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The Epidemiological Approach
Published in Hanna Pickard, Serge H. Ahmed, The Routledge Handbook of Philosophy and Science of Addiction, 2019
Estimated in this fashion, we found that for US community residents aged 18 to 54 years old, the NCS-estimated probability of developing a drug dependence syndrome varied drug by drug, as measured after the first occasion of extra-medical drug use. Among those who had smoked tobacco cigarettes at least one time, an estimated 1/3rd had developed tobacco dependence. Among those who had tried heroin at least one time, irrespective of administration route, an estimated 1/4th to 1/5th had developed heroin dependence. Corresponding estimates for other drug subtypes were: cocaine (1/6th); alcohol (1/6th to 1/7th); amphetamines and stimulants other than cocaine (1/9th), and cannabis (1/9th to 1/11th), as reported in Anthony et al. (1994).
Opiates
Published in G. Hussein Rassool, Alcohol and Drug Misuse, 2017
Users often experience nausea or vomiting on the first occasions that they use heroin, or when returning to use after a period of abstinence. Heroin dependence develops after repeated use over several weeks and sudden withdrawal leads to anxiety, nausea, muscle pains, sweating, diarrhoea and goose flesh. Tolerance develops quickly so that larger amounts of the same drug are needed to produce the same effect. During a period of abstinence (in treatment or prison), tolerance diminishes quickly so that an individual can easily overdose by taking their usual dose. Overdose occurs as a result of depression of the respiratory centre in the brain, which leads to respiratory and cardiac arrest and death unless immediate medical attention is received. Though stupor, coma and death can occur from overdoses, there is generally little effect on the motor skills and sensation. The user of opiates may appear detached or withdrawn with contraction of the pupils. Whilst pharmaceutical heroin is not especially toxic to human organs, adulterants in street heroin way well cause more damage, especially when they are injected. Injecting brings with it the risks of vein damage and collapse, local infections, abscesses, circulatory problems, ulcers, thrombosis, infections in heart valves and systemic infections. It also exposes users who share injecting equipment to blood-borne viruses including Hepatitis B and C, and HIV. However, most complications arise from unsterile injections and adulterated street drugs. Heroin, taken by injection, is also a risk factor in contracting hepatitis B and C, HIV and septicaemia.
Neurobiological Causes of Addiction
Published in Richard T. Spence, Diana M. DiNitto, Shulamith Lala Ashenberg Straussner, Neurobiology of Addictions, 2014
Carlton K. Erickson, Richard E. Wilcox
In the brain, heroin is converted to morphine so that the effects are actually those of morphine. Methadone is the mainstay of current treatment for heroin dependence. Methadone and heroin are both direct agonists at the brain’s receptors for morphine (endorphins). Thus, heroin and methadone (and morphine) mimic the endorphins. This means that methadone binds to the same receptors as heroin, activates the same receptors as heroin, and induces the same effects inside nerve cells as heroin. Another agonist, LAAM (L-alpha-acetyl-methadol), acts in the same manner as methadone but has a longer action. LAAM and methadone both prevent relapse in heroin dependent individuals because they substitute for heroin and thus reduce the craving for heroin.
The impact of discrimination on substance use disorders among sexual minorities
Published in International Review of Psychiatry, 2022
Ana Beatriz Balieiro Abrahão, Guilherme Trevizan Kortas, Israel Kanaan Blaas, Gislaine Koch Gimenes, Kae Leopoldo, André Malbergier, Julio Torales, Antonio Ventriglio, João Mauricio Castaldelli-Maia
As shown by Hamilton and Grella (2009), who surveyed eight gender-specific focus groups, 38 (19 women and 19 men) with long-term heroin dependence, women typically described the impact of their addiction on their families, while men typically described their surprise at still being alive. Noteworthy to mention that the available sound literature sources are originated in high-income countries, where national-level studies disaggregate data by sexual orientation. This is the case in the U.S., where the National Survey on Drug Use and Health (National Survey on Drug Use & Health: Lesbian et al., 2019) showed among 1.4 million LGB adults that, 51.6% struggled with illicit drugs, 64.4% struggled with alcohol use, 16.2% struggled with illicit drugs and alcohol, while 38.2% had some serious mental illness. Among illicit drugs used by this population sample, major concerns were opioids, cannabis (with a significant increase of 37.6% when compared to the previous year), and methamphetamine.
Craving and implicit attitude toward heroin use and their relationships with the levels of heroin dependence and methadone adherence in heroin users
Published in Journal of Addictive Diseases, 2021
Peng-Wei Wang, Huang-Chi Lin, Kun-Hua Lee, Lin Pai-Cheng, Hung-Chi Wu, Chih-Yao Hsu, Kuan-Sheng Chung, Chih-Hung Ko, Yi-Hsin Connie Yang, Cheng-Fang Yen
Craving has re-merged as a criterion for substance use disorders in the DSM-5.29 A previous study showed that craving for heroin may increase heroin use.26 In addition, heroin users undergoing MMT who have a low level of craving are more likely to remain abstinent from heroin use, whereas those with high levels of cravings are more likely to reuse heroin while in the MMT program.29,30 The present study found that craving for heroin had medium contributions to levels of heroin dependence and MMT adherence. Therefore, craving is still important for heroin users even though they have receiving MMT for a long time. This also highlights the importance of measuring craving for heroin users with MMT. Craving can be easily measured using the VAS, and thus clinicians should measure the level of craving for heroin routinely. In addition, influences of craving on heroin users’ addictive problems during MMT may vary because our results indicated the effect of craving on level of misuse was greater than that on attendance. This meant more studies may need to get a better understanding for how craving contributes to various addictive problems. Research on substance use other than heroin has shown that implicit attitude toward substances is related to relapse or continuing substance use8,31,32 and is also a reliable predictor of substance use.7 Research into alcohol use showed that a positive implicit attitude toward alcohol is associated with low motivation to change the drinking quantity and an increased amount of alcohol consumed per occasion.33
Sexual relationship, self-esteem, dysfunction, and sexual satisfaction in treatment naïve men with heroin dependence
Published in Journal of Psychoactive Drugs, 2021
Nishtha Chawla, Suraj Verma, Ragul Ganesh, Siddharth Sarkar, Atul Ambekar
Opioid dependence may be an important cause or effect of marital distress and poor sexual satisfaction and sexual relationships. Sexual problems faced by patients dependent on heroin is one reason for the continuation of or relapse on the drug (Calsyn et al. 2010; Grover et al. 2014). It has also been observed that almost half the individuals decide to stop opioid use on learning about its associated sexual dysfunctions (Palha and Esteves 2002). Treatment should not only be aimed at dealing with drug use but also with the problems associated with it, especially when there is equivocal evidence on whether the treatment of heroin dependence with substitution or antagonist may either improve, worsen, or have no effect on sexual dysfunction (Chen et al. 2012; Cicero et al. 1975; Meyer 2008; Mirin et al. 1980). It is important to understand the association of sexual dysfunction and relationship difficulties and use this understanding to educate the patients as a part of treatment.