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The Comedy of Errors

Through the eye of a needle

10 August 05 words: Anonymous
I've decided not to tell my parents that my adorable boyfriend of nearly a year is actually a heroin addict

I’ve decided not to tell my parents that my adorable boyfriend of nearly a year is actually a heroin addict. I think it might disappoint them somewhat.

They would feel appalled that they have allowed this loathsome creature into their home, even rewarded him with such treats as roast beef and Yorkshire pudding. They would also advise me to get shot of him so he could go back to a life of looking shifty on street corners, selling the Big Issue and mugging old ladies to fund to his habit. The thing is, this stereotype doesn’t really ring true. He is thoughtful, sensitive and bright. He has a decent job. You’ll find him helping old ladies across the street, not rifling through their purses. In short, he’s a nice lad who has recently suffered the agony of relapse after a year of being clean and doesn’t really know where to turn next.

This situation is not uncommon. Though impossible to judge accurately, an estimated 270,000 people use heroin in the UK. Up to 90% of heroin in Europe is grown from poppies in Afghanistan. Since the fall of the Taliban, who imposed a strict ban on the growing of poppies, there has been an explosion in the illegal drugs trade, and a bumper harvest of heroin is making its way onto our streets. Heroin is thus easier to get hold of than ever before and more and more people are being lured into trying it. Many find heroin to be a pleasant escape from an unpleasant reality, people who have suffered abuse and mental torture. But many others, my boyfriend included, have no obvious trauma to escape from. Is it just bad luck, then? A case of being in the wrong place at the wrong time? Scientists argue that there is a strong genetic basis for addiction.

A study on identical twins, fronted by Dr. David Goldman, showed that genetic factors are likely to be the main risk factor for heroin addiction, accounting for over 50% of cases. “Drug addictions join a series of other conditions, for example, lung cancer, cardiovascular disease, acquired immunodeficiency syndrome and alcoholism - that are recognised as common, complex, genetically influenced diseases,” Goldman summarised.

These are perfectly valid explanations as to why someone may decide to take heroin in the first instance. Yet why is it a continuing problem? 95% of people trying to come off the drug will go on to relapse. Physical dependence occurs very quickly. “When I started out, I injected heroin every day for a fortnight,” explains Jane (note: names have been changed) a 24-year-old addict. “When I stopped, I was violently ill with sickness, diarrhoea and muscle cramps. All I could think of was getting some more to make it go away.”

After a while, users do not take heroin to feel its euphoric rush; they have to take it to achieve normality. The brain and body have adapted to being constantly bombarded with the drug so they cannot function without it, and coming off seems impossible. This leads to a downwards spiral, as Jane goes on to explain. “I didn’t see the point in spending so much money just to feel normal, so I thought I might as well spend a bit more, take a bit more and actually feel good.”

But the psychological forces which drive people to take heroin are just as brutal as the physical horrors of withdrawal. Cravings are all-consuming, addicts are unable to concentrate on anything else when one occurs. And it’s not simply the desire for the drug’s effects, the act of actually doing a deal and buying the heroin is a powerful compulsion. Also, users can get fixated on the process of actually injecting which Dave a 28-year old addict explains. “Whenever I’ve tried to come off, I’ve seen needles everywhere. I can’t think of anything but piercing my vein with a needle. There have been times when I’ve sat in the bath with a syringe and injected myself with water, just to fulfil that need.” Though shocking, this is a fundamental part of any addiction. Nicotine inhalers and alcohol-free lager are testament to this, their success owing to the fact that addicts feel like they are using their particular poison.

Coming off, therefore, requires both physical and psychological treatment. Methadone is a form of heroin taken as a tablet, which is much less dangerous than injecting, and lessens the cravings for heroin. It is prescribed in measured amounts by a GP or a drug clinic. However, the doses of methadone are incomparable to street doses of heroin, so it may not be sufficient to stabilise the drug habit. Naltrexone is a drug which blocks the effects of heroin. It can be taken following withdrawal to try and prevent relapse, but its side effects of anxiety and depression can be as bad as the withdrawal itself. For those who can’t afford a rehabilitation clinic, there is a vast range of psychotherapy, group therapy and counselling available, which is extremely effective. Actually getting this help, though, is a different story. Users may be sent away from clinics until they test clean, with no help being offered for actually coming off. GPs refer patients to overrun clinics for which there is a 5 week long waiting list (too long to go without help for even the most determined of souls).

Finally, Narcotics Anonymous (NA) is an organisation where addicts meet to help each other stay clean. Many recovered addicts attribute their success to the long-term follow up with NA. Even NA has its dangers, though. “After my first NA meeting, I bumped into a dealer hanging round outside,” says Stephen, a 23-year old heroin addict. “It was awful to just have it thrust in my face when I was trying so hard to stay clean. I didn’t go again.”

Drug dealers sometimes target NA and other groups’ meetings, seeing it as a goldmine for vulnerable addicts. While a lot of people at will feel strong enough to say no, it can be very difficult for someone who has just come clean and is trying to avoid temptation at all costs. Different therapies suit different people, most recovering addicts will have tried several. There is no clear-cut solution to heroin addiction, no “cure”, but help is required and should be more readily available.

As for my boyfriend, he has lied to me, shouted at me, borrowed money off me and baffled me. But I know that I’m not completely blameless. I knew what he was before I got together with him, but I chose to live in a cosy fog of denial, frantically papering over the cracks and refusing to see anything but the perfect picture. Heroin addiction is not a problem which is diminishing, it is a problem which is being ignored by society at large. Heroin addicts are not dirty, they are not repulsive, and they should not be shunned. They are very unfortunate people who, for whatever reason, have contracted a chronic, lifelong disease, and need all the help they can get in managing it. I don’t know if my man will get off heroin. I don’t know if we’ll stay together. But I feel proud of him for even attempting to come through this atrocity and I hope he manages to get through the clouds, see the sunshine and rediscover reality.

Heroin: the facts
• Street names: Heroin, Brown, Dark, Smack, Skag, Gear
• Class: A
• Can be intravenously injected or ‘skin popped’ (subcutaneous injection into the bottom or thigh), smoked or snorted
• The Buzz: euphoria, a trance-like dreamy state called a gauch (user appears to be asleep or struggling to stay awake) after an initial enlivened, talkative state when injected intravenously which lasts for a matter of minutes at most, a sense of calm and contentment, a warm flushing of the skin, a warm feeling throughout the whole body (‘central heating for adults’): can make you feel immune to the cold, dry mouth, heavy arms and legs, feeling of intense relief, lethargy. Is often injected simultaneously with crack cocaine; the crack taking effect immediately and dropping you onto heroin’s more mellow content buzz.
• The risks: fatal overdose, miscarriage, collapse of veins, loss of limbs/ fingers/ loved ones/ life, HIV, hepatitis, infective endocarditis, abscesses and liver disease

Useful organisations:
• Narcotics Anonymous national helpline 0207 7300009 (www.ukna.org)
• Families Anonymous (for family and friends of drug addicts) helpline 0845 1200 660 (www.familiesanonymous.org)

Reference:
Goldman D. Bergen A. General and specific inheritance of substance abuse and alcoholism. Archives of General Psychiatry. 55(11):964-5, 1998

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