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Addictions/Co-Dependency Issues

Codependency


Co-dependency is a learned behavior that can be passed down from one generation to another. It is an emotional and behavioral condition that affects an individual’s ability to have a healthy, mutually satisfying relationship. It is also known as “relationship addiction” because people with codependency often form or maintain relationships that are one-sided, emotionally destructive and/or abusive. The disorder was first identified about ten years ago as the result of years of studying interpersonal relationships in families of alcoholics. Co-dependent behavior is learned by watching and imitating other family members who display this type of behavior.

Who Does Co-Dependency Affect?


Co-dependency often affects a spouse, a parent, sibling, friend, or co-worker of a person afflicted with alcohol or drug dependence. Originally, co-dependent was a term used to describe partners in chemical dependency, persons living with, or in a relationship with an addicted person. Similar patterns have been seen in people in relationships with chronically or mentally ill individuals. Today, however, the term has broadened to describe any co-dependent person from any dysfunctional family. 

What is a Dysfunctional Family and How Does it Lead to Co-Dependency?


A dysfunctional family is one in which members suffer from fear, anger, pain, or shame that is ignored or denied. Underlying problems may include any of the following:

  • An addiction by a family member to drugs, alcohol, relationships, work, food, sex, or gambling.
  • The existence of physical, emotional, or sexual abuse.
  • The presence of a family member suffering from a chronic mental or physical illness.

Dysfunctional families do not acknowledge that problems exist. They don’t talk about them or confront them. As a result, family members learn to repress emotions and disregard their own needs. They become “survivors.” They develop behaviors that help them deny, ignore, or avoid difficult emotions. They detach themselves. They don’t talk. They don’t touch. They don’t confront. They don’t feel. They don’t trust. The identity and emotional development of the members of a dysfunctional family are often inhibited.
Attention and energy focus on the family member who is ill or addicted. The co-dependent person typically sacrifices his or her needs to take care of a person who is sick. When co-dependents place other people’s health, welfare and safety before their own, they can lose contact with their own needs, desires, and sense of self.


How Do Co-Dependent People Behave?


Co-dependents have low self-esteem and look for anything outside of themselves to make them feel better. They find it hard to “be themselves.” Some try to feel better through alcohol, drugs or nicotine - and become addicted. Others may develop compulsive behaviors like workaholism, gambling, or indiscriminate sexual activity.
They have good intentions. They try to take care of a person who is experiencing difficulty, but the caretaking becomes compulsive and defeating. Co-dependents often take on a martyr’s role and become “benefactors” to an individual in need. A wife may cover for her alcoholic husband; a mother may make excuses for a truant child; or a father may “pull some strings” to keep his child from suffering the consequences of delinquent behavior.
The problem is that these repeated rescue attempts allow the needy individual to continue on a destructive course and to become even more dependent on the unhealthy caretaking of the “benefactor.” As this reliance increases, the co-dependent develops a sense of reward and satisfaction from “being needed.” When the caretaking becomes compulsive, the co-dependent feels choiceless and helpless in the relationship, but is unable to break away from the cycle of behavior that causes it. Co-dependents view themselves as victims and are attracted to that same weakness in the love and friendship relationships.

Characteristics of Co-Dependent People Are:

  • An exaggerated sense of responsibility for the actions of others.
  • A tendency to confuse love and pity, with the tendency to “love” people they can pity and rescue.
  • A tendency to do more than their share, all of the time.
  • A tendency to become hurt when people don’t recognize their efforts.
  • An unhealthy dependence on relationships. The co-dependent will do anything to hold on to a relationship; to avoid the feeling of abandonment.
  • An extreme need for approval and recognition.
  • A sense of guilt when asserting themselves.
  • A compelling need to control others.
  • Lack of trust in self and/or others.
  • Fear of being abandoned or alone.
  • Difficulty identifying feelings.
  • Rigidity/difficulty adjusting to change.
  • Problems with intimacy/boundaries.
  • Chronic anger.
  • Lying/dishonesty.
  • Poor communications
  • Difficulty making decisions.

