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Commentary: What You Need to Know About Heroin Addiction


Philip Seymour Hoffman’s tragic death has focused attention on heroin addiction. Unfortunately, heroin addiction is on the rise from teens to older adults.

Heroin addiction doesn’t discriminate. Individuals from every socioeconomic background have access to the drug because it’s cheap and easy to get. According to SAMHSA, in 2011, 4.2 million people age 12 and older used heroin at least once in their lifetime, and 23 percent became dependent.

Although heroin addicts are treated alongside those addicted to alcohol and other drugs, heroin addiction can be especially difficult to treat because of the euphoria it produces in the brain. Heroin can reach the brain more quickly than other drugs – depending on how it’s administered. For example, injecting it intravenously can actually speed up the process of becoming addicted.

For this reason, we do often recommend that heroin addicts stay in treatment for at least 60 days. We find that individuals addicted to heroin need extensive time in treatment because of how much the drug impacts their brain and behavior. Cravings can be intense and they need to relearn how to deal with life stressors and be able to use non-chemical coping skills.

One of the challenges for many recovering addicts – especially those with a preference for opiates – is that painkillers prescribed for a legitimate reason are addictive and lead many people to heroin. If a doctor is unaware of a patient’s history of addiction or the patient is unaware of the addictive nature of prescription painkillers – a dangerous flame is ignited. In some cases, patients don’t have a history of addiction, but their painkiller use eventually becomes abuse and spirals into heroin addiction.

In the case of a relapse, as was the situation with Mr. Hoffman, we believe this process happens even before someone picks up a drink or a drug again. They begin to fall back into unhealthy behavior such as not reaching out for help when dealing with stress, isolating themselves and not being accountable to friends and family. Addiction is a chronic disease and is therefore encoded on their brain. Therefore, once unhealthy behavior starts again there is a tendency to slip right back into old destructive familiar ways.

It’s important to understand that relapse isn’t synonymous with failure. Just like any other chronic illness – people who relapse can recognize that they need help and get the support they need to get back on the path to sobriety. A person has to be actively involved in order to achieve a full recovery.

The pain of addiction doesn’t just impact the individual. Families also suffer extensively. Some family members develop anxiety, depression or hypertension, for example, in response to being with the addict.

Families require treatment separately from their addicted loved one, which is an important part of any treatment center experience. At Caron Renaissance, for example, we have a specialized family restructuring program where families attend their own intensive treatment program.

For those families who are grappling with heroin or other addictions, I offer the following recommendations:

Learn about the disease of addiction. Many family members think, “If only they had loved me more, they wouldn’t have gotten addicted.”  That’s not true. You need to understand that addiction is a disease and that it affects you as a family member. Whether or not your loved one is ready to accept help – I want to encourage you to practice a healthy recovery program yourself, whether through Al-Anon or a family support group.

Know what is in your power to control. You can’t control another person; you only have control over yourself. Family members who want to talk to their addicted loved one could use this type of language: “You don’t look well. I’m worried about you. There’s a lot more stress in your life right now because of x, y, and z. Do you have a professional you can talk to or would you be open to attending a 12-step meeting?” You can’t force an adult into treatment but you can stage an intervention in which friends and family express their concerns and feelings to the addict in a loving way.

Learn how to appropriately set boundaries. Families often want to keep a loved one close to them because they feel like they can keep an eye on the individual and help to ensure their safety. However, that behavior frequently enables the addict to continue his or her use. It may seem counterintuitive, but many families have to enforce difficult consequences such as asking the addict to leave the house.

If you suspect a loved one might be abusing heroin, here are some signs to look out for:

• Small, or meiotic, pupils
• Lack of coordination (such as incoherent speech)
• Social withdrawal
• Changes in behavior
• Altered mental state
• New onset seizures
• Burns and bruises
• Social isolation
• Multiple falls

For more information on addiction treatment, you can visit us online or follow us on twitter @HanleyCenter.

Dr. Barbara Krantz is the Medical Director at the Hanley Center.

