Signs and Symptoms of Heroin Addiction

            In recent years, prescription pain killers, such as oxycontin, fentanol, vicodin, etc. were the drugs of choice for those addicts who favored opiates because they were easier to get than heroin and less expensive. Because of their popularity through efforts to clamp down by the FDA, they have become less accessible and more expensive.  As a result of our military presence in Afghanistan, where opium poppies grow in abundance, there has been an alarming influx of cheap heroin into the country. In response, the Mexican drug cartels are also flooding the market with cheap, “black tar” heroin. As a result, heroin addiction has become, once again, an epidemic in the U.S. and people are dying from overdoses in alarming numbers.

            If you believe someone you know or love is using heroin, what follows are the top 20 questions to assess heroin addiction symptoms:

1. Has their appearance changed; do they not appear to care how they look?

2. Are they eating properly?

3. Have they lost or gained weight?

4. Are there needle marks on their arms or legs?

5. Have they markedly slowed down?

6. Do they have the shakes?

7. Are their hands cold and sweaty?

8. Have you smelled something on their breath, or their clothing?

9. Do their eyes appear red?

10. Are their pupils dilated?

11. Is their face puffy?

12. Is their skin tone flushed or pale?

13. Do they have a blank stare?

14. Has their physical coordination changed? Are they staggering?

15. Have they missed a lot of school, or work?

16. Have their sleep habits changed? Are they always tired?

17. Have they become lazy?

18. Are they hyper?

19. Do they lapse into rapid speech patterns? Do they slur their words?

20. Have you seen heroin paraphernalia such as needles, syringes, used cotton, etc.?

This list is by no means complete, and even if they have these symptoms, it doesn't necessarily mean that person is addicted. Don’t assume the worst, but don't deny the obvious!

Along with the above signs and symptoms there are several other factors connected to heroin use to consider:

·        Health: There are a whole host of physical signs that can point to heroin abuse. Are they consistently lacking in energy – especially young kids? They don’t like getting up in the morning in the first place, but they don’t always refuse to get moving. Fluctuations in weight is also a sign.

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·        Appearance: With kids, this can be a difficult area because fashion is as fashion does, and what adults feel is acceptable is often, if not always, the opposite of what teenagers and young adults like. Kids want to fit in and there is peer pressure to influence the way they dress. Girls, especially, are bombarded with images on appearance For adults, careless dressing, lack of hygiene and a general slovenly appearance and loss of interest in how they look  is considered a sign.

·        Attitude and Behavior: As children enter their teen years it is natural for them to want to break away from the family. When kids go to extremes to make sure you don’t know who they are with or what they are doing, this is definitely a red flag. When they become secretive and guarded, when their privacy at home prevents your open access to them, there may be something beyond mere adolescent rebellion. Perhaps their only interaction with the parents is to ask for money, and when asked why they need money they refuse to answer, or become indignant. Worse yet, they may steal items from home to buy drugs. The eyes are often an indicator. Has the life gone out of their eyes, or is there a major change?  With all addicts, there is an old saying; “You can tell an addict is lying because their lips are moving.” If the adult has not generally played fast and loose with the truth, it is a pretty good indication that if lying accompanies a number of the previously stated symptoms, drug abuse is probably a factor.

·        Why do some drug users become addicted, while others don’t? As with many other conditions and diseases, vulnerability to addiction differs from person to person. Genes, age when one started taking drugs  and family and social environment all play a role in addiction. Risk factors that increase vulnerability include:

1.      Family history of addiction.

2.      Abuse, neglect, or other traumatic experiences in childhood.

3.      Mental disorders such as depression and anxiety.

4.      Early use of drugs.

More signs and symptoms of drug abuse

If one believes they have issues with heroin or other opiates, they need to consider if the following are taking place:

• Responsibilities are being neglected at school, work, or home (e.g. flunking classes, skipping work, neglecting your children) because of drug use.
• Drugs are being used under dangerous conditions or risky behavior is taking place while high, such as driving while on drugs, using dirty needles, or having unprotected sex.
• Drug use is resulting in legal trouble, such as arrests for disorderly conduct, driving under the influence, or stealing to support a drug habit. 
• Drug use is causing problems in relationships, such as fights with a partner, family members, an unhappy boss, or the loss of old friends.

