HEROIN ABUSE IN MEN: SIGNS OF ADDICTION & RECOMMENDATIONS FOR TREATMENT

Transcription

1 HEROIN ABUSE IN MEN: SIGNS OF ADDICTION & RECOMMENDATIONS FOR TREATMENT

2 TABLE OF CONTENTS INTRODUCTION HEROIN ABUSE: A GROWING EPIDEMIC SHORT-TERM EFFECTS, SIGNS & SYMPTOMS OF HEROIN ABUSE & DEPENDANCE OVERDOSE & OTHER HEALTH EFFECTS OF HEROIN ABUSE TREATING A HEROIN ADDICTION AFTERCARE IN HEROIN ADDICTION TREATMENT SOURCES

3 INTRODUCTION The face of heroin addiction has evolved over recent decades. In response to rampant prescription opioid drug abuse in the 1990s, the U.S. government made it harder to obtain prescription painkillers by shutting down pill mills and doctors who prescribed these drugs illegally, and pharmaceutical companies changed their formulas in an attempt to deter abuse. The result of these measures, according to the National Institutes of Health, was that it became more difficult and more expensive to obtain prescription painkillers, and many people who were abusing them turned instead to heroin, which is cheaper and easier to find. 1 The National Institute on Drug Abuse reports that in a recent survey of people being treated for addiction to opioids, 94 percent said they chose heroin because prescription painkillers were considerably more expensive and harder to obtain. 2 /// 3

4 HEROIN ABUSE: A GROWING EPIDEMIC /// 4

5 HEROIN ABUSE: A GROWING EPIDEMIC According to the Centers for Disease Control, between 2002 and 2004, roughly 732,000 men used heroin, compared to around 205,000 women. 3 By 2013, those numbers had grown to over 1.1 million men and 506,400 women. /// 5

6 The number of people using heroin for the first time continues to grow each year, according to the Substance Abuse and Mental Health Services Administration. 4 In 2003, 42,000 people between the ages of 18 and 25 used heroin for the first time, but by 2013, that number had grown to 66,000. The greatest growth in heroin use between 2003 and 2013 was among those 26 and older, with 25,000 new users in 2003 but a staggering 82,000 in THE GREATEST GROWTH IN HEROIN USE BETWEEN 2003 AND 2013 WAS AMONG THOSE 26 AND OLDER. /// 6

7 WHO USES HEROIN? Non-Hispanic white males make up the fastest-growing segment of people who are addicted to heroin. 3 A study published in the journal JAMA Psychiatry found that while whites and nonwhites began using heroin in roughly equal numbers before the 1980s, 90 percent of people who began using it in the last ten years are white. 5 Additionally, while the mean age of people who started using heroin in the 1960s was 16.5 years, recent users mean age is 22.9 years. Today s heroin users live in more rural areas than their urban counterparts of 50 years ago. The JAMA Psychiatry study cites the increase in prescription drug abuse in the late 20th century, followed by the government crackdown on opiate painkillers that sent scores of users looking for heroin, as one reason heroin abuse has moved out of the inner city and into the suburbs. /// 7

8 SHORT-TERM EFFECTS, SIGNS, & SYMPTOMS OF HEROIN ABUSE AND ADDICTION

9 SHORT-TERM EFFECTS OF HEROIN ABUSE Heroin is listed on Schedule I of the Controlled Substances Act, which means that it has a high potential for abuse but no medical value. The National Institute on Drug Abuse estimates that 23 percent of people who use heroin become addicted to it. 6 Heroin stimulates the release of the neurotransmitter dopamine, which is associated with feelings of pleasure, euphoria and a keen sense of wellbeing. After an initial surge of euphoria, the effects of heroin include several hours of sleepiness, slowed mental function and a reduction in heart and breathing rate. /// 9

10 HOW HEROIN ABUSE TRANSITIONS TO ADDICTION AND DEPENDENCE When you use heroin for the first time, your brain s reward center makes an association between the drug and the feelings of pleasure it elicits, and you crave the experience again. Each time you use it, the association becomes stronger. Soon, the relationship between heroin and pleasure is deeply ingrained in your brain, and your drug-seeking and drug-using behaviors become compulsive. When you continue to use heroin despite the negative consequences it causes for your health, relationships and finances, it s clear that an addiction has developed. Once an addiction sets in, according to the National Institute on Drug Abuse, finding and using heroin becomes the primary focus in your life, and even though you may think about quitting or even try to quit, you find that you can t. 7 /// 10

