Controlled Heroin Use and Addiction

Models pose as a group of friends drinking and using drugs
Controlled heroin use is possible for some users. Mario13 / Getty Images

Is controlled heroin use possible? Many drug users wonder whether controlled heroin use—recreational use of heroin without becoming addicted—is possible.

Although this is a very under-researched area of the addictions field, and most research points to heroin users becoming addicted and experiencing severe problems, there was research in 2014 indicating that some heroin users occasionally used heroin without becoming addicted. However, it is possible that these individuals may have gone on to develop an addiction after the study period ended. The study also ignored the important influence of genetics and family history.

What Research Says

Dr. Norman Zinberg of Harvard Medical School carried out clinical work with drug users for over twenty years and conducted a series of studies of people who were using illicit drugs, such as heroin. He found that not all drug users lost control over their use and became addicted.

Zinberg suggested that around 40% of the opiate-using population consisted of people who only used the drug occasionally. He also suggested that set and setting were key factors in determining whether or not an individual lost control of their drug use.

In researching British heroin addicts in the late 1960s, when heroin could be legally prescribed to those who were addicted, Zinberg found that there were two distinct types of heroin addict—those who were controlled in their use, and had functional and even successful lives, and those who were uncontrolled in their use, saw themselves as defective, and had self-destructive lifestyles.

Yet prior to the criminalization of heroin in Britain, neither type was not a cause of social unrest, crime, or public hysteria. Again, Zinberg saw this as an effect of the legal status of heroin in Britain at the time. Zinberg also studied heroin use by distraught American troops in Vietnam, which was excessive and uncontrolled, and he saw it as an effort to "blot out" the trauma they were experiencing there.

Once they returned home and were out of the horrific and uncontrolled social setting of Vietnam, 88% did not recommence heroin use, although many had significant problems. While this might indicate that some people are able to use heroin only intermittently, it may also indicate that some individuals have a genetic profile that makes them more or less susceptible to addiction.

Others have noted that it is possible for people to use heroin only occasionally—a group known as "chippers." These individuals tended to socialize with non-drug using friends, and kept tight control over their heroin use, cutting back as soon as they noticed signs of dependence.

How Heroin Users Keep Control

As Zinberg's work progressed, he proposed that two important aspects of the "setting" of drug use were important in setting limits and controls around use. These aspects were rituals and social sanctions. Rituals are predictable patterns of behavior, and social sanctions are the values held by the drug users and their related rules of conduct.

Sanctions include formal rules which reflect the values of the wider society, such as drug laws, and they also include informal, unwritten rules among drug users that restrict the use of drugs, such as knowing your limit.

Decades later, the ideas originally proposed by Zinberg are now finally being reflected in the diagnosis of addiction. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, also known as the DSM-5, makes an explicit distinction between opioid use disorder, which involves drug-seeking behavior and compulsive use, and the physiological aspects of opioid withdrawal, which can happen to anyone who is reducing or stopping opioid use, including people on opioid medications who are not addicted.

While some older research suggests that occasional heroin use might be possible, it is important to recognize that the situation is much different than it was when Zinberg's studied Vietnam veterans. Today, finding pure heroin is much more difficult than it was in the past. Most of what is sold as heroin is actually fentanyl or contains some fentanyl. Because fentanyl is much more potent and the quality of the drug is so variable, it has been responsible for much of the mortality associated with the opioid epidemic. 

The National Institute of Drug Abuse (NIDA) says that heroin is a highly risky drug, typically leading to long-term addiction, multiple serious life problems related to use, and a high probability of relapse.

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