History: Humans first discovered and cultivated opium poppies in prehistoric times and have been dealing with addiction to opium and its products ever since. The heroin that is sold on the street is derived from morphine which itself is extracted from the opium of poppies grown in either Central and South America, the Middle East, or South East Asia. In the late 1980’s and early 1990’s the potency of the heroin available in the United States increased dramatically. This increased potency allowed people to get high by smoking the heroin whereas previously it needed to be injected. This in turn increased the number of people willing to experiment with heroin as use of a needle was no longer necessary. As expected, the use of heroin rose dramatically during this period and it has taken a devastating toll on the lives of many individuals and their families.

Heroin Addiction:
Physical dependence - Like all opiates, heroin causes tolerance and withdrawal. This means that an individual must take ever increasing doses of heroin in order to achieve the same effect and that when an individual tries to stop or cut down their use of heroin they will experience an extremely unpleasant withdrawal syndrome. Symptoms of heroin withdrawal include cold sweats, nausea, vomiting, diarrhea, bone pain, and anxiety and the more heroin someone was using, the more intense these symptoms. That is one reason why it is so difficult for many people to get off heroin and why some are willing to do things they would never do otherwise including robbery, stealing from their families, and prostitution.

Psychological dependence - In addition to the physical dependence heroin addicts develop, there is a strong psychological component that accompanies all addiction. This is best described as an almost irresistible compulsion to use the drug despite the knowledge that it is not the right thing to do. Addicts will often continue to use heroin in spite of devastating consequences to themselves and their families. For many, it is not that they are unaware of these consequences or are inherently selfish and uncaring people; it is that when the compulsion to use grips them, all other thoughts and feelings are pushed away. When not in the midst of a compulsion to use, many addicts feel terrible about what they have done and their inability to stop. Many have described feeling as though they are split into two different people like Dr. Jekyll and Mr. Hyde.

Heroin Treatment: Because heroin is such and addictive substance, it is very rare for someone to be able to get sober on their own once they have become addicted. Fortunately, there are many programs that are effective in helping heroin addicts achieve sobriety.

Heroin Detox: The first step in recovery from heroin addiction is safely detoxing from the drug. Because the symptoms of heroin withdrawal are so unpleasant, many addicts undergo detox at a special facility or under the care of a physician. There are three main ways heroin detox is performed.

1. The first and most common method is called symptomatic treatment and involves a doctor prescribing the addict several medications each of which eases the discomfort of one symptom of heroin withdrawal. For example, a doctor would prescribe one medication for the anxiety, another for the bone pain, another for the nausea, etc. This is usually done in an inpatient setting.
2. The second method is called opiate replacement therapy and involves switching the addict from heroin to another opiate, either buprenorphine or methadone, and then either tapering them off that drug or allowing them to stay on it for a prolonged period. While staying on the buprenorphine or methadone long term may be viewed as switching dependence on one drug for dependence on another, many people on this program are able to lead normal lives because they are receiving legal mediation from a doctor and not engaging in the activities associated with illegal drug use.
3. The third option is known as ultra rapid opiate detox and involves being put under general anesthesia while an “anti-opiate” medication is administered. This sends the addict into immediate, full fledged withdrawal while they are unconscious. This method is generally not recommended as it has been associated with potentially life threatening complications and has not been shown to result in better outcomes (http://jama.ama-assn.org/cgi/content/full/294/8/903).

Heroin Rehab: After heroin detox, patients typically then begin an inpatient rehab program that usually lasts between 30 and 90 day. During this time, the addict usually begins to treat the issues that may be underlying the addiction and learns how to stay sober once discharged from the facility. After discharge, it is often recommended that the addict continue to actively treat the addiction. This can be done by attending twelve-step meetings, seeing a therapist on a regular basis, or enrolling in an outpatient rehab program. There are many different options available and which one is right will depend on the addict’s individual situation.

