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Helping an Addict
Heroin is a very addictive drug which can be used in many ways, the main being smoking, injecting or snorting. Within a week or so of starting to use the drug a person will become physically addicted, making it very hard for them to stop no matter how much they might want to.
This page gives a brief rundown for anyone who has discovered that their loved one is using heroin and needs some help and information. More information on all the subjects talked about is available on my website (http://helpingaddicts.net).
Understanding Heroin and Its Effects Heroin (Diacetylmorphine or Diamorphine) is one of the opiate
family, a group of pain killing drugs (analgesic’s) derived from the Opium
poppy. Opium, may be refined into morphine, codeine and heroin. Heroin is made
from the sap of the opium poppy, Papaver somniferum, which had been the most
effective painkiller known to medicine for at least 7000 years. Heroin exerts
its primary addictive effect by activating many regions of the brain; the brain
regions affected are responsible for producing both the pleasurable sensation of
"reward" and physical dependence. Together, these actions account for
the user's loss of control and the drug's habit-forming action. It mimics
certain chemicals in the brain that are already present (i.e. endorphins) that
block pain and induce feelings of pleasure and contentment. Soon after using, heroin crosses the blood-brain barrier. In the brain, heroin is converted to morphine and binds rapidly to opioid receptors. Users typically report feeling a surge of pleasurable sensation, a "rush." The intensity of the rush is a function of how much drug is taken and how rapidly the drug enters the brain and binds to the natural opioid receptors. Heroin is particularly addictive because it enters the brain so rapidly. The effects are almost immediate and the user may initially feel sick. A feeling of calm and warmth spreads through the body and any troubles or pains seem very distant and unimportant. At higher doses the user slips into a dreamlike state where they are not asleep or awake, but somewhere between. After a ‘fix’ users will feel warm, happy and content with themselves and the world around them. All negative feeling disappear and they have no worries. Time goes very quickly. This will continue until the effects wear off and the heroin is finished. The user will then need to start thinking about where to score and/or where to get the money from for the next hit. As well as being a very powerful painkiller, heroin also depresses the central nervous system activity, making the heart rate and breathing slow down, suppressing the cough reflex and depressing the activity of the bowel, causing constipation. Some blood vessels dilate, releasing heat through the body, giving a feeling of warmth. Opiates can change the brain stem, an area that controls automatic body functions and depress breathing; the limbic system, which controls emotions to increase feelings of pleasure; and can block pain messages transmitted by the spinal cord from the body. Someone who uses heroin can talk and think coherently.
Although at high doses the user becomes drowsy and starts gouching (nodding off
into a sleep like state). Pupils become tiny (pinned) and the eyes roll
back. Even with doses sufficiently high to produce euphoria, there is
little change to co-ordination, sensation or intellect. Although some users may take it occasionally, heroin offers most
users an unparalleled state of mind and once used, most find it difficult not to
keep going back for more. It has been documented that it only takes 3 days of
constant use to become addicted, remembering that there are different levels of
addition and withdrawal. Most people will not notice the subtle withdrawal
symptoms after this short a period and may put it down to feeling a little down,
getting a cold, etc. The two issues with addiction are the length of use and the
average morphine content in the body. Usually though, people will notice that
they have become addicted between 1 - 2 weeks after starting constant use. After
this amount of time, stopping will result in obvious withdrawal symptoms. Main Effects of Heroin
Heroin Myths It is important to remember that just because someone is an addict, it doesn’t make them a bad person. You cant assume that they are a thief, prostitute, criminal, etc. or that they are dirty, diseased, and not worth knowing. Many addicts go about normal life bringing up families and going to work, without anyone suspecting that they have a habit. This is why you don’t hear about the good ones, as they keep it under control and nobody has an idea. For example, my husband and I were addicted for eight years and during that time he always went to work. I also worked in the beginning and then I left to start a degree course at University. Nobody had any idea about us, as life continued as normal except for the fact that in private we were using heroin. It was only years later when our habits spiraled out of control and we borrowed money that we couldn’t pay back and had to pawn items from our home, that people began to suspect.
Helping An Addict It is always hard to learn that your loved one is using heroin.
You will feel angry with them for doing it, ashamed by their life choice as well
as many other things. If you share the problem with others, their advice might
be to cut them lose and have nothing more to do with them. PLEASE don’t do
this. My family was given this advice and thankfully they didn’t follow it.
