They don’t know each other, but they have much in common:

They’re both from small towns — Masure from St. Johnsbury, Vt., Payne from Hanover, Va. They used to steal beers from their dads before branching out into a variety of drugs.

They have been "clean" for three years, thanks in part to several 12-step program meetings each week. And they’re both preaching what they practice by working for organizations that offer support to people and families struggling with addiction.

Their stories touch upon themes made clear recently by scientists searching for answers about the genesis and treatment of addiction. The questions have plagued researchers for decades, but only in the past several years have they had the tools — such as technology that provides a real-time view of brain function — to unravel them.

The 2004 National Survey on Drug Use and Health found that of Americans 12 and older, nearly 8.4 million were addicted to alcohol and nearly 5 million were addicted to other drugs. About 1.4 million were addicted to both, according to the survey by the federal Substance Abuse and Mental Health Services Administration.

Thanks to advances in neurobiology, "we have enormous knowledge now of what’s going on" in addicts’ brains, says George Koob, professor of molecular integrative neuroscience at the Scripps Research Institute in La Jolla, Calif. Koob, who calls himself an "irrepressible optimist," says he is hopeful that new insights into the mechanisms of addiction will lead to new treatments and reduced suffering.

They might debate the terms used to describe addiction, but top scientists in the field pretty much agree on what it is.

"The inability to stop is the essence of what addiction is," says Nora Volkow, director of the National Institute of Drug Abuse, part of the National Institutes of Health. As Payne, 27, puts it, "my favorite drug was more and all."

That’s not to say that people who can’t make it through the day without latte grandes or Ghirardelli chocolate are addicts, says Volkow, a self-professed "chocoholic" who has pioneered brain-imaging studies of addiction. Caffeine does activate some of the same brain circuits as the drugs of addiction, but only very mildly, she says. Caffeine can be habit-forming, but Starbucks devotees won’t risk jail time or divorce to feed their habit.

Nor is addiction the same as dependence, although the American Psychiatric Association’s diagnostic manual says it is, says Volkow, who’s pushing to drop that wording. "Addiction is much harder to treat. Everybody given an opiate (such as morphine) will become physically dependent, but not everybody will become an addict."

They don’t know each other, but they have much in common:

They’re both from small towns — Masure from St. Johnsbury, Vt., Payne from Hanover, Va. They used to steal beers from their dads before branching out into a variety of drugs.

They have been "clean" for three years, thanks in part to several 12-step program meetings each week. And they’re both preaching what they practice by working for organizations that offer support to people and families struggling with addiction.

Their stories touch upon themes made clear recently by scientists searching for answers about the genesis and treatment of addiction. The questions have plagued researchers for decades, but only in the past several years have they had the tools — such as technology that provides a real-time view of brain function — to unravel them.

The 2004 National Survey on Drug Use and Health found that of Americans 12 and older, nearly 8.4 million were addicted to alcohol and nearly 5 million were addicted to other drugs. About 1.4 million were addicted to both, according to the survey by the federal Substance Abuse and Mental Health Services Administration.

Thanks to advances in neurobiology, "we have enormous knowledge now of what’s going on" in addicts’ brains, says George Koob, professor of molecular integrative neuroscience at the Scripps Research Institute in La Jolla, Calif. Koob, who calls himself an "irrepressible optimist," says he is hopeful that new insights into the mechanisms of addiction will lead to new treatments and reduced suffering.

USA Today — They might debate the terms used to describe addiction, but top scientists in the field pretty much agree on what it is.

"The inability to stop is the essence of what addiction is," says Nora Volkow, director of the National Institute of Drug Abuse, part of the National Institutes of Health. As Payne, 27, puts it, "my favorite drug was more and all."

That’s not to say that people who can’t make it through the day without latte grandes or Ghirardelli chocolate are addicts, says Volkow, a self-professed "chocoholic" who has pioneered brain-imaging studies of addiction. Caffeine does activate some of the same brain circuits as the drugs of addiction, but only very mildly, she says. Caffeine can be habit-forming, but Starbucks devotees won’t risk jail time or divorce to feed their habit.

Nor is addiction the same as dependence, although the American Psychiatric Association’s diagnostic manual says it is, says Volkow, who’s pushing to drop that wording. "Addiction is much harder to treat. Everybody given an opiate (such as morphine) will become physically dependent, but not everybody will become an addict."

WorldWideAddiction.com — Substance Addiction has been recognized "officially" as a disease for many years now, but there is still a great deal of ignorance on the subject -even amongst the medical profession.

