In the mind of a heroin abuser, depression and addiction are often deeply intertwined. Heroin is a powerful opiate that alters the user’s brain chemistry, causing mood changes, suicidal behavior, psychological dependence and addiction. Advances in Psychiatric Treatment estimates that close to half (48 percent) of opiate users have experienced depression at some point in their lives. When depression occurs in someone with heroin addiction — a condition known as a Dual Diagnosis — the chances of long-term recovery are slim.
Unless the user is treated for both conditions, it is likely that he or she will relapse soon after rehab. In many cases, the depressed heroin user will not receive treatment at all. Fortunately, clinical studies show that when depression and substance abuse are treated simultaneously, depressive symptoms often improve. According to Biological Psychiatry, opiate addicts who go through residential rehab or methadone maintenance treatment have significant improvement in their depression.
The key to treating heroin abuse and depression successfully is to identify both conditions early in the recovery process. Intensive neuropsychological assessment can reveal the signs of co-occurring psychiatric disorders like depression. Once mental illness has been identified, treatment must address both depression and heroin addiction to be successful.
How Heroin Affects the Psyche
Heroin is a synthetic drug produced from morphine, a potent analgesic that comes from the opium poppy. Heroin exerts its effects by binding with receptor cells in the brain that respond to opiates. When you inject, snort or smoke heroin, the drug converts to morphine in the brain, where it slows down neurological activity and induces a state of sedation.
For many users, a heroin high produces a rush of euphoria and a sense of profound relaxation. But the National Alliance on Mental Illness states that in people with psychiatric disorders, the side effects of heroin are more likely to be negative. For someone with depression, heroin may seem like an antidote to hopelessness, sadness and guilt.
But in fact, heroin may worsen depressive symptoms such as:
- A negative mood
- A flat emotional affect
- Low energy
- Anxiety or nervousness
- Social isolation
- Suicidal thoughts
The psychosocial effects of heroin can also contribute to depression. Heroin is highly debilitating, and users often experience job loss, relationship conflicts, legal problems and financial troubles.
Because the brain adjusts quickly to the effects of heroin, physical and psychological dependence develop rapidly. The National Institute on Drug Abuse states that nearly one-fourth (23 percent) of individuals who use heroin will eventually reach the point of addiction. Once addiction sets in, use of the drug becomes compulsive and uncontrollable — in spite of the devastating effects of abuse. All of these factors can intensify feelings of hopelessness, despair and self-loathing: the hallmarks of depression.
Factors Associated with Depression
Uncovering the causes of depression is one of the most challenging aspects of recovery for heroin users. Depression is much more than a low mood. It is a debilitating mental illness that can lead to isolation, job loss, broken relationships, poor physical health and an increased risk of suicide. Depression can arise from a number of sources, including:
- Genetic factors
- Imbalances in brain chemistry
- A stressful social environment
- Psychological trauma
- Physical disability
- Drug or alcohol abuse
Treating a Dual Diagnosis of heroin addiction and depression is especially difficult if the individual is still under the influence of the drug. Many of the symptoms of opiate addiction — fatigue, self-isolation, poor concentration and weight loss — can resemble the symptoms of major depressive disorder.
A study published in Drug and Alcohol Dependence followed 615 heroin users in various stages of treatment or non-treatment in Sydney, Australia. The study revealed that one-fourth of the subjects were currently experiencing a major depressive episode. Twenty-six percent of the individuals in treatment had a lifetime history of depression, while 16 percent of those who weren’t in treatment had been depressed. In the treatment group, a significant number of clients were also diagnosed with post-traumatic stress disorder, or PTSD. Others were living with a life-altering physical disability. In many of these cases, heroin was used as a maladaptive way to numb physical or psychological pain.
In long-term heroin users, it can be nearly impossible to determine whether depression led to addiction or vice versa. A comprehensive treatment plan must give equal attention to both conditions.
Depression and Heroin Withdrawal
Relapse is common among heroin users who try to quit this highly addictive drug. The unpleasant side effects of heroin withdrawal can drive even the most determined individuals back to the drug.
Giving up heroin all at once without professional support can trigger extremely uncomfortable symptoms within 12 hours, including:
- Muscle pain
- Sleeping problems
- A runny nose
- Watery eyes
As your body continues to clear the drug from your system, you may experience the late symptoms of withdrawal, such as:
- Nausea and vomiting
- Stomach pain
- Goose bumps
- Involuntary leg movements
- Intense cravings
Heroin withdrawal usually isn’t life-threatening. However, heavy users may have dangerous seizures if they try to quit without medical supervision.