What types of home drug testing kits are available?
Drug testing products for at-home use are designed to screen for single substances or multiple substances, depending on the product. Many at-home drug tests require a urine sample from the teen or person being tested, but some - like alcohol tests - use saliva to detect the presence of the substance. Another test uses hair samples. The tests can be purchased online and, in some cases, at your local pharmacy or other major retailers. Numerous products are offered to detect the presence of one or more of the following substances:

• Methamphetamines
• Amphetamines
• Cocaine
• Buprenorphine
• Marijuana (THC)
• Methadone, Oxycodone, and other opiates
• Barbituates
• Alcohol
• Nicotine
• Benzodiazepines
• PCP
• Ecstasy (MDMA)

What are the advantages of home drug testing?
Some of the retailers and manufacturers of drug testing products promote them as a way to help parents and teens have an “out.” If a peer offers the teen a substance, the teen can use the excuse of being “regularly drug tested” by their parents as a way to avoid peer pressure. In addition to providing results more quickly than by mail, home drug testing kits are relatively affordable (assuming they are not used too frequently) and are confidential.

What are the disadvantages of home drug testing?
Many medical professionals worry about the accuracy of these tests and warn that testing can damage the trust in the parent-teen relationship, which is already naturally volatile during the adolescent years. Additionally, a number of allowed substances – like cold medicines, mouthwash, and poppy seeds – may trigger a false-positive result and lead a parent to falsely accuse a teen of substance abuse. Because many drugs (but not all) are metabolized quickly, anything other than extremely frequent testing, which would be costly, may not catch all substances immediately. Finally, attempting to address abuse and addiction without the help of professionals may lead to devastating results. An August 2008 article in The U.S. News and World Report told the story of parents who were misled by their regular at-home drug testing into thinking that their son was slowly stopping marijuana use; in reality, he had just switched to other substances that their test couldn’t detect. His addiction worsened over the course of time. Ultimately, their son died of a heart attack and drowning after huffing an inhalant.

Despite these and other warnings from the medical community, the at-home drug testing industry has grown steadily over the past decade.

1. Pinpoint Pupils
Opiates cause the pupils (the black hole in the center of the eye) to become very small. Normally, the pupil will change in size depending upon the amount of light in the environment, becoming larger in the dark and smaller in the light. If someone’s pupils are very small, especially in a dimly lit room, this may be a sign that they are using opiates. Pupil size varies from person to person and tends to get smaller as we age, but if someone’s pupils are much smaller than everyone else’s in the same room, this may be a clue they have been using. This effect on pupil size remains present even when someone has developed a tolerance to the other effects of opiates, making it a particularly useful sign of intoxication.

2. “Nodding”
Opiates are a central nervous system depressant. This means that someone taking an opiate will become less alert and may appear sleepy. With higher doses of opiates people can become completely unconscious (and may stop breathing). A classic sign of opiate intoxication is “nodding”. This is when a person temporarily falls asleep at an unusual time like during a conversation or while standing. With prolonged use, people eventually develop a tolerance to the sedating effects of opiates and may seem completely alert despite being intoxicated. Therefore, just because someone is not nodding does not mean they are not using.

3. Withdrawal
Withdrawal is the process an opiate addict’s body goes through when they stop using. Because opiate addicts may not always be able to get their drugs, they will often show signs of withdrawal. These include sweating, goose bumps, nausea, vomiting, diarrhea, and cramping. If someone who you suspect may be using seems to suddenly come down with the flu and then spontaneously recover shortly afterward, this may be a sign that they are abusing opiates.

Pinpoint pupils, nodding, and withdrawal are all signs of opiate use and can help you determine if someone has been using opiates. Remember, however, that these are only guidelines and that a drug test is the most accurate way to tell.

There are three main areas though that influence whether someone will develop an addiction or not. These include the person’s genetic make-up, their environment of friends and family, and their age and stage of development at first use. If a person has all three risk factors they are more likely to become addicted than if they have just one risk factor.

Genetics

Drug and alcohol addiction clearly has a genetic component. Addiction tends to run in families. The more genetic code you share with an addicted family member the more likely you are to have an addiction. Additionally, if both your mother’s and father’s side of the family have a history of addiction, you are more likely to develop an addiction. Genetic factors account for about 50% of a person’s vulnerability toward developing an addiction.