23 Responses to this article

  1. Avatar of Lisa
    Lisa / March 26, 2014 at 4:16 pm

    My daugher has been in and out of rehab for three years, long term, she sees two therapists and attends meetings daily and she has not been able to stay clean for an extended period of time. Everyone is telling her not to use medication. If she goes into treatment again it will be two years before she sees her daughter again. I think since she has tried everything else, medication might be the answer.

  2. Gary / February 21, 2014 at 2:34 pm

    Brenda I think that is wonderful and I am happy that medication is working for you. I am not mad at anyone who can have a happy productive life however that happens. I think the addition of a recovery lifestyle is critical for addiction issues and again I say that there will be people that benefit from MAT but it seems self evident for anyone with any illness if healing can continue and health restored and a life worth living maintained without any medication that is worth working for. Not always attainable, but it does not need to be discounted and marginalized. I also have witnessed many doctors and pharmaceutical companies say things about addiction that just weren’t true so I am very cautious about a diagnosis that claims a person is incapable of abstinence. I’ve know people who were strapped in the basement of mental hospitals, selling themselves for the next hit, written off by everyone obtain sobriety, remain abstinent, and live happy full lives. The 20,000 people at Founders Day every year tell a pretty powerful story. All that being said, if methadone is working for you I am happy that you found a way out of the hell of addiction. There appears to be several approaches and we don’t have time to be fighting each other. I have referred people to the Suboxone clinic. I will work with people regardless. I want people to get better.

  3. Brenda / February 21, 2014 at 10:53 am

    I for one managed to live a productive life on methadone. I had made a choice to get on methadone because I could not manage my life without relapsing every time. On methadone I have stayed out of prison for 20 years and raised my children, got a college education, have my own house and auto, and do not even know any one who still uses illegal drugs. There are many ways to recover and what is best for you and what works is the right way. Please do not say methadone is not a good way. For me it was the only way and I am so thankful for that. I have also used other tools for recovery that is also needed, 12 step meetings and groups to discuss living life on its terms. If not for the methadone I would never found my way in the door to those meetings. Please give it a chance, for some of us it is the right way to start a better life.

  4. Avatar of Gary
    Gary / February 20, 2014 at 11:21 am

    Morphine to get people off of Opium, Heroin to get people off of Morphine, Methadone to get people off of Heroin. Now Suboxne and more coming. We need to work together but there is a sense that the big money of the drug companies is driving much of the treatment today. The gold standard is completely free of all drugs, prescribed or not. While that will not always be possible as addictions specialist we need always have an understanding that pills are not skills. The causes and conditions for relapse need extensive and in most cases a life time of work. Stabilizing, relief from craving, and just time to re-group I see as valuable and potentially life saving. Howver, this would just be a beginning in my relationship with the addiction population. Sometimes quickly, sometimes slowly, every client I encounter is encout=raged to develop a strong recovery life to enable them to have the needed skills to live life without any drug whether they be prescribed or not. It used to be the opinion of many that there was no recovery from late stage alcoholism, no recovery from crack addiction, and others. This simply isn’t true and I hope we don’t forget that. Abstinence is possible for almost everyone. It takes work and it would seem we could merge these two ideas (and others) into one primary goal…. help everyone have a chance at a drug and alcohol free life.

  5. Avatar of Gary
    Gary / February 20, 2014 at 11:01 am

    The dilemma any addict faces is not the drugs (including alcohol and marijuana) but learning to live without them. The problem with MAT is that it does not address the fundamental causes and conditions that keep taking a person back to using. Aside from the physical brain chemistry that is where addiction exists, there are the emotional and psychological supporters. This is where abstinence based treatment and ongoing recovery involvement are invaluable. A pill is not a skill. The approach of stabilizing a person and giving them time to establish new living skills, re-formulate their internal self-talk, help them move towards a life free of all drugs, percribed or not, should be the gold standard for anyone in the addictions filed. It will not always be attainable, granted, but there is this sense that the pharmucutical companies have doen it again. Morhine created to get people off opium, Heroin created to get people off, morphine, methadone created to get people off heroin, and now it continues. These tools can be important and useful but people, and probably most people, are capable with the right support of being completely free of all drugs. If we use these methods to work towards a drug free life for all our citizens, accepting that there will be cases that will need long term medication, I think we can more appropriately serve this population. Let’s not forget we are dealing with addicts. They often come with a well developed antisocial, manipulative lifestyle that will be glad to take out drugs, our money, and our house if we let them. Sometimes it appears we are in the enabling business more than the helping business. We need to work together and use everything available but it does sometimes feel like the money and influence of the drug companies is marginalizing another evidence based treatment known as abstinence treatment.

