Long-Term Comorbid Conditions Associated With Heroin Abuse

Medically Reviewed

Heroin is among the most dangerous drugs Americans are facing today, not because the substance is more volatile than other illicit substances but because of its addictive power and some other factors. If you were to use pure heroin at a regulated dose, you might develop an addiction, but your chance of overdose and other health complications would be extremely low. So why did more than 15,000 people die because of opioid overdoses in 2017? There are several factors.

For one, illicit heroin is far from pure, and because of that, its strength can be unpredictable. If you don’t know how strong a drug will be, it’s difficult to take a proper dose. If your dealer gets his supply from a new supplier, you may take think you’re taking a typical dose, but what you’re actually taking is a lethal amount. Street heroin also has unpredictable additives like adulterants and other chemicals. Most recently, the powerful synthetic opioid fentanyl is being mixed into heroin to increase its power and to give it the illusion of high quality. The inclusion of fentanyl can make heroin even more unpredictably strong, leading to deadly overdoses.

But that just accounts for overdose, which is just one, albeit severe, consequence of heroin addiction. However, there are a variety of serious consequences of long-term heroin use such as chemical dependency, addiction, diseases, financial struggles, legal problems, and strained relationships. Heroin addiction is also associated with other mental health problems that can complicate or worsen a substance use disorder (SUD). These co-occurring mental health issues can complicate addiction treatment and lead to chronic relapse.

What are some of these comorbid conditions that complicate opioid use disorders?

What Is a Comorbid Condition?

Comorbid conditions, or co-occurring disorders, are mental and physical conditions and complications that may come with and complicate a substance use disorder. In some cases, substance use problems can cause comorbid disorders. Other times, comorbid disorders can predate substance use issues, and once you become addicted, it triggers or worsens underlying problems.

When you enter an addiction treatment program, the existence of comorbid conditions is a major concern for clinicians. In the past, doctors were so confounded by SUDs that came with other mental health issues; they would turn people away. If these underlying problems aren’t addressed, treatment will most likely end in relapse. Today, we understand that SUDs and comorbid conditions need to be addressed at the same time because treating one and ignoring the other will usually mean both will continue to be problems.

Comorbid substance use disorders are more common than you might think. According to the World Health Organization, one in four people has some form of mental or neurological disorder.

Also, the Substance Abuse and Mental Health Services Administration (SAMHSA) states that more than 43 percent of American adults experience a form of mental illness. It also notes that 20 million adults have a substance use disorder.

According to a 2014 survey, almost 8 million people had both a substance use disorder and another mental health problem. But why is there so much overlap? Does one always cause the other? For as much as we’ve researched, the exact causes for SUDs and substance use disorders are poorly understood. Typically, it’s impossible to pinpoint one definitive cause. More likely, it’s a combination of environmental, developmental, and biological factors — a culmination of nature, nurture, and your surroundings that lead you to mental health and addiction problems.

Does Addiction Cause Mental Health Problems?

It might be that long-term abuse of substances like heroin can change your brain in such a way that you also develop mental health problems. Heroin addiction can eventually seep into every area of your life. The toll it takes on your health, relationships, career, finances, and everything else, can also have a significant mental impact. People who struggle with heroin addiction may also become anxious or depressed.

Addiction may also exacerbate or trigger dormant mental health issues that have existed for years. If you have certain mental illnesses, especially disorders such as schizophrenia, psychoactive drugs can exasperate your symptoms or make your condition worse.

Do Mental Health Disorders Cause Addiction?

Some mental illness seems to predate substance use problems often. Could they potentially cause them? It’s possible. Some mental health issues, even common ones like depression and anxiety, have been identified as potential risk factors for addiction. That doesn’t mean that everyone who becomes depressed will develop a SUD, but it doesn’t mean that it can increase your risk. In many cases, people with a mental health issue will self-medicate with alcohol or drugs to dull symptoms. Frequent drug use will then result in a substance use disorder.

Common Risk Factors

Mental health issues and comorbid mental health issues share some of the same risk factors. Genetics play a role in the development of both disorders. Childhood trauma can also lead to both addiction and mental health problems. According to the National Institute on Drug Abuse, environmental factors like trauma can even cause genetic changes that are passed onto the next generation. Sometimes both issues can develop at the same time because a person is influenced by risk factors that can lead to mental problems and addiction.

Medical Comorbid Conditions

Opioid use disorders can also come with medical complications and concerns. When you first enter an addiction treatment program, your medical health will be one of the first areas clinicians look at when determining the right level of care for your needs. Your treatment center will likely use the ASAM Criteria, a six-dimensional assessment provided by

the American Society of Addiction Medicine (ASAM) to help addiction medicine professionals find the right treatment for clients. According to this assessment, biomedical conditions and complications are the second dimension that should be assessed after addiction and withdrawal potential.

For treatment to be effective, it needs to address all of your needs. For example, you won’t be able to concentrate on therapy if you have an untreated broken arm. It is best to treat the physical needs along with the psychological needs.

Opioid use disorders can lead to serious medical issues, especially if you’ve spent time using illicit drugs. People may even come to treatment with disorders that are indirectly related to addiction. Because addiction causes you to push all other needs aside, you may neglect some of your basic health and wellness.

Some of the most common physical comorbid conditions associated with opioid use disorders are:

  • HIV
  • Hepatitis B and C
  • Other blood-borne diseases
  • Problems related to poor hygiene
  • Collapsed veins
  • Abscesses
  • Blood clots
  • Infections of the heart valves
  • Immune problems

Addressing Comorbid Disorders With Dual Diagnosis Treatment

Addiction treatment should be tailored to your specific needs for it to be effective. That means taking all of your needs into consideration, including mental and physical comorbid disorders. If you enter treatment with a co-occurring mental health issue, you may receive dual diagnosis treatment. Dual diagnosis is the clinical term for someone who has an SUD and a mental health disorder at the same time. In today’s modern approach to treatment, there are specific therapy options for people who have two or more disorders simultaneously.

In dual diagnosis treatment, you may pursue therapy options that are designed to address all of your most pressing needs at the same time. This can include individual, group, and family therapy. Behavioral therapies are also commonly used in dual diagnosis treatment.

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