Without them I would still be addicted to this day, it was only with their love
and support that I have managed to get clean and start living a normal life. During the eight years I was addicted I desperately wanted to get
clean and I tried many, many times. I was usually trying a detox every two
months, sometimes even more as I was that desperate to get off. I cant remember
a New Year or birthday that I didn’t try, as special dates seemed like they
might help. I would always think, this New Year my resolution is to be clean and
I would try and fail, yet again! I tried numerous different medical treatments
and had help from addiction services, but nothing can beat the help of loved
ones. When my family discovered my addiction and agreed to help me and my
partner, we finally did it. I wont say it was easy, because it wasn’t. It was
a stressful time but it worked out. Before dismissing the addict, remember the person that they were
and can be again. Remember that the longer it goes on the harder it is to stop.
If an addiction is stopped near to the beginning, the withdrawals will be easier
and not last as long as they will with a long term addict. For example in the
beginning I once managed to get clean on my own (had been addicted about 6
months) - the withdrawals lasted a week and I was feeling fine (Bumping into
friends and being encouraged to use again was my downfall). The point is though,
that after a week I was well. This time, after eight years of use, I was very
ill for a week, to the point of being hospitalized. Then the prolonged
withdrawals lasted about two or three months. So PLEASE try to help the addict as soon as you discover the
problem. It will save them (and you) a lot of pain in the long run. It will also
help towards ensuring they stay clean. Do remember though that not many addicts manage to complete a detox and remain clean on their first attempt. If the addict does relapse, don’t go crazy and disown them. Try to understand how hard it has been and help them to start again. Think of when you have tried to stop something or given yourself a resolution, do you always do it first time? Heroin addiction is not all physical as well, there is the mental addiction to cope with and even though the withdrawals might have gone – the mental addiction will still be there, urging them to use again.
Heroin Withdrawal When helping an addict withdraw, it is important to know the
facts and symptoms. Withdrawal occurs a few hours after taking the drug, once
the effect starts to wear off and the body has broken down the heroin in the
blood stream. This occurs more rapidly, the more frequently the drug has
been used. After the last dose, users will normally start experiencing mild withdrawal symptoms around 4-8 hours later. These will get worse until they peak on the third day. This is the worst day, with things slowly getting better from this day onwards. These acute symptoms are usually greatly improved by the fifth day and are largely gone by seven to ten days. For longer term users that isn't the end of it! This acute withdrawal is followed by a "protracted abstinence syndrome" which can continue for up to 32 weeks afterwards. The symptoms that continue over this time are: restlessness; disturbed sleep pattern, blood pressure & pulse rate; dilated pupils; feeling cold; irritability; change of personality and feeling; as well as an intense craving for the drug. Heroin and other opiate withdrawal symptoms are extremely uncomfortable and are not likely to be fatal or lead to permanent injury, but can cause death to the foetus of a pregnant addict. Often the hardest part of detox, is not the withdrawing itself but staying off it altogether. To remain clean, a whole change of life is required. New friends, keeping away from areas where you used to score, and finding things to relieve the boredom and time you would have spent using, are amongst the things that have to change, as well as wanting to stay clean. This is where people who have never used, can never hope to understand. It is not so easy to just change your whole life - never seeing your friends, starting to go out all the time when your used to staying in, etc. Even things like watching the TV are totally different when your clean, nothing feels the same. This is why so many people get clean and then go back to using. Symptoms (Cold Turkey)
Medical
Help There
is a number of treatments now available to try and help alleviate the withdrawal
symptoms. The main treatments are: Buprenorphine - a strong pain reliever which acts as a substitute and therefore aids the patient in withdrawing over a period of time. It is also used to detox from opiates over a week by helping to relieve the withdrawal symptoms.
Whilst the withdrawal symptoms are not as severe, the user will
still get all of them and will probably get little or no sleep. Sleeping
tablets can not be taken with Buprenorphine as they increase the sedative
effects of the drug and can increase the risk of overdose.
Like all drugs, Buprenorphine may cause side effects: constipation, headaches, difficulty in sleeping, lack of energy or weakness, drowsiness, nausea and vomiting, fainting and dizziness, drop in blood pressure on changing position from sitting or lying down to standing, sweating. Rarely the following have occurred: severe difficulty in breathing, liver problems, hallucinations.
