Managing Heroin Cravings and Preventing Relapse
Heroin is a powerfully addictive drug that can lead to intense cravings to keep using it. Heroin addiction treatment, including behavioral and medication-assisted methods, can help you to stop heroin cravings.
- Signs and symptoms of cravings include an intense desire to use heroin, daydreaming about using and physical signs, such as a pit in your stomach.
- Behavioral treatments can help strengthen motivation to quit heroin use.
- Heroin withdrawal is extremely uncomfortable, but medically supervised detoxification can help to manage unpleasant symptoms, as well as help prevent relapse.
- Heroin cravings can last for years but will likely happen less often and be less intense over time.
Heroin Craving Signs and Symptoms
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Repeated use of heroin changes the way the brain functions, which can lead to powerful cravings. No matter how motivated someone may be to quit heroin, periodic cravings for the drug are very common. The onset of a craving doesn’t indicate a failure in recovery, nor do they necessarily indicate that relapse is imminent.
A craving can be described as a powerful urge or compulsion to use heroin again. Different people experience heroin cravings differently, but there are some common symptoms.
Characteristic heroin cravings may include:
- An intense desire to use heroin, marked with difficulty focusing on anything other than getting and using heroin.
- Vivid daydreaming about using heroin – practically being able to smell, taste and feel the sensation of consuming heroin.
- Undesirable emotions, including anxiety and intense boredom.
- Physical signs, such as a pit in one’s stomach or a racing heart.
Why Do I Crave Heroin?
Many different things can cause heroin cravings. However, cravings generally have 3 key contributing factors, which may be experienced individually or simultaneously:
- Strong connections in the brain from previously using heroin, especially tied to circumstances that were formerly linked to heroin use, such as having money, being with certain people, being in specific places and feeling particular emotions.
- A desire to re-experience the pleasure of being high on heroin.
- A need to stop the symptoms of heroin withdrawal.
Treatments to Stop Cravings and Prevent Relapse
Effective treatment of heroin addiction often includes a number of components, including behavioral and psychosocial counseling, treatment for co-occurring disorders (such as depression or anxiety), medical services, medication-assisted therapy and vocational rehabilitation.2
While any of these treatment components can help, most heroin addicts see the best chance of success through a combination of behavioral approaches and medication-assisted treatments, while incorporating other treatment components as needed.1
Behavioral Therapy Treatments
Behavioral treatments are offered in different treatment settings, including outpatient and inpatient. Approaches that have been effective in treating heroin addiction include cognitive behavioral therapy, motivational interviewing and contingency management:
- Cognitive behavioral therapy helps you develop insight into how your thoughts, feelings and behaviors are related to your drug use as well as healthy coping skills to abstain from drug use.
- Motivational interviewing helps elicit and strengthen intrinsic motivation to change.
- Contingency management provides rewards for positive behaviors, such as abstaining from heroin use and having negative urine samples during routine drug screening.
Coping Strategies for Cravings
A key component of treatment includes teaching you how to cope with your cravings for heroin without giving in to the urge to use the drug. Common coping strategies include:
- Support system. Talking to your support system, which may include family, friends, a counselor or a sponsor from a 12-step program.
- Distraction. Distracting yourself by engaging in healthy and rewarding activities, such as exercising, playing with a pet or engaging in a creative outlet such as writing or playing music.
- Mindfulness. Practicing mindfulness in “riding the wave” of a craving or recognizing that you are having a craving and letting it pass.
- Self-talk. Using positive self-talk, including reminding yourself of the negative consequences of drug use and that the craving won’t last forever.
Medications to Block Heroin Cravings
If you’re looking for a rehab program for heroin addiction that offers medication-assisted treatment, contact a treatment support specialist at 1-888-319-2606
Three main medications may be prescribed to help ease heroin cravings and suppress withdrawal symptoms: methadone, buprenorphine and naltrexone. Pharmaceutical intervention for heroin addiction management is a type of medication-assisted treatment.
- Methadone is an opioid medication that activates the same brain receptors as heroin, albeit in a controlled and less powerful manner. Methadone is taken orally, producing a slow release of its effects, which decreases the chance of feeling a high.
