Treatment Of Heroin Addiction Research Articles

Polymorphisms in Stress-Related Genes Are Associated with Reduced Cocaine Abuse and Longer Retention in Methadone Maintenance Treatment for Opioid Use Disorder

Background: As CRH-binding protein (CRHBP) SNP rs1500 was associated with reduced cocaine abuse after 1 year in methadone maintenance treatment (MMT) for heroin addiction, we evaluated the association of additional 28 selected SNPs, in 17 stress-related genes, with MMT outcome. Methods: The distribution of genotypes of each SNP by cocaine abuse after 1 year in MMT was assessed under the dominant and recessive models using χ². Cumulative retention (up to 26.5 years) was studied using Kaplan-Meier analyses. Logistic regression and Cox model were used for multivariate analyses. Results: Of a nonselective sample of 404 patients, 25 patients with <50% Europeans/Middle Eastern ancestry were excluded. Of the remaining 379 patients, 330 (87.1%) stayed at least 1 year in treatment. Four SNPs were associated with cocaine abuse after 1 year in MMT. A lower proportion of cocaine abusers was found in the groups of subjects with the following genotypes: arginine vasopressin (AVP) SNP rs2282018 CC, CRHBP rs7728378 TT, galanin rs3136541 TT/TC, and neuropeptide Y receptor Y1 (NPY1R) rs4518200 AA. The following independent variables were associated with lack of cocaine in urine after 1 year (multivariate analyses): CRHBP rs7728378 TT, NPY1R rs4518200 AA, no cocaine in urine on admission, as well as opiate and benzodiazepine use after 1 year in MMT. Cumulative retention (n = 379) was longer in carriers of AVP rs2282018 CC (13.7 years, 95% CI 11.1–16.2) versus TT/TC genotypes (10.5, 95% CI 9.4–11.5) (p = 0.0230) Conclusions: The study suggests that a reduction in cocaine abuse and longer retention among MMT patients is mediated in part by variants in stress-related genes and is a step toward precision medicine.

Assessing effect of long-term abstinence on coupling of three core brain networks in male heroin addicts: A resting-state functional magnetic resonance imaging study.

Abstinence is one of the important measures for heroin addiction. However, it is unknown whether long-term abstinence (LA) would improve the coupling among three core brain networks (salience, default mode, and executive control) and decrease craving in treated heroin addicts. Forty-three heroin addicts with LA, 27 heroin addicts with short-term abstinence (SA), and 46 demographically matched healthy controls (HC) participated in the resting-state functional magnetic resonance imaging study. The authors compared the functional connectivity among the three groups and examined how the coupling among salience, default mode, and executive control networks related to duration of abstinence and craving before and after drug cue exposure among heroin addicts. Compared with the SA group, with a tendency toward the HC group, the LA group showed lower drug cue-induced craving, stronger connectivity between the dorsal anterior cingulate cortex (a key node of salience network) and left dorsolateral prefrontal cortex and right posterior parietal cortex (key nodes of executive control network), and stronger connectivity between the right dorsolateral prefrontal cortex and precuneus (a key node of default mode network). Meanwhile, the right dorsolateral prefrontal cortex-precuneus connectivity positively correlated with duration of abstinence. The LA and SA groups demonstrated lower connectivity between the left anterior insula (a key node of salience network) and dorsolateral prefrontal cortex and lower connectivity within the left dorsolateral prefrontal cortex, compared with the HC group. Our findings revealed that LA is associated with lower drug cue induced craving and improve the coupling among the three core brain networks in heroin addicts.

Acute Aerobic Exercise Ameliorates Cravings and Inhibitory Control in Heroin Addicts: Evidence From Event-Related Potentials and Frequency Bands.

