If you want to successfully integrate a slightly unstable patient into a therapy village, don’t promise to be their therapist, have one ‘one on one’ session, decide to sack them off onto someone else and leave it to a third party to inform them of that decision! Duh!
21/06/15 Another year, another Entgiftung. Six months of the most constant, most expensive and above all most obsessive drug use of my life. Crack, the personality stealer. The brainwasher. My mind has been white-washed. My nerves have been numbed, my thoughts too. Everything is white. I can’t write; white on white doesn’t show up. I have dissolved.
When you try to write a blog about your experiences of drug addiction, but are taking too many drugs to actually write anything.
An answer to an email from a friend of mine that is relevant to my last post…trying to explain addiction management.
Clean, clean…I am cleaner than I have been for a long time, let’s put it like that. After J— died and I was still at Uni, I spent about four months just sitting in my room taking drugs…of course, I didn’t manage to finish my degree, which is something I regret. I have managed to stick to about once a week since I came out of rehab in March, partly because I managed to get the job in the pub straight away. However, I want to stop. I know the last post on my blog seems to be to the contrary, but the aim of it wasn’t to say “drug taking is safe and the demonisation is completely unjust” but from a mental health point of view to say “I was using every day and I have managed to cut down so I need to stop giving myself a hard time”.
Who really feels bad about taking heroin: me or society? This question occupies me frequently, usually after an argument with my boyfriend following a relapse or during an awkward Skype session with my parents during which I try to conceal my most recent track marks. It’s a debate that is inextricably linked to staying clean; do I want to stop taking drugs for myself or to conform to the idea that history and social confines have impressed upon the people who care about me?
In order to try to understand the ambivalence toward sobriety that I’m experiencing, it’s necessary to explain the circumstances of my current use. Since returning from rehab, I have been injecting about once a week. This is, for me, infrequent use. Every Sunday, normally my day off from work, I find my body salivating in anticipation of a fix like one of Pavlov’s dogs. Weak kneed and sweaty palmed, I clock watch the entire day, waiting for my boyfriend to FUCK OFF to work so that I can score. It is, of course, no secret to him that I intend to get high. I am so restless and practically green with nervous energy that it’s merely a courtesy to wait until he’s out of the way. I protest my innocence and deny my plans because I know he disapproves, not because of any internal struggle about whether I should use or not.
My boyfriend doesn’t want me taking heroin for a number of reasons which I believe are a product of the negative reputation of heroin rather than any intelligently formed arguments based on evidence. Like most of today’s society, he is firmly of the belief that heroin is the worst drug in the world. “You could die!” he says. If I am in a contentious mood, I will attempt to counter this statement by reminding him that any of us could die simply whilst crossing the road. I will patiently explain for the umpteenth time that I take plenty of precautions: I have a regular, relatively trustworthy dealer; I use a certain amount each time; I inject slowly; I always have my phone close to hand if I’m alone, otherwise I inject in a shooting gallery which is overseen by trained professionals.
Another of my boyfriend’s gripes is the issue of money. Of course, before my second stint in rehab this was an issue for me as well. I was unemployed, using every day and taking crack (which, incidentally, is a drug that deserves its bad reputation – but more on that another time), which is horribly more-ish. However I now have gainful employment and my weekly fix is currently only totalling €40, which I make in Trinkgeld on a busy Friday night. I understand that the money goes on something intangible, something that he can’t see or hold on to, but compare that measly €40 to the amount I would be wasting on piss if I was still a drinker. Not to mention the added costs of replacing and fixing the hundreds of mobiles, cameras and iPods that are often casualties of binge drinking.
The third argument that my boyfriend uses is the detrimental effect of heroin on my health. I believe that the negative effects of moderate heroin use have been somewhat exaggerated, lumped in with the overuse and risk of sudden death and not properly explored. I’ll admit that for the first two days after a hit I am lethargic and somewhat weak. But it’s bearable. Also, heroin is the most effective antidepressant that I have ever come across – and I have tried a fair few – which has to count for something.
