The Drug Experience: Heroin, Part 3

In the last Briefing, we started to describe the experiences of people whose lives are seriously affected by heroin. The experiences are based on those described in the seminal book Beating the Dragon: The Recovery from Dependent Drug Use by James McIntosh and Neil McKeganey, and our own research with clients on the Peterborough Nene Drug Interventions Programme.

The recognition by individuals that they are addicted to, or dependent on, heroin can take anywhere from a few weeks to several months or even years, depending upon the amount of drug being used, the frequency with which it was being taken, and the person’s ability to fund their habit.

For the majority of individuals in each of the above research studies, the recognition that they were addicted usually came from the experience of withdrawal symptoms which arose when they purposefully attempted to stop using the drug, or through not having heroin available. The most common reason for being deprived of heroin is a lack of money to purchase the drug.

These withdrawal symptoms disappeared when heroin was used again. Some people are actually surprised to find that they actually needed heroin to function normally. They were no longer in control of their drug-taking; rather, it was controlling them.

These withdrawal symptoms included stomach cramps, vomiting and retching, muscle pains, the shakes, hot and cold spells, and headaches. Some people experience considerable discomfort and pain, and seek out the drug to escape or avoid this discomfort and pain.

The authors of Beating the Dragon: The Recovery from Dependent Drug Use describe Michael’s experience, who was taken to prison at a time of his drug-using career that he had never experienced withdrawal, and never considered the possibility that he might be addicted to the drug.

Once he started to experience withdrawal in the police cell, Michael started to ask for help believing that there was something wrong with him. The policeman knew what was wrong and asked, ‘Did your pals not tell you this?’

Michael continued:

‘But, as soon as I got out next day, I went straight for a hit and that was me, within seconds I was brand-new again. So that was me, I wasn’t usin’ it for fun anymore, I was usin’ it ‘cos I had to use it.’

Being deprived of the heroin they are using, for whatever reason, is absolutely fundamental to an individual’s realisation that they are addicted to heroin. In the absence of such enforced abstinence, and its physical consequences, it is possible for a person to maintain a belief that whilst they are using heroin they are doing so out of choice, rather than because they are dependent on the drug.

Heroin users will say that, apart from the experiences associated with withdrawal, there is little to indicate that they have become addicted to the drug.

“There’s no sign that says, ‘you’re now entering addiction’, there’s no big sign that says, ‘you’ll need to stop now, if you go once more that’s you’. You just cross that line and you don’t realise you’ve crossed it until you try to stop. I didn’t think about withdrawal symptoms or anything like that ‘cos I always had access to money.” (from Beating the Dragon: The Recovery from Dependent Drug Use)

When heroin users realise that they addicted to the drug, they respond in a number of ways. Some accept that they are addicted to the drug, but decide not to do anything about it at this time as they are enjoying using heroin and/or the drug-using lifestyle. They are also able to fund their habit.

Other users do not want to continue using the drug, but they soon discover that it is not just a simple case of stopping. This becomes a difficult and often emotional time as they realise that they have no choice. They have to continue using the drug to avoid the physical symptoms of withdrawal.

Some of our interviewees described becoming depressed, others either considered or tried to commit suicide.

Many heroin users point out that they reached a time where they no longer experienced pleasurable effects of the drug. They continue to take it just to feel ‘normal. Some say that they never really experience the same effect as those first few times that they injected or smoked heroin.

Sometimes, family members or friends inform the heroin user that they believe that they have a drug problem. This appears to happen less frequently than one might expect. This may be because heroin users hide their habit well from their families, or because the family members choose to deny that there is a problem or simply ignore it.

When the issue is first raised, the heroin user usually denies that there is a problem. As long as they can sustain their habit and avoid the distress of withdrawal, they can maintain the belief that they are in control.

Irrespective of whether heroin addicts regard their addiction as a problem or not, once they become dependent their lives become dominated by the need to feed their habit and to secure the means of doing so. In our next Briefing, we will focus on living with addiction.

Recommended Reading:

Beating the Dragon: The Recovery from Dependent Drug Use by James McIntosh and Neil McKeganey, Prentice Hall, 2002.

The Heroin Users by Tam Stewart, Oram Press, 1996.

Using Heroin, Trying to Stop and Accessing Treatment by Aimee Hopkins and David Clark, 2005.

> pdf document

> To be continued.