ObjectiveAerobic exercise is considered a potential adjunctive treatment for heroin addicts, but little is known about its mechanisms. Less severe cravings and greater inhibitory control have been associated with reduced substance use. The aim of the current study was to determine the effects, as measured by behavioral and neuroelectric measurements, of acute aerobic exercise on heroin cravings and inhibitory control induced by heroin-related conditions among heroin addicts.DesignThe present study used a randomized controlled design.MethodsSixty male heroin addicts who met the DSM-V criteria were recruited from the Isolated Detoxification Center in China and randomly assigned to one of two groups; one group completed a 20-min bout of acute stationary cycle exercise with vigorous intensity (70–80% of maximum heart rate, exercise group), and the other group rested (control group). The self-reported heroin craving levels and inhibitory control outcomes (measured by a heroin-related Go/No-Go task) were assessed pre- and post-exercise.ResultsThe heroin craving levels in the exercise group were significantly attenuated during, immediately following, and 40 min after vigorous exercise compared with before exercise; moreover, during exercise, a smaller craving was observed in the exercise group than in the control group. Acute exercise also facilitated inhibition performance in the No-Go task. After exercise, the participants’ accuracy, the N2d amplitudes, and the theta two band spectral power during the No-Go conditions were higher in the exercise group than in the control group. Interestingly, significant correlations between the changes in these sensitive measurements and the changes in cravings were observed.ConclusionsThis is the first empirical study to demonstrate that aerobic exercise may be efficacious for reducing heroin cravings and promoting inhibitory control among heroin addicts.

Bidirectional relationship between heroin addiction and depression: Behavioural and neural studies

Heroin is highly addictive drug that users use in spite of its negative consequences. Many research on drug dependence, persistence and relapse confirmed that there is a relationship between drug addiction and negative mood states. The present review article investigated the relationship between depression, negative mood, and drug abuse. In addition, the article investigated. The relationship between depression, anxiety, and negative mood-induced heroin-seeking behavior. Previous studies pointed out that depression symptoms could be as a result of heroin use, persistence, and relapse and should be considered in the assessment and treatment of heroin addiction. The greater severity attributable to comorbidity suggests that addressing depression and substance use is a complex and poses an increased challenge for treatment, recovery and abstinence.

Huperzine A inhibits heroin-seeking behaviors induced by cue or heroin priming in rats.

Cholinergic systems modulate dopaminergic function in brain pathways are thought to mediate heroin addiction. This study investigated whether huperzine A, an acetylcholinesterase inhibitor, has beneficial effects on heroin reward and heroin-seeking behavior. Rats were trained to self-administer heroin (50 μg/kg/infusion) under the fixed ratio 1 schedule for 14 days and then drug-seeking was extinguished for 10 days, after which reinstatement of drug-seeking was induced by conditioned cues or heroin priming. Acute treatment with huperzine A at dose from 0.05 to 0.2 mg/kg potently and dose-dependently suppressed the cue- and heroin-induced reinstatement of heroin-seeking behavior following extinction. Huperzine A at these doses failed to alter either heroin rewarding effect or spontaneous locomotion activity. The study demonstrated that acute treatment with huperzine A inhibited heroin-seeking behavior, suggesting that huperzine A may be used as an adjuvant treatment for heroin relapse and addiction.

Social support and relapse tendency in Chinese women experiencing heroin addiction: A moderated mediation model of active coping strategies and openness to experience

ABSTRACT Psychological factors play a critical role in the treatment of heroin addiction in women, especially in the prevention of relapse. However, little empirical research has explored how social support, active coping strategies, and openness to experience affect relapse tendency in Chinese women experiencing addiction. In a cross-sectional design, 467 Chinese women experiencing heroin addiction (aged 12–57 years) completed self-report measures of social support, active coping strategies, openness to experience, and relapse tendency. Then, the moderated mediation model was tested. The results show that active coping strategies completely mediated the relationship between social support and relapse tendency. Further, the mediated effect of active coping strategies on relapse tendency was moderated by openness to experience. Surprisingly, the role of social support for Chinese women experiencing addiction as an active coping strategy decreases as the level of openness to experience increases. Because this result seems to be different from results of existing research from Western cultures, we speculate that it may be related to the cultural background of Chinese collectivism. All in all, this study helps to better understand how social support acts on relapse tendencies. More importantly, the study of openness to experience provides some new ideas for addiction treatment and intervention in different cultural contexts. This will serve to sensitize researchers and professionals to the significance of cultural context and the bias of Western norms and values in many psychological measures.