The physical symptoms of heroin withdrawal can feel like a severe case of the flu, but for many users, the psychological side effects are even harder to tolerate. In the days, weeks or even months after quitting heroin, users may feel extremely depressed. Once the brain comes to rely on the euphoric rush of a heroin high, the pleasures of everyday life may seem meaningless in comparison. A condition called anhedonia, or lack of pleasure, often develops in recovering heroin addicts. One of the primary goals of treatment is to help the addict find peace, hope and joy in a drug-free life.
For the addict who has broken off ties with her loved ones, giving up heroin can seem like losing a best friend. The recovering addict not only loses his connections to the drug itself; he must give up his relationships with dealers and other users. Even if these relationships are shallow and destructive, they may represent the only human connections that the user has left.
Heroin, Depression and Suicide
Heroin abuse and depression are both risk factors for suicide. But when the two conditions are combined, the risk of self-injury or suicide increases exponentially. According to Addiction, the rate of death by suicide among heroin users is as high as 35 percent, and heroin abusers are more than 14 percent more likely than non-users to die of suicide.
Clinical studies suggest that hopelessness is one of the most common features in heroin addicts who are contemplating suicide. In a study that appeared in Substance Abuse and Misuse, 191 heroin addicts underwent psychometric testing to determine their level of hopelessness, the severity of their depression, and the extent of their suicidal intention. Suicidal intention was most strongly associated with feelings of hopelessness and despair.
Because heroin suppresses vital functions like breathing and heartbeat, accidental overdose is very common, and it may be hard to determine whether a fatal overdose was intentional. However, because of the high rates of suicide and relapse, it is essential that heroin addicts be assessed for depression and suicidal intention when they enter a recovery program.
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Approaches to Treatment
Depression can pose a lot of obstacles to recovery. Individuals who suffer from co-occurring addiction and mental illness often struggle with low motivation, poor concentration and social anxiety. In Dual Diagnosis rehab, treatment is tailored to the needs of the depressed patient. Therapists are trained in both psychotherapy and addiction counseling, so they understand the challenges of going through rehab while dealing with a serious psychiatric disorder.
Elements of a successful Dual Diagnosis approach to treatment include:
- Comprehensive neuropsychological testing to create an individualized treatment plan that accommodates the patient’s needs
- Intensive individual psychotherapy to address the causes of depression
- Peer group therapy to help the addict form healthy social bonds and learn new coping strategies
- Motivational support with therapeutic strategies like Motivational Interviewing (MI)
- Behavioral modification therapies like Cognitive Behavioral Therapy (CBT) or Dialectical Behavior Therapy (DBT)
- Opiate replacement therapy with medications like methadone or buprenorphine to minimize withdrawal symptoms and maximize the chances of long-term success
- Antidepressant medication to correct chemical imbalances, elevate mood and restore healthy energy levels
- Family education and counseling to build a supportive home environment
- Alternative therapies, such as acupuncture, yoga, art therapy, exercise therapy and massage to provide drug-free relief for the symptoms of depression
From the admission stage through rehab and aftercare, the emphasis of Dual Diagnosis treatment is on restoring psychological health while supporting recovery from addiction. Rather than treating depression and heroin abuse as separate issues, a Dual Diagnosis program treats these conditions as intersecting conditions.
Hope for Depression and Addiction
In spite of the hurdles to recovery, there is hope for people living with depression and heroin dependence. Integrated rehab programs approach mental illness and addiction with equal experience, education and compassion.
Clinical studies show that rehab outcomes for these hard-to-treat patients are often positive. The Archives of General Psychiatry describes the results of a study of 157 opiate addicts with depressive symptoms. The study subjects were evaluated as they were entering treatment, and again six months later. When they entered the program, 17 percent were experiencing major depression, and 60 percent had mild depressive symptoms. Six months later, 12 percent reported major depression, and only 31 percent had depressive symptoms.
Foundations Recovery Network has been treating persons with co-occurring disorders since 1995. As specialists in the field of Dual Diagnosis treatment, we offer a comprehensive rehab program that covers the entire spectrum of care. With residential facilities in Memphis, TN, Sautee, GA, Palm Springs, CA, and Malibu, CA, we are uniquely prepared to help you cope with the challenges of recovering from heroin abuse and depression.
If you or a loved one is battling heroin dependence and depression, we encourage you to call us at 844-768-0308 to find out how FRN can support you. Our compassionate admissions coordinators are available at any time to provide information, help and hope. Contact us today to start your own process of healing.
David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.
Reviewed by: Kim Chin and Marian Newton