Heroin Addiction:

Most people regard heroin as the most hardcore drug a person can abuse. In the public’s eye, heroin addiction is reserved only for the most severe drug addiction cases, but heroin addiction is actually one of the most common addictions in the United States. As of 2018, around 1 million people reported using heroin in the past year — a marked increase from just 10 years earlier. 

Although there is no cure for addiction, there are many effective treatments that can help you put addiction into remission. If you believe someone may be struggling with heroin, there are several signs you can look for before encouraging them to get help. 

What Is Heroin:

Heroin is a painkiller and a Schedule 1 narcotic, which has no recognized medical use and is highly abusable. Painkillers like heroin are known as opioids because they are synthetically created from morphine, which in turn, is made using the sap of the opium poppy plant. When heroin is ingested, it turns off pain reception in the brain by blocking the receptors meant to process pain. This absence of pain (physical or emotional) creates a feeling of warmth, safety, and euphoria — thereby compelling users to ingest more when these effects wear off. 

Street Names For Heroin:

Since heroin is an illegal substance, users may try to disguise its use or talk about it discreetly using nicknames like: 

  • H
  • Horse
  • Smack
  • Junk
  • Brown 
  • Hell Dust
  • Dope
  • Tar
  • Black Tar
  • White
  • White Horse
  • Chiba
  • China White
  • Scag

History of Heroin:

Heroin is made from morphine, which is created from the opium poppy plant. The use and trade of this poppy for pain relief spans more than 8,000 years. READ MORE

Why is Heroin Addictive:

Contrary to popular belief, it is not the chemicals in heroin that are addictive but rather the feelings they create. A common trait shared by nearly every heroin abuser is a conscious or unconscious desire to escape from something. Due to its ability to dull physical and emotional pain, heroin is the narcotic embodiment of escape. So when someone primed with this escapism tries heroin, they find the high very gratifying, and immediately seek more when the effects wear off.

Related: Why/How Do People Start Using Heroin?

Signs of Heroin Addiction:

People struggling with substance abuse are not always honest about their habits, even with themselves. If you think a loved one is addicted to heroin, then certain physical, mental, or lifestyle clues may help identify a heroin addiction. With the exception of needle marks, one of these is rarely enough to confirm heroin use.

Physical Signs of Heroin Use:

If you suspect someone is using heroin, you can look for physical signs like:

  • Constant dry cough (if smoking)
  • Extremely small pupils if they are high or extremely large pupils if they are withdrawing 
  • Scabs from skin picking 
  • Small “pinned pupils”
  • Tired, red, or puffy eyes
  • Needle marks on the arms, hands, or feet.
  • Wearing long or baggy clothes to hide needle marks.  

Short Term Effects of Heroin Use: 

Heroin can have many negative effects on a person’s life, health, and safety. In the short term these may include dry mouth, drowsiness “nodding off”, respiratory depression, itching and scratching the skin creating scabs, nausea or vomiting.

Long Term Effects of Heroin: 

Regular use of heroin comes with additional risks and effects. In addition to all the short term effects these can include constant insomnia, constipation, lung kidney or liver disease, sexual or menstrual dysfunction, risk of death by overdose, heart infections, skin abscesses from needles, HIV or hepatitis from using dirty needles. 

Behaviors of Heroin Use:

If you believe that a loved one may be using heroin, look for the following behaviors:

  • Being tired at odd times
  • Sudden disregard for personal hygiene. May stop bathing regularly or wearing the same clothes repeatedly
  • Sleeping or nodding off at odd times. 
  • Going from very high energy to very low energy
  • Wearing long sleeves or sweatshirts in hot weather to cover up injection spots
  • Constant disorientation
  • Slurred speech
  • Lack of appetite 
  • Being agitated or hostile towards others suddenly
  • Apathy or lack of motivation/energy to do things or go places.  

Other Lifestyle Signs of Heroin Use:

There may be other clues around your loved one as well that may indicate he is using heroin. 

  • Missing money or valuables that may have been taken to pay for drugs
  • New locked boxes or areas that nobody is allowed or able to open
  • Missing prescription bottles. Especially painkillers like Vicodin, Percocet, Oxycontin, or Codeine. 
  • Lost interest in former friends, hobbies, or romantic partners
  • Heroin withdrawal: Nausea, shakes, flu symptoms, diarrhea

    Heroin Paraphernalia:

    Using heroin requires certain objects, called paraphernalia. If you find any of these it strongly suggests heroin use. 

    Smoking Heroin: People melt the drug and inhale the vapors. Clues that someone is doing this are:

    • Aluminum foil, wrappers, or cut up soda cans: Used to hold the drug while it’s cooked. Heroin is also often smoked off of tinfoil. For this reason, burnt pieces of foil are signs of use. Red flags also include burnt straws and pens.
    • Lighters or candles: Needed to burn the foil and cook the heroin
    • Straws: Needed to inhale the smoke. Look for a vinegar smell.  
    • Burnt Spoons: Spoons are often used to “cook” heroin for smoking. Bent, burnt, and missing spoons or q-tips without cotton are common signs of intravenous heroin use.

