Heroin Addiction Cuts Across All Social Boundaries, Caron Foundation Study Reports.

Business Editors/Health & Medical Writers

WERNERSVILLE, Pa.--(BW HealthWire)--May 16, 2001

An epidemic of heroin use over the past five years crosses generational, socioeconomic and geographic boundaries to plague all areas of American culture.

Heroin, once a drug primarily associated with aging inner-city addicts, has become popular among suburban and rural populations, and is used by adults and adolescents.

These findings are included in "Heroin: Challenge for the 21st Century," a new report released today by the Caron Foundation, one of the premiere drug and alcohol treatment centers in the nation.

Authored by Dr. Susan M. Gordon, Caron director of research, the report examines heroin addiction as a biological, psychological and social disease, and outlines the ways in which Caron has increased its capabilities for effectively treating heroin addiction.

Dr. Gordon attributes the drug's rise in popularity to an increase in snorting and smoking heroin. "Earlier heroin epidemics were based on intravenous use," she states. "But the more recent availability of inexpensive and very pure heroin allows users to sniff or smoke it - rather than inject it - which has led to wider use."

According to federal government studies, shifts in the international drug market have doubled heroin production since the mid-1980s, leading to lower street prices for the drug. Those same studies conclude there are about eight million heroin abusers worldwide, with approximately a quarter of that group - two million - in the United States.

The recent heroin epidemic has dramatically altered the demographics of heroin-addicted patients in treatment at Caron, Dr. Gordon says.

"Almost 90 percent of recent admissions to Caron's adult treatment programs are white and have a high school diploma or higher level of education. More than 50 percent are employed full-time. In total, about 18 percent of our patients are addicted to heroin or other opiates as their primary drug."

An insidious trend, Dr. Gordon notes, is heroin's increasing appeal to younger populations. The 1999 National Household Survey on Drug Abuse found that nearly half of new heroin users were under age 25, with a quarter of them under age 18.

In 1999, the average age of an adolescent in treatment at Caron for heroin addiction was about 17, with some patients as young as 14. During that same period, adult heroin users in treatment at Caron had an average age of 29 - a full 10 years younger than the average age of 39 for those admitted for other drug or alcohol treatment.

The report also reveals that new users of heroin often believe snorting the drug is safe and will not lead to addiction.

"Dead wrong," Dr. Gordon affirms. "Since all methods of heroin ingestion follow the same brain pathway, they are equally addictive." She also believes some users may be avoiding needles to lessen their chances of contracting hepatitis or HIV.

Once in the brain, heroin - similar to other drugs of abuse - causes the release of dopamine, a neurochemical that mediates pleasure and is vital to the normal functioning of the central nervous system. The drug's addictive properties are believed to be related to a chronic and unnatural increase in dopamine levels.

Dr. Gordon admits that heroin's characteristics and its interactions with the brain are very complex. "Much still needs to be learned. But we do know addiction produces a variety of neurochemical and molecular changes in the brain that can have long-term negative effects."

Caron's philosophy is that addiction encompasses all forms of drug and alcohol use and that the ultimate goal of treatment is total abstinence.

Although the root causes of drug addiction remain unclear, the new study reveals that scientists have identified a number of biological, psychological and social conditions that can help to identify whether a person will become an addict.

"Heroin addiction is a bio-psycho-social disease," Dr. Gordon asserts. "On the biological front, a large body of clinical research points to a genetic vulnerability that some individuals have to drug abuse in general. This means a child can partially inherit a susceptibility to using heroin from a parent."

On the psychological level, the study cites a number of research reports indicating many heroin addicts also suffer from psychiatric disorders, including depression, antisocial personality disorder and post-traumatic stress disorder.

Social issues of addiction focus on how heroin addicts relate to their environment, including interpersonal and family relationships, employment and legal problems. "Relationship problems are very prevalent among heroin addicts in treatment at Caron," Dr. Gordon states.

"Only 25 percent of heroin addicts entering treatment are married or are living with someone in a committed relationship. One reason for this low rate is that addiction can have a devastating effect on family life. One addict in a household may pull a family apart as healthy family members become alienated from the addicted person."

She notes that legal problems for heroin addicts also are severe. "Adult heroin addicts in treatment at Caron report spending an average of $100 a day to support their habit. More than 75 percent of our adult heroin-dependent patients reported engaging in drug dealing, theft or other illegal means to obtain drug money."