Don’t misinterpret me, I am by no means advocating becoming a heroin addict. I am, however, suggesting that it isn’t the end of the world to occasionally use if you are able to do that safely and responsibly. I personally find it much easier to control how often I use heroin than that of crack or that wonderful, widely available demon: drink. I do not intend to take heroin for the rest of my life. But I do intend to stop berating myself every time I reach for the needle. I want to stop feeling bad just because other people, due to the negative portrayal of opiates and opiate users in the media rather than their own opinions, feel bad. I am imposing a personal opiate amnesty on Sundays. Sorry, boyfriend, but this is true love.
How should you interact with a friend, lover, family member, or anyone who has depression? It’s not easy, but here’s a rough guide. Written by someone who knows.
1) Know the triggers. These are many and varied and I’ll admit, hard to spot, but when you’ve known the person for a long time they do become more apparent. It might be music, a place, a specific activity or even meal. You will not be able to avoid these things, but being aware can help you treat your friend with compassion.
2) If you notice that your friend who has depression has become quiet and sad, don’t directly ask “what’s wrong?” – depression is an illness; everything is wrong. Instead, ask the person what they want for dinner, or if they fancy watching a film. A comedy. Sometimes distraction is the best technique.
3) Your friend feels overwhelmed by some seemingly inconsequential task (getting out of bed, taking a shower, changing the duvet cover). Don’t step in and take over. This can make the person feel helpless and worthless. Sometimes the best way to help someone is to wait until they are ready to help themselves. You could try making it easier for them, for example by playing a song they like to entice them out from under the covers.
4) Try and plan activities together, a few days beforehand. Having something, even if it’s just a coffee and a chat, to look forward to can be a great motivation for someone with depression.
5) Don’t try to compare the situation of your friend with those of others. I have been confronted with, for example, “but children are dying of hunger in Africa, that’s really sad”. I know. That makes me feel even more powerless and worthless, that I am capable of such complacency.
6) Remember: your friend is not defined by their illness. They don’t want to be miserable or make other people feel bad. They are capable of being fun, clever, interesting…just stick with it. Please.
As a heroin user that has experienced both the system in the U.K and here in Germany, I was interested to hear about the new system trialing in England at the moment, namely offering financial incentives for a) taking a vaccination against Hepatitis B or b) staying clean. These ‘financial incentives’ are actually shopping vouchers and are being offered, as far as I understand from the BBC and Independent, weekly in return participation in the vaccination programme or for clean urine samples. As far as I am concerned, here are two separate issues. The first is the issue of clean injecting practice and the second is that of abstinence; I don’t believe the two can both be solved by financial incentives.
Let’s look at the use of financial incentive in return for hep B vaccination. Putting aside for a minute the well-known risk of HIV, I believe that vaccination runs the risk of creating a false sense of invincibility. To then provide something that can easily be converted to cash and then to spoon filling is risky behaviour at best. At worst, it’s downright irresponsible. I believe that the best ways to help people intent on using drugs to stay as healthy as possible are choice and a sense of responsibility. In Germany, there are injecting rooms that provide clean kit and a safe space to inject in. In England, you have to find a pharmacy with a needle drop in your area in order to receive new or exchange needles and with that comes the risk that your pharmacist is a sour faced old cow who would rather spit in your face than give you a safe route to your drug of choice – she doesn’t care if you’re a junkie or a diabetic. The people who work in the injecting rooms in Germany are almost all sympathetic, cheery and fully trained and who respond to every user as an individual. This makes the rooms a by far preferable choice to sharing a second hand needle in the street. The freedom of choice and knowing that you have made a safer decision is meaningful.