- Buprenorphine partially activates the same brain receptors as heroin and also partially blocks the ability to feel rewarding effects from heroin and other opioid drugs. 3
- Naltrexone blocks the ability of heroin and other opioid drugs to produce a high. Naltrexone is not addictive or sedating, but people often have difficulty adhering to naltrexone treatment, so it has been less successful. 1
How Medication-Assisted Treatment Works
You may still miss the high, which is why accompanying treatments are important.
Medication-assisted treatment for heroin addiction involves working with a doctor to find the dosage that will suppress withdrawal symptoms and cravings with few side effects. Until the ideal dosage is determined, you may still experience cravings. Finding the right dose usually takes between a few days to a few weeks. While cravings and withdrawal symptoms should mostly be eliminated as part of medication-assisted therapy, you may still have a desire to use heroin because you miss the high. This is why accompanying treatments are important. They help you find other ways to experience pleasure and feelings of happiness.
When taken as directed under a doctor’s care, methadone, buprenorphine and naltrexone are generally safe. However, if you take these drugs in larger doses than prescribed, or in combination with other drugs, overdose or death could occur. Use of these medications while continuing to abuse heroin or other opiates can cause sudden withdrawal. It is especially dangerous to combine these drugs with substances that depress the central nervous system, such as benzodiazepines and alcohol. 2 In addition, because using methadone, buprenorphine and naltrexone reduce tolerance to heroin, there is a higher risk of overdose for those who return to heroin use, due to inadvertently taking too much heroin. 5
Cravings During Detoxification and Withdrawal Risks
When you first quit heroin, you go through a detoxification stage, where your body and brain adjust to not having heroin. Without medication-assisted treatment, you will likely experience extremely unpleasant withdrawal symptoms during this period.
Cravings are often the worst during detoxification. Your brain has adapted to and expects heroin usage, and using heroin again will stop withdrawal symptoms. While heroin withdrawal is exceptionally uncomfortable, it is not life-threatening. However, medically supervised detoxification is recommended to avoid relapse as well as other complications of withdrawal.
Withdrawing from heroin is an intense and difficult experience, both physically and emotionally. It can exacerbate any mental health problems, including suicidal thoughts. 4
- Stomach pain, nausea and vomiting.
- Cold sweats.
- Muscle and bone pain.
- Uncontrollable leg movements.
- Agitation and anxiety.
How Long Will I Feel Like This?
Withdrawal symptoms from heroin usually start 8-12 hours after the last heroin usage, peak around 24-48 hours after the last use and subside after about a week. However, some people experience withdrawal symptoms for many months. 1 Because of the changes in brain chemistry caused by heroin addiction, you may continue to have urges to use heroin for years after stopping use. However, over time, cravings will become less frequent, less intense and easier to overcome.
Frequently Asked Questions
Why Do People Who Use Heroin Crave Sugar?
Researchers theorize that people who use heroin may crave sugar for 2 main reasons:
- Using heroin activates receptors in one’s brain that induce a taste preference for sweet foods.
- Sweet-tasting foods activate the same receptors in the brain that heroin does and produce pain-relieving effects.6
Find Help to Quit
. National Institute of Drug Abuse (2014). Research Report Series: Heroin. Available from: http://www.drugabuse.gov/publications/research-reports/heroin/letter-director
. Center for Substance Abuse Treatment (2005). Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. Rockville (MD): Substance Abuse and Mental Health Services Administration (US). (Treatment Improvement Protocol (TIP) Series, No. 43.) Available from: http://www.ncbi.nlm.nih.gov/books/NBK64164/
. Center for Substance Abuse Treatment (2004). Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Rockville (MD): Substance Abuse and Mental Health Services Administration (US). (Treatment Improvement Protocol (TIP) Series, No. 40.) 2 Pharmacology. Available from: http://www.ncbi.nlm.nih.gov/books/NBK64236/
. Center for Substance Abuse Treatment (2006). Detoxification and Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US). (Treatment Improvement Protocol (TIP) Series, No. 45.) 3 An Overview of Psychosocial and Biomedical Issues During Detoxification. Available from: http://www.ncbi.nlm.nih.gov/books/NBK64110/
. U.S. National Library of Medication (2013). Opiate Withdrawal. Available from: https://www.nlm.nih.gov/medlineplus/ency/article/000949.htm
. Mysels, D. J., & Sullivan, M. A. (2010). The relationship between opioid and sugar intake: Review of evidence and clinical applications. Journal of Opioid Management, 6(6), 445-452. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109725/