Addicts/alcoholics (people tend to separate the two, but from here on in I will use the term "addict" to cover the broad range of substance abusers) are seen as weak people with no will-power.

Want to know what will-power is?

It is waking up in the morning, so nauseous that you race to the bathroom and don’t know which end to use first! After that initial wake-up purge, you then make your way shivering and shaking into the kitchen and drink an open, flat, warm beer that has a cigarette butt floating in it. Or because you are shaking so much, you drink that warm white wine that has been sitting out all night, through a straw since you can’t hold a glass! You do this, choking back the bile that is rising in your throat, because you know that the only way to begin functioning again on some sort of level is to try and build up the alcohol in your system before you take a seizure.

Do you think drinking methylated spirits at 5am in the morning is an easy thing to do?

I have known many addicts whose veins in their arms and legs are so damaged, that they inject themselves in their eyeballs. Because going without their "hit" is a far worse option.

Addicts have plenty of will-power…….

…it’s just focused in the wrong direction. Recovery teaches them us to refocus energy.

Back to the disease concept. Addiction is classified as a disease because it meets the criteria of all other terminal diseases:

- It has pattern of symptoms which are similar across all types of substance abuse

- It is a chronic condition. It doesn’t go away.

- It is progressive. Addiction only gets worse with continued use, and ends with death.

- The person is subject to relapse. In Australia, 66% of addicts who are lucky to live long enough to make it to detox will eventually die as a direct result of the disease.

- It is treatable. Here’s the good news, while substance addiction is a terminal illness, its progression can be arrested at almost any stage. But if you are seeking treatment, it is of the utmost importance that you gain medical advice. Sudden withdrawal, even from "socially acceptable" drugs such as alcohol, can cause death through seizures and coma.

It is crucial that you consult with a medical practitioner that understands addiction and withdrawal. Some well meaning, but uneducated doctors will prescribe large amounts of unsuitable medications that can lead to cross-addiction. This happened to me at one stage, and made a difficult situation worse. If you are addicted to one drug, the likelihood of becoming addicted to others is extremely high.

Wherever possible, detoxification is best carried out in a detox unit, where there is 24 hour patient care. There are a number of these units around the world, and in some cases (especially in Australia) there is no charge for this care.

When world governments begin to understand that the cost in providing this care free of charge is far outweighed by the benefits to society, we will begin to see an incredible drop in poverty, violence and divorce. The cost in providing this care will also be offset by the decrease in need of other hospitalization. 1 in 3 hospital beds in Australia are taken up by people with conditions that can be directly linked to drug abuse. At best, the world health systems overall are only currently providing band-aid solutions to one of the greatest scourges of mankind.

Are you thinking of getting help for yourself or a loved one?… do it now … for tomorrow may be too late. 

If you had terminal cancer, would you do anything about it? 

Substance addiction is a far worse disease in my opinion -it not only destroys the person, but everyone around them.

To those who helped me all those years ago -doctors, nurses, friends and strangers – even though I may not have been appreciative at the time….. my sincerest thank you. My life means something now.

Addiction is a disease, not just a state of mind.

A NIDA-funded study has demonstrated that the relapse rate for heroin addicts increases with time and that the probability of long-run abstinence depends on the age of first drug use. Those who start daily heroin use at a younger age are more likely to relapse than those who start later.

The study, conducted by Dr. Marnik G. Dekimpe of the Catholic University Leuven in Belgium and his colleagues in Belgium and at the University of California, Los Angeles, examined the treatment histories of 846 patients at methadone clinics in central and southern California. The researchers looked at males and females, whites and Chicanos, most of whom started using heroin between the ages of 17 and 25. Subjects were interviewed over a 4-year period during and after treatment to determine the probability of their relapse to heroin use.

The finding that relapse is connected to time suggests the need for long-term periodic monitoring of a former heroin user’s abstinence, Dr. Dekimpe says. The researchers also found drug relapse odds were significantly different across the sociodemographic groups studied, suggesting that prevention resources could be directed to groups at higher risk. No significant differences in relapse probability were associated with either gender or education.

Heroin addicts, who use regularly, develop a tolerance. To get the same effect from the drug, the user must have higher doses, which in turn causes physical dependence and addiction. Despite the glamorization of heroin chic in films, fashion, and music, heroin use can have tragic consequences that extend far beyond its users. Fetal effects, HIV/AIDS, tuberculosis, violence, and crime are all linked to its use. Long-term effects of heroin use are also devastating to the body and mind.
 

