HEROIN ABUSE

In 2002, among past year heroin users, 50% abused or were dependent on heroin during the past year

Heroin abuse means the voluntary abuse of heroin - i.e. where people choose to do so.
Dependence is a bit further down the line and involves compulsive abuse of heroin - i.e. where people are driven to abuse heroin by various internal compulsions.

Although the current epidemic of cocaine use has commanded more attention, heroin abuse remains a serious problem in the United States. For example, the number of hospital emergency department visits related to the abuse of heroin rose from 38,100 in 1988 to 63,000 in 1993, an increase of 65 percent. In addition, some researchers have noted that snorting and smoking heroin may be growing in popularity as alternatives to injecting the drug.

Heroin abuse is defined as the chronic or habitual use of heroin to alter states of body or mind for other than medically warranted purposes. Traditional definitions of addiction, with their criteria of physical dependence and withdrawal (and often an underlying tenor of depravity and sin) have been modified with increased understanding; with the introduction of new drugs, such as cocaine, that are psychologically or neuro-psychologically addicting; and with the realization that its stereotypical application to heroin abusers was invalid because many of them remain occasional users with no physical dependence. Addiction is more often now defined by the continuing, compulsive nature of the drug use despite physical and/or psychological harm to the user and society and includes both licit and illicit drugs, and the term “substance abuse” is now frequently used because of the broad range of substances (including alcohol and inhalants) that can fit the addictive profile. Psychological dependence is the subjective feeling that the heroin abuser needs the drug to maintain a feeling of well-being; physical dependence is characterized by tolerance (the need for increasingly larger doses of heroin in order to achieve the initial effect) and withdrawal symptoms when the user is abstinent.

Definitions of heroin abuse and addiction are subjective and infused with the political and moral values of the society or culture. For example, the stimulant caffeine in coffee and tea is a drug used by millions of people, but because of its relatively mild stimulatory effects and because caffeine does not generally trigger antisocial behavior in users, the drinking of coffee and tea, despite the fact that caffeine is physically addictive, is not generally considered drug abuse. Even narcotics addiction is seen only as drug abuse in certain social contexts.

• People abuse heroin for many different reasons. Here's a few examples:
  • To avoid feeling bored,
  • To fit in with our peers,
  • To have more self-confidence,
  • To belong to a special 'group',
  • To forget about problems,
  • To relax,
  • To feel good.

You'll note that all these reasons are about changing the way people feel. They're about avoiding boredom or loneliness, feeling powerful and part of a group, feeling relaxed, feeling "good" etc. Heroin abuse provides 'good' feelings that are otherwise missing from a person's life. That's why people choose to abuse heroin - at least to begin with.

People who have become physically or psychologically dependent to some degree on heroin often realize that they're using more than they used to. They may then make some effort to reduce their heroin intake. This could involve cutting down the amount taken each time; only using on certain days; switching to another drug (e.g. heroin to methadone) etc. Sometimes attempts to cut down may involve a life change such as moving home or changing job. It's very common for such efforts to end in total failure, much to the utter bewilderment and dismay of the individual concerned. He or she cannot reduce their heroin intake. They're now faced with the fact that their heroin abuse is beyond their control. It has taken on a destructive force of its own. He or she now needs help to deal this problem.