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Heroin Addiction Treatment: What to Expect

Heroin Addiction Treatment: What to Expect

When seeking answers for heroin use disorder (HUD) or heroin addiction treatment, one needs to take two things into consideration. Firstly, the physical need for the drug: the chemical dependency that has developed with prolonged use. Secondly, the psychological reason: why a person uses heroin in the first place. Was there dissatisfaction with the natural exuberance of life? What was missing in their life that drove the need to fill the void with the sensations that came from using heroin?

Addressing the Chemical Dependency

Our brains naturally make dopamine when the occasion calls for it—during moments that bring about pain, such as physical injury, or times filled with elation during happy experiences. However, when heroin is introduced into the body, the brain is tricked into producing dopamine each time the user shoots up, smokes, or snorts it.

Heroin is an extremely addictive substance that binds with our natural opioid receptors that reside in the brain’s rewards center, activating them. The receptors trigger the release of dopamine, the neurotransmitter known for bringing on feelings of euphoria and bliss.

Removing the Need with Detox

The chemical dependency makes heroin withdrawal very hard on the body. During detox from heroin, withdrawal symptoms can include bone pain, muscle pain, restlessness, cold flashes, vomiting, and diarrhea (severe in some instances). This is why medication-assisted treatment (MAT) has become the new norm for heroin addiction treatment. Some of the medications used for MAT are methadone, buprenorphine, naloxone and naltrexone. These medications are used to mitigate the withdrawal symptoms and allow the addict to come through the detox process without too many physical problems.

Each of these MAT drugs bind with the opioid receptors in the brain, just as the heroin did, but to a lesser extent and for longer periods of time, keeping cravings and withdrawal symptoms to a minimum. They are administered in decreasing amounts (tapered approach) over a five to seven day period, thus weaning the body and the brain from the need for heroin.

Methadone MAT for Heroin

Methadone, although addictive in its own right, has been used to treat heroin addiction since the 1960s when it was first developed as a response to the post WWII heroin epidemic. It is an agonist that has been used as part of a maintenance treatment to reduce HIV, addiction related crimes, and death. It is considered a long-term treatment replacing the need for heroin, without providing any of the euphoric effects associated with heroin.

Buprenorphine and Naloxone

Buprenorphine is a partial agonist that has been around for over 30 years and administered in other countries before the U.S. started prescribing it for medically assisted treatment (MAT). Sometimes naloxone is added to the buprenorphine as part of the drug treatment. Buprenorphine helps prevent withdrawal symptoms caused by opioid intake cessation. Naloxone is a narcotic antagonist that blocks the effect of opioids. This combination, known as suboxone, prevents abuse of this medication and comes as a sublingual film (dissolved under the tongue) or inside the cheek.


Naltrexone, an opioid antagonist, was developed in the late 1960s and approved for use in 1974 as an alternative to methadone. The idea was to find something that was not addictive but would have the same effect on heroin addiction. It completely blocks the opioid receptors in the brain and, with it, the euphoric feelings from heroin. Naltrexone, when used with cognitive-behavioral therapy, is a proven method to overcome heroin addiction.

Addressing the Psychological Dependency

The psychological effects of heroin withdrawal during detox can include emotionality, depression, anxiety, agitation, irritability, and a lack of mental clarity. Unfortunately, these symptoms can continue after detox. Once the detoxification process is complete, the now recovering addict generally enters a heroin rehab program to treat these symptoms and the underlying causes and supporting factors for addiction. Either a contingency management program or cognitive-behavioral therapy is started at this point.

In a contingency management program, patients typically earn points in a voucher-based system for each negative drug test. The vouchers can be exchanged for items that encourage a healthy lifestyle. In cognitive-behavioral therapy, patients are taught stress-coping skills and learn to modify their expectations and behavior related to drug use, either as one-on-one, group therapy sessions, or a combination of both.  Anti-anxiety and antidepressant medications may be added to help with some of the psychological side effects as well.

Additional Restoratives

Therapies work best when combined with a pharmacologic treatment to help alleviate the drug cravings and anxiety that is part of continuing withdrawal and recovery. Exercise is an excellent tool towards recovery as well, and is strongly encouraged, as are yoga and meditation, for a whole body, mind and spirit (holistic) healing. Adding a 12-step program can also help by giving heroin addicts a voice to tell their personal stories, share their problems with other recovering addicts, and create a greater community for support, awareness and help.

The rehab process is meant to not only learn new life-coping skills, but to address the underlying causes of why the escape into heroin addiction happened in the first place. These could be rooted in childhood traumas, a specific traumatic event, or exposure to unhealthy environments where poorly formed coping skills and negative interpersonal relationships were the norm. Therapy can be continued after rehab, especially if the underlying issues have not been resolved.

New Treatment Option?

Recently, CBD (cannabidiol) oil is touted as one of this century’s best new medical discoveries. To some, CBD oil is referred to as today’s snake oil – a veritable cure-all for every known ailment under the sun. Whichever perception is taken and embraced about cannabidiol, the research on it continues. There are findings that indicate additional benefits of CBD use besides pain management and relieving chemotherapy’s discomforting side effects.

A recent study has found a promising and unexpected new use for CBD oil: for a reduction of the triggered cravings and anxiety in patients recovering from heroin use disorder. The small study, using only 42 former heroin users, was done by researchers at Mount Sinai Hospital in New York and published in the American Journal of Psychiatry. It stated that the effect of CBD on drug cravings and anxiety triggered by environmental cues was significant. This is a good thing, because most of the drug cravings from heroin addiction are environmentally triggered and can be overwhelming, putting patients at a heightened risk for relapse.

CBD oil has been shown to reduce drug cravings and anxiety and, in turn, reduces the chance of relapse and overdose risk. Although more research is needed, many health industry professionals are hopeful that further studies will confirm this and consider CBD oil as a viable option as MAT for heroin.

Challenges in Heroin Addiction Treatment and Recovery

Getting past heroin use disorder can be harder than recovering from other types of drugs, including methamphetamines, benzodiazepines, and even cocaine. The best chance for successful recovery is to address both the chemical and psychological dependencies surrounding heroin abuse. This can prevent drug relapse and associated incidences of overdose and death. What remains as the biggest problem faced by heroin addicts in recovery is how certain environments trigger drug cravings and anxiety.

Over the years, the right heroin addiction rehab, engaging in progressive therapies, and receiving individually-assessed medication assisted treatment has been proven to help mitigate the risks of the recovery process.

Find Industry Leading Heroin Addiction Treatment Here at Acceptance Recovery Center

About Dr. Greg Gale, MD

Dr. Greg Gale has been practicing and providing leadership in the field of psychiatry, substance use, and integrated care in the Phoenix metropolitan area for over 11 years. He joins us from his role as a national medical director overseeing behavioral health, substance use, and integrated care services for Humana Behavioral Health. Previously, he was CMO and VP of Clinical Services at Partners in Recovery, a not-for-profit behavioral health and substance use service organization, which operates five clinics throughout Maricopa County. Read more about Dr. Greg Gale, MD 

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