The Drug Experience: Heroin, Part 2

Heroin can have a devastating effect on human lives, although as we described in the last Briefing, evidence indicates that it has this impact on only a minority of people who first try the drug.

In this Briefing, we start to describe the experiences of people whose lives are seriously affected by heroin. The experiences are based on those described in the seminal book Beating the Dragon: The Recovery from Dependent Drug Use by James McIntosh and Neil McKeganey, and our own research with clients on the Peterborough Nene Drug Interventions Programme.

The majority of people in these studies committed crimes to fund their heroin habits. In fact, the Peterborough project recruited many of the highest-level offenders in Peterborough. However, it must be emphasised that this does not mean that all people who take heroin commit crimes.

Many people who use heroin describe a steady progression from use of legal substances (alcohol, solvents), through to softer drugs such as cannabis and then on to heroin.

The most frequently cited reasons for trying heroin are curiosity and a desire to comply with the expectations of others, particularly of a peer group. However, there is little indication that heroin users are pressurised to take the drug for the first time—the vast majority feel that they have made their own decision.

However, this decision is often not well-informed. Many of our interviewees emphasised that they were naïve about the effects of heroin before they first tried the drug. Some believed that it was no worse than other drugs; others were not even aware that they were trying heroin.

Some people admit to not thinking about the consequences of their actions, and in fact do not think much about their drug use at all. Many others, when they first start taking heroin, are confident that they will not become addicted. A common belief is that:

‘… addiction is not something that could happen to me; it happens to other people.’

Many of our interviewees discussed the ease of availability and frequent exposure to various substances, including heroin. Drugs were rife on the housing estates in Peterborough on which some of our interviewees had been brought up.

Many people who first try heroin will say that they experienced a feeling of great relaxation and detachment from the outside world. They may feel drowsy, experience a clouding of mental functioning, and feelings of warmth (from dilation of blood vessels). They may also experience feelings of euphoria, particularly after intravenous injection. Heroin also reduces anxiety and emotional pain—it helps people escape from reality.

There is a reduction in respiration, heat rate and pupil size. Many first-time users feel sick and vomit, although this vomiting is often not enough to stop them using again, as the pleasurable effects far outweigh this negative side effect. This vomiting subsides in many people after the first few experiences of heroin.

Many first-time users try the drug again because they enjoyed the first experience. Others, some of whom may even have had a bad initial experience, continue taking the drug because they remain in the same social circles that led them to their first use.

Some people very rapidly move towards daily use of the drug, whilst others may continue to use on a periodic basis over a period of weeks or months. Our Peterborough sample, whose lives were badly affected by heroin, all ended up using the drug daily.

Heroin users develop a tolerance to the drug, such that increasing amounts of the drug must be taken in order to achieve the same positive effects. This tolerance results in the drug habit becoming more costly.  Some users will shift from smoking heroin to injecting the drug because the same effects can be achieved with much smaller amounts of the drug.

They may also start injecting drug as part of a continued desire to experiment and to find new “highs”. As part of this process of finding new “highs”, some people use multiple drugs, sometimes at the same time. Use of benzodiazepines, legally and illegally obtained, is common amongst heroin users.

Many heroin users recognise the decision to inject as having been a significant step in their drug using career. Injecting is an invasive process that heightens the risk of overdose and introduces additional risks such as contracting hepatitis C, HIV and other blood-borne infections.

Often, these are not the factors that make people reluctant to start injecting. Rather, they appear to be apprehensive about the actual process of injecting. Many users have a fear of injections and, of course, generally people do not know how to inject. Other users help first-time injectors and continue to do so until the latter person feels confident in the process.

There are variations in individuals’ experiences when they first inject heroin. Many people experience a pronounced euphoria almost immediately after injection. Other people do not experience this rush, whilst others report feeling very ill.

However, many of those who initially have negative experiences continue to persevere taking the drug and eventually became intravenous drug users.

In our next Briefing, we will continue to look at the experiences of those people whose lives are seriously affected by heroin, focusing first on the withdrawal syndrome.

Recommended Reading:

Beating the Dragon: The Recovery from Dependent Drug Use by James McIntosh and Neil McKeganey, Prentice Hall, 2002.

The Heroin Users by Tam Stewart, Oram Press, 1996.

Using Heroin, Trying to Stop and Accessing Treatment by Aimee Hopkins and David Clark, 2005.