11 THE RELATIONSHIP BETWEEN HEROIN AND PLEASURE IS DEEPLY INGRAINED IN YOUR BRAIN, AND YOUR DRUG-SEEKING AND -USING BEHAVIORS BECOME COMPULSIVE. /// 11

12 CHANGES IN THE STRUCTURES AND FUNCTIONS OF THE BRAIN LEAD TO PHYSICAL DEPENDENCE. Heroin carries a high risk of dependence, largely because it produces a high degree of tolerance very quickly, according to the National Institute on Drug Abuse. 8 This means that as the brain compensates for the presence of heroin by suppressing or increasing the activity of certain neurotransmitters, it takes increasingly higher doses of heroin to get the desired effects. Over time, these changes in the structures and functions of the brain lead to physical dependence, which means that the brain operates more normally when heroin is present than when it s not. The key indicator of dependence is the onset of withdrawal symptoms when heroin is withheld from the body. These include hot and cold sweats, vomiting and diarrhea and body aches, and these are often too intense to handle without medical help. Someone who tries to quit on his own will generally go back to using heroin very quickly just to alleviate the withdrawal symptoms. /// 12

13 SIGNS & SYMPTOMS OF HEROIN ABUSE Signs that someone you love is abusing heroin include the presence of paraphernalia, such as small baggies containing white or brown powder residue, small glass pipes, syringes and burnt spoons. Needle marks may be visible on his extremities if he injects heroin, although many who inject it do so between the fingers or toes to minimize needle marks. Your loved one may wear long sleeves and pants, even in hot weather, to hide these marks. Signs that your loved one is high on heroin include dilated pupils, droopy eyelids and nodding off. His skin may be flushed, his nose may run, and he may complain of nausea or constipation. His breathing rate will slow considerably, and he ll likely experience a loss of appetite. /// 13

14 SIGNS & SYMPTOMS OF HEROIN ADDICTION AND DEPENDENCE /// 14

15 According to the National Council on Alcoholism and Drug Dependence, signs and symptoms that you or someone you love has developed an addiction to heroin include: 9 Continuing to use heroin despite the negative consequences of doing so. Neglecting hobbies and other activities that were once important. Neglecting duties at home, work, or school. Taking risks in order to obtain heroin and engaging in risky behaviors, such as unsafe sex or driving under the influence, while taking it. Becoming socially withdrawn. Changes in behavior, including becoming aggressive or combative when confronted about the drug abuse and experiencing symptoms of anxiety or depression. Increasingly neglected personal hygiene. Borrowing or stealing money for drugs. Building up a tolerance so that more heroin is needed to get the same effects. The onset of withdrawal symptoms when heroin is withheld from the body. /// 15

16 OVERDOSE AND OTHER HEALTH EFFECTS OF HEROIN ABUSE

17 Heroin overdose is a major concern for people who abuse it. Heroin reduces your breathing rate, and a large dose can suppress breathing to the point of death. Between 2001 and 2013, heroin overdose deaths more than quadrupled, according to the National Institute on Drug Abuse, which reports that in 2013, 1,732 women and 6,525 men died of heroin overdose. 10 While a heroin overdose isn t always fatal, it will likely cause hypoxia, a condition marked by a reduction in the amount of oxygen that reaches the brain. Hypoxia can have long-term neurological and psychological effects, including permanent brain damage and coma. 6 /// 17

18 According to Johns Hopkins University 11, pure heroin is generally cut with other additives like powdered milk, talcum powder or chalk, and heroin on the street can range in purity from three to 99 percent. When you take a dose of heroin, you have no idea how pure it is, and if you take a normal dose of very pure heroin, chances are, that dose will be too much for your body to handle. HEROIN OVERDOSE IS A MAJOR CONCERN FOR PEOPLE WHO ABUSE IT. WHILE A HEROIN OVERDOSE ISN T ALWAYS FATAL, IT WILL LIKELY CAUSE HYPOXIA. /// 18

19 SIGNS AND SYMPTOMS OF HEROIN OVERDOSE The National Institutes of Health cites a number of signs and symptoms that may indicate a heroin overdose. 12 Respiratory symptoms include a cessation of breathing or shallow, slow, and difficult breathing. You may have a dry mouth, a discolored tongue, and pupils that have dilated to the size of a pinhead, known as pinpoint pupils. Your pulse will likely be weak, indicating dangerously low blood pressure, and your skin, lips and nails may turn blue. You may experience stomach and intestinal spasms, and you ll be very drowsy, disoriented and possibly delirious. You may slip into a coma. /// 19

