Signs of Heroin Addiction

When we hear about heroin or “the opioid crisis” on the news, it often seems distant and impersonal instead of happening nearby, close to home.

For the family of a loved one that is living with heroin addiction here in Norfolk County, the topic of heroin addiction is very personal. A son, daughter, aunt, uncle, brother, or sister could be taken from you due to the deadly consequences of heroin use. Every time you interact with your loved one, you feel you are grasping tight to a memory and moment that may be their last with you.

For the loved ones of people struggling with addiction, learning the signs of heroin addiction can be a great place to start gaining knowledge. This knowledge may then lead to informed conversations with your loved ones to express your care and concern for their well-being.

Read on to learn more about heroin; the behavioral, physical, and psychological signs of heroin addiction; opioid-related data in Massachusetts; and heroin addiction treatment available at East Coast Recovery in Massachusetts.

What Is Heroin?

Heroin is an opiate drug that comes from morphine, which is taken from certain poppy plants.  

Heroin comes in various forms, including a white or brownish powder and a black, sticky substance known as “black tar heroin.”

Heroin is often “cut” or mixed with other drugs or substances, such as sugar, powdered milk, or the man-made opioid fentanyl. 

Fentanyl is cheaper to produce than heroin yet still produces a high feeling. Fentanyl is very dangerous because it’s 50 times stronger than heroin and is often the cause of many overdose deaths.

To summarize, a person may have the impression they are using heroin but be unaware of how much actual heroin there is in the product or what other substances may be mixed in, too. Unfortunately, this leads to an increased likelihood of overdose and even death.

How Does Heroin Work in the Brain and Body?

According to the National Institute on Drug Abuse, heroin binds to and activates specific receptors in the brain. 

The body contains naturally occurring chemicals called neurotransmitters. Neurotransmitters bind to receptors throughout the brain and body to help regulate pain, hormone release, and feelings of well-being.

When receptors are activated in the reward center of the brain, they cause the release of a neurotransmitter called dopamine. The person taking heroin now craves the feel-good release of dopamine. The person continues to use more and more heroin in an effort to satisfy this craving.

Signs of Heroin Addiction

Being aware of the behavioral, physical, and psychological signs of heroin addiction can help you to identify when your loved one is struggling. 

To highlight the common signs of heroin addiction in a real-life way, we will be following the storyline of Mary, the concerned mother of a 23-year-old son, Tim, who is struggling with heroin use. Mary has driven Tim to his first appointment at a local addiction treatment center. Mary and Tim will be responding to questions posed by the intake (first evaluation) counselor.

Behavioral Signs of Heroin Addiction

Counselor: What are some of the work, school, or home struggles you’ve noticed? 

Tim: Yeah, at work I can’t concentrate. My job is pretty simple. I unbox and load equipment onto a conveyor belt in a factory. When I started, I didn’t have any issues. Over time, I had difficulty with concentrating and completing basic tasks, like stacking things in order.

I just feel tired from being out the night before. I can’t really focus on anything at work. I’ve thought about going back to school, but using “H” has gotten in the way.

Counselor: Mary, I know Tim is living temporarily at home, from what you have shared. How does he interact with you and your husband? 

Mary: He doesn’t really. I mean, he holes up in his room the few times he is home. If we try to talk about his heroin use, he becomes very irritable and usually argues or completely shuts down. It’s hard to know the right words to say to get him to talk.

We worry every day and every night knowing that it could be his last. I am hoping a therapist can talk with Tim, and that he’ll feel comfortable opening up with them. I looked at your website, and even group therapy or 12 steps would be a great place for Tim to learn from other people’s experiences.

Counselor: Mary, what changes have you noticed in Tim since he started using heroin? 

Mary: I mean, he’s just a ghost of the kid we knew. He doesn’t eat, he looks tired all the time.  He hates when I talk about his childhood, but that’s where my heart goes. When he was a kid, he was happy, singing, dancing, and playing. Now he has this heavy weight on his shoulders, and I can’t lift it for him. I can’t fix this.

Counselor: Mary, to change the subject a little bit, has Tim ever had to borrow money from you all or steal to support his heroin addiction? Does he ever lie to continue use?

Mary: We’ve noticed a few things missing around the house. We’ve had to stop having any cash out at home as it is too tempting for him to take. With lying, I would say he is more mysterious than anything. We don’t know where he is or who he is with most times. We first learned about his heroin addiction by finding needles and tie-offs in his room when I was putting away clothes.

It is complicated because he is an adult, but he depends on us financially, so we still have to set appropriate boundaries, and it is difficult to know how to navigate this.