No one gene is responsible for the tendency for addiction to run in families. Instead, it seems that a variety of traits and biological responses that are passed down work together to influence the development of an addiction. For instance, a person may have a biological tendency to enjoy risk. Their brain may reward them for engaging in risky behavior. But they also may have a biological tendency to act impulsively. Their brain circuitry might respond more quickly than others. These two factors together may then influence a person to engage in risky, impulsive behavior more often such as drug use. There also may be genetic differences in people’s experience of addictive chemicals. Biologically, some people may get more of a reward from using substances than someone else.

Additionally, some people have a greater genetic risk to develop mental illness. Issues such as depression, anxiety, or bipolar disorder can make people more vulnerable to self-medicating through the use of drugs or alcohol. All the factors that influence the genetic component to addiction are not clearly known, but it is likely that several genetic traits work together to influence addiction.

Environment
A person’s social context can also affect their tendency to develop an addiction. Someone who has grown up in an abusive or chaotic home is more likely to use substances. Substance abuse can be a means to escape from reality, and if real life has been unpleasant in the past there will be a greater drive to escape. Some family environments teach their children how to cope with stress and negative feelings in a healthy manner. Other families do not provide those resources to their families, thus leaving their children vulnerable to cope by using alcohol or drugs. Furthermore, healthy use of substances may not be modeled in the home. If it is normal within the household for people to get drunk often, a child will feel less tension about getting drunk frequently.

The person’s current environment also influences the probability of an addiction developing. If a person is experiencing stress or depression, they are more likely to develop a problem with substances. When work is stressful and marriage is not going well, the tendency to use substances increases. If someone surrounds themselves with friends who are drinking or using drugs they are more likely to use. Friends can normalize behavior that is deviant. Peer pressure can affect the development of an addiction, and, in a related way, someone’s sense of self-worth, confidence, and self-efficacy influence whether or not someone can resist peer pressure.

Stage of Life
Some stages of life are more conducive to substance use and abuse. During adolescence the frontal lobes of the brain lag behind the rest of brain development. The frontal lobes control such functions as self-control, judgment, and decision-making. Thus adolescence can be a vulnerable period for people to engage in behaviors that lack sound judgment, such as drug or alcohol abuse. This is dangerous because the earlier that a person first uses alcohol or drugs, the more likely they are to have an addiction.

If alcohol or drug use started early, it is more likely to be an important part of the person’s coping skills. If someone learned to deal with social stress in junior high school by using alcohol, they did not get the chance to learn other ways of handling stress as well as they should have; thus, they will continue to exhibit an over-reliance on substances to deal with uncomfortable feelings.

Adolescence is a time when people begin to establish their identity. If a person used substances heavily during this time, it is likely that they see substance abuse as a part of who they are. Until the person develops a new sense of identity, their substance abuse problem will be difficult to overcome.

What is addiction?
The medical understanding of addiction is grounded in two other concepts: tolerance and dependence. When a user develops tolerance to a drug, he or she requires higher and/or more frequent doses of the substance in order to achieve the same high that they experienced the first time. Someone whose addiction may have started as recreational use for social reasons may escalate into addiction and dependence when they develop tolerance and start using more often to recreate the high.

Dependence is often broken down into physical dependence and psychological dependence. If a person experiences physical withdrawal symptoms when they discontinue a drug, they are considered to be physically dependent on that drug. Not all substances cause physical dependence. Of those that can cause physical dependence, not all individuals who use the substance will develop an addiction or become physically dependent on it like, for example, alcohol. Psychological dependence refers to the ways in which substance use and abuse causes activity in the brain’s reward center. When the addict uses the substance, the brain receives a positive signal of “good”. An addict who is not physically dependent on a substance may become addicted to the reward signal, and develop an obsession over recreating that experience, leading to psychological dependence.

So, why can’t they stop using?
Especially in the case of individuals who are physically dependent on a substance, discontinuing use means more than losing out on what you may perceive to be a selfish desire to continually get high. Individuals who are physically dependent will experience withdrawal symptoms when they stop using. These symptoms can range from mild headaches and nausea to seizures, coma, and even death depending on the substance in question and the dosages they were taking. Some addicts are terrified of going through withdrawal because they have experienced mild withdrawal symptoms when they had a hard time acquiring the substance. Withdrawal symptoms can be extremely serious, and it is recommended that addicts who are trying to stop their addiction go through a detox process that is monitored by medical professionals to ensure their safety.

