Heroin Abuse and Addiction

Posted on May 18th, 2021

  • What are Opioids?
  • What is Heroin Addiction?
  • What Are the Signs of Heroin Use and Addiction?
  • Treatment for Heroin Addiction
  • Find Out If Your Insurance Plan Covers Heroin Rehab

Heroin is an opioid drug derived from morphine, a substance found in poppy plants. It currently has no legitimate medical use in the U.S. but is a common illicit street drug commonly known as smack, horse, wren, and big H.

Heroin and other opioids are highly addictive, but treatment can help people quit using heroin and live healthy, productive lives.1 This page will discuss the impact of and treatment of heroin addiction.

What are Opioids?

Opioids are a class of drugs that include many prescription medications for pain relief as well as illicit drugs like heroin. Heroin and other opioids attach to the opioid receptors in the brain, and when taken, it dulls an individual’s perception of pain; they may also experience pleasurable feelings and even euphoria at higher doses.2 Some prescription opioids, such as Oxycodone and Vicodin, are also sold illegally as street drugs.2

Heroin is typically found as either a white or brown powder or as a black, sticky substance known as black tar heroin. Heroin can be snorted, smoked, or mixed with water and injected.1

Am I Addicted to Opioids?

Over time, people who use heroin and other opioids can develop an opioid use disorder (OUD), which is a type of substance abuse disorder (SUD), a diagnostic term for a drug addiction. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition published by the American Psychiatric Association provides the criteria that physician’s use to diagnose mental health disorders, and to be diagnosed with an OUD), an individual must meet at least 2 of the following criteria within a 12-month period:3,4

  • You take more opioids than you originally intended.
  • You make unsuccessful attempts to cut back or stop using opioids on your own.
  • You spend a lot of time and money looking for opioids, using it, and recovering from using it.
  • Your use of opioids creates family conflict.
  • Your use of opioids keeps you from being able to fulfill your responsibilities at school, home, or work.
  • You use opioids in risky situations, such as driving.
  • You keep using opioids even though it makes a physical or emotional issue worse.
  • You give up things you used to enjoy and use opioids instead.
  • You have cravings to use opioids.
  • You develop tolerance to opioids, which means you get used to it, and your body adapts to it, and you need more and more of it to keep feeling the same effects.
  • You go through withdrawal when you stop using opioids.

The severity of an OUD depends on how many symptoms a person has. For example, if you have 2-3 symptoms, you have a mild OUD. Those with a moderate OUD have 4-5 symptoms, while a severe OUD means having more than 5 symptoms.3

Dependence, Tolerance, Addiction, and Overdose

When a person has an OUD, they may be using a prescription opioid or an illicit drug such as heroin, or a combination of the two.3 Users may experience tolerance after regularly using the drug for several weeks. Tolerance to a drug results in diminished effects of the original dose and a person needs more and more of the drug to feel the same way it used to make you feel.5

Continued, regular use of heroin or other opioids can also result in physiological dependence, which means the body becomes used to exposure to the drug and a person experiences withdrawal symptoms when stopping or reducing opioid use .5 Tolerance and dependence may occur together, although they can both be experienced on their own as well.5

Taking any opioid (whether legally or illicitly) poses a risk of dependence, tolerance, and addiction. Opioid and heroin users also risk life-threatening overdose.16 Over 28% of all opioid overdose deaths in 2019 involved heroin, and heroin-involved overdose deaths were five times higher in 2019 than they were in 2010.17 Injection of heroin and other opioids not only carry the potential for overdose but also other serious health complications, including viral infections such as HIV, Hepatitis C, and Hepatitis B, as well as bacterial skin infections and endocarditis (infection of the lining of the heart).1,17

What is Heroin Addiction?

Heroin addiction is the continued, compulsive use of heroin despite serious negative consequences, such as health, work, school, and relationship problems.6 Addiction is a treatable medical illness that affects the brain and changes behaviors such as self-control.6

Heroin use and prescription opioid use in the United States is a serious public health issue. According to the 2019 National Survey on Drug Use and Health, approximately 750,000 people in the United States aged 12 or older used heroin in the past year, which is almost double the number of people who reported using it in 2002. The same survey estimates 9.7 million people aged 12 or older misused prescription opioids in the past year, with 404,000 misusing both prescription opioids as well as heroin. 7 Sadly, around 130,000 have died as the result of a heroin overdose in the United States.8

What Causes Heroin Addiction?

There is no single cause of heroin addiction. Scientists and researchers have identified many genetic, biological and environmental risk factors that can contribute to a person developing an addiction. Drugs like heroin get some of their addictive power through a person enjoying the feelings of euphoria and pleasure.6 Not only do people generally like to repeat enjoyable experiences, but heroin and other opioids activate parts of the brain that contributes to the reinforcement of rewards. Repeated drug use alters the way the brain functions in a way that makes it harder and harder to stop using heroin and other opioids.6

Many people who are addicted to heroin have developed a physiological dependence, where stopping heroin or reducing their opioid intake leads to experiencing uncomfortable withdrawal symptoms and intense drug cravings. Avoiding these uncomfortable symptoms can be a powerful motivator for continued heroin use.9

What Are the Signs of Heroin Use and Addiction?

