Challenges of Heroin Treatment

Sometimes it’s hard to understand why a loved one struggles to get clean, especially for people who have no history of substance abuse.

But learning more about the challenges of heroin addiction and the necessity of drug rehab treatment can help you gain insight into the complexity of recovery.

The Struggle of Heroin Withdrawal

Heroin use can easily lead to physiological dependence on the substance.  As a result, withdrawal symptoms appear whenever the addict goes without the drug for a period of time.  These withdrawal symptoms are severe, making the initial part of addiction treatment very difficult.

The first signs of heroin withdrawal typically begin within a few hours following the last use. Symptoms are much like a bad case of the flu.

  • Restlessness
  • Insomnia
  • Bone pain
  • Cold flashes
  • Diarrhea
  • Vomiting

While heroin withdrawal is rarely fatal, the symptoms are extremely uncomfortable and often traumatic. In some cases, the fear of withdrawal will keep a heroin addict from entering into drug rehab treatment. Some addicts may start treatment, but are unwilling to continue because the process becomes too intense and coping with it is too difficult for them.

Some Withdrawal Symptoms Linger

Heroin belongs to the category of drugs known as opioids. Many opioid addicts experience a condition called post-acute withdrawal syndrome (PAWS). After the initial withdrawal period, many heroin addicts continue to experience some symptoms for a period of time.  The lingering symptoms usually peak 3-6 months after the addict’s last use, tapering off slowly after that.  Some addicts, however, will struggle with persistent symptoms for as long as two years.

The symptoms of post-acute withdrawal syndrome include depression, anxiety, sleep disturbances, coordination problems, an inability to feel pleasure (clinically known as anhedonia), and impaired concentration. In addition, the symptoms often come and go. For example, a recovering addict will go weeks without symptoms, and then suddenly feel awful, causing frustration and stress.  Unfortunately, PAWS is often a trigger for relapse.

Heroin Abuse Triggers Cravings

As a processed from morphine, heroin reaches the brain quickly and generates an intense high. When regular users stop taking the drug, they experience powerful cravings for it.  The drive to feel that euphoria again is extremely hard to resists. Cravings are especially intense during the initial withdrawal period, but they sometimes continue for years after the last use of the drug.  This is another reason many addicts have such a difficult time staying clean, despite going through an intensive treatment program.

Heroin Hinders Good Decisions

As an outside observer, you see how destructive heroin is. It tears you apart to see it ruining the life of someone you love. But heroin addicts don’t see it the same way. Like most recreational drugs, heroin use clouds a person’s thinking. That’s why most addicts are unable to recognize they have a serious problem that requires treatment. Effectively confronting the problem often requires an intervention.  An intervention involves gathering family and friends (of the addict) to collectively convince him or her that rehab is imperative.

Of course, even if the addict gets into treatment, it may be short lived. Clouded judgment makes it hard for some addicts to stay in treatment, even when their life has completely fallen apart as a result of their drug use. It’s not uncommon for addicts to prematurely leave treatment.  They convince themselves they’ve done the all the necessary work to stay sober after just a few days or weeks, even though full recovery is more likely to take months or years.

Heroin Addiction Carries a Stigma

While drug abuse itself frequently brings judgment, prejudice, and disapproval from others, heroin carries a particularly powerful stigma.  Some heroin addicts avoid treatment because they fear others will find out the nature of their addiction and label them a junkie.  The fear surrounding the stigma of HIV, which is a risk for heroin addicts who share needles, is a potential barrier to drug rehab treatment as well.

Complications in Treatment

Addiction is a serious condition that frequently co-occurs with other psychiatric disorders. For instance, it’s not uncommon for a heroin addict to also struggle with depression, anxiety, or posttraumatic stress disorder (PTSD). In fact, many individuals who become addicted to heroin and other drugs began using them to self-medicate troubling symptoms of other mental health conditions.  Drug abusers with a co-occurring mental health disorder are less likely to complete treatment. They’re also less likely to take medication as directed and more likely to miss appointments.

Treatment Can be Hard to Access

In some parts of the country, particularly rural areas and smaller towns, addicts often have a hard time finding proper addiction treatment. For example, treatment that involves the use of methadone or buprenorphine, two prescription drugs often used in the treatment of heroin addiction, is not widely available in some states, such as Arizona. Rural areas, in particular, may have just one physician who can prescribe heroin addiction drugs within several hundred square miles.

Heroin Treatment Often Requires Residential Care

Because heroin use creates both physiological and psychological dependence, residential treatment offers the best chance for a successful recovery. Residential programs require addicts to live at the facility 24/7. In addition to the intensive treatment, residential programs are also very beneficial because they allow addicts to focus solely on their recovery — without the demands of day to day life.  Also, living at the facility prohibits access to drugs (and drug-using/drug-dealing friends and acquaintances), making relapse during this crucial time next to impossible.  But a 24/7 facility requires a tremendous commitment. Some addicts won’t enter or remain in treatment because a residential program takes them away from family or friends. For example, a mother unable to see her young children while in treatment may experience stress and anxiety that can prevent or significantly hamper her recovery.

The Need for Long-Term Treatment

Following the initial withdrawal from heroin, which typically takes 5-7 days, addicts will need residential treatment. Although there are programs that last only 2-3 weeks, research suggests that heroin addicts get the most benefit from 3-6 months of residential treatment. A longer rehab stay allows them more time to learn about and understand their addiction — including contributing factors and triggers for use — and practice the skills needed to maintain abstinence.

Sober living programs can be a very helpful extension of drug rehab treatment. These facilities are like halfway houses, allowing the recovering addict freedom to work or go to school while living in a drug-free environment. Furthermore, for some, treatment continues on an outpatient basis for months or years after the initial rehab. Heroin addicts may not be willing to invest the extended time it takes to get clean once and for all.

Methadone treatment carries a stigma. As mentioned above, methadone is a prescription medication often used in heroin addiction treatment.  Administered under strict medical supervision, it works by suppressing withdrawal symptoms and reducing cravings, both of which are primary triggers for relapse. Although also an opioid, methadone doesn’t produce a high like heroin.  Its use allows recovering addicts to live more normal lives. The challenge, however, is that methadone is viewed by some as a replacement drug that essentially serves as a crutch. Those using methadone to recover from heroin addiction often experience conflict regarding its use, or face pressure to discontinue methadone treatment, from relatives, friends and even employers.

Heroin addiction is a particularly challenging condition to treat for many different reasons. Recovery often requires several attempts in rehab. 

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