Questionnaire To Identify Signs Of Co-Dependency


This condition appears to run in different degrees, whereby the intensity of symptoms are on a spectrum of severity, as opposed to an all or nothing scale. Please note that only a qualified professional can make a diagnosis of co-dependency; not everyone experiencing these symptoms suffers from co-dependency.
1. Do you keep quiet to avoid arguments?
2. Are you always worried about others’ opinions of you?
3. Have you ever lived with someone with an alcohol or drug problem?
4. Have you ever lived with someone who hits or belittles you?
5. Are the opinions of others more important than your own?
6. Do you have difficulty adjusting to changes at work or home?
7. Do you feel rejected when significant others spend time with friends?
8. Do you doubt your ability to be who you want to be?
9. Are you uncomfortable expressing your true feelings to others?
10. Have you ever felt inadequate?
11. Do you feel like a “bad person” when you make a mistake?
12. Do you have difficulty taking compliments or gifts?
13. Do you feel humiliation when your child or spouse makes a mistake?
14. Do you think people in your life would go downhill without your constant efforts?
15. Do you frequently wish someone could help you get things done?
16. Do you have difficulty talking to people in authority, such as the police or your boss?
17. Are you confused about who you are or where you are going with your life?
18. Do you have trouble saying “no” when asked for help?
19. Do you have trouble asking for help?
20. Do you have so many things going at once that you can’t do justice to any of them?
If you identify with several of these symptoms; are dissatisfied with yourself or your relationships; you should consider seeking professional help. Arrange for a diagnostic evaluation with a licensed physician or psychologist experienced in treating co-dependency.


How is Co-Dependency Treated?


Because co-dependency is usually rooted in a person’s childhood, treatment often involves exploration into early childhood issues and their relationship to current destructive behavior patterns. Treatment includes education, experiential groups, and individual and group therapy through which co-dependents rediscover themselves and identify self-defeating behavior patterns. Treatment also focuses on helping patients getting in touch with feelings that have been buried during childhood and on reconstructing family dynamics. The goal is to allow them to experience their full range of feelings again.


When Co-Dependency Hits Home


The first step in changing unhealthy behavior is understanding it. It is important for co-dependents and their family members to educate themselves about the course and cycle of addiction and how it extends into their relationships. Libraries, drug and alcohol abuse treatment centers and mental health centers often offer educational materials and programs to the public.
A lot of change and growth is necessary for the co-dependent and his or her family. Any caretaking behavior that allows or enables abuse to continue in the family needs to be recognized and stopped. The co-dependent must identify and embrace his or her feelings and needs. This may include learning to say “no,” to be loving yet tough, and learning to be self-reliant. People find freedom, love, and serenity in their recovery. 
Hope lies in learning more. The more you understand co-dependency the better you can cope with its effects. Reaching out for information and assistance can help someone live a healthier, more fulfilling life.


Where to Get Help!


Treatment for co-dependency is available at Olive Branch Counseling Associates, Inc. by calling (708)-687-3479
**Information found on this website regarding codependency can be found with additional information at http://www.nmha.org/infoctr/factsheets/43.cfm

 

Addictions

When habits or behaviors such as drinking, drug taking or gambling come to dominate daily life and people find themselves powerless to stop the chaos despite many promises to do so, then it is very likely that an addiction is active. Addictions can be formed to any activity or behavior which allows people to escape from life and its problems and includes shopping or spending, sexual activities, gambling, food, prescribed and illegal drugs, alcohol and even other people. There is a growing problem in drug and alcohol abuse amongst young people. Fortunately, it is a highly treatable condition and this web site is set up to help people learn about the illness and sources of help.

Alcohol Addictions

As with all addictive behavior problems, it is very difficult for a person to acknowledge the existence of a drinking problem and this means that people suffer for many more years than is necessary. It is often confused with recurring depression and high anxiety levels which are not relieved by conventional treatments, and a failure to identify the role of alcohol in these conditions often means a failure to refer for the correct treatment.

How common is it?


Alcohol Dependency is by far the most common addiction and is responsible for the deaths of many thousands of people every year. Government figures suggest that up to 9.7% of the UK population may be classified as dependent on alcohol.

How do I know if I have it?


People who are concerned should always seek professional assessment. Some symptoms are more easily detected: 1) loss of control once drinking has started; 2) withdrawal symptoms ranging from mild tremors to frightening hallucinations; 3) Noticeable changes in the effects alcohol has on the individual over time.

How do people develop it?


