Heroin

Autumn Davis & Breanna Barber

Initial Understanding + Perceptions
Autumn: My initial understanding of heroin was it is a drug administered through a syringe.
With unsafe use of syringes, you can spread many diseases, most commonly HIV. Heroin
can come in a powder form or turned into a liquid form to inject.

Breanna: My initial understanding of heroin was limited, but I did know that it is a highly
addictive substance. Due to it being a highly addictive substance, when I think of people
who might use heroin I think of those who escalate to anger and violence very easily.
 Psychotropic Effects/Symptoms

Heroin is most commonly injected into a vein using a

needle which produces an intense rush of euphoria,
unlike the milder effects felt when snorted or smoked
(CAMH, 2024). With this euphoric rush, users enter a
state of sedation known as "on the nod." Individuals
using heroin for the first time may often experience
nausea and vomiting, but the desired effects include
relief from physical and emotional pain and a sense of
well-being. When injected, the rush is felt within
seconds and lasts a few minutes, while the overall
effects last three to five hours. Regular users must dose
every six to 12 hours to avoid withdrawal.
 Biological + Psychological Consequences
Heroin is dangerous due to the risk of overdose, which can slow or stop
breathing, leading to unconsciousness and/or death (CAMH, 2024).
Overdose risks are heightened by the drug's unknown purity, injection
method, and combining heroin with other substances. Naloxone can
temporarily reverse an overdose while waiting for medical help.

Additional risks of heroin use include:

• bacterial infections
• blood poisoning
• skin infections
• collapsed veins
• the spread of HIV and hepatitis from needle sharing

Addiction can lead to criminal behavior, familial relationship issues,

job loss, and poor health. Pregnant women using heroin risk the health
of their babies, and general long-term use results in lasting brain
changes that may take years to normalize after quitting (CAMH, 2024).
Social Consequences
Due to Heroin being an extremely addictive substance, those who use tend to become addicted. This
leads to many social problems such as:
• financial problems
• getting and sustaining work
• broken relationships, marriages, and friendships
• loss of child custody
• domestic abuse
• child abuse

Signs that someone might be using:

• small pupils
• disorientation
• sudden changes in behavior
• hyper alertness followed by fatigue or nodding off

(United Recovery Project, 2024)

Economical Consequences
• For the reoccurring users who have HIV, HCV, and HBV the costs
can reach over $300,000 for medical treatment (Jiang et al., 2017).
• Heroin use disorder was estimated to cost the U.S. $51.2 Billion
dollars in 2015 (Jiang et al., 2017).

Factors that went into the calculation of costs:

• Incarceration
• Addiction and overdose treatment
• HIV, HCV, HBV, and TB treatment
• Crime
• NAS (neonatal abstinence syndrome) treatment
• Productivity
• Cost of Heroin to user
Environmental Consequences
Heroin is produced from the opium poppy plant in semiarid regions like Afghanistan, Mexico, and Myanmar.
Valuable amounts of water are allocated to producing the opium plant as well as harmful pesticides are used to
protect the plants from wildlife. The excessive amounts of water needed to sustain these opium farms have depleted
already limited water supplies (DEA Museum, 2022).

Pesticides contribute to toxic waste on our planet and can lead to serious environmental implications. Toxic waste
affects wildlife, ecosystems, and drinking water pollution. Drinking water contaminated with pesticides can cause
many health problems for individuals who consume it. Those health implications might include:
• increased risk of developing cancer
• reproductive system disruptions
• Immune deficiency
• Treatment-resistant bacteria
• Nervous system impacts

(Banyan Treatment Centers, n.d.).

Evidence-Based Treatment Interventions

Contingency Management (CM) is a behaviorally based clinical intervention used

to treat substance use disorders (SUD) by providing tangible
rewards/reinforcements to clients contingent on specific behaviors (US
Department of Health and Human Services, 2023). These behaviors include
abstinence from substances verified through clean substance tests, attendance at
treatment sessions, and medication adherence. The primary goal of CM is to
reinforce recovery-oriented behaviors to enhance self-awareness and
accountability among clients regarding their substance use.
Evidence-Based Treatment Interventions

1. Prize-Based CM: Clients earn draws from a fishbowl containing prize tickets, which may have
monetary value or simply compliments like "good job." The number of draws can increase with
consecutive achievements but resets if the behavior lapses.

2. Voucher-Based CM: Clients earn vouchers with set monetary values for each successful behavior
(e.g., $2 per negative drug test), which escalate with continued success but reset upon failure. These
vouchers can be exchanged for goods or services.
 Evidence-Based Treatment Interventions

Cognitive Behavioral Therapy (CBT):

• CBT is a talk therapy that is goal-oriented and used to assist in
changing thoughts and behaviors that are problematic for the
individual (American Addiction Centers, 2024).