20 TREATING A HEROIN OVERDOSE If you or a loved one abuses heroin, talk to your physician about Evzio, an FDA-approved, hand-held auto-injector of naloxone, a narcotic antagonist that s injected into the muscle or under the skin to displace the heroin from the receptor sites in the brain and effectively reverse the respiratory depression that typically causes death. According to the National Institute on Drug Abuse, Evzio can be used by friends or family members to buy valuable time until medical assistance arrives. 13 /// 20

21 OTHER HEALTH EFFECTS OF HEROIN ABUSE Chronic heroin abuse causes a number of serious health problems in addition to overdose. HIV, hepatitis, collapsed veins, and infections of the heart lining and valves are a major concern for those who inject heroin, and liver and kidney disease, gastrointestinal problems and pulmonary complications like pneumonia are common among those who abuse heroin in any form. Additionally, heroin is often cut with toxic additives that cause permanent damage to vital organs by clogging blood vessels that lead to the kidneys, liver, lungs or brain. 6 Heroin use also leads to the deterioration of the brain s white matter, which can cause permanent damage that affects your ability to make decisions, regulate your behavior and respond appropriately to stress. If you have a mental illness, heroin abuse will almost certainly make it worse, and heroin can cause the onset of a mental illness where one didn t previously exist. /// 21

22 IF YOU HAVE A MENTAL ILLNESS, HEROIN ABUSE WILL ALMOST CERTAINLY MAKE IT WORSE. /// 22

23 TREATING A HEROIN ADDICTION

24 Professional treatment is almost always necessary for beating a heroin addiction. The highly addictive nature of heroin, the intense withdrawal symptoms associated with detox and the complex underlying issues surrounding the abuse make it very difficult to stop using heroin based on willpower alone. Treatment through a high quality drug rehab program starts with detox, which is the process of removing traces of heroin from the body so that treatment may begin. After detox is complete, various traditional, complementary and experiential therapies are employed to help those in recovery address the issues that contributed to the abuse of heroin in the first place. According to an article published in the Journal of Addictive Diseases, treating a heroin addiction with behavioral therapy alone produces very poor outcomes, with over 80 percent of people in recovery returning to heroin abuse. 14 That s why pharmacotherapy, or the administering of prescription medications, is also essential for treating an addiction to heroin. /// 24

25 DETOX AND WITHDRAWAL The flu-like withdrawal symptoms associated with heroin detox can be excruciating. Medical detox is standard protocol for most drug rehab programs and involves 24-hour medical care and supervision and the administration of various medications to help ease the intensity of symptoms. Physical symptoms of withdrawal may last for several days, according to the National institute on Drug Abuse, while the psychological symptoms, including depression, can last for weeks. 15 /// 25

26 Medications commonly used during heroin detox include clonidine and buprenorphine, according to the National Institutes of Health. 16 Clonidine reduces the anxiety and agitation associated with heroin withdrawal, and it helps to alleviate muscle aches, abdominal cramping, runny nose and hot and cold sweats. Buprenorphine can also help reduce the intensity of some withdrawal symptoms, and it has been shown to shorten the duration of the detox process. Once the detox process is complete, long-term maintenance of the addiction will begin. The most effective medications used for maintenance are methadone and buprenorphine. Maintenance treatment with these medications has been shown through extensive research to reduce cravings, improve social functioning and stress response and promote long-term recovery from a heroin addiction. 14 /// 26

27 Methadone is a slow-acting opioid agonist, which means that it activates the opioid receptors in the brain. However, since it reaches the brain slowly, it doesn t cause the high that heroin produces, but it prevents withdrawal symptoms and alleviates heroin cravings, according to the National Institute on Drug Abuse. 17 Methadone is administered on a daily basis through tightly controlled outpatient programs, and it normalizes many of the body s physiological responses, such as those related to stress, that often lead to relapse, making it a highly effective relapseprevention tool. 14 Suboxone is a prescription medication that combines buprenorphine, a partial opioid agonist, and naloxone, an opioid antagonist. Buprenorphine is another effective maintenance medication, and because it s only a partial agonist, it relieves drug cravings without producing the euphoric effects of opiates. The naloxone prevents the ability to obtain a high in the event a patient tries to inject the Suboxone for that reason. /// 27