Individuals who are psychologically dependent on a substance will not experience physical withdrawal symptoms (unless they are also physically dependent as well). However, psychological dependence can dominate an addict’s thought process and make finding more of the substance the only focus of their thoughts. They cannot imagine or understand a life that does not include the reward signal they experience every time they administer the substance.

How can you help an addict?
The first step in helping an addict is to understand how addiction works. Talk to your doctor and theirs – ask questions – do research – join a support group. Next, stop enabling them. You may also want to consider seeking the professional help of an intervention team or a rehabilitation facility. While it is possible to persuade an addict to seek treatment alone, professional assistance can help them avoid the many unpleasant and potentially dangerous effects of going through detox alone. Rehab facilities may be better able to give your loved one the time, resources, and skills necessary to get them on the path to recovery than you can alone.

Whatever path you choose, you will achieve much more success if you stop trying to argue with the addict and educate yourself on how to fight the addiction.

This article is not an attempt to excuse or justify the poor decisions or lapses in judgment that are often the catalysts of addiction; nor is it an attempt to minimize the many hurtful and destructive consequences of those decisions, which affect both the addict and their family, friends, and community. This article aspires to give the families and friends of those who are suffering from an addiction more awareness of the physical and psychological mechanisms behind addictive behavior. Regardless of how addiction begins or what stage it is in, it is a troubling reality that is complicated by lack of understanding.

SIGNS/EFFECTS OF USE: Consuming small amounts of alcohol can make the user feel relaxed and uninhibited - the main reason why its popular in social circles. The liver can usually metabolize one drink per hour (depending on the alcohol content in the drink); drinking more than this can lead to intoxication. Excessive use of alcohol during a single sitting, sometimes called binge drinking, can have more severe negative effects, impairing judgment and coordination. During this situation, users may also experience feelings of depression. When binge drinking occurs frequently over an extended period of time, the individual may begin to damage his or her liver, possibly leading to cirrhosis. Like other potentially addictive substances, users may develop tolerance to alcohol, meaning that they require larger amounts more frequently to achieve the same effect.

Addiction occurs when the individual develops physical and psychological dependence on alcohol. Physical dependence is marked by withdrawal, which is explained in more detail below. Psychological dependence is characterized by obsessive thoughts and a perceived need of a substance. An alcoholic may also begin to believe that he or she cannot function without alcohol.

WITHDRAWAL: The symptoms of alcohol withdrawal can be severe; medically monitored detox is the safest way to go through withdrawal. The user may experience visual or tactile hallucinations, insomnia, anxiety, depression, seizures, and/or delirium tremens, which may include dangerously high heart rate and blood pressure as well as periods of waxing/waning consciousness.

SIGNS/EFFECTS OF USE: The primary method of administration is swallowing the substance. Some users experiment with intravenous (IV) injection. Because the solution of depressants is often thicker than that of, for example, heroin, the user must use a thicker needle, which can cause more severe damage to the skin.

By acting on the central nervous system and slowing the brain, depressants impair voluntary actions as well as involuntary processes including respiration and heart rate. Many people are familiar with the effects of excessive alcohol consumption, and the effects of many other depressants are similar. These include impaired vision and coordination, reduced inhibitions, extreme emotional responses (both positive and negative), decreased judgment, and altered speech, among others. Fast- and slow-acting depressants tend to produce short- and long-lasting highs, respectively.

DANGERS: Overdosing on depressants, which sometimes happens when users are attempting to counteract the effects of stimulants, can cause drowsiness, fainting and a sensation of cold, clammy skin. Anyone attempting to recover from depressant use or overdoses should be under the care of a physician because the decreased respiration that may result can lead to respiratory failure and, ultimately, death.

Many rehab programs incorporate cognitive behavioral therapy, which makes addicts aware of their cognitive distortions and teaches them how to counter these negative, self-destructive thoughts with positive ones. While addicts are ultimately responsible for their choices, understanding these potential cognitive distortions can give an outsider some insight into an addict’s often tormented world. These distortions, in combination with addiction and other traumatic life experiences, deflate an addict’s self-esteem and feelings of self-worth.

