Heroin addiction is a recognized mental disorder, and is classified in the DSM-IV as Opiate Dependence, although heroin is just one of several opiates that people can become dependent on. Research shows that compared to users of other illicit drugs, such as cannabis, meth and cocaine, people addicted to heroin fare the worst. However, it is not clear from the research whether this is an effect of heroin itself, or whether there are characteristics of the people who get addicted to heroin -- or even take it in the first place -- that make them vulnerable to these difficulties.
The following symptoms indicate heroin addiction:
- Frequent, often daily use of heroin -- heroin addicts may even use heroin several times a day.
- Tolerance to the effects of heroin –- Increasing doses of heroin are needed to be satisfied with its effects. One of the dangers of tolerance to heroin is that when heroin use is decreased (for example, if the person is unable to take heroin for a period of time, or if they temporarily quit or cut down) and they then take their previous dose of heroin, they run a much greater risk of overdose, because their physical tolerance to the drug has gone down.
- Withdrawal symptoms –- Heroin users often refer to this as "getting sick," and most accept the unpleasant heroin withdrawal symptoms as part of heroin addiction.
Research shows that as heroin users become more identified with the role of the heroin addict, marked by social marginalization, personal networks of heroin users, and the heroin using lifestyle, they shift to higher risk taking, injecting rather than sniffing the drug. Heroin addiction can become central to the life of people who become addicted, and it typically has a negative impact on other areas of life, such as family, school, work, or recreational activities. Many heroin addicts are not able to function in the usual sense, and spend their lives focused on obtaining money to buy heroin and taking heroin in a place of secrecy, where they can recover from the effects -- which can include vomiting, and drowsing off or "nodding out."
A study comparing users of different drugs shows the life patterns of people who take heroin to be much worse than those of other drug users, often involving time in and out of jail and multiple failed attempts to quit. However, some people who are addicted to heroin are able to live a "double life," in which they are able to hold down a job, have a family, and so on. This double life is typically very stressful, and requires an enormous amount of energy and organization, as well as a constant source of money.
Heroin addicts often describe a love-hate relationship with the drug. Typically, it is perceived as the only really effective way of coping with the stress of life, and the burden of a history of trauma and emotional and physical pain. Heroin addicts also find the effects of the drug pleasurable, whereas those who try heroin and do not become addicted are put off by the unpleasant effects. The drug is often romanticized in the minds of heroin addicts, but really, it comes down to an artificial and very temporary state of tranquility, which is comforting to users in contrast with the uncomfortable emotional state that occurs during withdrawal.
If you or someone you know has progressed from heroin use to heroin addiction, you should seek help as soon as possible. Heroin addiction is well-recognized by the medical profession, and treatment services are often freely available.
And although overcoming a heroin addiction is a difficult journey, recovery is possible, and a range of treatments are now available to help you to detox, to manage withdrawal symptoms, to prevent relapse, and to help you to get your life back on track. Many people who are unable to quit heroin completely are able to transition to methadone maintenance, or another type of ongoing medication to prevent them from getting sick.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Text Revision, Fourth Edition, (Copyright 2000). American Psychiatric Association.
Hser, Y., Evans, E., Huang, D., Brecht, M. and Li, L. "Comparing the dynamic course of heroin, cocaine, and methamphetamine use over 10 years." Addict Behav 33:1581-1598. 2008.
Sanchez, J., Chitwood, D. and Koo, D. "Risk Factors Associated with the Transition from Heroin Sniffing to Heroin Injection: A Street Addict Role Perspective." Journal of Urban Health 83:896-910. 2006.
Zinberg, N. Drug, Set, and Setting: The Basis for Controlled Intoxicant Use. Yale University Press. 1986.