Something has shifted, and you can sense it. Whether it’s your own use, or if you’re watching someone becoming less of ‘themselves’, we understand that you are looking for a way through.
Heroin addiction is a recognised medical condition that changes the brain in specific, well-understood ways. It also responds to rehabilitation and treatment. It doesn’t get easier to address the longer it goes on, but many people recover from it every day.
Learn more about how heroin addiction develops, what the signs and risks look like, what withdrawal involves, and what structured treatment at Castle Craig offers.
Are you concerned about your heroin use?
What is heroin addiction?
Heroin addiction forms when repeated use of heroin changes the way your brain works, particularly the parts associated with reward, motivation and stress. Over time, you end up reliant on the drug to feel normal, and have to use more to achieve the same effect.
Heroin addiction is recognised as a medical condition by the NHS, the National Institute for Health and Care Excellence (NICE NG216), and the Royal College of Psychiatrists. It sits within the broader category of opioid addiction, which also covers prescription opioids like codeine, oxycodone and fentanyl.
Heroin addiction is common enough that the UK has dedicated treatment services for it. In England and Wales, opiate-related drug poisoning deaths have risen by 388% since 1993. According to government figures, around 138,604 adults were in treatment for opioid use in England between April 2022 and March 2023. The Royal College of Psychiatrists estimates that over 260,000 people in England have been using heroin long-term.
Understanding heroin addiction as a medical condition helps people see that it’s something in need of clinical support and professional treatment, rather than some form of ‘moral failure’.
How heroin addiction develops
Heroin addiction usually develops gradually, through a mix of biology, circumstance and what was happening in your life when you started using.
Heroin binds quickly to the brain’s opioid receptors, releasing a flood of dopamine. With repeated use, your brain adjusts. You build tolerance, and end up needing more to feel the same effect. Your brain adjusts until your body needs heroin just to function – that is dependence, and it can develop within weeks of regular use
But not everyone who uses heroin becomes addicted, and the reasons some people do come down to a combination of factors:
- Genetics. A 2023 study that involved more than 150 researchers worldwide identified shared genetic identifiers that increase the risk of substance use disorders. If a close family member has lived with addiction, for example, your risk is higher.
- Mental health. Untreated depression, anxiety, post-traumatic stress disorder (PTSD) and childhood trauma all raise the likelihood of developing heroin addiction.
- Exposure. Many people who become addicted to heroin first encounter opioids through prescribed pain medication, or through people around them.
- Environment. Stress, isolation, bereavement and poverty all play a part.
This goes to explain that addiction has causes, and those causes need understanding before treatment can begin for you, or someone you know.
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The signs of heroin addiction
Heroin addiction appears in different ways. The person using often notices the internal experience first. Family and friends usually notice the outward changes before they understand what is happening.
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Behavioural signs
The behavioural signs of heroin addiction are often what families notice first. They include:
- Pulling away from close relationships
- Secrecy about where you are, what you are doing and who you are with
- Missing work, study or family commitments
- Money problems that do not have an obvious explanation
- New social circles, often replacing old friendships
- Lying, even about small things
These changes rarely happen all at once. They build up gradually, and are easy to miss or explain away.
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Physical symptoms
The physical symptoms of heroin addiction can include:
- Track marks or bruising on the arms, hands, legs or feet from injection
- Noticeable weight loss
- Very small (constricted) pupils
- Drowsiness, nodding off mid-conversation
- Neglect of personal hygiene
- Flu-like symptoms when not using, including sweating, runny nose and stomach cramps
The flu-like symptoms are early heroin withdrawal symptoms. They are often what tips a worried family member from concern into certainty.
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Psychological symptoms
The psychological signs of heroin addiction can include:
- Strong cravings that take over your thinking
- Mood swings
- Anxiety, depression or paranoia
- Feeling like you cannot cope without heroin
- Shame, secrecy and a sense of being trapped
Mental health and heroin use are closely linked. Research found that people dependent on heroin have higher rates of physical and mental health challenges. It also found that longer heroin use is linked to higher rates of anxiety and other conditions. NICE guidance exists specifically for this combination, because treating one without the other doesn’t lead to sustainable recovery.
