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I keep hearing that "*Heroine is so addictive the very first dose is enough to get you hooked on it*".

Personally, I have a hard time believing any substance could do that to you. But I could believe people spreading that idea to discourage people from consuming it.

Now obviously, I have zero desire to test that hypothesis myself. :P

Still, I'm curious. Does anybody know papers that shed some light on this matter?

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"The United Nations World Drug Report 2013 estimated that approximately 16.5 million people worldwide aged 15 or older used heroin or opium. Of these users, approximately 23% are estimated to develop opioid dependence."

This is from the introduction section of Hser, Y. I., Evans, E., Grella, C., Ling, W., & Anglin, D. (2015). Long-term course of opioid addiction. Harvard review of psychiatry, 23(2), 76-89.

They cite: United Nations Office on Drug and Crime. World drug report 2013. Vienna: UNODC, 2013.

&

Anthony JC, Warner LA, Kessler RC. Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: basic findings from the National Comorbidity Survey. Exp Clin Psychopharmacol 1994; 2: 244–68.

There are various factors that push that probability up or down, sex, age, personality factors, circumstantial factors, some people would have a higher probability, some lower. But the base-rate probability is roughly 1 in 4. For perspective, it's worse odds than Russian roulette (1 in 6), but better odds than unprotected sex leading to an unplanned pregnancy (somewhere around 1 in 3, depending on various things). If you're comfortable with the folk-wisdom of either "Russian roulette will kill you" or "sex leads to pregnancy" you should also be comfortable with the statement "heroin will get you hooked". Sure, they're all approximations, but not terribly misleading ones.

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Short answer
Addicition is defined as: repeated involvement with a substance or activity, despite the substantial harm it now causes, because that involvement was (and may continue to be) pleasurable and/or valuable. The 'repeated involvement' basically excludes any drug from a diagnosis of addiction after first-time use. Addiction is a behavioral dependence characterized by repeated and prolonged abuse. So because of the criteria needed to be medically 'addicted', a one-time drug use cannot lead to a diagnosis of addiction.

Background
This question is a matter of definition. The question hinges on the use of the term 'addiction'. Addiction is diagnosed as such using the following criteria:

  1. Impaired control
  2. Social impairment
  3. Risky use
  4. Pharmacological indicators (tolerance and withdrawal)

Impaired control may be evidenced in several different ways, namely 1) using for longer periods of time than intended, or using larger amounts than intended; 2) Wanting to reduce use, yet being unsuccessful doing so; 3) Spending excessive time getting/using/recovering from the drug use; 4) Cravings that are so intense it is difficult to think about anything else.

Social impairment is related to the addiction being defined as repeated involvement with a substance or activity, despite the substantial harm it now causes, because that involvement was (and may continue to be) pleasurable and/or valuable. Social impairment is one type of substantial harm (or consequence) caused by the repeated use of a substance or an activity. For example, people may continue to use despite problems with work, school or family/social obligations. This might include repeated work absences, poor school performance, neglect of children, or failure to meet household responsibilities. Addiction may also be indicated when someone continues substance use despite having interpersonal problems because of the substance use. This could include arguments with family members about the substance use, or losing important friendships because of continued use. In addition, important and meaningful social and recreational activities may be given up or reduced because of substance use. A person may spend less time with their family, or they may stop playing golf with their friends.

Risky Use; the key issue of this criterion is the failure to refrain from using the substance despite the harm it causes, as addiction may be indicated when someone repeatedly uses substances in physically dangerous situations. For instance, using alcohol or other drugs while operating machinery or driving a car. Some people continue to use addictive substances even though they are aware it is causing or worsening physical and psychological problems. An example is the person who continues to smoke cigarettes despite having a respiratory disorder such as asthma or COPD.

Pharmacological indicators: Tolerance and Withdrawal. For many people, tolerance and withdrawal are the classic indicators of advanced addiction. As such, these are particularly important concepts. This criterion refers to the adjustment the body makes as it attempts to adapt to the continued and frequent use of a substance. Tolerance occurs when people need to increase the amount of a substance to achieve the same desired effect. Withdrawal is the body's response to the abrupt cessation of a drug, once the body has developed a tolerance to it. The resulting cluster of (very unpleasant and sometimes fatal) symptoms is specific to each drug.

A person needs to meet at least 2 of these criteria to be diagnosed with a substance-use disorder. The severity of addiction is determined by the number of criteria met. In any of the criteria a matter of prolonged use is characteristic.

Sometimes craving is also included in the criteria list.

Source
- ASAM
- Horvath et al., AMHC (2017)

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    $\begingroup$ Thank you for that. However, I do feel your answer is not necessarily complete yet. Is there anything on how likely one is to develop a condition from that one-time use? Going by the definition you provided, "cravings that are so intense it is difficult to think about anything else" coupled with withdrawal would be enough to justify a diagnosis of "substance-use disorder", for example. $\endgroup$ – User1291 Sep 9 '18 at 23:55
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    $\begingroup$ @User1291 - The definition includes ....repeated involvement with a substance or activity,.... I know this is not what you are after, but what I'm saying is that a diagnosis of addiction needs repeated use. Hence you can never tell whether that one shot did lead to addiction. Addiction is a habit, it becomes a way of life. It doesn't occur after a single shot, per definition. $\endgroup$ – AliceD Sep 10 '18 at 7:55
  • $\begingroup$ @User1291 I think you need to carefully dissect addiction, dependence, tolerance and withdrawal and perhaps consider asking a new question if you are interested in just one of the characteristics of addiction. By the looks of it, a new question for you may be whether a single shot of heroin may lead to dependence and/or cravings. That is not the same as a full blown addiction. Note that there are two answers in place here and gross edits of this post are discouraged - if you think my comment makes sense, ask a new question. $\endgroup$ – AliceD Sep 10 '18 at 7:58
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    $\begingroup$ @AliceD Great answer, as usual. I believe what the OP is asking though, is something along the lines of: "Out of all people that try heroine once, how many people end up becoming addicted (within x time period)?" Your main answer that they are not instantaneously addicted is of course a valid one, but I presume you can infer this is the question the OP is really asking. $\endgroup$ – Steven Jeuris Sep 22 '18 at 16:41
  • $\begingroup$ @StevenJeuris Thanks for the compliment :) It's a difficult question to interpret for sure, but it is interesting though and great to see that other folks also took a bash at it. $\endgroup$ – AliceD Sep 22 '18 at 18:50

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