  6. Avatar of Will
    Will / February 14, 2014 at 8:37 am

    I must say the for some MAT is a viable option but when we remove abstinence based options from the table or limit them are we really providing choices for those who seek another way. Why are people who continue to push the MAT agenda afraid of abstinence. Abstinence cost nothing and ends the perpetual cycle of dependency and should also be a choice. I agree with Gail and have met too many addicts that methadone is their drug of choice.(some people really get high off of it) Who convinces people that drugs use in MAT can’t get people high and that they can’t use other drugs while on them? I’d like to meet your pool of addicts. There are some people who use methodone and suboxone responsibly and my hats are off to them. Most of them are in the action stage of change and are doing what it takes. However, there are many who are abusing it and diverting it. If we deny this reality we are just not being honest. I would also like to state that yes some people do die from addiction while seeking recovery but we have millions who have recovered and yes from opiates too in an abstinence based setting. Utilizing proven methods and you can physically see them (not just people on paper) if you ever go inside the recovery community. Abstinence is not a bad word. In my area since MAT became the primary treatment our overdose rates and death have been record breaking. I respect science but I look at outcomes too. Respectfully submitted.

  7. bob wiley / February 13, 2014 at 11:35 pm

    During a Congressional hearing last week the Deputy Director of ONDCP was strongly chastised for for the misleading messaging from our federal drug warriors. Rep Steve Cohen stated: “It is ludicrous, absurd, crazy to have marijuana at same level as heroin. Ask the late Philip Seymour Hoffman if you could. Nobody dies from marijuana. People die from heroin.”
    Why don’t our drug warriors have the courage to speak honestly about the relative harms associated with drugs? Please watch all the segments in this C-Span clip, but most importantly the one highlighted below.

  8. Cheryl / February 13, 2014 at 4:30 pm

    Every, addict in recovery, finds his own way. While harm reduction offers an alternative addiction problem, it does help “some” stop their antisocial behaviors………….it certainly doesn’t cure the disease.

    While anyone can simply abstain from using a drug, the disease is only arrested by changing one’s lifestyle. That’s why the 12 Step Programs Offer lifestyle changing recovery, not just abstention.

    No matter how many alternatives are offered, it is up to the addict to make the changes in order to free himself from this plague.

  9. Avatar of My Truth
    My Truth / February 13, 2014 at 3:08 pm

    I must have read a different article than the rest of the those who commented before. I felt it was speaking to the family. What THEY need to know about addiction. They don’t need to know the best way the addict should handle their opiate addiction. That is between the addict and those they receive help from not what I see as the purpose of the article. To me, the article discusses the understanding of addiction, heroin and opiates in particular. That relapses happen. That unhealthy behaviors precede relapse. That it affects the family. Addiction and relapse can cause family members to behave in ways that may harm, not actually help the addict or themselves. Like in the article, keeping them close instead of a consequence of living on the street. Or not reporting theft because they don’t want to see them in jail, because the family loves them and knows they are a good person and would be just fine if they stop using. And of course, the greatest fear… DEATH. Families make choices on how to handle some one else’s addict almost entirely based on FEAR. The article emphasize on to help an addict, by understanding the disease, developing healthy boundaries and making better choices to assist the addict in seeking treatment. Encourage family members to get help. To get their OWN form of treatment. The article mentioned Al-Anon, but Nar-Anon helps families cope with the fear associated with a using, clean or in recovery opiate addict. To the professionals or those that care: please keeping encourage those addicted AND their families to find something that helps them. Not to be in it ALONE. And just like an addict, families to to keep seeking out what helps THEM the most in order for what we ALL wish to achieve: A BETTER Way to LIVE. Thank you for listening.