Behavioral signs of heroin addiction include the following:

  • Problems at work, school, and/or home
    • This may include trouble concentrating and difficulty completing important tasks
  • Interpersonal or social problems
    • This could look like frequent arguments with a partner, family members, and friends
  • Isolating or separating self from activities, people, and things they used to love and enjoy
    • If the person lives with you, they may spend more time alone in their room. If the person lives independently, they may not return phone calls or other outreach attempts made by family and friends.
  • Financial problems
    • Your loved one may steal, borrow money, and sell or trade valuables to be able to continue heroin use
    • They may be behind on bills and have debts
  • Sleep disturbance such as sleeping too much, too little, or overall poor quality of sleep
    • They may appear drowsy
  • Loss of appetite
  • Legal problems
  • Frequently mentioning heroin or other drugs
    • Your loved one may spend increased time researching drugs and have increased social media activity that is related to drugs
  • Lying about or frequently minimizing heroin use
    • When in the midst of addiction, it can be difficult and very painful to fully acknowledge and appreciate the effects of drug use upon self and others.

Counselor: Tim and Mary, what happens to Tim’s body when he is using heroin? 

Tim: I feel high. It’s the best and worst feeling because I want to feel it again and again. I tend to feel really happy when using, and then there’s a crash after, where all the sadness creeps in again. Sometimes when using, I get sick and spend lots of time on the toilet throwing up. I have a hard time concentrating and thinking straight about anything. I cover my arms because it shows all the places I’ve put the needles in. I’m embarrassed.

Mary: I sincerely worry about him getting HIV or hepatitis due to his IV heroin use. He’s been tested and tests negative, but it’s always on my mind as a possibility. When he is in the throes of using, which is all the time now, he doesn’t take care of himself. He looks like he hasn’t showered in a very long time.

Physical or bodily signs of heroin addiction include the following:

  • Pupils, or the black centers of the eyes, appear constricted or smaller
  • Marks, scars, scabs, and bruises in the area where the needle is inserted or may indicate areas where a person is skin picking
  • Lack of personal hygiene
    • Your loved one does not frequently bathe or shower and often appears disheveled or messy
  • At an increased risk for getting transmissible diseases [hepatitis B virus, hepatitis C virus, human immunodeficiency virus (HIV) that later develops into acquired immunodeficiency syndrome (AIDS)] as a result of intravenous heroin use

Counselor: Tim and Mary, what happens to Tim’s body when he stops using heroin or is between uses? We call this process withdrawal as the body reacts to the substance leaving its system. 

Mary: I’ve noticed the pupils (black centers of eyes) are super dilated and look like saucers. He has a bunch of flu-like symptoms, like fever, muscle aches, vomiting, and sweating. He’s got goosebumps on his arms, a super runny nose, and yawns all the time. He just wants to lay down.

Tim: I have to go constantly. Lots of diarrhea. It’s awful, and all I want to do is use “H” again to feel better. I’m trying hard right now to think about getting help instead of going out to use it again. I promised my mom I’d give this a shot, so here I am.

If a person is in withdrawal (stopped or reduced use) from heroin, they may be experiencing the following physical symptoms:

  • Pupils, or the black centers of the eyes, appear dilated or larger than usual
  • May have flu-like symptoms (fever, muscle aches, vomiting, sweating)
  • Goosebumps
  • Runny nose
  • Diarrhea
  • Yawning

Psychological and Emotional Signs of Heroin Addiction

Counselor: Tim and Mary, what are some of the emotional signs that Tim is struggling with heroin? 

Tim: I know I’m up and down (mood swings) a lot. I know it’s totally unpredictable when I’ll be happy or sad — anything can set me off. I worry sometimes. I feel sad almost always.

Mary: I mean, his self-talk is awful. It’s tough because he’s the center of our conversations right now. He knows we are worried and trying to help, and some days he seems ready to go to treatment, like today. But other days, it’s a total uphill battle to convince him to try to live differently.

The hardest moments are when he says things like, “I wish I wasn’t here,” and “I don’t even want to live this stupid life anymore.” We are eager to get him into counseling to work through some of these things. He never actually has plans to die, but we don’t want him to even think about dying as an option. If he’s open to it, I’d like to participate in family sessions, too, so I can learn better ways to connect with him. Lately, we’ve been so distant, and it’s been tough on everyone. We want to help, but lately, it seems like we are just pushing him further toward using.