Sulfonate-isosteric replacement examined within heroin-hapten vaccine design

Heroin overdose and addiction remain significant health and economic burdens in the world today costing billions of dollars annually. Moreover, only limited pharmacotherapeutic options are available for treatment of heroin addiction. In our efforts to combat the public health threat posed by heroin addiction, we have developed vaccines against heroin. To expand upon our existing heroin-vaccine arsenal, we synthesized new aryl and alkyl sulfonate ester haptens; namely aryl-mono-sulfonate (HMsAc) and Aryl/alkyl-di-sulfonate (H(Ds)2) as carboxyl-isosteres of heroin then compared them to our model heroin-hapten (HAc) through vaccination studies. Heroin haptens were conjugated to the carrier protein CRM197 and the resulting CRM-immunoconjugates were used to vaccinate Swiss Webster mice following an established immunization protocol. Binding studies revealed that the highest affinity anti-heroin antibodies were generated by the HMsAc vaccine followed by the HAc and H(Ds)2 vaccines, respectively (HMsAc > HAc≫HDs2). However, neither the HMsAc nor H(Ds)2 vaccines were able to generate high affinity antibodies to the psychoactive metabolite 6-acetyl morphine (6-AM), in comparison to the HAc vaccine. Blood brain bio-distribution studies supported these binding results with vaccine efficiency following the trend HAc > HMsAc ≫ H(Ds)2 The work described herein provides insight into the use of hapten-isosteric replacement in vaccine drug design.

Heroin-induced respiratory depression and the influence of dose variation: within-subject between-session changes following dose reduction.

Globally, more than 100 000 people die annually from opioid overdose. Opportunities to study physiological events in at-risk individuals are limited. This study examined variation of opioid dose and impact on respiratory depression in a chronic injecting heroin user at separate time-points during his long-term diamorphine maintenance treatment. A single-subject study over 5years during which participant underwent experimental studies on diamorphine-induced respiratory depression, at changing maintenance doses. A clinical research facility. Participant Male subject on long-term injectable diamorphine (pharmaceutical heroin) maintenance treatment for heroin addiction. Physiological measures of oxygen saturation (SpO2 ), end-tidal carbon dioxide (ETCO2 ) and respiratory rate (RR) were used to indicate severity of respiratory depression. (1) After diamorphine injection, respiratory regulation became abnormal, with prolonged apnoea exceeding 20sec (maximum 56sec), elevated ETCO2 (maximum 6.9%) and hypoxaemia (minimum SpO2 80%). (2) Abnormalities were greater with highest diamorphine dose: average SpO2 was 89.3% after 100mg diamorphine versus 93.6% and 92.8% for the two 30-mg doses. (3) However, long apnoeic pauses and high levels of ETCO2 % were also present after lower doses. With marked inter-session variability, these findings corroborate observations of inconsistent relationships between opioid dose and overdose risk.

GAD1 but not GAD2 polymorphisms are associated with heroin addiction phenotypes

IntroductionHeroin addiction is a chronic complex brain disease that contains multiple phenotypes, which vary widely among addicts and may be affected by genetic factors. A total of 801 unrelated heroin addicts were recruited and divided into different subgroups according to eight phenotypes of heroin addiction. Polymorphisms in GAD1 (rs3762555, rs3762556, rs3791878, rs3749034, rs11532313 and rs769395) and GAD2 (rs2839669, rs2839670 and rs2236418) were genotyped using the SNaPshot assay. Associations between genetic variants and the eight phenotypes were mainly assessed by binary logistic regression. ResultsWe found that the frequencies of G allele of GAD1 rs3749034 and rs3762555 were associated with daily dose of methadone use and memory change after heroin addiction. The C allele frequency of GAD1 rs3762556 was associated with lower daily dose of methadone use. In GAD1, SNPs rs3762556, rs3762555, rs3791878 and rs3749034 had strong linkage, and the frequency of the C-G-C-A haplotype was higher in the lower dose of methadone group. Patients with the TT genotype of rs11542313 were maintained on lower dose of methadone than patients with the CC genotype. The G alleles of rs3762555 and rs3749034 were lower, while the T allele of rs11542313 was higher, in the memory decreased group. The results of association analyses of GAD2 with phenotypes of heroin addiction showed no significant differences. ConclusionGAD1 polymorphisms were associated with phenotypes of heroin addiction, especially the daily dose of methadone use and memory change in the Han Chinese population. These results may provide individualized guidance for the treatment of heroin addiction.

