, Newburyport, MA

April 18, 2014

The heroin addiction scourge

Health and Well-Being
Dr. Jim Manganiello

---- — Opiate addiction — in particular, heroin addiction — is becoming a worldwide scourge. In the United States, heroin abuse has moved far beyond our inner cities, resulting in a dramatic increase in addiction and death.

The quiet, peaceful and pastoral state of Vermont is in the midst of a devastating heroin crisis. Vermont Gov. Peter Shumlin devoted his entire State of the State address to the addiction problem. In his words: “In every corner of our state, heroin and opiate drug addiction threatens us.”

Massachusetts has also been hit hard by the torment of heroin addiction; 185 people died from heroin overdoses between November 2013 and February 2014.

The current opiate abuse epidemic in America is not entirely new. As early as 1972, drugs were the greatest killers of young people between the ages of 18 and 40 in most major cities in the United States.

While a serious issue, physical addiction is not the primary problem for heroin addicts. While the co-director of a drug addiction therapeutic community associated with Boston City Hospital, I learned a lot about heroin addiction. The real addiction problem is psychological. It is more difficult and more dangerous to withdraw from alcohol and some sleeping pills than it is from heroin.

Despite the longevity and now-acute nature of heroin addiction, we still don’t understand it. One of the major reasons we don’t is that both the professional and lay communities have tended to regard heroin use as a moral and criminal problem. In reality, politically generated public policies have held back really meaningful research that could generate badly needed knowledge. Many prevention and treatment programs are operating on the basis of faulty knowledge and moral preconceptions about drug abuse.

A good example of this is the notorious methadone maintenance programs that first emerged in the early 1970s to treat heroin addicts. “Experts” regarded heroin addiction as a biological disease similar to diabetes. If the diabetic needed insulin to be normal, then, it was argued, the opiate addict needed something to blockade the desire for heroin. Methadone, a powerfully addictive synthetic opiate, was prescribed for heroin addicts. It still is. But methadone “treatment” is a little like “curing” the alcoholic who drinks a 12-pack of beer every day by giving him a quart of rum to drink every morning.

Addicting people to high dosages of synthetic drugs is not a solution to dependence on other drugs. But the federal government has, in the past, committed a majority of its resources to methadone maintenance programs. And this despite warnings from the National Academy of Sciences and the World Health Organization.

I conducted two years of research on heroin addiction that established it as a psychological problem, not a metabolic one. My research, published in the International Journal of the Addictions, served as a model for therapeutic communities.

The single most important question that we must ask focuses on the demand side of the problem: Why do so many people compulsively crave heroin and what can we do about it? The heart of the problem is the psychology of people who get trapped into drug abuse, not the drugs themselves.

A majority of drug treatment and prevention programs are a waste of time and money. Two major studies evaluated our Department of Health, Education and Welfare’s past drug prevention programs. The studies concluded that these multimillion-dollar programs have been entirely ineffective and thoroughly irrational in cost-benefit terms. These studies concluded that rather than wasting money on useless programs, the federal government must make greater efforts to focus on the psychological reasons that people use drugs. Effective prevention and treatment efforts must be developed and implemented.

Of course, the ideal would be to prevent the conditions that tend to lead people into seeking chemical relief from pain they do not understand. Until that issue is addressed, it is unlikely that we will find any substantial relief from the curse of heroin addiction.

The bottom line is that all opiate drugs lead to temporary relief, elation and feelings of profound well-being. And heroin does this more and better than all other drugs. The template that drives heroin addiction is emotional pain. When people who feel burnt-out, lonely, powerless and confused discover heroin, they are like hungry infants who discover their mother’s breast. Unfortunately, increasing numbers of people feel the sharp sting of a meaningless life filled with a nasty combination of woe, trauma, misery and emptiness. When they experience heroin elation, they feel overwhelming relief, an experience that can become irresistible.

Too many of us have lost the connection to the deeper parts of ourselves and so to the things that truly make life worth living, to the things filled with the depth, meaning, purpose and happiness.


Dr. Jim Manganiello is a clinical psychologist and diplomate-level medical psychotherapist based in Groveland and West Boxford. He is also an author and teacher focusing on stress, personal growth, meditation and “inner fitness.” His book “Unshakable Certainty” is available on Amazon. Email him at or visit