Heroin tolerance, dependence, and addiction are all manifestations of brain changes resulting from repeated heroin use. The struggle for recovery is in great part a struggle to overcome the effects of these changes. New pharmacotherapies act on the same brain structures and processes as addictive opioids, but with protective and normalizing effects. Despite the effectiveness of these unique medications, they must be used in conjunction with appropriate behavioral-based treatments.
As stated above, heroin abuse has great potential for tolerance, physical dependence, and addiction, all of which develop rapidly. Tolerance to heroin means the user needs more heroin to get the same intensity of effect. Dependence means the heroin user is susceptible to heroin withdrawal following discontinuation. Addiction refers only to specific behaviors and is defined by tenacious seeking and compulsive using of heroin despite harmful consequences.
Heroin tolerance has two categories; innate and acquired. Innate tolerance refers to a person’s genetic makeup at the initial dose. Studies show that some people are more prone to addiction but others not so much. Acquired tolerance refers to the body’s response to heroin over time after repeated use. Scientific evidence shows that acquired tolerance to heroin is rapid and begins developing at the first dose.
Studies show that opioid receptors take up to 15-days to reset after activation. Meaning that after a single activation of an opioid receptor it may take upwards of 15-days before it can be reactivated. As heroin users must use on average 4-times per day, it does not take long before there are not enough opioid receptors available to maintain the heroin addict’s needs.
Symptoms of heroin withdrawal
- Low energy
- Difficulty focusing
- Difficulty concentrating
- Difficulty making decisions
- Drug cravings
- Physical pains
- Reduced interest in sex
Pharmacotherapies vs Behavior-based therapy
A variety of treatment options are available for heroin addiction, including both behavior-based therapy and pharmacotherapies. Both approaches help to restore a degree of normalcy to brain function and behavior, resulting in increased employment rates, lower risk of HIV, Hepatitis C and other diseases.
Scientific research has established that pharmacotherapies increase retention in addiction treatment programs. When people initially quit, they often develop withdrawal symptoms (pain, diarrhea, nausea, and vomiting), which can sometimes be quite severe. There are specific medications that are helpful for treating heroin withdrawal. Heroin withdrawal treatment a.k.a. heroin detoxification, is typically the initial treatment strategy. Detoxification is designed to treat heroin withdrawal symptoms and drug cravings. While behavioral based treatment typically typically follows heroin detox, it is designed more so, for addiction, though both methodologies often overlap.
Heroin addiction specific pharmacotherapies work predominantly with mu opioid receptors (MOR), which are the same receptors that heroin binds to and activates. There are three FDA approved pharmacotherapies used to treat heroin addiction and they include: (1) full-agonists, like methadone, which fully activate mu opioid receptors; (2) partial agonists, like buprenorphine, which partially activate mu opioid receptors but produce a smaller drug effect; and (3) antagonists, like naltrexone, which block mu opioid receptors and interfere with drug effects.
The many effective behavioral treatments available for heroin addiction can be delivered in outpatient and residential settings. Treatment approaches such as cognitive-behavioral therapy and contingency management have been shown to effectively treat heroin addiction, especially when applied in concert with pharmacotherapies. It is important to match the right treatment approach to meet the needs of a particular patient.
- Cognitive-behavioral therapy is designed to help modify the patient’s expectations and behaviors related to drug use and to increase skills in coping with various life stressors.
- Contingency management uses a voucher system in which patients earn “points” based on negative drug tests, which they can exchange for items that encourage healthy living.