  10. Doug Moser / February 13, 2014 at 1:27 pm

    I posted a response yesterday that did not, for some reason, get posted. I’ll try again, and summarize what I said… Basically, both Dr. Krantz’s article – and its title/headline – are misleading. When it came to the body of Dr. Krantz’s article, I agree with Zac. Dr. Krantz was/is guilty of omission – neglecting to present to the reader the topic of medication assisted treatment. And the misleading title/headline – however luring and catchy — also does damage to our profession and the public. There are a number of systemic problems that affect the addictions treatment industry, as Anne Fletcher points out often in her writings. And what gets printed in the media can be one of them. I am grateful to the JT website for allowing readers to make the necessary corrections to articles (and headlines!) and thus better inform the public and advance our field.

  11. Avatar of Tori Galloway
    Tori Galloway / February 13, 2014 at 12:22 pm

    My husband took methadone for a couple of years and tapered off. I will always believe methadone saved his life. Two other loved ones who instead went the rehab route again and again are dead of overdose. People are dying over the misinformation being spread about methadone. With my husband’s life on the line, I am siding with science. I understand that companies are profiting off of methadone and suboxone, but Gail you are profiting off of the addicts too. We are not hearing the success stories around methadone because of all the efforts to perpetuate the stigma.

  12. Zac Talbott, BA, CMA / February 13, 2014 at 12:07 pm

    Gail I don’t ask anyone to take it from me (though I am in long term sustained recovery thanks to methadone); Folks can take it from the CDC, SAMHSA, U.S. Dept. Of Health & Human Services, Institute of Medicine, World Health Organization and COUNTLESS other medical and academic authorities throughout the world. If we are to be people who profess a belief in science, research and FACTS the acceptance of medication assisted therapies with methadone and buprenorphine is non-negotiable.

  13. Avatar of Leslie
    Leslie / February 13, 2014 at 10:54 am

    Gail, you are so wrong in your thinking you can make addicts get off drugs by limiting treatment and molding it to your certifications and the way you think addicts should be treated. Methadone is anything but liquid handcuffs or a drug of choice. First off there is no “high” off methadone so how could it be a drug of choice? And for people who have relapsed over and over methadone is the way to go as it blocks other opiates. So there is NO high of other opiates either. You can not MAKE an addict quit or motivate anyone until that person is ready inside themselves to quit. Methadone gives people a chance to learn to how to work, get a bank account, pay bills instead of their dealer, just plan learn to live a constructive life. If you make people get off methadone maintenance when they are not ready they will just relapse again. For some methadone may be needed a lifetime in order for relapse not to take place ever again. Why would that bother you if it works? People need to to what works for them. Not do what you think works for them. Your statistics that being on MAT leads to overdose and death is ridiculous. You say ask any recovering addict about methadone and they will tell you it is pure hell? We’ll ask me. I am a recovering addict. It is anything but hell. Thanks to methadone, I learned to get of the streets, quit ALL drugs, work, get a bank account, which in turn created a good credit rating and I have a house and car. No one would even know I am on methadone or suspect my past life. I was able to learn haw to live a constructive life. I am an older person now and have been on methadone many years in order not to relapse as I have so many times before I took methadone.