Psychological and emotional signs of heroin addiction include the following:

  • Mood swings
    • There are many ups and downs. Mood can seem erratic in nature.
  • Anxiety or worry
    • This may include ruminating thoughts and not being able to let go and focus on the present
  • Irritability
  • Depressed, sad mood
    • This may include negative self-talk, feeling bad about self, tearfulness, feeling tired, having little energy, difficulty concentrating, and thoughts of death or dying
  • Lack of motivation
    • It can be difficult to get up and work toward any goal. This sign aligns with having a depressed mood.
  • Your loved one may display negative emotions (be defensive, aggressive, irritable, hostile) when you try to discuss their use
    • It is difficult to be on the receiving end of negative emotions, especially when they are coming from a loved one
    • Possible solutions for this problem: you may brainstorm other individuals the person may be more receptive to having this conversation with. If your loved one is willing, an outside professional, like a mental health therapist, or a person successfully living in recovery may be able to offer them a different perspective and feedback.

Opioid-Related Deaths and Hospitalizations in Massachusetts

According to the Commonwealth of Massachusetts Health Policy Commission, as of August 2016, there were 1,531 confirmed unintentional and/or undetermined opioid-related deaths in Massachusetts in 2015, which was a 150% increase from 2011 and an 18% increase from 2014.

Heroin and fentanyl caused the greatest number of fatal (deadly) overdoses. In 2016, nearly 70% of opioid-related mortality was caused by fentanyl, which was a stark increase from 2014.

Between 2007 and 2014, heroin-related hospital discharges increased by 201%, and opioid-related hospital discharges increased by 84%.

The misuse of prescription opioids adds to the significant and growing portion of opioid-related

hospital use, whereas heroin and fentanyl are linked to the largest proportion of opioid-related deaths.

Heroin Addiction Treatment at East Coast Recovery

East Coast Recovery offers treatment for heroin addiction. The first step will be completing an intake and assessment. The intake and assessment allows our professional staff to get to know you or your loved one better. Our staff will provide recommendations for the appropriate level of care to meet your needs and goals.

We offer comprehensive addiction treatment that includes varying levels of care: detox, a partial hospitalization program (PHP), and an intensive outpatient program (IOP). 

Detox is often the first level of treatment recommended at intake and assessment for those living with heroin addiction. Detox is a safe, medically supervised inpatient treatment option. 

Detox can help a person gain comfort and stability as they are withdrawing from substances. Detox is 24/7 care; the person in detox stays overnight for ongoing care. The day-and-night structure and monitoring that detox provides can be helpful for a person at the very beginning stages of treatment. In detox, there are fewer distractions and outside influences to potentially derail progress achieved.

After detox, people in treatment may “step down” or go down to a lower level of care. One lower-level care option is the partial hospitalization program (PHP). In PHP, people will come to the center for treatment up to seven days per week. PHP includes individual, group, and family therapy. The frequent support that PHP offers makes it a good transition before seeking lower levels of care like IOP.

The intensive outpatient program (IOP) consists of about 10 hours of therapy each week. These sessions often take place at the treatment facility, but there are some online options that exist for people lacking care in their communities. IOP allows for a person to return home at night to enjoy the comfort of sleeping in their own bed and the support of nearby family and friends.

In addition to detox, PHP, and IOP, we offer aftercare treatment to support and encourage people to maintain recovery. The options for aftercare programs include 12-step meetings, different levels of outpatient care, and individual and family counseling. Recovery is a long-term journey. Ongoing participation in an aftercare treatment program can help a person achieve continued success.

Connect with East Coast Recovery to Begin Treatment for Heroin Addiction

At East Coast Recovery Center, we have the belief that the opposite of addiction is connection. We are here to help you build connections within your immediate support system and with others that are also creating a path forward from addiction to recovery.

If you or your loved one is living with heroin addiction, begin your treatment journey today at East Coast Recovery. Call us at (617) 390-8349.


Which of the following are signs of addiction?

The common signs of heroin or opioid addiction include the inability to control opioid use, uncontrollable cravings, drowsiness, changes in sleep habits, weight loss, frequent flu-like symptoms, decreased libido (sex drive), lack of hygiene, changes in exercise habits, isolation from family or friends, new financial difficulties, and stealing from family, friends, or businesses.

Does heroin cause heart palpitations?

Heroin can have damaging effects on the heart. Heart palpitations are the sensations that the heart is racing, pounding, fluttering, or skipping a beat. Heart palpitations are possible with heroin use.

Heroin can also put a person at greater risk for other cardiovascular (heart) conditions, such as hypotension (low blood pressure), cardiac arrest (heart suddenly stops), and endocarditis (inflammation in the inner lining of the heart).

Does heroin cause stomach cramps?

Heroin withdrawal happens when heroin use is stopped or greatly reduced. Heroin withdrawal symptoms can include stomach cramps.

Is heroin a hydrochloride?

Yes, heroin is a type of hydrochloride. According to the National Institutes for Health, other names for heroin include diacetylmorphine hydrochloride and diamorphine hydrochloride.

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