Public health officials and lawmakers alike seem to agree on something: the United States is in the midst of an opioid epidemic. Part of this American drug crisis is heroin abuse, which has been on the rise. In 2015, deaths from opioids soared past 33,000 people for the first time in American history. In fact, heroin deaths alone topped even gun homicides in 2015, another gruesome first in America.
Part of the reason this crisis is so severe is the incredible extent of heroin’s addictive power. But what is it about heroin that makes it so addictive? Heroin actually changes the brain, and it’s these chemical changes that make heroin so addictive—and so tough to resist.
Anatomy of a Heroin Addiction
Decades of scientific research into drug addiction and heroin addiction, in particular, has allowed scientists to identify a number of physical and chemical changes that heroin wreaks on the brain. Some of them are simply related to the way the human brain perceives pleasure and survival itself.
The nucleus accumbens is a small neurological structure in the center of the brain. This congregation of nerve cells plays a powerful role in addiction, because it helps your brain process rewards, pleasure, motivation, and positive reinforcement. Whenever you undertake some positive action your brain connects to your survival—like biting into a cookie or getting a kiss from someone you love—you get a flood of dopamine in this portion of your brain.
Dopamine is a neurotransmitter that gives you the feeling of pleasure that you get from these experiences and activities. But where your normal chocolate chip cookie fix gives you a normal level rush of dopamine, heroin gives you a “rush.” This is a faster, bigger, longer-lasting surge of dopamine in your brain’s reward center.
Think about it: the biggest wave of pleasure and reward chemicals your brain has ever experienced, linked directly to heroin. It’s a tough thing to resist, because as soon as it subsides, changes start taking place.
How the Brain Responds to Heroin
When a heroin user subjects their body and brain to repeat doses of the drug, the brain’s nucleus accumbens gets a repeated and unhealthy level of stimulation. In response, it is exhausted, and the brain takes action, dampening your response to dopamine from any source. This means that not only do you suddenly need more of the same drugs to achieve the same high, but you also don’t get the same pleasure you once did from other things. That ongoing barrage of dopamine has, in essence, made it impossible for your brain to feel as much pleasure in the future.
What’s more, some of the receptors in that area of the brain appear to die off entirely. This makes it even harder to get the pleasure response from anything but drugs. Heroin addicts need and search for hits that are bigger and bigger because their experience of pleasure is shrinking. They have a problem feeling pleasure or satisfaction from even the things that used to make them so happy, the things that healthy people usually enjoy.
The addict’s brain also gets conditioned by the heroin experience. If you’re a chocolate chip cookie fiend, seeing or smelling one might make your mouth water—and send dopamine to the nucleus accumbens. But once your brain is trained to get its rush from heroin, you’ll experience the power of behavioral conditioning and addiction. Places where you’ve used or been high, people you get high with, even smells, sounds, sights, and other sensations your brain links to that rush prime your brain for a dopamine flood. This priming motivates the addict to do whatever it takes to score more heroin.
Dopamine plays a critical role for humans; it creates feelings of pleasure that our brains connect with essential physiological acts like procreating and eating. We have a drive to take care of these critical needs because our brains expect and desire the rush of dopamine that comes with them. Drugs like heroin, though, cause a dopamine flood in the brain, and condition us to expect dopamine levels that are artificially high. In the end, the brain of a heroin addict needs more dopamine than it could ever produce naturally, and creates dependency on heroin, even though heroin can’t supply the need it has created either.
Can You Recover from Heroin Addiction?
Addiction to heroin involves a strong neural pathway in the brain. The user takes the drug, the drug provides the rush of dopamine, the dopamine subsides, and the user seeks out more. Every time this drug-seeking pattern is reinforced, the addict is less flexible. Their brain is less able to construct other pathways, which is called a loss of plasticity. A loss of brain plasticity is also sometimes seen in certain older adults.
Those who use heroin for a long time find that more and more of their life ends up being about using the drug. Maybe at first just going out to clubs makes them feel like getting high, but before long, everything makes them think about using. Ultimately, they can’t do much of anything without being preoccupied by their need to use heroin. This is in part the result of a loss of plasticity.
But not all older adults lose brain plasticity, and not all addicts permanently lose plasticity, either. Although it is a much more difficult process, the user needs to re-learn how to create new pathways in the brain. This involves making new associations between pleasure and things that aren’t heroin in the brain. They need help to do this—help from supportive friends and family members who can remind them how to enjoy life again.
Cognitive-behavioral therapy (CBT) is another tactic for rebuilding plasticity, as is contingency management. In cognitive-behavioral therapy sessions, former heroin users work with therapists to modify their behaviors and expectations surrounding drug-use over time, and to manage their stress and triggers more effectively. In contingency management programs, former heroin users focus on various motivational incentives, such as small gifts, cash rewards, prizes, or vouchers, for positive behaviors like remaining sober.
Heroin is dangerously addictive. It has the power to “rewire” the brain’s responses to pleasure. However, it’s not necessarily a death sentence. Modern research has uncovered the how and why of what makes heroin addictive. This in turn has allowed modern, evidence-based treatment centers to provide much better services. If you’re ready to recover from heroin use, don’t wait and make the situation worse. Reach out for help now.