There’s this joke going around:
Q:”What do you call a heroin addict who breaks up with his girlfriend?”
Now, I don’t find the joke particularly funny simply because it’s all too true. There’s a strong relationship between homelessness and opiate abuse and it’s a sad and troubling reality that heroin takes over a person’s entire sense of being to the point that nothing else matters. Literally. The only thing that matters to a heroin addict is getting and using heroin.
But, according to a clinic I attended today, there’s a third element to the heroin abuse – homelessness dyad: Anxiety disorders. I’ve suspected for years that either (or both) PTSD or GAD are hugely contributing factors to developing an opiate addiction. To me it’s always been clear: Anxiety is painful, opiates treat pain, those who suffer from anxiety disorders may then seek opiates to relive their anxiety suffering. The data to support this theory of mine is overwhelming: According to the National epidemiologic Survey on Alcohol and related Conditions, someone who’s addicted to heroin has an odds ratio of 4.27 that the person also struggles with GAD and/or PTSD. What this means is that someone who is addicted to heroin is extremely likely to suffer from an anxiety disorder. According to the clinic, there are three (3) probably reasons for this strong association:
- Self medication of anxiety symptoms
- Shared neurobiological connections
- Genetic predispositions
While the first and third bullet are mostly self-explanatory, the neurobiology of anxiety disorders and heroin addiction are so similar that if someone struggles with an anxiety disorder, he or she is already wired for heroin addiction. It’s like anxiety disorders lay the foundation for heroin addiction.
This data strongly suggests that, as I’ve often discussed, that treating heroin addiction isn’t a matter of focusing on the heroin use. Really, it’s almost always about treating the underlying and co-occurring anxiety or PTSD. In order to do so, clients need:
- Education and coping skills training for both disorders
- Behavioral interventions for the anxiety disorder (cognitive framing, exposure)
- Relapse prevention for the substance use disorders
Furthermore, there are times when medication is needed and it appears that GABAPENTIN has shown to be effective for treating anxiety with a low risk of abuse.
Really, neither homelessness or prison or death have to be outcomes of heroin addiction. The reality is that understanding the layers that lead to the addiction can go a long way towards treating the addiction. Really, some people are “wired” for anxiety and addiction. The important thing to remember is that there are avenues to treat this insidious phenomena and those avenues usually require a deep understanding of the person who’s addicted and what he or she needs in order to find health.