• A tolerance to drugs has been built up. More of the drug is required to experience the same effects that were reached with smaller amounts.
• Drugs are used to avoid or relieve withdrawal symptoms. If one goes long without drugs, symptoms such as nausea, restlessness, insomnia, depression, sweating, shaking, and anxiety are often experienced.
• Complete loss of control over drug use. Doing drugs or using more than planned, even though promises were made to self or others to quit or slow down. The addict may want to stop using, but feels powerless.
• Life revolves around drug use. A lot of time is spent using and thinking about drugs, figuring out how to get them, and recovering from the drug’s effects.
• Once-enjoyable activities have been abandoned, such as hobbies, sports, and socializing, because they get in the way of drug use.
• Even though it’s causing major problems, the drug use continues despite the knowledge that it’s seriously damaging one’s life —blackouts, infections, mood swings, depression, paranoia—all are occurring but the use continues anyway.

The overwhelming sign of heroin addiction, however, is the repeated need for the drug in ever-increasing quantities. Without obtaining a regular dose, addicts begin withdrawal, which causes severe cravings. This craving and drug-seeking behavior trump normal commitments and behaviors. The sole focus of the user will be getting their “fix.”.

The consequences of addiction then stem from both the seeking activities and using the heroin itself. Because heroin is illegal in all forms, arrest and incarceration are real risks, but even without getting caught, addicts face risks of infection and overdose.

One of the more obvious signs of heroin addiction is the presence of “track marks.” These are areas where the skin and blood vessels have been damaged by injection. While users will attempt to use the smallest needle possible (diabetic syringe) and vary the sites of injection, heroin is caustic and will damage veins or capillaries no matter what technique is used. And because of the strong pain-killing effect of the drug, the user often does not feel the damage or ignores it in favor of injecting into a convenient location.

Additionally, when the needle penetrates the vein through to the other side, abscesses can be the result. An abscess is a collection of pus in any part of the body that, in most cases, causes swelling and inflammation around it. Abscesses occur when an area of tissue becomes infected and the body's immune system tries to fight it. White blood cells move through the walls of the blood vessels into the area of the infection and collect within the damaged tissue. During this process, pus forms. Pus is the buildup of fluid, living and dead white blood cells, dead tissue, and bacteria or other foreign substances. Abscesses in the skin are easy to see. They are red, raised, and painful. Treatment varies, but often surgery, antibiotics, or both are needed – they do not go away on their own. In cases where addicts have ignored these abscess, a clot can form, thereby becoming very dangerous. If it breaks off and travels to the heart or brain, it can cause stroke, heart attack and even death.

After prolonged intravenous drug use, the veins collapse entirely and the skin develops hard scar tissue in the area. The tracks then become a series of injection sites along the line of a vein. While this may be the clearest sign of IV heroin use, some addicts inject in locations that are not readily visible – such as between the toes or under the tongue.

Constricted pupils are another accompanying sign of heroin use, as is lethargy, respiratory ailments, depression, and confusion. However, those who are experienced with the drug may be able to conceal these signs. Some are not discovered until an “outfit” is found. This is a kit containing their paraphernalia and drug. Addicts never venture far from their next hit.

Other medical conditions may point to IV drug use. AIDS, hepatitis C, infections at the injection site – all can result from repeated injections, especially when needles are shared. Another common symptom is constipation.

There are many ways to treat heroin addicts. A long-term user often has to use methadone or a form of buprenorphine for a long time to diminish the strong withdrawal symptoms of the addiction. By using this substance, patients can stabilize and start revalidation or rehabilitation. However, some patients will never be able to stay abstinent for a long time. In that case, it is better to focus on decreasing the physical risk and the chance of death.

Psychosocial treatments are effective parts of a total treatment plan of patients with opiate disorders. Cognitive behavioral therapy, behavioral therapy, psychodynamic therapy, group therapy and family therapy can be effective with heroin dependence. The choice for a certain treatment should be made after it is obvious what the patient wants, what problems should be solved, whether there are any other psychological problems and what have been the results of earlier treatments.

A patient with mild or moderate withdrawal symptoms can sometimes deal with these problems at home. The treatment of a heroin withdrawal syndrome is usually focused on relief of the critical symptoms and the motivation to take part in a long-term treatment of heroin addiction. Methadone or buprenorphine can be prescribed temporarily and also clonidine (originally intended to help reduce high blood pressure) can be used to suppress the withdrawal symptoms. The use of other narcotics can interfere with or complicate the attempt to kick the habit.

The success of the treatment depends on various things:

• The quantity and the kind of substances used.
• The severity of the disorder and the consequences.
• Simultaneous physical and/or psychological disorders.
• The strong and weak characteristics of the patient.
• The patient's motivation
• The social surroundings of the patient (friends, acquaintances, colleagues, family, etc.)