The affect of heroin on the body is dependent on the method of administration. Heroin can be taken orally, which is metabolized into morphine before crossing the blood-brain barrier; snorted, which results in onset within 10 to 15 minutes; smoked, which has immediate effects; intravenously injected, which results in rush and euphoria within 7 to 8 seconds; and, intramuscularly injected which takes longer but results in onset within 5 to 8 minutes. Finally, heroin can kill. Of all reported drug abuse deaths, heroin is one of the top two most frequent. As with any drug addiction and physical dependency, withdrawal symptoms occur if use is reduced or stopped.
 

Withdrawal can occur anywhere from a few hours to 72 hours after the last dose and symptoms can include: drug craving, restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes, and kicking movements. For the user trying to quit, medications and behavior therapies are the most common treatment options.
 

First, the medications Methadone and Buprenorphine have proven to be successful in treating heroin addiction. Methadone, a synthetic opiate, blocks the effects of heroin for about 24 hours. Buprenorphine is the most recent addition to the array of medications available for treating addiction to heroin and other opiates. This medication is different from methadone in that it offers less risk of addiction and can be dispensed in the privacy of a doctor’s office. Other medications include naloxone and naltrexone, both of which block the effects of morphine, heroin, and other opiates.6 In addition; there are many effective behavioral treatments available for heroin addiction. These can include residential and outpatient approaches. Contingency management therapy uses a voucher-based system, where patients earn "points" based on negative drug tests, which they can exchange for items that encourage healthful living. Cognitive-behavioral interventions are designed to help modify the patient’s thinking, expectancies, and behaviors and to increase skills in coping with various life stressors. Treatment can and should be integrated with support services to enable the heroin user to return to a stable and productive life.
 

In conclusion, heroin addiction is a terrible way of life but can be overcome with hard work, a support group, a drug rehabilitation program or center and pure determination.

Maryland — The lifestyles of Jean Duley’s clients run the gamut: long-time street drug users, those who were prescribed powerful painkillers after an injury or operation and are now addicted, and middle-class housewives who abuse prescriptions, to name a few.

"Prescription drug abuse is the biggest kept secret," said Duley, program director at Comprehensive Counseling Associates in Frederick. "It’s a lot more prevalent than people can imagine."

In December, Comprehensive Counseling became one of three practices in Frederick County to prescribe suboxone, which Duley calls a "miracle drug" for those addicted to pain medication. The center now prescribes suboxone to about 50 clients.

Suboxone is a partial opioid agonist, containing enough buprenorphine (an opioid) to eliminate cravings and symptoms of withdrawal. The pill also contains naloxone, an opioid antagonist, which blocks the user’s ability to get high on any other drug, Duley said.

Clients usually come to the center for suboxone in the midst of withdrawal, and with regular treatment, clients have gone from "living a nightmare, to feeling like they have a brain for the first time in a long time," said Dr. Allan Levy, a psychiatrist at Comprehensive Counseling.

Duley said while some people lie about the severity of their pain to acquire their abused prescriptions legally, physicians themselves can fuel prescription addiction. Some prescribe increasing strengths of painkillers and then abruptly stop after patients have already become dependent, forcing them to get their fixes from either prescriptions sold on the street or illegal drugs like heroin.

Others prescribe painkillers too loosely. Duley said some of the center’s suboxone clients have Percocet "handed to them like candy for every little ache and pain — it’s a culture of doctors not paying attention. The worst is OxyContin. That drug — is so highly addictive, it’s so difficult to come off of."

Some people can stop taking suboxone after a few months, but most continue for as much as a year before weaning themselves off, Levy said. For others, it becomes a lifelong maintenance drug.

While suboxone addresses the neurological aspect of addiction, Duley said giving medication without regular therapy defeats the drug’s purpose. She facilitates a support group at the center three times a week, and suboxone users are asked to attend at least once a week.

"They usually have all kinds of issues going on at the same time (as the addiction)," Duley said, including problems with employment, family and mental health. "You have to address the whole piece. The drug alone doesn’t work by itself."

And all addiction treatments should revolve around the key factor — a person’s health, Duley said.

"(Beating addiction) is a complicated issue, but it’s very doable," she said. "It’s not a moral issue, it’s not a criminal issue, it’s a health issue."

ABC NEWS — A study at the University of Western Australia has found that heroin addicts with naltrexone implants are far less likely to return to heroin use than those taking oral tablets.