    Injecting heroin: People cook solid heroin into a liquid, put the liquid into a needle, and inject the drug directly. If you think someone is injecting heroin, look for:

    • Needles: Used to inject the prepared heroin into the bloodstream. There may also be white or brown residue on/in the needle. 
    • Cotton Balls, Q-Tips, or cigarette filters: Used to remove unmelted chunks before injection. 
    • Spoons or bottle caps: Used to hold the heroin while it is cooked into liquid form before injection. Look for burn marks, brown or white residue, or a faint vinegar smell. 
    • Lighters or candles: Heat that cooks the heroin into a liquid. Look for excessive amounts of lighters or a sudden interest in scented candles.
    • Shoelaces, rubber hose, or string: Used to tie-off the arm like a tourniquet during injection to make veins easier to find. 

    Snorting Heroin: Though rare, some people also inhale powdered heroin through the nose. Things commonly used for this are pen cases, straws, rolled up money or papers, small rubber tubes, or nasal spray bottles. 

    What Does Heroin Look Like:

    Due to the chemicals and additives added to heroin by dealers, heroin can be any number of colors including pink or purple. But most commonly it is one of three colors.

    Related: Pictures of Heroin: How To Recognize It.

    Tolerance, Dependence, and Withdrawal: How to Know If You Need Treatment

    As someone continues to use heroin they will eventually require more to create the same effect. As their use becomes larger and more frequent the brain will adapt to heroin by reshaping its chemistry. Once this happens, any decrease or absence of heroin will produce uncomfortable or painful effects.

    Tolerance: When any substance is repeatedly used, the body and brain learn to process it better, which means the person must use more to create the drug’s original effect. This is often the first sign of addiction. Without help at this stage, it’s very likely the addiction will develop into a more severe problem. 

    Dependence: Physical dependence is a sign of moderate to severe addiction to heroin. Heroin, like all narcotics, alters brain chemistry. Eventually, the brain adjusts to these alterations and begins relying on narcotics for certain functions. When this happens, removing or decreasing heroin will compromise brain function. 

    Withdrawal: Withdrawals are the most severe sign of a heroin use disorder. At this point, a person must continue using heroin or they will experience painful uncomfortable symptoms known as withdrawals. These occur because the brain has come to rely on heroin for certain things, and cannot properly function without it.

    Heroin withdrawals include:

    • Diarrhea
    • Vomiting,
    • Aching muscles
    • Chills
    • Flu Symptoms
    • Pain or discomfort 
    • Insomnia

    Luckily, heroin withdrawals are very manageable with medical detox. 

    Heroin Overdose:

    Heroin is the second most deadly drug in the United States, killing nearly 20,000 people in 2019.


    Treating Heroin Addiction:

    There are a number of proven (or evidence-based) therapies used to bring heroin addiction into remission and allow someone to live their life outside of their Substance Use Disorder. This begins with overcoming withdrawals, continues with discovering what makes heroin feel so appealing, and ends with developing and practicing other healthier ways to cope. 

    Medical Detox: 

    Unless someone has a mild addiction, any treatment for heroin should start with a supervised medical detox. This will help a person remain safe and comfortable while their body goes through withdrawals. If you need help finding a detox center that takes your insurance, call us at 855-202-2138. 


    After detox, it’s important to identify the thing or things that primed you to enjoy the feelings produced by heroin. Of course, every addiction is unique, but the root of these is often traumatic experiences, mental health, or family dynamics.

    To help with these drug counselors may guide you through dialectical behavioral therapy, which helps you come to terms with and ultimately accept painful parts of your self or your past. DBT often involves strategies to turn shame into forward momentum and self-actualization.

    Click here for more information on DBT

    Family Therapy can be used to treat problems with family members, heal old problems, and develop new healthy behavioral patterns or relationship dynamics. Family therapy can also help your entire family unit support your sobriety just by teaching them more about addiction. It’s key in helping build a home-based sobriety support unit.

    Click here to learn about our Family Therapy Program.

    Finally, Cognitive Behavioral Therapy (CBT) is an evidence-based therapy designed to, first, identify addiction-related thoughts or feelings, and create customized behaviors capable of pivoting away from those thoughts and feelings towards healthier ones. CBT believes that thoughts, feelings, and actions are all connected to each other. Thus, changing one can affect the rest. 

    Click here to read more about CBT

      Getting Over Heroin:

      The idea of a loved one being addicted to heroin can feel overwhelming. Fortunately, heroin addiction is very treatable, so if you believe someone you love is using it, you should plan to have a conversation about getting them help. If you need help with any of this, we can guide you. Give us a call at 855-202-2138. 

        Important info when getting sober:

        ANHEDONIA | The Feeling of Blahhhh
        Do you feel a lack of joy when you do things that should give you pleasure? Lean About Anhedonia in Early Recovery

        Got sober and now you feel depressed, irritable and some anxiety? It could be PAWS; a common and temporary condition as your brain and body heal.

        Are You ready to get help?

        Call (855) 202-2138