Please note that anyone - not just addicts - may employ these distortions. However, addicts often exhibit signs of some of these negative, usually unrealistic, and frequently highly inaccurate, ways of thinking and negotiating reality.

1. Emotional Reasoning: “I feel it, therefore it is so.”
This type of reasoning is primarily based on gut feeling or can be a result of having used other faulty reasoning to lead to a certain feeling. “I feel like a failure; therefore, I am a failure.” The sad irony is that negative thoughts often produce negative emotions, which can snowball into a destructive downward spiral as they feed off each other.

2. Should Statements: “I should get help for my problem.”
As long as an addict has the above should statement in their head, they probably will not seek treatment. When should statements are directed toward oneself, and when the associated expectations are not met (”I should, but I haven’t and don’t really want to”), the individual will feel guilty, inadequate, and even resentful because they have not fulfilled this abstract should requirement. Addicts, especially, will have better success when they seek treatment as the result of an internal, conscious choice instead of as a response to what they imagine to be the unspoken expectations of friends, family, and society.

3. Mental filter and disqualifying the positive.
These distortions are usually addressed separately, but are grouped together here because if an addict is using one, they are usually using the other as well. In the case of the mental filter, imagine that a clear blue film has been placed over the addict’s eyes. The addict’s entire understanding of reality is experienced through that film, which represents different events or issues unique to each addict. A veteran of war, for example, may be unable to shake the traumatic memories of a friend’s death and is reminded of this in everything they do. Addiction itself can be a type of mental filter.

To continue with this example of the veteran, he or she may minimize the positive things - like personal successes and interpersonal relationships - in light of this traumatic experience. “Nothing else matters” and
“that’s not really important.” Many individuals, including veterans, turn to substances as a form of avoidance coping to try to deal with the difficult experiences that they have had. Addicts often give the drug priority and gradually minimize the value of other aspects of their life.

4. Labeling.
Labeling is a form of over-generalization, in which an individual perceives a single event to be part of a larger pattern of cosmic “unfairness” targeted at the person. Addicts will often label themselves, which can begin a destructive cycle of circular reasoning. “I behaved this way; therefore, I am a bad person,” which is followed by “I am a bad person; therefore, it makes sense that I behave this way” and so on. An example of over-generalization would be “My mother did not love me; therefore, I am not worthy of love.” When it appears in combination with should statements, labeling can create troublesome internal conflict in an addict. Over-generalizations can diminish an addict’s feelings of self-worth, impairing them from recognizing the reality that they are loved by many, and are worthy of love and a happy life!

5. Magnification (and/or minimization).
Is the addict still feeling the aftermath of a poor career decision? Have they not recovered from a romantic relationship that ended badly? Was someone else’s addiction “easier” to overcome? Most people experience periods of grieving or regret, but some individuals prolong this period past what would be considered a reasonable time and obsess over their errors and flaws (magnification) while also justifying and excusing those of others (minimization).

6. Personalization.
Perhaps the easiest example of this cognitive distortion is the child who feels at fault for his or her parents’ divorce, or who excuses abuse as a form of deserved punishment. In personalization, the individual believes he or she is somehow - in whole or in part - to blame for an event or issue that is not directly related to anything that he or she has done.

Ask yourself the questions that follow and assess yourself and your behavior honestly. In order for a positive change to occur, you might need to take the first step.

1. How often do you give the addict money?
People who have substance abuse problems often have difficulty funding their addiction because they usually cannot maintain a job. An addict will often ask for money for “rent” or “groceries”; this money, more than likely, goes directly to the addiction. In some cases, they actually use the money on these things, but spend all of their own money on the substance. Either way, you are making the addiction possible, and certainly less difficult, by openly supporting the addict financially.

2. How often do you make money accessible to the addict?
As an addict’s priorities shift to make acquiring more of the substance their ultimate goal, they become less concerned with the ethical problems of stealing money from anyone, including their friends and family. If the addict has stolen money from you once – and you continue to passively allow them to “find and take” your money, you are equally guilty of enabling them as someone who hands them cash. Many people justify this behavior by saying that they aren’t doing anything wrong, but as the saying goes “Fool me once, shame on you! Fool me twice, shame on me!”