• Learning to cope with stress without the need to get high is

important for those with OUD, as the chances for relapse are high.
CBT, in combination with MAT, can help build the skills to cope
with life stressors and reduce the chances of substance use (NIDA,
2018).
Five Examples of Public Messages
Indirect Examples
Five Examples of Public Messaging
Direct Examples
Five Examples of Public Messaging
Direct Examples
Five Examples of Public Messaging
Five Examples of Public Messaging
 Diagnostic Criteria
Reform
The Diagnostic and Statistical Manual of Mental
Disorders (DSM) is beginning to incorporate cultural
sensitivity into the diagnostic criteria for mental health
disorders. However, it is evident that it remains on
western ideals, lacking in cultural competency and
humility on an international level.
 Diagnostic Criteria Reform
• Incorporating culturally specific practices: involves implementing
aspects of a patient's cultural background, community, and family
support in treatment interventions (Parra-Cardona, 2018).

• Client-Centered Approach: assessing patients based on their

perceptions and interpretations of symptoms or behaviors in order to
create treatment plans that align with their cultural values and traditions
(American Psychiatric Association, 2022).

• Adapting Diagnostic Criteria to Other Ideologies: involving a holistic

approach by contextualizing symptoms based on social, cultural, and
spiritual elements of health and well-being (American Psychiatric
Association, 2022).
 Diagnostic Criteria Reform
• Trauma-informed care: an approach that considers trauma’s impact on a
patient’s health and behavior and integrates those understandings within a
treatment protocol (Aces Aware, n.d.).

• Advocacy and Systemic Changes: Healthcare professionals play a vital role in

ensuring individuals and families are connected to the necessary resources and
receive wrap-around care. Systemic changes can only happen when problems
are brought to light. Professionals can work with organizations such as ASAM
(American Society of Addiction Medicine) to help improve addiction
treatment (ASAM, n.d.).

• Cultural humility: A practice of self-exploration and reflection of the

professional. Honoring and learning about the beliefs, values, and customs of
their clients in an intentional and humble way (Calhoun, 2024).
 References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).

CAMH. (2024). Heroin. CAMH. https://camh.ca/en/health-info/mental-illness-and-addiction-index/heroin

Gordon, E. (2018, December 6). Is America ready for prescription heroin?. NPR. https://www.npr.org/sections/health-shots/2018/12/06/673986164/is-america-ready-for-
prescription-heroin

McKerlie, K. (2023, March 21). Cultural adaptations to evidence-based interventions . Texas Institute for Child & Family Wellbeing.
https://txicfw.socialwork.utexas.edu/effective-cultural-adaptations-to-ebps/

National Drug Intelligence Center. (2003, May 15). Heroin Fast Facts. https://www.justice.gov/archive/ndic/pubs3/3843/3843p.pdf

Opioid Facts. Heroin and Opioid Awareness. (2022, November 28). https://www.justice.gov/opioidawareness/opioid-facts

U.S. Department of Health and Human Services. (2023, November 7). Contingency Management for the Treatment of Substance Use Disorders: Enhancing Access, Quality,
and Program Integrity for an Evidence-Based Intervention. https://aspe.hhs.gov/sites/default/files/documents/72bda5309911c29cd1ba3202c9ee0e03/contingency-
management-sub-treatment.pdf
 References
United Recovery Project. (2024, June 12). Social consequences of heroin. https://unitedrecoveryproject.com/rehab-blog/social-consequences-of-heroin/

Banyan Treatment Centers. (n.d.). The environmental impact of drugs. https://www.banyantreatmentcenter.com/2022/08/08/the-environmental-impact-of-drugs-stuart/

Jiang, R., Lee, I., Lee, T. A., & Pickard, A. S. (2017). The societal cost of heroin use disorder in the United States. PloS one, 12(5), e0177323. https://doi.org/10.1371/journal.pone.0177323

DEA Museum. (2022). Illegal drugs and the environment. https://museum.dea.gov/news/dea-museum-presents-illegal-drugs-and-environment

National Institute on Drug Abuse. (2018). What are the treatments for heroin use disorder? NIH. https://nida.nih.gov/publications/research-reports/heroin/what-are-treatments-heroin-use-disorder

American Addiction Centers. (2024). Heroin addiction treatment and rehab centers near me. https://americanaddictioncenters.org/opioids/heroin/rehab-treatment

Aces Aware. (n.d.). Trauma-informed care: Understanding and caring for patients affected by toxic stress. https://www.acesaware.org/ace-fundamentals/principles-of-trauma-informed-care/

Calhoun, V. (2024). Cultural humility and competency in occupational therapy: Looking through the lens of real life experiences. https://www.occupationaltherapy.com/articles/cultural-humility-and-
competency-in-5705#:~:text=Cultural%20humility%20is%20an%20ongoing,of%20the%20individual%20being%20served.

American Society of Addiction Medicine. (n.d.). National advocacy. https://www.asam.org/advocacy/national-advocacy