The condition is characterized by the fact that the sufferer, despite many attempts at control, finds that their drinking and the attendant consequences continues to get worse over the period, and the dependent person's guilt, shame and remorse levels become increasingly more burdensome. Attempts to stop can result in withdrawal symptoms which are relieved by taking more alcohol. Attempts at control ('just a couple of drinks won't hurt') almost always end in drunkenness, and things seem to get progressively worse. In extremes, suicide may seem the best option as depression and severe anxiety coupled with feelings of hopelessness and helplessness often accompany addiction to alcohol.

Can it be inherited?


Although an actual gene has not been identified there is considerable evidence of genetic predisposition to the illness, through studies of twins and apocryphal evidence.

Can it be cured?


Alcoholism is almost impossible to overcome alone, but with the help of others, a large number of people find recovery.

Drug Addictions


Everyone will have their own picture of what a drug addict is. It may be the image of the junkie shooting up heroin, and although this may represent one facet of drug addiction the vast majority of addicts do not conform to this stereotype. Addiction can affect anyone and there are many drugs, both legal (for example tranquillizers and sleeping tablets etc.) and illegal (cocaine, cannabis etc.) that people can become addicted to. 

How common is it?


Department of Health statistics for a six month period to 30th September 1999 report a 7% increase over the previous period in the number of people seeking help from drug misuse agencies. Heroin was the most commonly used drug (59%) followed by cannabis, methadone, amphetamines and cocaine. It is estimated there were over 72,000 drug overdoses in 2017, with 30,000 overdose deaths related to fentanyl (an opioid).

How do I know if I have it?


People who are concerned should always seek professional assessment.

Can it be inherited?


There is growing evidence that there is a genetic predisposition to addiction, but addictions are also common in people with no genetic predisposition, especially in the area of drug addiction.

Gambling Addictions


Like all addictions, Gambling or risk taking involves escaping from reality. It is not just the actual risk, but the whole panoply of events leading up to taking the risk and the fantasy which surrounds it. The process of addiction and the inherent Denial processes prevent the sufferer from seeing the reality of what is happening. The belief that the next risk will be the one which will put everything right, the delusory sense of certainty about the outcome combine to convince the person that just one more risk is essential. 

How do I know if I have it?


The consequences of compulsive gambling can be catastrophic. Not only are enormous debts accrued, but these may well have been increased through the use of loan sharks and other unsavory sources which can place the life of the person and their family or friends in jeopardy. 

How do people develop it?


As with all addictions, the sufferer seeks escape from the mounting anxiety and depression which accompanies high levels of guilt, shame and remorse, by taking yet more risks. Common sense does not apply in addictions, the person is powerless to find a solution on their own and their lives descend into more and more chaos. 

Can it be cured?


Also, in common with all addictions, help is available and treatment is highly effective, restoring people to normal functioning and happiness.


Shopping Addictions

People use what is called retail therapy as a way of enjoying themselves. The normally buy items for which they have a need or have developed a desire for. Compulsive or addictive shopping is not like that, it is a form of behavior designed to avoid unpleasant reality, and is accompanied by a high which causes the sufferer to lose control and buy many items for which they have no need. The adrenaline rush, the fantasy which surrounds the episode and everything which precedes the actual spending spree all add to the sense of unreality which brings a false sense of freedom from life's problems.

How common is it?


It is difficult to ascertain the full extent of this problem as statistics have not been compiled, although it is known that more people are identifying this as a problem and seeking professional help.

How do I know if I have it?


As with all addictions, the resulting overwhelming sense of shame, remorse and guilt accompanied by feelings of hopelessness and helplessness, lead to despair. Often the remedy for the despair is more addictive behavior resulting in more self destructive feelings. The consequences of shopping addiction are obvious: high levels of debt, fear of discovery and retribution leading to more denial and desperate acts to cover up the behavior. For those closely connected to the sufferer life becomes frightening and unpredictable with a growing sense of uselessness and the belief that the sufferer is deliberately causing chaos and a feeling of desperation sets in. 

Can it be cured?


Many sufferers are multi addicted, often abusing prescribed drugs or alcohol in addition to the compulsive spending. The despair can be ended through successful treatment and people can be restored to normal life. As with other addictions, success follows an honest admission of the problem and the seeking of help from others.

