Dr. Gregory Teas of Alexian Brothers Behavioral Health Care center in Hoffman Estates specializes in dealing with heroin addiction. Here is an edited version of an interview with Teas, an addiction psychiatrist who runs the chemical dependency program at the center.
Q. Why is heroin so addictive?
A. Heroin causes a very rapid physical dependency. It only takes a few doses in order for a person to develop physical withdrawal. A lot of people like heroin because they like the way they feel. In a very short time, in sometimes less than a month, they start taking it because they're experiencing withdrawal symptoms. An example: We might admit people for heroin detox who have only been using heroin for one week. The physical withdrawal is so strong they have to be in an enclosed setting.
Q. Why is it popular now?
A. No. 1 is the purity and the cost of heroin is better now than it's been in 25 years. If you go back ten years on the streets people used to buy Mexican Brown, a brown dirty heroin. It doesn't look as attractive as the white crystalline product on the street nowadays. It's also more potent now.
Q. Why do addicts turn to needles?
A. Within six months they start using a needle. It's both a better high and it removes the withdrawal symptoms faster. (After awhile) they no longer use heroin to get high, they use it to take away the sickness they feel if they don't use it.
Q. How likely is it to come clean from heroin?
A. The recovery rates are quite low - only 10 to 15 percent of people who try to quit are successful after one year. That includes everybody from middle-aged users to teenagers to hard-core inner city addicts. The rates are probably a little bit better for teenagers.
Q. Why do addicts relapse after rehab?
A. It's very hard for young people to quit seeing their friends who they use with. They get re-exposed to the drug and at a moment when their defenses are down. Anxiety and depression follow for three to four months after getting clean. Once they leave the structured setting ... they can relapse.
The other thing is, the cornerstone of addiction is denial. People say: "I'm not so bad. I'm on top of it," so they stop going to meetings.
Q. What can be done to combat the problem?
A. In our treatment program we strongly urge heroin addicts to use Naltrexone. Heroin goes to "mu" receptors in the brain and stimulates them. Naltrexone blocks the receptors. If you take it once a day, every day, you cannot get high on heroin.
You have to have another person observe you take it (to avoid a relapse). People who are dependent on heroin rarely will take this drug on their own for the length of time it's required. Most experts recommend six to 12 months.
One danger of using Naltrexone: Let's say they decide they're going to use heroin. They stop the Naltrexone and it takes $80 worth of heroin to get them high. The next day, they say: "It took me $80 yesterday, so I'll buy $80 today." Then they'll accidentally overdose (because there's less Naltrexone in their system).
Q. Are there any signs an addict is headed for a relapse?
A. It's hard to tell. Patients enter a honeymoon period. They feel very positive about the support they're getting from their environment. After another month, that initial support is no longer there. They start dealing with their negative feelings. When a heroin addict has a bad day they immediately think: "I want to change/alter my feelings." The fastest way to do that is to get high.
Q. Is there something we can do to step in?
A. There are several things that work for heroin addiction. Taking Naltrexone with supervision while attending recovery support groups is one.
(Another is) completely changing your social behavior. You stop any association with old drug-using people. Sometimes that means staying busy like getting a job, filling your time. The other is methadone (which Teas does not recommend at his center). It is for people who failed at rehab on at least two occasions. It's a controlled addiction. It's fairly cheap, it's pure. You're not going to get HIV or Hepatits C from it.
Q. How difficult is it to shake the methadone addiction?
A. Methadone is a very hard drug to come off. It's harder than heroin because the withdrawal lasts longer. The withdrawal from heroin is most intense for three to five days. Methadone is five to 10 days.
Q. Is there anything else on the market that can help?
A. Buprenorphine. It's newly approved. The withdrawal is milder, if you take too much of it, it doesn't shut off your breathing, which is what happens with too much methadone. The drug companies haven't released it yet. We think it's going to be available in one to two months. It will make that last part of the withdrawal much more tolerable.
A lot of the heroin addicts tend to know one another and the word spreads quickly. This will be spreading like wildfire once it comes out.