Controlled Heroin Use

Your Mindset and Environment Affect Whether You Become Addicted

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 suffering from severe problems, there has been research indicating that some heroin users get away with occasionally using heroin without becoming addicted.

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, and that set and setting were key factors in determining whether or not an individual lost control of their drug use.

Set and setting, a term which refers to the mental state of a drug user, or "set," and the environment in which the drug is taken, or "setting," has been found to have a profound impact on whether people who use intoxicating drugs go on to become addicted to them.

Even back in 1962, Dr. Zinberg found that physicians were reluctant to prescribe opiate pain medication to patients who needed it, for fear that the patients would become addicted. Yet this fear was based on social and cultural expectations of the physicians, not on fact. In reality, Zinberg noticed that very few patients in the hospital became addicted to prescribed opioids. This was Zinberg's first experience of how setting can affect subsequent addiction.

Stigma Among Physicians

While we might expect physicians to be objective and fair in the way that they view their patients, nothing could be further from the truth. More recent research has shown that physicians have a lot of hesitation around the prescription of opiate pain medication, with their view of patients they are considering prescribing pain medication to being divided between those who are seen as "deserving pain patients," and those that are considered to be "drug seeking."

Physicians often believe that judging patients in this way is part of their job, as they weigh the balance between soothing the pain of "genuine" pain patients while avoiding the possibility that they are enabling the addiction of those who are merely drug seeking.

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 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.

Powell, a colleague of Zinberg's, found that it was 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. This study showed that controlled use of heroin was possible.

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 which 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-V or 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.

In spite of this research, the majority of studies show 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. If you haven't taken heroin before, it is safer not to risk it.

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Article Sources
  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Washington DC: American Psychiatric Association, 2013.
  • Powell, D. "A pilot study of occasional heroin users." Arch Gen Psychiatry 28 (4), pp. 586-94. 1973.
  • Zinberg, N. Drug, Set, and Setting: The Basis for Controlled Intoxicant Use. Yale University Press. 1986.