As I walk down the street heads nod. Homelessness is rampant. “This is all heroin addiction,” my mom says. We were just leaving an event supporting families of those in prison, headed towards the Harlem 125th Street Metro-North. The train that passes over areas many don’t go on the road from midtown Manhattan to Westchester.
As I avoided watching one man pee in the corner.“How can you tell?,” I asked.
“The nod,” my mom replied. “Heroin gives people that nod, like they are drowsy, sleepy, out of it.”
Heroin has now been labeled an epidemic. It’s plagued areas like Harlem for decades yet now, thanks partially to big pharma, it is also an addiction that plagues suburban and urban communities alike. Of those who began abusing opioids in the 2000s, 75 percent reported that their first opioid was a prescription drug.
Heroin is notorious for its addictiveness - the intensity in which it calls and plagues those fighting its pull.
Though Harlem, for the good or bad, is being gentrified it is still home to many of Manhattan’s methadone clinics. Methadone clinics -- places where those in recovery from opioid-based drugs, such as heroin or prescription painkillers, can receive medication-based therapy -- serve as an intermediary step in recovery.
They are quite controversial and prior to writing this article I wondered what place they served inside of recovery. Were they a really step in recovery or a drug of a different name defined as legal in some efforts of puppeteering addiction (80’s crack era anybody?). This is a good point
I actually still don’t truly know the answer to this. In my research I have learned two things which I would like to spread light on in this article.
My intention in writing this series is partially self-support as I have family members in recovery and inside of that to raise awareness for those of us supporting loved ones on their experience, their conversation. Hopefully increasing compassion, grace, ability to cope, and understanding of how one may be able to support their loved ones.
For those frustrated with what seems like ambivalence, lack of commitment, maybe weakness inside of loved ones struggling with support -- I’d like to offer three concepts that have opened my eyes dramatically.
The Stages of Change
There are six stages of change for anyone recovering from addiction -- pre-contemplation, contemplation, preparation, action, maintenance, and termination. If interested in learning about each stage, here is a link that discusses it further.
The stages aren’t necessarily a linear process as much a construct to understand where one is in their journey. The most impactful gem given to me in this process is that relapse is on the road to recovery.
What may even seem like a setback can be a stumble forwards is a context that gives space for mistakes and growth which are both part of the human experience.
Recovery is not a linear process and a loved one struggling with recovery whether it look like relapse, lack of commitment -- whatever it is in your eyes -- may still be on the road to recovery. It is all part of the natural progression of change really for anyone especially with a challenging of a change as addiction. Which leads us to the next piece.
Harm Reduction
In initial recovery phases for such a painful addiction as heroin there is a concept called Harm Reduction. Harm reduction is controversial in nature because it actually supports those suffering from addiction, support in using safely. Ultimately, it is any positive step towards change that leads to safer use and possible abstinence if the individual is ready.
Using a drug such as heroin is highly addictive due to the physical nature of the addiction. Often, once someone using is on -- they’re using not to get high but to not get sick. The withdrawal effects of heroin are highly painful and can lead to vomiting, sweating, loss of control of bowels, dehydration, and extreme bone pain.
Heroin is a drug in which you do not die from withdrawal itself - whereas other drugs withdrawal can have harmful effects. In fact, the only drugs one can die from withdrawal are alcohol and benzos. However, the physical experience of heroin withdrawal feels as if one is dying. Therefore a heroin user is highly physically dependent on using which increases its impact.
If someone wants to get clean they typically will check themselves into a hospital for 3-5 days during the withdrawal phase followed by a recommendation of an inpatient treatment.
Having said that programs such as needle exchanges and methadone clinics mentioned earlier serve as ways to support those with addictions not ready to truly quit in using safely. Methadone is a contained way to sustain someone’s need for opiates without the risk of getting a bad bag or dirty needle however it can be controversial in the sense it restricts clients; “liquid handcuffs” some call it because they have to go every day to pick it up. Suboxone also an option, typically prescribed by a psychiatrist and taken in one’s own home, is an opiate blocker.
For some, this may seem like a cop out or a lack of commitment. Something to consider here is grace and empathy, from the outside looking in quitting may seem very obvious to a non-user. Within there is an internal mental, physical, and emotional battle. Traumatic experiences, such as being bullied, the loss of a loved one, divorce, or sexual trauma can change one’s brain chemistry and cause extreme mental health issues such a PTSD or depression. Often those using substances want to numb their feelings rather than understanding where they are come from and find safer ways to alleviate them.
Many people have addictions, some of which are more socially acceptable - to shopping, food, exercise. Either way these things can become harmful in their own way and serve as a vice. When supporting someone with an addiction work to understand their story, their pain, their trauma.
Which leads to my last point for this piece.
Mental Health
Many times those struggling with addiction are numbing and/or coping with an undiagnosed or untreated mental health issue. 75 percent of women who enter treatment programs report having experienced sexual abuse.
Mental health is something that is heavily stigmatized in our society especially amongst communities of color. Left untreated, the internal struggle that comes with mental illnesses such as depression, bipolar I & II disorders, or even schizophrenia, can lead someone to become highly dependent on drugs as a coping mechanism to deal with symptoms.
Healing then has its layers and journey. Recovery alone may also need attention to mental and emotional trauma or other mental complications that those using may be suffering with.
This is a fact that is often overlooked and unconsidered by those using and those supporting them. Recovery is a healing journey and truly an opportunity to begin again, to look at what plagues a person, and what is possible.
Just like anything truly worth doing and any transformational change it is a process and has to begin within. The best way to support someone in your life that may be suffering from addiction may be to show them grace and love. Look at them as a human, which they still are no matter what they’ve done and been through. And potentially encourage them to check out their mental health if willing -- things like psychotherapy and group therapy are very powerful tools for people suffering to better understand their behaviors. Above all love them with grace and compassion -- which may mean starting with harm reduction practices to support their well being on the road to yes.
There are naloxone trainings available that teach attendees how to administer this life saving agent that can prevent opiate users from dying in the midst of an overdose. Informing yourself, understanding their journey, and getting support if necessary are critical.
Because let’s be honest; when someone is using, it doesn’t only impact them. It impacts everyone who loves them, cares for them, misses the real sober them. It’s a version of trauma for those of us that love family or friends that are choosing that life for now. Dealing with a substance abusing loved one is really very painful and individuals may want to seek their own supports such as Alanon meetings and talk therapy.
Anger, hurt, sadness, judgement, rage, and even depression are all normal reactions to what feels like losing a loved one as they go through their journey. Be gentle with yourself through the process and accept the opportunity to learn unconditional love. Because that is what your loved one needs and is asking for.
Unconditional love does not mean love without boundaries. Be clear and what you can do and cannot. It may be one of the hardest things you have to do in your life. Get support.