3. How often do you provide for them with other needs?
Watching a family member or friend struggle with an addiction is extremely difficult, especially for parents whose role has always been to provide for the needs of their children, including food, clothing, shelter. It is difficult to separate the needs of the addict – a sick person whom you love more than anything – from the needs of the addiction – a disease that is costing them everything. But fulfilling any need – even transportation or company – enables the addict to continue living a life that is still, for them, tolerable with your help. It is important to remember that, in choosing to use alcohol or drugs, the person has made an independent, adult decision, and, if you, your wallet, car, refrigerator, or house didn’t exist, would have to accept the consequences of that decision. You should help them in a positive direction if they are ready for it; but enabling them to continue an addiction will not help.

4. How often do you justify their behavior to yourself and others?
Did the addict have a particularly traumatic event in his or her past and the addiction has helped them forget? Is substance abuse a good way for them to “fit in” at college? Is it “just a phase” that they’ll grow out of? Are they using a substance that “isn’t really that dangerous”? Do they deviate from the doctor’s orders when taking pain medicine because the doctor “just doesn’t understand” what they’re going through? Is this something your neighbor’s kids might do, but certainly not your own? Being in denial about someone else’s substance abuse problem helps an addict not only continue their behavior, but also increase it in intensity and frequency until you can’t keep ignoring it and are forced to recognize it – sometimes too late.

5. How often do you cover for their behavior to help them avoid negative consequences?
When the addict wakes up with a hangover, do you call their boss and claim they have “the 24-hour flu”? Has the addict become violent or verbally abusive to you or someone else, and you tell others that something else caused a physical injury or conflict? Do you bail them out of jail? Do you find yourself apologizing or accepting blame for things that have happened to them?

Why should an addict stop engaging in dangerous or destructive behaviors if you continually protect them from the consequences?

If you are able to answer any of these questions positively, it may be time to reconsider your role in relationship to the person who has been abusing substances. The good news is that, unlike many other chronic or terminal conditions your loved one may be diagnosed with, you do have options in how you respond to addiction. Your choices and behaviors can help them find the path to recovery.

While high school still represents a challenging time for young adults, drug and alcohol use may begin in middle school and even elementary school. It is important for parents to equip their children with knowledge of the threat that it poses as well as reasons to say no if they find themselves under pressure.

Below are suggestions for how to talk to a child about drugs and alcohol.

1. Use age-appropriate language and information.
Methamphetamine is a long word for adults, let alone children! You can still convey the gravity of the situation with words and phrases like dangerous and very bad if your facial expression remains stern and serious.

2. Be a good role model.
It is hard to persuade anyone to believe you if you aren’t living by what you preach to others. Children are very perceptive and will notice if their parents behave strangely after drinking large amounts of alcohol. If your behavior isn’t consistent with your words, your child will be confused and you will invalidate your efforts. Develop a clear position on drugs and alcohol and stick to it, especially in the child’s presence.

3. Role-play potential situations.
Many children learn by doing. Role-playing potential situations in which they may find themselves – a friend offering them a substance, finding prescription medicines at a neighbor’s house – will give them a concrete memory of how to respond in each situation. Being active in a type of play will also hold their attention longer than being forced to listen to a serious topic.

4. Listen and let the child ask questions.
A conversation – which means that both people participate – is often more effective than simply talking at the child. Make sure you give them space to voice their questions and concerns.

5. Reaffirm them.
Children need to be reminded of their value. They also want praise for their efforts. By reaffirming them, you give them another reason to say no when confronted. They do not need a substance to feel better about themselves: they are loved.

6. Give them skills for choosing friendships wisely.
In the same way that children want affirmation from their parents, they also want to have the approval of their peers. Ask your child “what makes a good friend?” When the child has answered, ask “what makes a bad friend?” If necessary, ask more leading questions that can help them realize that people who offer substances that can harm them do not have their best interest in mind.

7. Be appropriately honest.
You certainly should not tell a child everything about drugs if they are not developmentally ready for it. However, if a child has never been told that “drugs make you feel good for a little while”, they may be surprised when they hear it from a peer and wonder why you lied to them. It can be helpful to anticipate the arguments that someone else might make to persuade your child, and teach them to expect those arguments.