Histone 3 lysine 9 acetylation of BRG1 in the medial prefrontal cortex is associated with heroin self‑administration in rats

Heroin addiction is a chronic relapsing brain disorder with negative social consequences. Histone acetylation serves a role in drug‑induced behavior and neuroplasticity impairment. Brahma/SWI2‑related gene‑1 (BRG1) participates in cerebellar development, embryogenesis and transcriptional regulation of neuronal genes concurrent with histone modifications. However, little is known about the relationship between histone H3 lysine 9 acetylation (H3K9ac) and BRG1 in response to heroin. The present study aimed to assess the contribution of histone 3 lysine 9 acetylation of BRG1 to heroin self‑administration. The present study established a Sprague‑Dawley rat model of heroin self‑administration under a fixed‑ratio‑1 paradigm. Chromatin immunoprecipitation followed by reverse transcription‑quantitative PCR (RT‑qPCR) was used to detect the accumulation of H3K9ac on BRG1 in the medial prefrontal cortex (mPFC) and nucleus accumbens (NAc) following heroin self‑administration. The relative expression levels of BRG1 were analyzed by RT‑qPCR. H3K9ac at the promoter region of BRG1 was significantly elevated (P=0.002), and the expression of BRG1 in the mPFC increased 1.47‑fold in the heroin self‑administration group compared with the control group. No significant difference in H3K9ac at the BRG1 locus was observed in the NAc (P=0.323), with the expression of BRG1 decreasing 1.38‑fold in the heroin self‑administering rats compared with the control group. H3K9ac is associated with transcriptional activation, and the increased BRG1 expression suggested an essential and novel role for BRG1 and its H3K9ac‑mediated regulation in the mPFC after heroin self‑administration; and this may function through epigenetically modulating the activation of neuroplasticity‑associated genes. This association may provide a novel therapeutic target for the treatment of heroin addiction.

Weighted gene co-expression network analysis to explore the mechanism of heroin addiction in human nucleus accumbens.

Heroin dependence is a complex behavioral disease, and a chronic encephalopathy with theimportant feature of relapse. The purpose of the study was to identify the regulatory mechanism of the nucleus accumbens (NAc) in heroin dependence. We used weighted gene co-expression network analysis to analyze the GSE87823 data package, which included 27 heroin users and 22 controls of human NAc tissue. Modules were correlated with basic information of samples and enrichment analyses used to identify biological function and transcription factors and online tools were used to perform the gene ontology of significant genes. We identified one gene module from the total data (blue) and the male data (turquoise), respectively. The overlap genes of top 10 hub genes in significant modules (PRR11, SLC35E1, LPP, ZNF721, ZNF611, LRRFIP1) were selected to identify as candidate genes in the regulation mechanism of NAc in heroin dependence. Then, we accorded the results to further explorethatmiRNA-hsa-miR-155-5p in male and total may be apotential marker. The candidate genes may serve as novel prognostic markers and treatment targets. Hsa-miR-155-5p may be a promising regulatory point for the treatment of heroin addiction.

Health, Social and Economic Costs of Complex Treatment of Heroin Addiction

The use of drugs is a significant health and social problem worldwide. It gets increasingly complicated due to the emerging new challenges that give rise to concerns about public health. Besides the controlled use for medical purposes, around 250 million, (5.7%) of the world population aged 15-64 years, use illegal drugs. The opioid addiction is a mental and behavior disorder with complex bio-psycho-social genesis and chronic recidivistic course. One of the treatment methods is the so-called medication-assisted treatment that is performed by use of opiate agonists (methadone, etc.). Practically, this treatment means administration of the relevant medicine products in combination with a wide range of medical and rehabilitation services to alleviate the adverse medical, psychological and physiological effects that are inherent of opioid addiction. It is presented a good practice of a treatment methadone program by describing the organization of the Methadone Treatment Program at the Mental Health Center of Varna. It is presented an assessment of the effectiveness of the Program and its dynamics over the years as an expression of the health, social and economic costs of complex treatment of heroin addiction

Decision making of individuals with heroin addiction receiving opioid maintenance treatment compared to early abstinent users

Background and aimsIndividuals with heroin addiction are prone to dysfunctional decision-making. They frequently choose the short-term rewarding option of drug intake despite experiencing long-term negative consequences. Opioid maintenance treatment (OMT) is the most common treatment of heroin addiction. MethodsIn this study, 38 individuals in an early stage of abstinence from heroin addiction (ESA-HA individuals) at the end of inpatient detoxification treatment and 41 individuals in long-term OMT were examined. Decision-making was assessed by (I) a modified version of the Iowa Gambling Task (IGT) with drug-related stimuli focusing on decision-making under ambiguity and (II) the Game of Dice Task (GDT) assessing decision-making under objective risk. ResultsOMT-individuals showed significantly better performance in the IGT than the ESA-HA-individuals. They also showed significantly less craving under exposure of drug-related pictures. In the GDT, OMT-individuals showed significantly less risky decision-making than ESA-HA-individuals. ConclusionThe results suggest that patients receiving OMT show better functional decision-making and lower craving reactions. It could be assumed that the effectiveness of OMT in preventing relapse is linked to better decision-making and lower craving among these patients.