With regard to the model of abstinence, I am afraid I am going to have to upset all of the non-users out there – it’s not worth a tenner at Tesco. The first issue I have is that of the urine sample. I’ll let you into a secret: if you’ve never done it before, taking a whizz in front of someone is quite daunting. If you are with a social worker who you like and who treats you with respect, the embarrassment factor can be minimised with light humour or simply talking about something else. If, however, you are with a worker with whom you don’t get along, it can be degrading and painful. I would expect at least a crisp twenty bill in my hand for this weekly torture.
The second issue, which I briefly mentioned, is assigning a worth to abstinence. What sum is too high, when one considers that it ultimately saves lives? I am not so enamoured with the drug that I fail to recognise the dangers of it. Anyone who has contact to the community that uses, knows either personally or of someone that has overdosed. I won’t go into too much detail, but the person I lost was so much more than any trivial sum of money. There is a danger that this assignment of worth is actually devaluing addicts; making them less of a person and more of a statistic.
On the other hand, there is the benefit of enabling people to improve their own situation. Every addict, no matter how rich they start off being, will eventually have financial issues. For long term addicts, this shopping voucher could be a god send – the chance of nourishing a suffering body. However, when so small a sum is enough to make a difference then further questions must be answered: where is this person living? How are they funding their habit? These questions bring then further concerns for the safety and well being of the individual.
I would propose a multi-pronged approach and a potentially better way of spending NHS money. Firstly, make clean kit easier to get hold of. Make sure that the people who are able to provide this kit are trained to work with people with addiction problems. Secondly, make it easier to get help when addicts ask. If that means increasing the number of treatment centres then do it! A six month wait is a question of life and death. Thirdly and finally, reconsider the type of incentives used in regard to abstinence. I believe the motivation of perhaps a flat of their own or even the chance of a place of work would be a far more effective system. Apply a touch of German efficiency to the system and maybe the U.K would start to see a similar trend of positive results
This is an email that my father sent to my boyfriend shortly after I had told him about my addiction. My father had only himself known about the drug taking for a few months but had a good idea of the extent of my previous alcohol problem. I think it provides an interesting perspective on addiction. It’s also particularly poignant as it was over a year ago, I haven’t ‘triumphed’ and am still as lost in addiction as ever.
Hi T—
I think the first thing to say is that it is very positive that Emily has told you what’s been going on. I expect that it was a horrible shock. The first step in dealing with addiction is for the addict to accept that there is a problem.
It’s also very good that Emily has told us about this because a lot of addictive behavior causes the person shame so they tend to be secretive about the behavior. This can cause already terrible problems to become worse because the person can’t get help, and because those who are close can be damaged by the things they don’t know about like no money, health problems or violence.
A lot of us are at risk from addiction. It might be alcohol, Nicotine, sex in it’s various forms, exercise, even wealth and power. I have a strong addictive streak like Emily.
We build our addictions through the idea of reward. We do something like have a drink or smoke a cigarette and we feel some relief, or we place a bet and win some money. The feeling of relief or the money are the reward. The reward makes us do it again. The more we do it the stronger the link between the behavior and the reward becomes. Unfortunately it’s also the case that the behavior has to become more extreme to get the same reward. A €5 bet becomes a €500 bet; a picture of a naked woman becomes a video of woman being tied up and assaulted; a glass of wine becomes a bottle of Vodka.
For alcohol and narcotics there is also the physical dimension of addiction. Withdrawal brings horrible feelings of anxiety and pain. Only more of the substance brings relief. This is the downward spiral of addiction.
For Emily as an individual there is the obvious complication of her mood disorder.
On the other hand the longer the person resists the temptation to seek the reward then the link between the behavior and the reward weakens. If you have tried giving up smoking you will know that the craving slowly becomes less. But you may also know that one cigarette can put you back to the beginning. And the risk of relapse is also always present and therefore must be guarded against.
What can you do?
It is essential to take it one day at a time. Because the “pull” of addiction is so strong the idea of doing without the “reward” for ever is too much to cope with. Better just to think, “can we get through today?”. One day at a time.