But critics are sceptical about the study and say that naltrexone is still a risky option for drug users trying to kick the habit.

Naltrexone is a drug which blocks the effects of heroin on the brain. It is usually taken as a tablet, but if heroin users stop taking the pill they often fall back into drug use.

That is why scientists have been working on an implant which automatically releases naltrexone into the body.

Gary Hulse from the University Of Western Australia is confident about the naltrexone’s success.

"It means that you’ve got a a one-stop shop. People can come in, they receive their treatment or implant and for five months or six months, they carry that treatment with them," he said.

The six-month trial involved 69 heroin users. Fifty-four completed the trial. Of the 28 participants who received a naltrexone tablet, 15 returned to regular heroin use. Of the 26 people who received a naltrexone implant, just two returned to heroin use.

Researchers like Mr Hulse say it is a good result for naltrexone implants.

"This is a relatively safe and a treatment which has good clinical outcomes," he said.

The study is yet to be published in a peer-reviewed medical journal, but the team at the University of Western Australia are confident the research will be well received.

"I’m not only confident that it’ll be published in a peer review but I would be surprised if this wasn’t accepted by one of the extremely high rating journals," said Mr Hulse.

But critics like Dr Alex Wodak, from the Alcohol And Drug Services at Vincents Hospital in Sydney, have little time for the new study.

"The paper hasn’t been published yet in a scientific journal and so therefore, it’s the equivalent of hearsay in a court of law. That is, it’s not really evidence," he said.

Naltrexone is a controversial drug. The implants are yet to be approved by Australia’s Therapeutic Goods Administration (TGA) and there have been mixed results for heroin users.

Some patients have stopped using heroin after receiving an implant. But others have cut them out of their body or suffered serious side effects.

"The implants, I know for a fact, were at one stage required by the therapeutic goods administration to be stamped, not for use in human subjects, and the authors have conceded that to me in writing," said Dr Wodak.

But researchers such as Moira Sim from the Naltrexone Trial Independent Monitoring Committee say the implants used in the Perth trial were approved by the TGA.

"The committee reviewed all the processes that the trial went through and we are confident that they followed the correct processes that the data was collected properly, and therefore I’m very confident in the results of the trial," she said.

The researchers say the next step will be to conduct a trial comparing naltrexone implants with methadone and other drugs used to control heroin addiction.

PARIS (AFP) — The drug buprenorphine is twice as effective as a rival treatment called naltrexone in helping heroin patients stay off the narcotic, a trial published in The Lancet on Friday said.

The two drugs, along with a dummy pill called a placebo, were tested for 22 months among 126 patients in Malaysia who had emerged from a detoxification and counselling programme, it said.

Buprenorphine, which is marketed as Temgesic or Buprenex, was twice as effective as naltrexone (branded as Revia, Depade or Vivitrol) and the placebo in terms of days of abstinence from heroin and a full-fledged relapse to the narcotic.

Indeed, buprenorphine proved to be so superior that the trial was halted early, as it would have been unethical to continue it to its scheduled end.

The study, led by Yale University’s Richard Schottenfeld, gives support for placing buprenorphine alongside methadone, and both of them over naltrexone, as pharmacological treatments for helping addicts stay off heroin.

The three drugs belong to a class called opioid antagonists.

These treatments are increasingly used to help ease heroin dependence but remain prohibited in some countries, amid suspicions that they are liable to be abused or simply substitute one addiction for another.

The study is important because it gives the first assessment of the relative effectiveness of two of the opioid antagonists.

Heroin and other illicit opiates were once a problem mainly confined to developed countries, but in the past few decades have spread to developing economies and nations of the former Soviet bloc.

China, India, Indonesia, Iran, Malaysia, Pakistan and Russia are among the countries where expansion of heroin use has risen fastest, according to a 2004 World Health Organisation (WHO) paper.

John Walters, the White House drug czar, declared earlier this year that “courageous and effective” counternarcotics efforts in Colombia and Mexico “are disrupting the production and flow of cocaine.”

This enthusiasm rests on a very selective reading of the data. Another look suggests that despite the billions of dollars the United States has spent battling the cartels, it has hardly made a dent in the cocaine trade.

While seizures are up, so are shipments. According to United States government figures, 1,421 metric tons of cocaine were shipped through Latin America to the United States and Europe last year — 39 percent more than in 2006. And despite massive efforts at eradication, the United Nations estimates that the area devoted to growing coca leaf in the Andes expanded 16 percent last year. The administration disputes that number.