  14. Avatar of claude
    claude / February 13, 2014 at 3:15 am

    Gail, The Federal gov recognizes methadone as the number treatment for the disease of opiate dependency with maladaptive behaviors along with irrational thinking. I’m not going to make accusations but due to your irrational thinking i have some concern. People that want to make the uninformed public believe that your method is going to cure a disease that has no cure. You are playing with emotions. We are putting people who has no options left after rehab after rehab. And after being on methadone getting the counseling and peer support along with any other needed ancillary care we have viable citizens who now give back. Yes it’s not for everyone and yes there are those that relapse
    as we all know addiction is a brain disease that has the component of relapse and yes there are those with dual diagnosis that sometimes falls through the cracks in the system. I recommend you reading some of the research by Dr.Dole who in the fifties discovered how the brain is being changed and mis-wired by the abuse of opiates and just to inform you methadone is not an opiate it is an opioid and due to the changes with the firiong of neurons and the breakdown of the endorphin system in which
    alot of patients never regain full capacity or unable to produce and connect receptors for the endorphin system thus creating cravings which are unbearable and the magic of dolophine stops the cvravings and withdrawal and also he4lps with mood stablizing where a person for the first time in their lives feel what they refer to as “normal”
    Due your research and stop trying to mislead the public with lies and myths thus creating stigma. if you work with people with opiate dependency and nothing seems to work for them and they ask about mat, what would you tell them, I dont know what credentials you have my credentials come from many places
    my first one came from my long time addiction to heroin, the second from my 40 years on a medication that you say is nothing but dope, my third is working as an advocate volunteer since the last century
    and my last one is from the state gov certifying me as a professional substance abuse counselor, and I love my patients as
    iot was God’s plan to place me back in the world of addiction however this time I’m not taking I’m giving back, what have you given lately.

  15. Anne Fletcher, Author of Inside Rehab / February 12, 2014 at 9:44 pm

    It’s truly unfortunate when some rehabs refuse to prescribe and/or encourage long-term use of Suboxone and/or methadone. As others have suggested, these meds have been clearly shown in numerous research studies to lower relapse and death rates of people addicted to opioids. Last year, Caron issued a statement suggesting it does not support such long-term medication-assisted treatment and that it is not truly “recovery for life.”

  16. Robin Robinette / February 12, 2014 at 4:48 pm

    Sorry Gail & author of this “opinion”, the National Institutes of Health, the Center for Disease Control, the Institute of Medicine, the Center for Substance Abuse Treatment, numerous professional societies, countless people in recovery by way of medication assisted treatment, their family members and friends disagree with you. No one modality of treatment will be right for everyone. But to exclude the most researched, effective treatment for opioid addiction is kind of like “doing the same thing over and over again and expecting different results”. No one treatment modality is perfect either. My son went to inpatient rehab at a respected facility more than four times and each time was using the whole time he was there and none of the staff knew it. Methadone saved my husband’s life an gave me nine years with him that I would have had. His recovery was difficult because of the poor quality of treatment and lack of reasonable choice of providers due to incredible ignorance on the part of people with “opinions” similar to yours who inhabited positions of authority in his state. I can find lots of “abstinence-based” providers of poor quality along with those that provide medication assisted treatment. This does not damn the entire modality. Anecdotal evidence is just that, including my story. Look at the vast amount of research and open your mind.

  17. Gail / February 12, 2014 at 3:45 pm

    I totally disagree with Zac. I have worked in the addiction field for 22 years and have never seen such unethical treatment of people with addictions particularly opiate addicts. Methadone/Suboxone are nothing but legal drug dealing. Giving opiate addicts opiates and calling it “treatment” is disgusting. False hope which keeps people in the cycle of addiction. “Gold standard” of recovery is just that, recovery off all chemical not “liquid handcuffs” of methadone or Suboxone. Dont agree with the stats that Zac presents either. Most individuals on MAT (methadone or Suboxone) continue to use other drugs which often leads to overdose deaths. If a person is just taking methadone how can they “relapse” when they have continued to be on their drug of choice. Ask any RECOVERING opiate addict what their experience was on MAT, “total hell. Reckitt Benckiser, the makers of Suboxone made 56 BILLION last year from what I read, a huge part of that on Suboxone. Therefore it is easy to see how they can spend millions on marketing, lobbying, paying off doctors to support their drug. They have NO motivation for people to stop taking their drug!

  18. Zac Talbott, BA, CMA / February 12, 2014 at 12:08 pm

    I find it truly outrageous that a piece titled “What you need to know about heroin addiction” makes absolutely NO mention of what the CDC has called the “most effective treatment” and the NIH has deemed the timeless “gold standard treatment” for opiate addiction: methadone maintenance treatment (MMT). The relapse rates for “traditional” inpatient treatments, even after the 60 days mentioned above, is greater than 90%! Yet the relapse rates for MMT are between 10-30% with a decrease the longer someone remains in treatment. If we are going to be serious about confronting the opioid addiction epidemic in an effective way that fosters recovery, omitting the most effective, gold standard treatment from discussions (especially those claiming to profess what you “need to know”) must become a thing of the past.