Be as consistent as possible. Take the rough with the smooth because if Emily is serious about facing this massive challenge it’s unlikely to be plain sailing.
Managing access to money is a good idea but in the light of what I’ve written already, addiction encourages secretive and dangerous behaviors. Heroin addiction is very powerful and the loveliest person can be powerless to behave normally. Addicts have been known to steal from their families, to sell anything and everything, to lie and to trick to get what they need if money is short. This is why it’s also so positive that Emily is being open with you; she wants to change and she trusts you.
Make sure that you both stay as well as possible by eating well. See if exercise can become a bit of a substitute.
Most importantly I would discuss with Emily and your Doctor the idea of professional help. I have no idea of the quality of “Specialist Drug and Alcohol” services in Germany but if they exist then you both need to think seriously about accessing any support on offer. Emily has made that essential first step but the journey is long and difficult and will have ups and downs.
In the UK there is AA for drinkers and Narcotics Anonymous for those addicted to drugs. There are similar groups for the families of addicts. Your doctor should have more information.
But Emily is brave and strong as well as beautiful so hope burns brightly!
Emily’s father.
P.S – Emily will need to speak for herself but the original “motivation” to start on such a risky, destructive and ultimately unsustainable path only she knows. We can guess that it may be a way to mask anguish and distress, it may be that she doesn’t value her own life, it may be a way of living that she has come to rely on. The difficulties of a “normal” life are too great to bear without “help”.
It’s important to say that we might feel that it’s because we’ve not provided enough help to Emily; that somehow we should have been able to rescue her and keep her safe. As her father I do feel this; as her partner you needn’t feel this. But you need to be aware that Emily’s addiction has been an ongoing theme all the time you’ve known her. Let’s pray that the “real” (sweet, intelligent, capable, energetic, hard-working and loving) Emily can triumph.
You still manage to catch my eye, even though our relationship has long since run its course, whether you’re in a bar with a bunch of giggling girls or in a posh restaurant on yet another date. I know you’re trying to reel me back in, trying to land me – gasping – back on board. But I still remember how you drowned me.
I know you inside out and up and down. You were my saviour: you made every grey day into a bright caricature of itself; every night was a deeper shade of velvety-black, seductive. And we danced. You whirled me across the mosh-pit in front of sweating musicians, twirled me into back alleys with questionable companions and waltzed with me straight into bed. Where you took my virginity. You encouraged my promiscuity and then you pimped me out. And still I danced with you.
I hated you. You held me in suspended animation, saturated and stuck in your jar like the grotesque result of a mad experiment. You made every bright day spin out of my control and the velvet night suffocated me. Years passed. Did they? All I know is that my feet slowly began to tire of the dance. Blood followed blisters, until they were a pulpy, red mess; were they even my feet? I couldn’t tell anymore. I began to make plans – if I couldn’t walk away from you I would crawl on my hands and knees.
You had one last trick, with which you hoped to ensnare me, and it was a dirty one. You took my love from me. It was the first love I had ever known and he was my everything. If anyone could have saved me, I thought it would be him. I hadn’t yet realised that all I needed to do was stand still for a minute and rest. He left me. All I had was you.
Another few months passed in which I was completely yours, so deeply involved with you that even now I can’t remember, don’t want to remember, what we did together. I think it’s better that way. Our world was a small, dark room that I couldn’t leave. Until one day, shortly before I was to turn twenty two, a sound broke through – the ringing of a telephone. “He’s dead. Heroin. I’m so sorry.” My love.
With my heart irreparably broken, it was so easy to walk away from you. I was finally free. I no longer have a heart, just a hollow space where it used to be. But I still have my feet. I walked away from you with my head held as high as grief allowed. It’s been over a year since I was in your grasp and I know that I can never, ever go back to that dark space that we shared. So go ahead, dance all night with whoever you want. I’m not jealous anymore. I’m free.
As if, Emily. 