The drug cartels are not running for cover.

Mexico and parts of Central America are being swept up in drug-related violence. Latin Americans are becoming heavy consumers of cocaine, and traffickers are opening new routes to Europe through fragile West African countries. Some experts argue that the rising price of cocaine on American streets is mostly the result of a strong euro and fast-growing demand in Europe.

Workplace drug tests notwithstanding, cocaine use in the United States is not falling. About 2.5 percent of Americans used cocaine at least once in 2006, the same percentage as in 2002, according to the Department of Health and Human Services.

While cocaine use has fallen among younger teenagers, 12th graders are using more: 5.2 percent used cocaine last year — up from 4.8 percent in 2001 and 3.1 percent at the low point in 1992, says a Monitoring the Future survey done by the University of Michigan.

All this suggests serious problems with a strategy that focuses overwhelmingly on disrupting the supply of drugs while doing far too little to curb domestic demand.

Washington spent $1.4 billion on drug-related foreign assistance last year — mostly to equip Colombia’s security forces and spray coca crops in the Andes. It spent another $7 billion on drug-related law enforcement and interdiction efforts at home and abroad. It spent less than $5 billion on education, prevention and treatment programs at home to curtail substance abuse.

The counternarcotics effort has produced some successes. Marijuana use in the United States has declined since 2002, the earliest year for which the government has comparable data. Teenage use of other drugs, like methamphetamine, has fallen sharply. With American aid, Colombia’s armed forces have severely weakened the FARC guerrillas, a major player in the drug trade.

The next administration should continue to help Latin American governments take on the traffickers. But it must learn from the current strategy’s shortcomings.

Eradication efforts are most likely to have more success if more money is spent on programs to wean coca growers from the business and improve the lives of their families and communities. Mexico, in particular, is in deep trouble, and the next American president should build on the Bush administration’s plans to provide counternarcotics aid. There needs to be a different mix: less money for equipment for security forces and more for economic development and programs to reform and strengthen Mexico’s judicial system.

Above all, the next administration must put much more effort into curbing demand — spending more on treating drug addicts and less on putting them in jail. Drug courts, which sentence users to treatment, still deal only with a small minority of drug cases and should be vastly expanded. Drug-treatment programs for imprisoned drug abusers, especially juvenile offenders, must also be expanded.

Over all, drug abuse must be seen more as a public health concern and not primarily a law enforcement problem. Until demand is curbed at home, there is no chance of winning the war on drugs.

Opiates suppress pain, reduce anxiety, and at sufficiently high doses produce euphoria. Most can be taken by mouth, smoked, or snorted, although addicts often prefer intravenous injection, which gives the strongest, quickest pleasure. The use of intravenous needles can lead to infectious disease, and an overdose, especially taken intravenously, often causes respiratory arrest and death.

Addicts take more than they intend, repeatedly try to cut down or stop, spend much time obtaining the drug and recovering from its effects, give up other pursuits for the sake of the drug, and continue to use it despite serious physical or psychological harm. Some cannot hold jobs and turn to crime to pay for illegal drugs. Heroin has long been the favorite of street addicts because it is several times more potent than morphine and reaches the brain especially fast, producing a euphoric rush when injected intravenously. But prescription opiate analgesics, especially oxycodone and hydrocodone, have also become a problem.

In anyone who takes opiates regularly for a long time, nerve receptors are likely to adapt and begin to resist the drug, causing the need for higher doses. The other side of this tolerance is a physical withdrawal reaction that occurs when the drug leaves the body and receptors must readapt to its absence. This physical dependence is not equivalent to addiction. Many patients who take an opiate for pain are physically dependent but not addicted: The drug is not harming them, and they do not crave it or go out of their way to obtain it.

Detoxification

For some addicts, the beginning of treatment is detoxification — controlled and medically supervised withdrawal from the drug. (By itself, this is not a solution, because most addicts will eventually resume taking the drug unless they get further help.) The withdrawal symptoms — agitation; anxiety; tremors; muscle aches; hot and cold flashes; sometimes nausea, vomiting, and diarrhea — are not life-threatening, but are extremely uncomfortable. The intensity of the reaction depends on the dose and speed of withdrawal. Short-acting opiates, like heroin, tend to produce more intense but briefer symptoms.