Although heroin use is rare in the population of people who misuse prescription opioids, some individuals turn to heroin after becoming dependent on prescription opioids.1 It’s estimated that around 80% of heroin users started with opioid prescription drug misuse.1

Response to the opioid overdose crisis generally has resulted in prescriptions for opioid painkillers becoming more difficult to obtain. At the same time, heroin has seen increased availability, and studies suggest that heroin is typically cheaper and easier to obtain than most prescription opioids.1,10,18

Signs of possible heroin use and/or addiction may include:11,12

  • Drowsiness and “nodding off.”
  • Clouded thinking and judgement.
  • Small pupils.
  • Needle marks if the person injects heroin (or hiding needle marks by wearing long sleeves).
  • Signs of withdrawal, such as nausea, muscle aches, sleep problems, and chills, if the person cannot obtain heroin.
  • Heroin becomes a more important priority than anything else, including relationships, work/school obligations, and personal health.
  • Isolation from family and friends.
  • Performance issues at work and/or school.
  • Poor hygiene.

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Treatment for Heroin Addiction

Effective treatment exists for heroin addiction and OUD. Treatment may be delivered by private rehab or via state or local treatment programs in either an inpatient or outpatient setting.

  • Inpatient treatment typically involves staying in a facility with around-the-clock care and monitoring, group therapy, and individual counseling.
  • Outpatient treatment allows the patient to attend group and individual counseling sessions while living at home. This type of care may provide you with the opportunity to attend, school, work, and participate in daily life while working on your recovery.

There are several evidence-based therapies that can be used in any treatment setting:13-15

  • Behavioral therapy, which may be delivered individually or in a group, helps you identify your relationship with heroin and other drugs and teaches you strategies to avoid people, places, things, or events that may trigger drug use, such as alternative coping methods to deal with stress.
  • Medication-assisted treatment (MAT) is the use of one of three FDA-approved medications to treat OUD, methadone, buprenorphine, and naltrexone. These help manage cravings, prevent withdrawal, and keep people on the road to long-term recovery.
  • Integrated treatment of co-occurring disorders. Many people who have SUDs also meet the criteria for another mental health disorder, such as depression or anxiety. The relationship between both disorders is complex and intertwined, with symptoms of SUDs and other mental health conditions often overlapping. Integrating the treatment of both conditions has been found to be consistently superior vs. treating each diagnosis separately.
  • Individualized treatment plans. There is no one size fits all plan for addiction treatment, and a successful treatment approach is tailored to the individual’s needs, addressing all areas of a person’s life, such as employment training, housing, or legal issues, that may affect a person’s ability to stay on track with treatment and avoid relapse.

Find Out If Your Insurance Plan Covers Heroin Rehab

American Addiction Centers provides comprehensive rehabilitation services for those seeking recovery from addiction and substance abuse, including heroin and opioid addiction and abuse. To find out if your insurance covers treatment at an American Addiction Centers facility, click here or fill out the form below. Your information is kept 100% confidential.


  1. National Institute on Drug Abuse. (2019). Heroin DrugFacts.
  2. National Institute on Drug Abuse. (2020). Prescription Opioids DrugFacts.
  3. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th). American Psychiatric Publishing.
  4. National Institute on Drug Abuse. (2018). Questions for Identification of Opioid Use Disorder based on DSM-5.
  5. National Institute on Drug Abuse. (2018). The Science of Drug Use and Addiction: The Basics.
  6. National Institute on Drug Abuse. (2018). Understanding Drug Use and Addiction DrugFacts
  7. Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health (HHS Publication No. PEP19-5068, NSDUH Series H-54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
  8. Centers for Disease Control and Prevention. (2021). Opioid Overdose: Heroin.
  9. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Is there a difference between physical dependence and addiction?
  10. National Institute on Drug Abuse. (2018). Prescription opioid use is a risk factor for heroin use.
  11. National Institute on Drug Abuse. Signs of heroin use.
  12. Healthline. (2021). Signs of heroin addiction.
  13. National Institute on Drug Abuse. (2019). DrugFacts: Treatment Approaches for Drug Addiction DrugFacts.
  14. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Principles of Effective Treatment.
  15. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Types of Treatment Programs.
  16. Centers for Disease Control. (2021). Patients’ Frequently Asked Questions.
  17. Centers for Disease Control. (2021). Heroin.
  18. National Institute on Drug Abuse. (2018). Prescription Opioids and Heroin Research Report: Heroin use is driven by its low cost and high availability.

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