What are the risks of heroin use?
Heroin use carries serious risks, and we think it is more useful to be straightforward about them than to either minimise them or dramatise them.
Overdose is the most immediate risk. In Scotland in 2022, opioids were involved in 82% of all drug-related deaths. Heroin slows your breathing, and a large enough dose can stop it entirely. Risk is higher when heroin is mixed with alcohol or other drugs, after a period of not using, or when the heroin is contaminated with stronger opioids like fentanyl.
Infections are a risk for anyone who injects heroin. Sharing needles or equipment can transmit HIV, hepatitis B and hepatitis C. Skin infections and blood poisoning are also common.
Long-term physical health. Long-term heroin use is linked to heart problems, lung problems, liver and kidney damage, and dental problems.
Mental health. Heroin use can both worsen existing mental health conditions and trigger new ones; particularly depression and anxiety.
Social and legal. Heroin is a Class A drug in the UK. Possession can lead to up to seven years in prison. Beyond the law, heroin addiction tends to erode the parts of life that hold a person up: such as work and relationships of those closest to you.
The risks are among the strongest reasons for seeking help.
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Heroin withdrawal: what to expect
Heroin withdrawal is not usually life-threatening for healthy adults, but it is uncomfortable and can be genuinely difficult. It is one of the main reasons people who want to stop using heroin find it so hard to do alone.
According to clinical guidelines published by the World Health Organization, heroin withdrawal symptoms typically begin 8 to 24 hours after the last dose and last between four and 10 days. The symptoms can include:
- Nausea and vomiting
- Anxiety and restlessness
- Insomnia
- Hot and cold flushes, often with goosebumps
- Sweating
- Muscle cramps and bone aches
- Watery eyes and runny nose
- Diarrhoea
People often describe heroin withdrawal as feeling like a bad flu, combined with intense psychological discomfort, cravings and low mood. The physical symptoms usually peak around day two or three and then start to ease. The psychological side, particularly cravings and low mood, can last much longer.
For some people, low mood, cravings and sleep difficulties can continue for weeks or months after acute withdrawal ends – sometimes called post-acute withdrawal. Medical supervision matters here for two reasons:
- First, withdrawal symptoms can be eased significantly with the right medication. Medically assisted withdrawal is recommended by NICE for opioid dependence, and is much safer and more comfortable than going cold turkey.
- Second, the risk of relapse is highest during withdrawal, and relapse after a period of not using is when overdose risk is greatest because tolerance has dropped.
Some people should not attempt opioid withdrawal at all without specialist input. Pregnant women, in particular, are usually maintained on methadone rather than withdrawn from opioids, because withdrawal in pregnancy can cause miscarriage or premature birth.
This is not a process to manage alone if it can be avoided. Medically supervised drug detox is safer and gives a much better foundation for what comes next.
Heroin addiction treatment at Castle Craig
Heroin addiction treatment at Castle Craig is delivered through a structured, psychiatrist-led residential programme with 24-hour clinical support. It follows the evidence base set out by NICE NG216 and adapted to each person we work with.
We do not offer a single fix. We offer a pathway, with four stages that fit together.
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Medical detox
Heroin detox at Castle Craig takes place in our admissions unit, Kirkurd House, with 24-hour nursing care. On arrival, you are assessed by the nursing team and the resident doctor, and a personalised detox plan is put in place.
Where appropriate, medically assisted withdrawal using supportive medication is used to ease symptoms. This could include buprenorphine, methadone, clonidine, or others.The aim is not to make withdrawal painless, which is not realistic. The aim is to make it safe and bearable so that the remainder of recovery work can begin.
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Residential rehab programme
After detox, you move into our main rehab treatment programme. Life is structured and busy with individual and group therapy, educational sessions, meals and evening recovery meetings – with time for rest built in
You live alongside other people in recovery. That shared experience is, for many people, as significant as any single therapy session. Isolation is part of how heroin addiction takes hold, and community is part of sustained recovery.
