is out of the body system, and usually precedes treatment. Because of the physical dependency, the user goes experiences withdrawal symptoms, which include pain, diarrhea, nausea, and vomiting. These symptoms can be severe, so much that addicts enrolled in detoxification programs are given medications to ease the symptoms and reduce craving for the opioid.
Medications used in Heroin addiction treatment include Methadone, also known as Dolophine or Methadose; Buprenorphine, also known as Subutex; and Naltrexone, also known as Depade or Revia.
Methadone is an opiate, but it acts more slowly than heroin. Because it is an opiate, Methadone eliminates withdrawal symptoms, but the rush is reduced because Methadone is taken orally. In treating Heroin addiction, substituting one opiate for another has been criticized; Methadone has been used since the 1960s and remains an excellent option for addicts who don’t respond to other medications. However, Methadone is only available through approved outpatient drug treatment programs, where it is dispensed on a daily basis, and this can make access difficult for some.
Buprenorphine is also an opiate, but one that relieves cravings without the side effects or the high produced by other opiates. A version of Buprenorphine known as Suboxone contains Naloxone to offset the opiate. Like Methadone, Buprenorphine and Suboxone are meant to be taken orally, however, if an addict injects Suboxone, seeking a rush, the Naloxone induces withdrawal symptoms. Buprenorphine and two generic forms of Suboxone have been approved by the FDA, so any certified physician may prescribe these drugs, making access easier for those unable to make daily visits to a drug treatment clinic.
Naltrexone is a non-opiate drug that blocks the rush, even if the addict continues to use heroin. Naltrexone is not addictive or nor is it a sedative, and it does not produce physical dependency. Some addicts do have difficulty remaining on naltrexone, possibly because opiates are eliminated. The FDA, however, recently approved Vivitrol, an injectable version of Naltrexone that is administered only once a month. It may be that eliminating the need for a daily dose will help addicts continue to use naltrexone.
Among the forms of behavioral therapy used to treat Heroin addiction are contingency management therapy and cognitive behavior therapy.
Contingency management therapy is used to motivate recovering heroin addicts to remain in treatment by rewarding each step, especially the small, initial steps. A recovering heroin addict might receive a movie pass or a small gift certificate for each group meeting attended or for each drug-free test. Larger rewards come for later, larger steps, such as holding a job for a certain number of months or maintaining a stable housing environment.
In cognitive behavior therapy, the recovering addict works with a therapist to identify the thoughts, feelings and circumstances that serve as triggers for drug use. The addict then knows what circumstances to avoid, but when that isn’t possible, the therapist teaches the addict coping strategies to deal with trigger situations. The therapist also teaches the recovering addict how to replace the triggering thoughts and feelings with other, more positive, healthier thoughts.