  19. Anne Fletcher / February 13, 2014 at 11:30 am

    Totally agreed that no one form of treatment is right for everyone, which is why it’s wrong for treatment facilities to do just that: offer just one form of treatment rather than options or to say, “this is recovery and this is not.” We certainly should tell clients what the weight of the evidence supports and in this case, it’s medication-assisted treatment. That’s not to say that there aren’t plenty of people who have overcome opioid addiction without it. I know some of them well. (My first book, Sober for Good, is all about the many paths to alcohol sobriety.) The main goal of treatment should be helping people with substance use disorders find what’s right FOR THEM, as individuals. If one thing doesn’t work, another approach should be tried – just as with other disorders in other branches of medicine.

  20. Gail / February 13, 2014 at 1:26 pm

    It never ceases to amaze me how those who are not in the fire can come up with such wonderful data and information that tingles the ears. Must I remind you of the history of addiction and how heroin came on the scene. Heroin was a MAT for OPIUM and at the time everyone said the same things they are saying now about the new kids on the block. Then came methodone another government sanctioned treatment that has gone on for years without the outcomes promised. Many alcoholics and addicts died becuase of good willed people who really don’t understand the nature of addiction. Currently Suboxone is being diverted at higher and higher rates for abuse. Dealers have explained their methods of selling it and the new demand for it. If these drugs were so effective would we really see the number of deaths we are experiencing. It is about trying to save money at the expense of lives anyone knows that we need good detox followed by long term treatment then followed up by half-way houses not some magical short term substance that changes one addiction for another.

  21. Gail / February 14, 2014 at 11:31 am

    Maybe I should have confined my comments to what is going on in my County and State. I totally agree with Will. Abstinence based options have been taken away in this Co. giving people no options about what treatment/recovery course they want to take. Also the person that commented on my “credentials” I not only have an addiction counseling license, I also have a MS, Professional Clinical Counselor license and am in 24 years of recovery. In my posts I do not point out any particular person. I am TOTALLY supportive of addicts (using or in recovery). However, I will stand by my opinion that people with addictions are being treated in my opinion like they are cattle. Take this drug and come back tomorrow. That is what I experience in my community.

  22. Perry Kaplan / February 16, 2014 at 1:08 pm

    Gail, I find it astonishing that you can talk about methdone/suboxone as “handcuffs,” when a few posts before you are practically bragging that you keep opiate addicts in treatment for 60 days. If this is what passes for drug-free treatment in your area, no wonder it is no longer an option.
    It is clear that you and some of your fellow correspondents in this thread–in spite of paying lip service to addiction as a disease–are still mired in a moral model view. How can you think it is OK to treat someone for sixty days and send them out into the world with a follow-up appointment and information about where to find an NA group, and telling them that it’s their fault if they get high! No wonder 98% of opiate addicts relapse within a year of treatment.
    The problem is that people like you who have found a way to stay abstinent think that they have found THE solution, not A solution. You decry methadone because it didn’t work for you or because you found a different way and you have come to believe that your way (drug-free) is somehow morally superior to how other people choose to deal with their addictions. The moral equivalent here is between methadone/suboxone and insulin. These drugs are only problematic if you start, a priori, from a place that says any medication that helps you stabilize your life is unacceptable, no matter that the consequences of not using may be death. We should be talking about co-prescribing naloxone with painkillers, and no one should walk out of your 30- or 60-day wonder programs without a prescription for it. If addiction is the chronically relapsing disease that you claim, how can you justify letting an addict leave treatment without the tools to protect him/herself from relapse. I suspect the reason is that your view of addiction is rooted far deeper in a view that addicts are on some level immoral and need to be punished for using than you are willing to admit.

  23. Gail / February 20, 2014 at 9:16 am

    Perry, not sure what you are talking about as I never mentioned anything about 60 days in treatment or “letting an addict out of treatment without tools”. Also, I do not believe addicts are “immoral or need punished” in fact just the opposite. My whole point is addicts are being treated poorly by not being given a choice of abstinence.

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