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Therapy and relapse prevention
Therapy in heroin addiction treatment addresses what sits underneath the drug’s use. For many people that includes trauma, untreated mental health conditions, grief, or long-running difficulties with managing emotions.
Therapy draws on 12 Step facilitation as its foundation, with trauma-informed approaches and CBT used where someone is also living with a mental health condition – with dual diagnosis support integrated into their programme.
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Continuing care
Heroin addiction is a long-term condition. Discharge from residential treatment is not the end of recovery, and we do not treat it as such.The first year after residential treatment is when most relapses happen, and continuing support is one of the strongest things known to reduce that risk.
Continuing care includes structured online support and ongoing therapy. After leaving, you can remain connected through our recovery community network, which includes peer support and ongoing monitoring to help the first year of recovery. You can read more about how this works on our website.
The path to recovery from heroin addiction
Recovery is rarely a straight line, and many people relapse at least once on the way to sustained recovery. Relapse is part of many people’s recovery, not a sign of failure. What matters is what happens after a relapse: whether the person gets back into treatment, and whether they have a support structure that holds them.
The evidence on opioid treatment outcomes is encouraging. NICE’s clinical knowledge summary on opioid dependence reports that opioid substitution treatment can reduce illicit opioid use, improve physical and mental wellbeing, and reduce both overall mortality and overdose deaths.
For example, of the 127,385 people who left the drug and alcohol treatment system in England in 2022 to 2023, 46% completed treatment successfully and were free from dependence. The average time in treatment for opiate dependence was 3.3 years.
Recovery from heroin addiction usually takes time, but works better with structured, long-term support than without.
Seeking help for heroin addiction
Whatever stage you are at, seeking help for heroin addiction ought not be postponed. It does not get easier to treat the longer it continues, you don’t need to have lost everything before reaching out, and you do not need to be certain that you’re ready to stop.
If part of you is asking the question, that is enough.
The same applies if you are worried about someone else – you do not need to wait until things are unmistakably bad. We talk to family members every week who started by asking us whether they were overreacting, which is almost never the case.
Castle Craig is part of a wider network of drug addiction treatment services, and we are happy to talk through what would suit your situation, including if that turns out not to be us.
Speak to our team about heroin addiction.
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FAQs about heroin addiction
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Is heroin the same as other opioids?
Heroin is part of the opioid family, along with prescription opioids like codeine, oxycodone, fentanyl and tramadol. They all act on the same receptors in the brain, which is why dependence on one can lead to use of another. Many people who develop heroin addiction first encountered opioids through prescribed pain medication.
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What is the difference between heroin tolerance and dependence?
Tolerance is when your body adjusts to heroin so that you need more to feel the same effect. Dependence is when your body has come to rely on heroin to function, so that stopping causes withdrawal symptoms. Tolerance usually develops first. Dependence usually follows with continued use.
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Can heroin addiction affect anyone?
Yes. Heroin addiction can affect anyone. Some people carry a higher genetic risk, and repeated exposure to prescribed opioids is a known route in – but background and circumstance are not predictors.
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What happens if someone overdoses on heroin?
A heroin overdose slows breathing to dangerous levels. Signs include very slow or stopped breathing, blue lips or fingertips, gurgling sounds, and unresponsiveness. Call 999 immediately. Naloxone is a medication that can reverse an opioid overdose, and it works on heroin, methadone and other opioids.
In the UK, naloxone kits are available free from local drug services and many pharmacies, and the training to use one takes about 10 minutes. One dose may not be enough – if the person does not respond within a few minutes, a second dose can be given. Always call 999 even if naloxone appears to have worked, as the effects of heroin can outlast it.
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Does Castle Craig treat heroin and other opioid addictions?
Yes. We treat heroin addiction and addiction to other opioids, including fentanyl, oxycodone, codeine, tramadol and prescription pain medication. The treatment pathway is the same in shape: medical detox, residential rehab, therapy and continuing care, adapted to your situation.