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Understanding Symptoms and Signs of Heroin Addiction

Defining Heroin Addiction 

Addiction is defined as a chronic, relapsing disorder that is characterized by compulsive drug-seeking behaviors and continued use in spite of harmful consequences. Heroin addiction is considered to be a complex brain disorder because of the lasting-changes it makes on the brain structure.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) doesn’t include addiction as a specific diagnosis. Instead, the categories of substance dependence and substance abuse are combined within a single category of a substance use disorder, with mild, moderate, and severe subclassifications.2 Substance use disorder has four major groups of symptoms: social impairment, impaired control, risky, use, and pharmacological criteria such as withdrawal and tolerance. 

Signs of a heroin addict: eyes, look, symptoms

Heroin Dependence as a Symptom of Addiction 

Addiction is defined as compulsive substance use despite injurious consequences. Addiction is characterized by a chronic inability to stop using the drug, failing to meet social and professional obligations, and after a sufficient period of regular drug use, drug tolerance, and withdrawal symptoms. 

Tolerance and withdrawal, in particular, reflect physical dependence on heroin, in which the user’s body adapts to the drug.1 Tolerance happens when the body requires greater dosage of the substance to achieve the desired effect. Withdrawal generally occurs upon the abrupt cessation of drug use. Those struggling from withdrawal may exhibit certain mental or physical symptoms.  

The physical signs of dependence often accompany heroin addiction, but they do not constitute it in and of itself. In addition to physical dependence, heroin addiction also entails a range of behavioral and psychological symptoms and signs. 

Behavioral Signs and Symptoms of Heroin Addiction

Once heroin use becomes the user’s priority, their entire lifestyle shifts to revolve around the substance. This often results in a variety of observable changes in the individual’s life. A person in the grip of addiction may keep prioritizing heroin despite the numerous problems associated with use, choosing the drug over important personal, social, and professional obligations and relationships. Here are some specific signs a heroin user may exhibit:3 

  • Behavioral changes 
  • Presence of heroin paraphernalia (syringes, baggies, metal or glass pipes, etc.) 
  • Use of heroin street slang
  • Missing money or valuables 
  • Legal troubles 
  • Secretive behaviors 
  • Track marks (needle marks, scabs, scars, or bruises) 
  • Intermittent heroin use (chipping)

Individuals who abuse heroin may alter their behavior in a number of ways. This may include depression, withdrawing from friends and family, as well as erratic and/or aggressive behaviors.4 Such behavioral changes can alert family members, friends, and other concerned individuals that there may be a need for heroin treatment

Frequently Asked Questions

How Does Heroin Use Transition Into Addiction? 

The transition from heroin use to addiction is reinforced through both positive and negative factors.5 Repeated heroin use arises from the neurochemical actions of the drug which generate positive reinforcing effects. These neurochemical actions progressively lead to neurobiological changes in the user’s brain reward circuits, resulting in addiction characteristic behaviors, such as tolerance, dependence, withdrawal, sensitization, and craving. 

Other sources, such as the decrease of negative emotional states arising from repeated use, may also be at play.6 The combination of these positive and negative reinforcement sources (euphoria and alleviation of dysphoria) can incite a strong motivational force for the user to engage in compulsive drug taking. 

What Are the Signs of Heroin Addiction?

To be able to help loved ones get the help they need, it is beneficial for concerned family members and friends to be aware of the common symptoms associated with heroin addiction. If you are wondering how to spot a heroin addict, you may look for some of the following behavioral and physical signs of addiction:7

  • Impaired control: The individual may fail at attempts to control or cut down on substance use due to experiencing strong urges and cravings. 
  • Social issues: The individual may fail to complete significant tasks at home, in school, or at work, give up on leisure activities, or break up social relationships. 
  • Hazardous use: The person may use heroin in risky settings despite physical dangers. 
  • Physical effects: heroin addicts may have marks on the skin from the needle. The drug may also cause the pupils in the person’s eyes to constrict and look very small.8 

What Are the Typical Types of Heroin Paraphernalia?

The presence of characteristic paraphernalia is one of the common signs of a heroin user. Different paraphernalia is associated with the preparation requirements of the drug (depending on the presence of impurities) and the methods of ingestion.9 Some of the most common methods for heroin use include injecting it into a vein or a muscle, snorting it, and smoking it. The different paraphernalia used for heroin are:10 

  • Hypodermic needles.
  • Cotton balls. 
  • Bottle caps or spoons. 
  • Tie-offs (shoelaces, rubber hose pieces, strings).
  • Candles or lighters. 
  • Aluminum foil. 
  • Straws. 
  • Rolling papers. 
  • Pipes. 

Why Do Heroin Users Crave Sweets?

Research has shown associations between heroin consumption and increased sugar intake.11 But why do opiate addicts crave sugar? Opioids, such as heroin, act on the brain’s mu-opioid receptors. Studies have indicated that the eating behaviors of heroin users, including glucose intake and glycemic control, may be dictated by the activation and inactivation of these receptors, which connects heroin addiction to other markers such as weight gain, diabetes, and dental health. 


  1. National Institute on Drug Abuse. (2020). The science of drug use and addiction: The basics
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  3. Duong, A. (2013). How to tell if someone is using heroin
  4. Alavi, S. S., Ferdosi, M., Jannatifard, F., Eslami, M., Alaghemandan, H., & Setare, M. (2012). Behavioral addiction versus substance addiction: Correspondence of psychiatric and psychological views. International Journal of Preventive Medicine, 3(4), 290–294.
  5. Justinova, Z., Panlilio, L. V., & Goldberg, S. R. (2009). Drug addiction. Current Topics in Behavioral Neurosciences, 1, 309–346. 
  6. Koob, G. F., Sanna P. P., Bloom, F. E. (1998). Neuroscience of addiction. Neuron, Vol. 21, 467–476. 
  7. Parekh, R. (2017). What Is addiction?.
  8. National Institute on Drug Abuse. Signs of heroin use
  9. Strang, J., Keaney, F., Butterworth, G., Noble, A., & Best, D. (2001). Different forms of heroin and their relationship to cook-up techniques: Data on, and explanation of, use of lemon juice and other acids. Substance Use & Misuse, 36(5), 573–588. 
  10. The United States Department of Justice. Drug paraphernalia fast facts
  11. Mysels, D. J., & Sullivan, M. A. (2010). The relationship between opioid and sugar intake: review of evidence and clinical applications. Journal of Opioid Management, 6(6), 445–452. 

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