Sex Addictions

Sex is a powerful driving force, and for some people it becomes an all pervading preoccupation which can lead to dangerous behaviors and life threatening habits. Like any source of pleasure, sex can become addictive, in which case it becomes distorted and is used as a means of escape from the problems of everyday life. Like all addictions it becomes self perpetuating, participation in the act becoming necessary as a way of avoiding the overwhelming sense of shame, remorse and guilt. Rather than deal with the problem, fantasizing about the next or some past sexual activity leads to a feeling of comfort and encourages the sufferer to proceed to turn the fantasy into reality. 

How do I know if I have it?


The consequences of this addiction are many, from social rejection to suicide. Many sufferers are arrested and imprisoned without being offered help. They may have hurt others in their pursuit of the addiction and are overcome by remorse and guilt. Those who are closely connected to them suffer grievously either directly or indirectly and share in the growing sense of hopelessness and helplessness which can often lead to suicide. Help is available and many sufferers do manage to find a way forward which can help restore them to normal functioning and heightened self worth. As with other addictions, success follows an honest admission of the problem and the seeking of help from others who understand the nature of the problem and will not seek to judge them. There is a questionnaire on this web site that will help you decide whether you need to seek help.

Can it be cured?


Treatment is available at counseling facilities

Food Addictions


Bulimia nervosa is characterized by cycles of bingeing and purging. Bulimia nervosa usually begins early in adolescence when young women attempt restrictive diets, fail, and react by binge eating. In response to the binges, patients purge by vomiting or by taking laxatives, diet pills, or drugs to reduce fluids. Patients may also revert to severe dieting, which cycles back to bingeing if the patient does not go on to become anorexic. Eating binges prior to purging average about 1,000 calories, but intake during a binge can be as high as 20,000 or as low as 100 calories. Patients diagnosed with bulimia average about 14 episodes of binge-purging per week. People with bulimia that does not progress to anorexia have a normal to high-normal body weight, but it may fluctuate by more than 10 pounds because of the binge-purge cycle. Compulsive Overeating may not involve purging in the same way as bulimia, but is equally damaging in terms of physical and mental health.

How common is it?


It is particularly common in young women, although more men are now being diagnosed with eating disorders of one form or another. Many sufferers also have other forms of addiction.

How do I know if I have it?


One of the most bewildering symptoms of eating disorders is the distorted body image. Although people typically associate distorted body image with severe anorexia, one study indicated that distortion is even more likely in people with bulimia. They were more likely to overestimate their size, and there was a greater disparity between what they wanted to look like and what they believed they looked like than in people with anorexia or with no eating disorders. In another study, people with anorexia tended to have an accurate perception of their upper body, but overestimated the size of their abdominal and pelvic area. 

How do people develop it?


There is no single cause for eating disorders. All are rooted in emotions, however, which are triggered by one or more factors or events, including cultural and family pressures, chemical imbalances, and emotional and personality disorders. Genetics may also play a role. 

Can it be cured?


The first major difficulty in treating eating disorders is often the resistance of the patient, who believes that the emaciation is normal and even attractive, or the patient who feels that purging is the only way to prevent obesity. Even worse, the anorexic condition may be encouraged by friends who envy thinness or by dance or athletic coaches who encourage low body fat. The family itself may deny the problem and be obstructive or manipulative, adding to the difficulties of treatment. It is very important that the patient and any close friends and relatives be informed about the serious potential of these conditions and the importance of receiving immediate help.
Eating disorders most commonly begin in adolescence, particularly in girls and young women, although boys and young men can be affected. Eating disorders interrupt normal growth and development and at the most severe can be life threatening.

How do I know if I have it?


Having an eating disorder means being controlled by an obsession with food. It could mean being 60kgs overweight, planning diets which are regularly broken and living with feelings of shame, or a distorted body image, thinking that one is fat when, in fact, one is dangerously underweight. Having an eating disorder is being caught in a destructive cycle of compulsive behavior characterized by low self worth, secretiveness, isolation, feelings of loss of control, guilt and great misery. Coping with an eating disorder is a considerable challenge for sufferers and their families. As with other addictions recovery is very possible, and compulsive behavior can be changed.

Can it be cured?


As with other addictions recovery is very possible, and compulsive behavior can be changed. Help is available through various organizations.