28 PSYCHOTHERAPIES While behavioral and other talk therapies alone aren t generally enough to prevent relapse, these therapies are absolutely essential for promoting long-term recovery from a heroin addiction. Behavioral therapists view opiate addiction as a learned association involving patterns of punishment and reward, and various behavioral therapies address these associations and related learned behaviors as well as help patients identify and work through the complex psychological issues that underlie a heroin addiction, according to Harvard Medical School. 18 /// 28

29 STRESS IS A MAJOR TRIGGER FOR RELAPSE, AND COMPLEMENTARY THERAPIES HAVE BEEN FOUND HIGHLY EFFECTIVE. Cognitive-behavioral therapy, or CBT, is considered one of the most effective therapies for treating addiction. CBT helps patients identify harmful thoughts and behaviors associated with heroin abuse and replace these with healthier thoughts and behaviors. Group therapy and family counseling are also extremely valuable in treating a heroin addiction. Group therapy reduces feelings of isolation and shame and enables people with addictions to help others while receiving help themselves. Family therapy helps families work through problems that can serve as a trigger for relapse, and it improves communication and family functioning and helps restore trust and repair damaged relationships. /// 29

30 COMPLEMENTARY & EXPERIENTIAL THERAPIES Stress is a major trigger for relapse, and complementary therapies have been found highly effective for helping patients develop techniques and strategies to relieve both chronic and acute stress. Research published in the journal Complementary Therapies in Medicine shows that yoga combats mindless states, social isolation and emotional reactivity. 19 The National Institutes of Health s National Center for Complementary and Integrative Health acknowledges the important role of practices like mindful meditation, biofeedback, and acupuncture in helping to treat a wide range of physical and mental health conditions. 20 /// 30

31 ART THERAPY HAS BEEN FOUND TO DECREASE DENIAL AND REDUCE AMBIVALENCE TOWARD RECOVERY. /// 31

32 Experiential therapies like art and music therapy, adventure therapy and aqua therapy are also valuable in addiction treatment. Art therapy has been found to decrease denial and reduce ambivalence toward recovery, according to an article published in the Journal of Addictions Nursing. 21 An article in the American Journal of Public Health found that drum therapy promotes a sense of spiritual connection with others and combats feelings of isolation. 22 Experiential treatments like these help patients work through obstacles, connect their thoughts to their behaviors in meaningful ways and develop a higher level of self-esteem. /// 32

33 DUAL DIAGNOSIS If a mental illness co-occurs with an addiction, you or your loved one will receive a dual diagnosis. A dual diagnosis requires integrated treatment that addresses the mental illness in the context of the addiction and vice versa. Treating an addiction without addressing a co-occurring mental illness will usually lead back to drug abuse. /// 33

34 AFTERCARE IN HEROIN ADDICTION TREATMENT

35 Upon completion of the treatment program, an aftercare plan is individualized and set in place to help prevent relapse and improve the chances of long-term recovery. According to the Butler Center for Research, a 2011 study found that the likelihood of maintaining long-term sobriety increases by 20 percent for each consecutive month someone in recovery engages in their aftercare plan. 23 /// 35

36 COMPONENTS OF AN AFTERCARE PLAN The typical aftercare plan includes ongoing group, individual and family therapy and participation in a support group like Narcotics Anonymous as well as continued monitoring of maintenance medications and those being used to treat any co-occurring mental disorders. /// 36

37 Other components of the aftercare plan are chosen based on need and may include: Vocational rehab to help those in recovery brush up on workplace skills and find employment, which is shown to reduce the risk of relapse. Legal or educational assistance. Help with finding safe housing. Time spent in a sober living facility to help ease the transition from long-term residential treatment back to real life. Activities that promote developing healthy and meaningful relationships with other non-users or those also in recovery. Activities that promote developing enjoyable hobbies that help prevent boredom and isolation, which are potent relapse triggers. The aftercare plan is carefully monitored by a case worker, who periodically assesses for changing and emerging needs and adjusts the plan accordingly. /// 37

38 HEROIN ADDICTION IS TREATABLE, BUT THE RIGHT TREATMENT PROGRAM IS ESSENTIAL Many people recover from a heroin addiction and go on to lead happy, healthy and productive lives, but the right treatment program is essential for increasing the chances of successful long-term recovery. /// 38