> pdf document

> Part 3

The Drug Experience: Heroin, Part 1

Heroin is the illegal drug that has the worst reputation. The popular press never tires of informing us of new ‘heroin deaths’. Government considers heroin to be the cause for much of the acquisitive crime that occurs within the UK. Local officials will often ignore heroin problems in the community because of the stigma associated with the drug.

Heroin is also the drug of which myths are made. In their book Heroin Century – Heroin Addiction Care and Control: The British System 1916-1984, Tom Carnworth and Ian Smith point out that no drug has been subject to more misinformation and moral panic.

Here is a drug that is pilloried on the one hand, and yet is used [diamorphine] in the UK without controversy to treat severe and intractable pain, such as that arising from illnesses such as cancer.

It is a drug that is so controversial that when two Scottish researchers published a paper that identified 126 long-term heroin users in Glasgow who were not experiencing the health and social problems normally associated with the drug, there was an outcry from certain circles. Some people considered it irresponsible that such research was published.

In one sense, the first part of the title of this Background Briefing is misleading: ‘The drug experience…’ There is, of course, no single drug experience, rather a multitude of experiences. It is important to emphasise this point, particularly when considering a drug as controversial as heroin.

Heroin has terrible long-term consequences for some people who try the drug. They become addicted to, or dependent on heroin, and experience withdrawal symptoms when not taking the drug. They reach a point where the drug is more important to them than anything else. They need it on a daily basis in order to function normally.

Their addiction to heroin has many repercussions, which can include a deterioration in their physical and mental health, breakdown of family relationships, loss of employment, housing and material possessions, and participation in criminal offences to fund their habit. They risk overdose, as well as catching blood-borne viruses, such as hepatitis C or HIV, from sharing needles and syringes.

However, only a small minority of people of people who try heroin take this drastic path.

This is clearly evident from statistical data from the US National Household Survey. The vast majority of people who try heroin do not become addicts. This fact is evidenced by findings from the 2017 National Survey on Drug Use & Health in the US showing that approximately 1.9% of Americans aged 12 years or older have ever used heroin. In the same survey, the percentage using heroin in the last 30 days was 0.2%. Therefore, about 89.5% of people who have tried heroin at some time in their lives have not used it during the past month, i.e. i.e. they were not using heroin in an addictive manner.

It is easy to consider drug effects in a simplistic, physiologically pre-determined fashion. However, as we have discussed in various Briefings, the subjective effects of drugs are determined by drug, set (e.g. a person’s personality, expectancies, emotional state) and setting (the physical and social setting in which drug use takes place). This fact is no less relevant to heroin, than to other drugs that are considered less dangerous.

Whilst some people experience great difficulty in stopping use of heroin, I have previously described a large-scale study which showed that the vast majority of American soldiers who were addicted to heroin in Vietnam, did not show addictive behaviour in the twelve months following their return to the US.

If we are to understand the factors that underlie problematic drug use and addiction, and help people recover so that they can lead healthy lives, then we need to look at the lives of people who use heroin, (and stop or try to stop using the drug). Ethnographic studies dating back to the work of Robert Park and his colleagues in the US in the 1920s have provided important insights.

Chuck Faupel (1991), on the basis of interviews with heroin users in Delaware, talked in terms of heroin ‘careers’. He described a career as, ‘a series of meaningful related statuses, roles and activities around which an individual organises some aspect of his or her life.’

Faupel provided a chart of four common patterns of heroin use which depended on two key elements: the availability of the drug and the underlying structure of the user’s life. Structure was considered as a function of the regularity of social networks and patterns of behaviour.

Four types of user were described by Faupel: the occasional user, the stable user, the free-wheeling user and the ‘street junkie’.

The street junkie is the type of user most described by the popular press, the one that most people perceive as being the ‘typical’ heroin user. The street junkie is the most visible heroin user—and the one most likely to attend treatment services.

The most common route into ‘junkiehood’ is through lack of life structure. Many people who become street junkies do not have a life structured around conventional jobs and activities, and do not have a commitment to a conventional personal identity, factors which can help keep drug use under control. They commonly lack adequate funds to purchase heroin. In fact, many of these people have had bad life experiences (e.g. social deprivation, long-term unemployment, sexual abuse) before they started taking heroin.