Addictions and Young People

Everyone will have their own picture of what an alcoholic, or drug addict is. It may be the image of the old man on the park bench drinking, or the junkie shooting up heroin. The fact is that whilst these images may represent addiction in one form, the vast majority of addicts are not like this. Solvent abuse may be the beginning of an addiction problem which can affect anyone, including people in their teens and early twenties. If recognized and acknowledged early addiction does not have to have the devastating consequences that prolonged drinking or drug taking can cause. 

How common is it?


There is growing evidence of an increase in the number of young people that are drinking and using other drugs problematically, especially in Northern Europe.

How do I know if I have it?


The common symptoms of addiction are preoccupation with using addictive substances, finding you need more in order to achieve the desired effect, loss of control once you have started using, withdrawal symptoms such as shaking excessive sweating and vomiting. Some people experience visual or auditory hallucinations. Feelings of paranoia can also be as a result of drug use. Complete a self assessment questionnaire on this site, and/or seek a professional assessment of your problems.

Can it be inherited?


Addiction can be seen as an illness and there is evidence to support a theory of genetic predisposition. This is not always the case however and if you feel that you are using substances problematically you should seek further help.

Can it be cured?


Addiction is almost impossible to overcome alone, but with the help of others, a large number of people find recovery.

Facts about Addictions


Alcohol and drug abuse disorders constitute one of our society's greatest health concerns.


Alcohol and Drug Abuse and Addiction Prevalence


Alcohol and other drug abuse and addiction are major problems for the nation's youth, adults and families. According to the 1999 National Household Survey on Drug Abuse, an estimated 14.8 million Americans are current users (use within past 30 days) of illicit drugs such as sedative-hypnotics or barbiturates, opiates, hallucinogens and stimulants. (SAMHSA 2000) 
An estimated 3.6 million people met the diagnostic criteria for dependence on illicit drugs (SAMHSA 2000) Alcoholism, or alcohol addiction, is a progressive disorder and afflicts approximately 8.2 million adults and youth in the U.S. (SAMHSA 2000)
Alcohol and other drug abuse and addiction are major social problems. They affect both men and women, impact all cultures, and are experienced by people of all ages. In the United States, the rates are lower in women than in men, higher in young adults (18-29) than in seniors (65 or more). The incidence of addiction and other substance abuse related problems, as well as the types of substances abused, vary among the major U.S. ethnic groups.
According to the 1999 National Household Survey on Drug Abuse, about 14.8 million Americans had used an illicit drug—a stimulant (upper), a sedative (downer), or a hallucinogen--within the thirty days prior to the survey. Drug addiction could have been diagnosed at that time in about 3.6 million people over the age of 12, including 1.5 million people addicted to both illicit drugs and alcohol. 
Alcohol, while legal when used by adults, can be misused, abused and lead to addiction. An estimated 8.2 million adults and 3 million youth in this country suffer from alcoholism (alcohol addiction), which is a chronic, relapsing disorder. Many more use alcohol dangerously. About 45 million people, including 6.8 million under age 21, had “binged” (taken 5 or more drinks) once during the 30 days before the study. More than 12 million individuals, including 2.1 million youth, were “heavy drinkers” who had taken 5 or more drinks for 5 or more days.  

RISK FACTORS FOR SUBSTANCE ABUSE PROBLEMS:


The causes of alcohol or other drug abuse and addiction are complex, with heredity, environment, and social factors all playing a part. However, some specific risk factors are associated with substance abuse by youth.  These risk factors are:
A chaotic home environment (children of alcohol and other drug-dependent parents are at higher risk for developing substance abuse, mental health and related problems)

  • Ineffective parenting;
  • A lack of rewarding and nurturing relationships;
  • Poor social and coping skills;
  • Failure in school;
  • Inappropriately shy and/or aggressive behavior;
  • Affiliation with deviant peers; and
  • The perception that parents, teachers, and other key adults in the community approve of drug abusing behavior

It is particularly important to address risk factors early. The younger a person starts drinking or using drugs, the more likely that person is to develop an addiction.  In fact, young people who begin to drink or use drugs before the age of 15 are 4 times more likely to become addicted than if they wait until they are 21 to drink, regardless of other hereditary or environmental factors.


SIGNS AND SYMPTOMS OF ABUSE AND ADDICTION:


While a professional assessment is necessary to accurately diagnose a substance abuse or addiction problem, the CAGE instrument provides a self-administered tool for alcohol and other drug abuse screening in educational and primary care settings. The CAGE is comprised of four questions related to behavior surrounding drinking, not directly to clinical diagnostic issues.