No single approach to detoxification is guaranteed to be best for all addicts. Many heroin addicts are switched to the synthetic opiate methadone, a longer-acting drug that can be taken orally or injected. Then the dose is gradually reduced over a period of about a week. The anti-hypertensive (blood pressure lowering) drug clonidine is sometimes added to shorten the withdrawal time and relieve physical symptoms.

Methadone Maintenance

Since the 1970s, professionals who care for opiate addicts have reluctantly recognized that many of them will not or cannot stop taking the drug. The solution is maintenance — dispensing opiates under medical supervision. More than 100,000 American addicts are now using methadone as a maintenance treatment. Although it is still politically controversial, this practice has better scientific support than any other treatment for any kind of drug or alcohol addiction.

Because there is a risk of diversion to the illicit market, addicts must come to specialized clinics for methadone, which they take daily in liquid form. A single dose lasts 24–36 hours, and there are few side effects. Some methadone clinics also provide other medical and social services.

Addicts who switch from illicit opiates to methadone avoid the highs and lows and the medical risks of intravenous injection and the criminal behavior that supports it. Studies show that they are less depressed, more likely to hold a job and maintain a family life, less likely to commit crimes, and less likely to contract HIV or hepatitis. Methadone can be continued indefinitely, or the dose can be gradually reduced in preparation for withdrawal. It has been estimated that about 25% of patients eventually become abstinent, 25% continue to take the drug, and 50% go on and off methadone repeatedly.

Buprenorphine

A promising approach to maintenance is the partial opioid agonist buprenorphine. This drug is taken three times a week as a tablet held under the tongue. It occupies opiate nerve receptors and produces a mild opiate-like effect. At higher doses, it continues to produce the same weak effect while displacing more potent drugs. In a person who is physically dependent on opiates, buprenorphine causes a withdrawal reaction. There is some risk of abuse if the tablet is dissolved and injected, so buprenorphine has been made available in combination with the short-acting opiate antagonist naloxone, which has little effect when absorbed under the tongue but neutralizes the effect of injected opiates.

The main advantage of this combination, sold under the name Suboxone, is that patients do not have to come to clinics to take it, because there is no illicit market and no danger of diversion. Since 2002, individual physicians with proper training and certification have been allowed to prescribe buprenorphine in their offices for patients to take home.

In November 1997, the National Institutes of Health (NIH) convened a Consensus Panel on Effective Medical Treatment of Heroin Addiction. The panel of national experts concluded that opiate drug addictions are diseases of the brain and medical disorders that indeed can be treated effectively. The panel strongly recommended (1) broader access to methadone maintenance treatment programs for people who are addicted to heroin or other opiate drugs; and (2) the Federal and State regulations and other barriers impeding this access be eliminated. This panel also stressed the importance of providing substance abuse counseling, psychosocial therapies, and other supportive services to enhance retention and successful outcomes in methadone maintenance treatment programs. The panel’s full consensus statement is available by visiting the NIH Consensus Development Program Web site at consensus.nih.gov.

Methadone, a synthetic opiate medication that blocks the effects of heroin for about 24 hours, has a proven record of success when prescribed at a high enough dosage level for people addicted to heroin. Other approved medications are naloxone, which is used to treat cases of overdose, and naltrexone, both of which block the effects of morphine, heroin, and other opiates.

Buprenorphine is the most recent addition to the array of medications available for treating addiction to heroin and other opiates. This medication is different from methadone in that it offers less risk of addiction and can be dispensed in the privacy of a doctor’s office. Several other medications for use in heroin treatment programs are also under study.

For the pregnant heroin abuser, methadone maintenance combined with prenatal care and a comprehensive drug treatment program can improve many of the detrimental maternal and neonatal outcomes associated with untreated heroin abuse. There is preliminary evidence that buprenorphine also is safe and effective in treating heroin dependence during pregnancy, although infants exposed to methadone or buprenorphine during pregnancy typically require treatment for withdrawal symptoms. For women who do not want or are not able to receive pharmacotherapy for their heroin addiction, detoxification from opiates during pregnancy can be accomplished with relative safety, although the likelihood of relapse to heroin use should be considered.

There are many effective behavioral treatments available for heroin addiction. These can include residential and outpatient approaches. Several new behavioral therapies are showing particular promise for heroin addiction. Contingency management therapy uses a voucher-based system, where patients earn "points" based on negative drug tests, which they can exchange for items that encourage healthful living. Cognitive-behavioral interventions are designed to help modify the patient’s thinking, expectancies, and behaviors and to increase skills in coping with various life stressors.