In our next Briefing, we will look at the heroin experience from the perspective of people of whose lives have been seriously affected.

NB. That the statistics relating to heroin use shown in the Background Briefing linked to below have been updated here.

Recommended Reading:

Heroin Century – Heroin Addiction Care and Control: The British System 1916-1984 by Tom Carnwath and Ian Smith, Routledge, 2002.

> pdf document

> Part 2

‘Experiences of a Mother of Two Young Heroin Addicts’ by Mark

A very moving blog which first appeared on Wired In To Recovery (WITR) in May 2009. Mark blogged regularly on WITR until the community closed. I also published this on Recovery Stories in June 2013.

‘We found my 20 year old brother dead of an overdose. He had just kicked the habit so tolerance was low. He started a job and the first payday was his last. Mum wrote this after I got clean. Copy and use it anywhere it can be of use.’ Mark

‘What is it like being the mother of an addict? (Experiences of a Mother of Two Young Heroin Addicts)

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Factors Facilitating Recovery: Overcoming Withdrawal Symptoms

People who decide to stop taking drugs or drinking alcohol after using or drinking for long periods of time, need to be aware that they might experience withdrawal effects which can be irritating, debilitating and even life-threatening.

Many of these withdrawal signs, which can be psychological and physical in nature, are generally opposite to the effects the person experienced when the drug was being taken. For example, abrupt withdrawal from long-term use of Valium (diazepam) and other benzodiazepines, drugs which are prescribed to alleviate anxiety and insomnia, can lead to pronounced anxiety, insomnia, agitation, intrusive thoughts and panic attacks.

In addition, people withdrawing from benzodiazepines can experience physical withdrawal signs, such as burning sensations, feeling of electric shocks, and full-blown seizures. The duration and strength of these withdrawal signs is in part dependent on the amounts of drug having been used and the duration of time the person has been using the drug. 

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Historical Perspectives: Opium, Morphine and Opiates (Part 3)

Concluding a brief history of the opiates by looking at the massive increase in heroin use that occurred in America and the UK during the later parts of the 20th century. (1,012 words)

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Historical Perspectives: Opium, Morphine and Opiates (Part 2)

Continues a brief history of the opiates, which includes describing the different responses of the United States and Britain to opiate problems in the earlier parts of the 19th century. (880 words)

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It’s Not Just About the Drug, Part 3

I continue my series of blog posts focused on drug, set (the person) and setting (the social context) [Part 1 is here]. Drug, set and setting is not only of relevance to addiction, but also to overcoming addiction.

The path into and out of addiction
The ‘person’ and ‘social context’ factors influence early substance use and the likelihood that a person will develop problematic use and addiction. In general, individuals are less likely to develop substance use problems if they have fewer complicating life problems, more resources (social, personal, educational, economic), and opportunities for alternative sources of reward.

One explanation is that these individuals develop a weaker attachment to the substance in that for them substance use does not serve as many emotional, psychological or social needs.

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My Friend Natalie

I first met Natalie in my early days of working in the addiction field in the community. I still remember clearly her telling me that when she was using heroin, she did not know how to stop. She could find no information about how to stop using heroin. She knew no one who had stopped using.

Fortunately, Natalie accessed a high-quality treatment agency (WGCADA) and she found recovery. When we met, she told me that there needed to be stories of people who had found recovery available so that people with a drug and/or alcohol problem could read and learn from them.  I asked her if we could write her Story. She agreed.

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It’s Not Just About the Drug

The effects of a drug depend on an interaction between drug, person (set)  and social context (setting). These three factors also influence the likelihood of addiction and recovery from addiction (2,200 words).

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‘Newsflash – Heroin Addicts CAN Be Good Mothers!’ by Robin Sherwood

9e84425a-905c-44d9-a250-d4307755d13a-620x372Thanks to Mike Scott for finding  this great article in the Huffington Post.

‘I was eight years old when I accidentally walked in on my mum injecting heroin in the kitchen. I’ll never forget the confused look on her face – the warm embrace of the opiates blunted any acute feelings shame and panic, leaving her with an ugly, dumbfounded grimace.

Luckily, this episode was the turning point in both our lives; she knew that she needed to find help and enter rehab, otherwise she’d either OD or I’d be taken away from her. Sadly, not everyone is blessed with the same foresight.