Dr. Gordon believes that treatment for heroin addiction, like other chronic diseases such as diabetes, hypertension and asthma, must be a life-long process. "It's a matter of managing the disease, rather than curing it, with effective treatment addressing all areas of the patient's biological, psychological and social functioning. And no single treatment is appropriate for all individuals."

Dr. Gordon admits that Caron, like many other treatment centers, initially was unprepared to handle the heroin epidemic of the mid-1990's as an increasing number of addicts entered treatment. As a result, Caron undertook numerous new research studies to discover the treatment needs of the escalating heroin population, leading to revised treatment protocols.

"We learned that a high number of heroin-addicted patients were leaving treatment against medical advice or were failing to comply with the treatment regime. Because of this, we broadened the scope of our treatment to reduce relapse."

Caron employs physicians, nurses and other healthcare professionals; psychiatrists, psychologists and psychotherapists; recreational and nutritional therapists; certified addiction counselors to address the physical, psychological and social needs of patients; and our chaplains focus on patients' spiritual needs.

Issues that cannot be addressed in treatment are referred to other community resources, either during or following treatment.

Dr. Gordon believes a high rate of chronic relapse problems among heroin addicts pushed Caron into the forefront of substance abuse treatment centers through its development of relapse prevention programs. "Our intermediate treatment program is specifically designed to treat patients who have had repeated relapse to drug use. Much of the program is based on teaching relapse prevention skills, which are enhanced by attending to patients' other psychological, social and medical problems, and providing a strong spirituality component."

The changes have led to an increase in the number of patients able to cope with the treatment protocol. In 2000, 85 percent of heroin-addicted patients remained in Caron programs throughout their treatment regimes, compared to about 75 percent in 1997.

Dr. Gordon believes the major challenge for the 21st century will be to decrease heroin addiction through prevention and treatment. "We need to get the message out that heroin, regardless of purity or how it is administered, is highly addictive and extremely unsafe."

The study also noted that:

-- Most heroin addicts have histories of multi-drug use, however heroin appears to be a drug that controls the user by decreasing the desire for other drugs.

-- When heroin-addicted patients at Caron first tried heroin, they were using an average of four other drugs. But when the heroin-addicted patients were admitted for treatment that figure had dropped to an average of 1.8 other drugs.

-- About two-thirds of heroin addicts seeking treatment have reported using marijuana.

-- Laboratory research on animals suggests a compelling case for the importance of environmental factors (nurture) as determinants of future drug use.

-- Other medical problems directly or indirectly caused by chronic heroin use are tuberculosis; liver and kidney disease; pneumonia, bacterial infections of blood vessels and heart valves; abscesses and soft-tissue infections; scarred and collapsed veins; and irritation of nasal and pulmonary mucosa.

-- Pregnancy may have severe medical consequences for female heroin users, causing miscarriage and premature delivery, and a risk of children born to addicted mothers dying from sudden infant death syndrome.

-- Female heroin addicts are more likely than male addicts to attribute dysfunctional family dynamics as a motivator for drug use.

-- "Cold turkey" withdrawal from heroin, without medication to relieve the short-term symptoms, can cause a rapid return to heroin use because the addict feels unable to tolerate the symptoms. Detoxification medicines, including methadone, clonidine, and naltrexone, can alleviate some of the withdrawal symptoms.

The Caron Foundation, which since 1957 has helped tens of thousands of adults and adolescents recover from addiction, is a not-for-profit organization whose mission is to provide an enlightened and caring treatment community in which those affected by the disease of addiction may begin a new life.

Based in Wernersville, Berks County, Caron operates a full spectrum of chemical dependency and codependency treatment programs for adults, adolescents and families. Caron has been listed as a "best" treatment center in the nation by New York Times, Forbes, Self, Town and Country, REHAB and 100 Best Treatment Centers.

Editors/producers:

-- Charts/graphics available upon request.

-- For a copy of "Heroin: Challenge for the 21st Century," call

1.800.678.2332, ext. 3288, or visit our web site at www.caron.org and mouse/over on Support Resources, click on Resource Center, then click on Published Materials.

-- For an interview with Dr. Susan M. Gordon or a Caron official, call Sally Orth at 610.678.2332, ext. 3245, or Joy Tasco at 610.378.1835.