Defining and Predicting Opioid and Cocaine Treatment Response

Background: Treatment with methadone is effective in reducing heroin use, HIV risk, and death; however, not all patients respond to treatment. Better outcomes may emerge with personalized treatment based on factors that influence treatment courses. Objectives: To investigate psychosocial variables contributing to treatment response, using a comprehensive definition of treatment response. Methods: Seventy participants seeking treatment for heroin and cocaine addiction completed up to 40 weeks of daily methadone. At week 22, we administered a semi-structured interview for DSM-IV symptoms. We defined opioid treatment responders as people still enrolled at 22 weeks, not meeting past 30-day criteria for DSM-IV opioid abuse or dependence or DSM-5 opioid use disorder, and providing ≥75% opioid-negative urine samples in the 30 days prior to week 22. The same criteria were applied to assess cocaine treatment response. Results: Sample was 71% male, 41% White, and averaged 39.4 ± 7.9 years old. Opioid treatment response was more likely in participants who had been employed over the past 3 years (OR: 8.1, 95% CI: 1.2–55) and less likely in those who spent more time on hobbies (OR: 0.45, 95% CI: 0.23–0.88). Cocaine treatment response was more likely in participants who had a good relationship with their father (OR: 5.3, 95% CI: 1.2–24) and less likely if positive for hepatitis C (OR: 0.15, 95% CI: 0.03–0.75). Conclusions: Pretreatment characteristics differentially predict treatment response for heroin and cocaine use. Similar research in diverse patient groups may aid in the development of personalized treatment combining biologic treatment with targeted psychosocial interventions.

Functional Correlates of Resting-State Connectivity in the Default Mode Network of Heroin Users on Methadone Treatment and Medication-Free Therapeutic Community Program

The treatment of heroin addiction is a complex process involving changes in addictive behavior and brain functioning. The goal of this study was to explore the brain default mode network (DMN) functional connectivity using resting-state functional magnetic resonance imaging (rs-fMRI) and decision-making performance based on the Cambridge gambling task in heroin-dependent individuals undergoing methadone treatment (MT, n = 11) and medication-free faith-based therapeutic community program (TC, n = 11). The DMN involved the medial prefrontal cortex (mPFC), left inferior parietal lobe (IPLL), right inferior parietal lobe (IPLR), and posterior cingulate cortex (PCC) subregions for all participants in both the MT and TC groups. Compared with MT, TC had an increased functional connectivity in IPLL–IPLR and IPLR–PCC and decreased functional connectivity in mPFC–IPLL and IPLL–PCC. Both groups exhibited no significant difference in the regional rs-fMRI metric [i.e., amplitude of low-frequency fluctuation (ALFF)]. In the analysis of the neural correlates for decision-making performance, risk adjustment was positively associated with ALFF in IPLL for all participants considering the group effects. The involvement of IPL in decision-making performance and treatment response among heroin-dependent patients warrants further investigation.

F19ANALYSIS OF BDNF VAL66MET VARIANT AND EXON IV PROMOTER METHYLATION IN AUTISM SPECTRUM DISORDER TRIOS

Heroin addiction is a chronic complex brain disease that contains multiple phenotypes, which vary widely among addicts and may be affected by genetic factors. A total of 801 unrelated heroin addicts were recruited and divided into different subgroups according to eight phenotypes of heroin addiction. Polymorphisms in GAD1 (rs3762555, rs3762556, rs3791878, rs3749034, rs11532313 and rs769395) and GAD2 (rs2839669, rs2839670 and rs2236418) were genotyped using the SNaPshot assay. Associations between genetic variants and the eight phenotypes were mainly assessed by binary logistic regression.We found that the frequencies of G allele of GAD1 rs3749034 and rs3762555 were associated with daily dose of methadone use and memory change after heroin addiction. The C allele frequency of GAD1 rs3762556 was associated with lower daily dose of methadone use. In GAD1, SNPs rs3762556, rs3762555, rs3791878 and rs3749034 had strong linkage, and the frequency of the C-G-C-A haplotype was higher in the lower dose of methadone group. Patients with the TT genotype of rs11542313 were maintained on lower dose of methadone than patients with the CC genotype. The G alleles of rs3762555 and rs3749034 were lower, while the T allele of rs11542313 was higher, in the memory decreased group. The results of association analyses of GAD2 with phenotypes of heroin addiction showed no significant differences.GAD1 polymorphisms were associated with phenotypes of heroin addiction, especially the daily dose of methadone use and memory change in the Han Chinese population. These results may provide individualized guidance for the treatment of heroin addiction.

