Heroin

Heroin use means the voluntary use of heroin, where people choose to do so.
Dependence is a bit further down the line and involves the compulsive use of heroin, where people are driven to heroin by various internal compulsions.

Although the current epidemic of cocaine use has commanded more attention, heroin remains a serious problem in the United States. For example, the number of hospital emergency department visits related to the use of heroin rose from 38,100 in 1988 to 63,000 in 1993. This is an increase of 65 percent. In addition, some researchers have noted that snorting and smoking heroin may be growing in popularity as alternatives to injecting the drug.

Heroin abuse is defined as the chronic or habitual use of heroin to alter states of body or mind for other than medically warranted purposes. Traditional definitions of addiction involve the criteria of physical dependence and withdrawal, and often an underlying tenor of depravity and sin. These views have been modified by increased understanding with the introduction of new drugs, such as cocaine, that are psychologically or neuro-psychologically addicting. Researchers realized that its stereotypical application to heroin users was invalid because many of them remain occasional users with no physical dependence. Addiction is now more often defined by the continuing, compulsive nature of the drug use despite physical and/or psychological harm to the user and society. It includes both licit and illicit drugs. The term “substance ” is now frequently used because of the broad range of substances (including alcohol and inhalants) that can fit the addictive profile. Psychological dependence is the subjective feeling that the heroin user needs the drug to maintain a feeling of well-being. Physical dependence is characterized by tolerance (the need for increasingly larger doses of heroin in order to achieve the initial effect) and withdrawal symptoms when the user is abstinent.

Definitions of heroin abuse and addiction are subjective and infused with the political and moral values of the society or culture. For example, the stimulant caffeine in coffee and tea is a drug used by millions of people. Because of its relatively mild stimulatory effects and because caffeine does not generally trigger antisocial behavior in users, it is not generally considered drug. This is despite the fact that caffeine is physically addictive. Even narcotics addiction is seen only as drug in certain social contexts.

People use heroin for many different reasons.

Here's a few examples:

To avoid feeling bored,
To fit in with peers,
To have more self-confidence,
To belong to a special "group",
To forget about problems,
To relax,
To feel good.

You'll note that all these reasons are about changing the way people feel. They're about avoiding boredom or loneliness, feeling powerful and part of a group, feeling relaxed, feeling "good" etc. Heroin provides "good" feelings that are otherwise missing from a person's life. That's why people choose to use heroin, at least to begin with.

People who have become physically or psychologically dependent to some degree on heroin often realize that they're using more than they used to. They may then make some effort to reduce their heroin intake. This could involve cutting down the amount taken each time, only using on certain days, switching to another drug (e.g. heroin to methadone) etc. Sometimes attempts to cut down may involve a life change such as moving home or changing jobs. It's very common for such efforts to end in total failure, much to the utter bewilderment and dismay of the individuals concerned. He or she cannot reduce their heroin intake. They're now faced with the fact that their heroin use is beyond their control. It has taken on a destructive force of its own. He or she now needs help to deal this problem.