Dihydrocodeine (DF 118) - is a medium strength, short-acting opiate. It is a very strong painkiller and is very addictive. A detox on DF118 is similar to methadone but the physical withdrawal symptoms may be less severe and not last quite as long. However, the fact that DF118 feels more like heroin means that it can make the cravings to use heroin worse than if you are detoxing on methadone. Because of this many services won't prescribe it, along with the fact that it can be more psychologically dependency forming than methadone - because it gives more of a rush.
Because it is addictive in itself, your dose will be reduced gradually as you will need to wean yourself off it slowly to avoid additional discomfort. You will also need to get your heroin use to a low amount before starting, as it is a relatively weak opiate and won't therefore be much help if your habit is too large.
A DF118 detox may mean that:
Lofexidine - is a drug that reduces the effect of excess noradrenaline in your system during a detox. It isn't an opiate and its only function is to prevent the action of extra noradrenaline in your system. Using opiates makes it harder for the body to produce a chemical called noradrenaline, so your system gears up to work extra hard to produce it. When you stop using opiates your body is still working hard to produce extra and it is this overload of noradrenaline that causes most of the physical withdrawal symptoms, as it over-stimulates the brain and nervous system. You can't get dependent on it in the same way that you can with opiates. It can be taken as part of an inpatient detox programme or at home.
There is a similar drug that is still used sometimes in detox units and hospital wards called Clonidine. Clonidine tends to lower blood pressure more than Lofexidine, so it can't be safely prescribed to people who are detoxing at home. This excess lowering of blood pressure also makes it difficult to increase the dose of Clonidine if the withdrawal symptoms are not being controlled.
Lofexidine:
Methadone - treatment has been used effectively and safely to treat heroin addiction for more than 30 years using it as a substitute for heroin. The Methadone is usually taken orally in the form of a sweet tasting green liquid, although you can get it in tablet and injectable ampoule form. It suppresses withdrawal for 24-36 hours, relieves the craving associated with heroin addiction and patients are able to perceive pain and have emotional reactions. Combined with behavioral therapy or counselling and other supportive services, Methadone enables patients to stop using heroin and return to more stable and productive lives, as you will be able to see what a drug free life is like (having more money in your pocket, going out, etc.) be able to do more things, etc.
Rehab - addicts can also go to Rehab. Most of which are inpatient, with the addict staying a required length of time until they are clean and on the road to recovery. The only problem with this is the cost. Medication will be given to them in rehab as well as counselling.
There is a lot of help out there. You can click on the Useful Contacts page to find help in your area, or if your area is not listed do a search on the internet for your area, or contact me and I will try to find it for you. Useful Contacts Page (http://helpingaddicts.net/useful.htm)
Encouraging a User to Quit Most peoples reaction when finding out that a loved one is using, is to speak to them about stopping by threatening, pleading or begging. This wont work – heroin is too strong an influence over their lives for them to be able to stop just because you want them to. Heroin users will only stop when they are ready to. You might be able to force them by locking them in a room, but sooner or later you will have to let them out and they will go straight back onto it. Nothing is then achieved apart from them being more devious and sneaky, to ensure that you don’t find out about their relapse and force them again.
The best way to help a user is to offer your help when THEY are ready for it. Sooner or later they will get sick of the life and want to come off themselves, this is the time for you to step in and encourage them further. Think about anything that you enjoy doing that other people don’t (smoking, drinking, even things like cycling, riding your motorbike). If someone told you to stop because they didn’t like it – would you? Could you? Try to help them whilst they are still using by:
The best way to encourage an addict toward a safer lifestyle is to be understanding and supportive of them. You can't make decisions for them. Keep in mind that most heroin addicts do eventually get and stay clean and that the average length of time that someone stays addicted to heroin is about three years. If you have a loved one who is a heroin addict, take heart; it probably isn't as bad as you think.
Final Word It might be hard but try to stick by them and offer your help. They MIGHT get clean on their own without you but its unlikely. The best way to ensure their safety and return to being clean, is to help.
If you need any more information or advice, I am always willing to help. Feel free to contact me on: brownaddictuk@aol.com. Also, remember that you can always speak to your loved one. They are the expert when it comes to their addiction. Ask them how they are feeling, what they want to do about it, etc. Communication is the key.
Best of luck. Nicky
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Last updated: 24 December 2004 |