39 When making treatment decisions for yourself or a loved one, choose a holistic program that addresses issues of the body, mind and spirit through a combination of traditional, complementary and experiential therapies. A quality treatment program will utilize research-based protocol, adhere to industry-standard best practices and follow the National Institute on Drug Abuse s Principles of Effective Drug Addiction Treatment. 24 JOINING A SUPPORT GROUP WILL GO A LONG WAY TOWARD IMPROVING HIS CHANCES OF RECOVERY FOR THE LONG-TERM. /// 39

40 The more fully you engage in treatment, the better your outcome will be. Likewise, if your loved one is addicted to heroin, getting involved in his treatment through family therapy and by joining a support group will go a long way toward improving his chances of recovery for the long-term. 18 Heroin addiction doesn t have to be a death sentence. Extensive research into this disease and its treatments makes it clear that recovery is within reach for anyone who wants to live free of addiction and vastly improve their overall quality of life. /// 40

41 SOURCES 1. Why more painkiller addicts are using heroin, too (October, 2015), U.S. National Library of Medicine, MedlinePlus, retrieved from 2. Heroin use is driving by its low cost and high availability (2015), National Institute on Drug Abuse, retrieved from heroin-use/heroin-use-driven-by-its-low-cost-high-availability 3. Today s heroin epidemic (2015), Centers for Disease Control, retrieved from 4. Lipari, R.N. and Hughes, M.S. (April, 2015), Trends in heroin use in the United States, Substance Abuse and Mental Health Services Administration, retrieved from ShortReport-1943.html 5. Cicero, T., Ellis, M., Surratt, H., & Kurtz, S. (2014). The Changing Face of Heroin Use in the United States. JAMA Psychiatry, 71(7), Retrieved from 6. DrugFacts: Heroin (October, 2014), National Institute on Drug Abuse, retrieved from /// 41

42 SOURCES 7. What is heroin and how is it used? (2014), National Institute on Drug Abuse, retrieved from 8. Neurobiology of drug addiction: Definition of tolerance (2007), National Institute on Drug Abuse, retrieved from morphine/6-definition-tolerance 9. About addiction: Signs and symptoms (2015), National Council on Alcoholism and Drug Dependence, retrieved from Overdose death rates (2015), National Institute on Drug Abuse, retrieved from Heroin, Johns Hopkins University s Center for Health Education & Wellness, retrieved from Heroin overdose (2015), U.S. National Library of Medicine, MedlinePlus, retrieved from /// 42

43 SOURCES 13. What can be done for a heroin overdose? (2014), National Institute on Drug Abuse, retrieved from Bart, G. (2012). Maintenance Medication for Opiate Addiction: The Foundation of Recovery. Journal of Addictive Diseases, 31(3), Retrieved from Frequently asked questions (2015), National Institute on Drug Abuse, retrieved from Opiate withdrawal (2015), U.S. National Library of Medicine, MedlinePlus, retrieved from What are the treatments for heroin addiction? (2014), National Institute on Drug Abuse, retrieved from Treating opiate addiction, part II: Alternatives to maintenance (20015), Harvard Health Publications, Harvard Medical School, retrieved from alternatives_to_maintenance /// 43

44 SOURCES 19. Khanna, S., & Greeson, J. (2013), A narrative review of yoga and mindfulness as complementary therapies for addiction, Complementary Therapies in Medicine, 21(3), , retrieved from articles/pmc / 20. Complementary, alternative, or integrative health: What s in a name? (2015), National Center for Complementary and Integrative Health, retrieved from Aletraris, L., Paino, M., Edmond, M., Roman, P., & Bride, B. (2014), The use of art and music therapy in substance abuse treatment programs, Journal of Addictions Nursing, 25(4), , retrieved from articles/pmc / 22. Winkelman, M. (2003). Complementary therapy for addiction: Drumming out drugs, American Journal of Public Health, 93(4), , retrieved from Research update: The importance of continuing care, Butler Center for Research, April, 2013, Principles of drug addiction treatment: A research-based guide (third edition) (2012), National Institute on Drug Abuse, retrieved from /// 44

45 At ACHIEVE, your recovery is our primary concern. We promise to provide each and every one of our clients with first class care, regardless of their financial condition. Money isn t what drives us it s helping people like you achieve their dreams, and we won t stop until we succeed. At ACHIEVE we don t just keep you sober, we give you the time and tools you need to build a life you can maintain. Get the help you deserve. 1 (844) achievetreatmentcenter.com