Fallen Agents: Negotiations of Patient Agency in Norwegian Opioid Substitution Treatment

Based on an ethnographic fieldwork, this article explores how patients in a Norwegian heroin-addiction treatment program negotiate their agency, navigating between policies, medical guidelines, and their own lived experiences as they seek what they perceive as appropriate medication. Outlining these patients’ participation in treatment inside and outside the clinic, I illustrate that different types of agency are involved across these domains. I argue that patient agency is not something one has or does not have, but rather involves the institutional interpretations of these mobilised elements: What kind of agency is appropriate to exert in the Norwegian healthcare system? The analysis highlights the social constructions of the “addicted patient” and raises questions of the value of patient subjectivity and the politically tinged ascriptions of agency manifested in patient rights and guidelines for clinical decision-making.

Positive reinforcement targeting abstinence in substance misuse (PRAISe): Study protocol for a Cluster RCT & process evaluation of contingency management

There are approximately 256,000 heroin and other opiate users in England of whom 155,000 are in treatment for heroin (or opiate) addiction. The majority of people in treatment receive opiate substitution treatment (OST) (methadone and buprenorphine). However, OST suffers from high attrition and persistent heroin use even whilst in treatment. Contingency management (CM) is a psychological intervention based on the principles of operant conditioning. It is delivered as an adjunct to existing evidence based treatments to amplify patient benefit and involves the systematic application of positive reinforcement (financial or material incentives) to promote behaviours consistent with treatment goals. With an international evidence base for CM, NICE recommended that CM be implemented in UK drug treatment settings alongside OST to target attendance and the reduction of illicit drug use. While there was a growing evidence base for CM, there had been no examination of its delivery in UK NHS addiction services. The PRAISe trial evaluates the feasibility, acceptability, clinical and cost effectiveness of CM in UK addiction services. It is a cluster randomised controlled effectiveness trial of CM (praise and financial incentives) targeted at either abstinence from opiates or attendance at treatment sessions versus no CM among individuals receiving OST. The trial includes an economic evaluation which explores the relative costs and cost effectiveness of the two CM intervention strategies compared to TAU and an embedded process evaluation to identify contextual factors and causal mechanisms associated with variations in outcome. This study will inform UK drug treatment policy and practice.Trial registration ISRCTN 01591254.

Prior prescription opioid misuse in a cohort of heroin users in a treatment study

This study investigates prior prescription opioid misuse in a cohort of heroin users whose progress was tracked in a treatment study conducted in the US from 2006 to 2010. Half of the sample misused prescription opioids (“other opiates/analgesics”) prior to their onset of heroin misuse (POBs). We found that POBs were demographically younger and more likely to be white than other heroin users (OHUs). There were differences between the two groups with respect to the reporting of at least one year of regular use of substances and age of onset of substance use. POBs were more likely to report regular use, and earlier onset of use of several substances, mostly of the type potentially obtained via prescription. POBs were more persistent in their opioid use and more likely to suffer near-term elevated depressive symptoms compared with OHUs. These findings suggest that heroin addiction treatment may need to be tailored according to opioid misuse history.

Enlisting the immune system to fight addiction

When Caron Block meets people who don’t understand the struggle of drug addiction, she asks them to imagine that someone has wrapped their head with saran wrap. “You are desperate for a breath; you’d do anything to get that saran wrap off your face so you can breathe,” Block says. That’s how a person dealing with substance abuse feels when having a craving, she explains. “So how horrible is it to have a craving like that and know at the same time that if you shoot up you could die?” Block heard the saran wrap analogy while participating in a program at the Betty Ford Center that was designed for family members of those grappling with a substance use disorder.At the time, her son was receiving treatment for heroin addiction. He’s now 29 and has been sober for six years. Once he got sober, Block started to look into possible