Without knowing what kind of parent Peaches Geldof was it’s really hard to comment on the latest revelations about her death without sounding like a sanctimonious hack, but in my experience of growing up with a junkie for a mother, I’d like to make two points: 1: Being addicted to heroin does not necessarily mean you’re a bad mother and 2: They fuck you up your mum and dad (to paraphrase Philip Larkin).

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I Am Not Anonymous: Adam’s Story, ‘An Open Book’

Adam-Text-1024x681(pp_w1000_h665)‘For the entirety of my addiction – many sad, painful years of car accidents, overdoses, barroom brawls and street fights, failed relationships, small-time legal skirmishes and stints at rehabs – everyone wanted me to admit I had a problem, to talk about it.

Then, after I got clean and sober and became a husband, father, hockey dad and a union president that negotiated my co-workers salaries and medical benefits, many people wanted me to put it behind me, to shut up about it.

The planet witnessed the train wreck, yet I was supposed to cover it up after I got that bad boy back on the rails, which was no small feat.

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Today, I am Alive

The drugs made me feel ‘normal’. They drowned out the feelings and the negative, self-destructive thoughts.  They were my medication to the real problem. The problem was ME.

Samantha_Paulus_Text-1024x681(pp_w1000_h665)Please check out this beautiful story on I Am Not Anonymous.

‘Where to begin…My life today is a beautiful thing.  It has reached measures and consistency that I could have never imagined.

I am currently 261 days into my journey and I am finally feeling awake and alive.  Today, I am conscious of myself, of the happiness of others and I have a love for life that I never thought possible.

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Bunny and Wolf fight overdose

Mike Scott found this great animation. Here is what the makers have to say:

Bunny and Wolf: An Animated Guide to Prevent Overdose Deaths
Opioid overdose continues to be a top killer of young people all over the world. In some countries, drug overdose deaths now outnumber those attributable to firearms, homicides or HIV/AIDS.

Few people realise that most of these deaths are easily preventable with the right information, and an inexpensive antidote, Naloxone, which can reverse overdoses.

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My Favourite Blogs: ‘Experiences of a mother of two young heroin addicts’ by Mark’

IMG_4069A very moving blog which first appeared on Wired In To Recovery (WITR) in May 2009 and on Recovery Stories in June 2013. Mark blogged regularly on WITR until the community closed.

“We found my 20 year old brother dead of an overdose. He had just kicked the habit so tolerance was low. He started a job and the first payday was his last.

Mum wrote this after I got clean. Copy and use it anywhere it can be of use.”

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The culture of addiction: Part 1

384985_10150365241281765_1866835833_nThis is the first of two blogs on the culture of addiction. I will later look at the culture of recovery, and after that consider how we can help people move from the culture of addiction to the culture of recovery.

These articles are based on the seminal writings of William L White, in particular from his book Pathways from the Culture of Addiction to the Culture of Recovery. In this book, Bill provides key insights into how we can help people move cultures – essential in their journey along the path to recovery.

‘Culture’ generally refers to patterns of human activity and the symbolic structures that give such activities significance and importance. Wikipedia

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Needle Exchange

Needle Exchange tells the story of Spencer and Glenn, two best friends who helped each other swap their heroin habits with a passion for tattoos. Ink is their link, but their bond is tested when a new romantic relationship threatens the friendship.

Winner – Best Short Documentary, Galway Film Fleadh 2011

‘Sue: A Personal Story’ by Sue Murphy

2007_0118walpole0076“I was, what you were once described as in the 70s, ‘a problem child’. So to me, looking back, it was inevitable I ended up an addict.

My first love was LSD after postnatal depression. Not an excuse, just how it was. LSD was the only thing that made me feel alive. Until ecstasy. Wow, good days and they were until all the garbage arrived.

Skip many years, many tablets, many lines later and I found heroin. Or should I say it found me? It kept me enslaved for 15 years along with crack.

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‘Experiences of a mother of two young heroin addicts’ by Mark

IMG_4069A very moving blog which first appeared on Wired In To Recovery (WITR) in May 2009. Mark blogged regularly on WITR until the community closed.

“We found my 20 year old brother dead of an overdose. He had just kicked the habit so tolerance was low. He started a job and the first payday was his last.

Mum wrote this after I got clean. Copy and use it anywhere it can be of use.”

‘What is it like being the mother of an addict? (Experiences of a mother of two young heroin addicts)

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