Heroin is a powerful opioid derived from morphine, a natural substance derived from opium. It can be smoked, inhaled or injected. Usually, it is smoked or inhaled in attempt to avoid infection risks linked to injections; furthermore, some people erroneously think that by inhaling or smoking heroin the individual has less probability of developing addiction.
There are many different subtypes of heroin, which differ for impurities or other substances used for mixing it during or after production. The most common types of heroin are white heroin and the one known as brown sugar.
It has very impactful effects on the central nervous system, especially on the brain and its reward system. It also increases the production of some neurotransmitters such as dopamine and endorphins, which induce positive emotions.
Right after use, heroin travels all the way up to the brain through the blood stream and links itself to opioid receptors, causing euphoria and pleasant feelings (flash or rush) within a few seconds.
SHORT TERM EFFECTS
The initial rush lasts only for a few minutes and it is followed by analgesia, a sense of well-being, decreased negative psychic states, warmth, peace and detachment from reality. These particular effects are what drive the individual to seek heroin again and use it. Along with these positive effects, the individual may experience mouth dryness, nausea, vomiting, itching, heavy arms and legs.
After these initial effects, reasoning becomes difficult, there is a decrease in heart rate and respiratory rate. These effects fade away a few hours after use.
LONG TERM EFFECTS
Long term effects of heroin abuse can be devastating.
The addicted individual will firstly develop a series of physical issues such as: infective diseases, a critical low immune system, respiratory problems, heart disorders, liver diseases, venous collapse, infertility, erectile dysfunctions, malnutrition, constipation, psychological disorders and behavioral issues linked to the urge of seeking the drug (which may lead to legal issues).
ADDICTION, TOLERANCE AND WITHDRAWAL
Regular use of heroin cause addiction and habituation. Physiological addiction from heroin manifests itself even just after a few days of use. To avoid withdrawal symptoms, the user is led to seek heroin again and again. Physiological addiction is also characterized by an increased habituation to heroin, which leads the individual to increase the dose in order to obtain the desired effects.
Withdrawal symptoms start after 8 hours since the last use, may last from three days to a week and can be pretty painful. Some of these symptoms are sweating, irritability, mydriasis, nasal leakage and a general sense of discomfort. These symptoms will then evolve to twitching, cold, pain to arms and legs.
The worsening of these symptoms causes also respiratory problems, abdominal pain and cramps, nausea, vomiting, shiver and muscular cramps.
These symptoms usually fade after 4 days, leaving the individual feeling extremely weak and tired.
Psychological symptoms include anxiety, depression, dysphoria, guilt and shame. They are so intense that it is thought to be the primary cause for relapse.
The longer the individual has been addicted to heroin, the longer these withdrawal symptoms will last.
OVERDOSE
If an excessive amount of heroin has been taken, the individual experiences comatose states, as well as a critical decrease of heart and respiratory activity.
Heroin overdose may lead to death due to cardiac or respiratory arrest
in the event of overdose, treatment consists in the administration of opioid antagonists, or medications used as antidotes for this specific substance.
TREATMENT
The treatment for heroin addiction must be accompanied by a multidisciplinary approach which involves in: an initial detoxification, an intensive period of treatment and a last phase focused on preventing relapses. A psychiatrist and toxicological expert opinion must always be sought and included in treatment. A psychological and psychotherapeutic approach must also be included, which can take place in a residential community first and a semi-residential community in a second moment.
It is crucial that the addicted individual is granted psychological support even after this first phase of treatment, even as an outpatient, to maintain his/her achievements and prevent relapses.
Cognitive behavioral or family systemic therapy have proven to be the best course of action for heroin addicts.
Patient’s care must necessarily include his/her relatives and family for a successful recovery, especially from a family systemic point of view.
TRATTAMENTO
Il trattamento della dipendenza da eroina non può prescindere da un intervento di tipo multidisciplinare che preveda l’attuazione delle seguenti fasi: disintossicazione, trattamento intensivo e prevenzione delle ricadute. Fondamentale nella presa in carico del dipendente è il sostegno medico specialistico tossicologico e psichiatrico, seguito da intervento di tipo psicologico e psicoterapeutico, da attivarsi inizialmente presso comunità residenziali ed in seguito semi-residenziali.
È fondamentale che il soggetto in recupero continui a fruire di sostegno psicologico anche a livello ambulatoriale dopo una prima fase di trattamento intensivo, per mantenere i risultati e prevenire la ricaduta.
Da un punto di vista psicoterapeutico gli approcci cognitivo comportamentale e sistemico relazionale sono considerati ad oggi i più efficaci.
La presa in carico del paziente deve necessariamente prevedere il coinvolgimento della famiglia nel processo di recupero, in un’ottica di intervento sistemico.