C – Have you ever felt the need to Cut down on your drinking/drug use?
A – Do you get Annoyed at criticism by others about your drinking/drug use?
G – Have you ever felt Guilty about your drinking/drug use or something you have done while drinking or using other drugs?
E – Eye-opener: Have you ever felt the need for a drink early in the morning?


One positive answer provides an indication that the person may be at risk for developing a problem with alcohol or other drugs.  Feedback about this potential problem can provide valuable information to an individual, especially if that person has a family history of alcoholism or other drug addiction or has other risk factors for his or her own substance abuse problems.


COSTS: Alcoholism and substance abuse tear at the fabric of the whole community, hurting families, businesses, and neighborhoods, disrupting education, and choking the criminal justice, health, and social service systems.  Drug abuse kills 14,000 Americans every year.  The monetary costs also are astounding. In 1992, additional health care, extra law enforcement, auto accidents, crime, and lost productivity cost taxpayers about $246 billion.  Alcoholism accounted for most of that amount ($148 billion); the remaining $98 billion cost is attributed to the abuse of other drugs. 


PREVENTION: Effective prevention programs teach skills and promote the development of factors that are known to help reduce the risk of drug use. These protective factors include having strong bonds with family, involved parents who communicate rules clearly; success in school; strong bonds with institutions that support society (such as family, school, and religious organizations); and a belief that drug use is unacceptable. 


RECOVERY:  Achieving abstinence from using drugs is the primary goal of recovery. The recovery process is enhanced for some people by involvement in individual and group therapy to increase understanding of the addiction process, behavior and motivations, enhance self-esteem and teach life skills. Self-help groups such as Alcoholics Anonymous and Narcotics Anonymous offer the recovering person a supporting network of peers struggling with similar issues. Al-Anon and Alateen groups assist family members in dealing with the issues resulting from the impact of addiction and the changes that take place during recovery. 


RESEARCH: New instruments and techniques have given scientists a better understanding of the effects of alcohol and drug use on the brain, and clearly established addiction as a disorder with significant changes in the brain function that persist long after drug taking has stopped. Medications have been designed that may improve the treatment of alcoholism and drug addiction and abuse, although there is ongoing debate about the wisdom of treating substance abuse with other substances. Research continues and promises to change the landscape of addiction treatment in years to come.


RELATED MENTAL HEALTH ISSUES: Co-occurring mental health and substance abuse disorders are common. More than half (52 percent) the people surveyed who had ever been diagnosed with alcohol abuse or dependence had also experienced a mental disorder at some time in their lives. An even larger proportion (59 percent) of people with a history of other drug abuse or dependence also had experienced a mental disorder. Mental health problems often predate substance abuse problems by 4-6 years; alcohol or other drugs may be used as a form of self-medication to alleviate the symptoms of the mental disorder. In some cases, substance abuse precedes the development of mental health problems. For instance, anxiety and depression may be brought on as a response to stressors from broken relationships, lost employment, and other situations directly related to a drug-using lifestyle.


            Treatments for Addictions


Detoxification
Detoxification is a process of facilitating safe withdrawal from drugs or alcohol. Withdrawal without medical assistance can be dangerous or life threatening (particularly in the case of alcohol) in some cases and medical advice should always be sought before undertaking it alone. Detoxification centers are provided by public, private and voluntary agencies. Services will vary according to your area. Local telephone directories should list help services.


Inpatient Care
Intensive inpatient treatment programs vary from 4 weeks to 6 months dependent on individual need and program options at the selected facility. Assessment should be sought in order to identify appropriate treatment.


One to One Counseling
This service is provided by some voluntary organizations and private sector providers. As the name suggests it is a less intensive therapy usually involving sessions of about one hour per week. This is also offered as an addition to other programs.


Where to Get Help!
Treatment for addictions is available at Olive Branch Counseling Associates, Inc. by calling (708) 633-8000
**Information found on this website regarding addictions can be found with additional information at http://www.addictions.co.uk/index.asp and http://www.nmha.org/substance/factsheet.cfm

https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

More information on heroin addiction can be found at:

https://www.help.org/guide-to-heroin-addiction/