How to break heroin addiction
October 14, 2011 12:59 PM   Subscribe

There is a person who is close to me who is addicted to heroin. We need to help her. For those of you who have experience with this, please help us figure out what the next steps are.

I'm going to be somewhat vague for obvious reasons.

She has been on methadone and suboxone which have helped a lot, but have both caused other problems. She went to a clinic recently and got extensive treatment. As far as we know she was clean for several weeks after that. However, we just found out that she shot up late last week.

Here are our questions:

- Does rehab work? Is there one kind of rehab that works better than another? Is in-patient required? Or is out-patient sufficient?

- If rehab is not the answer, what is? What should we do? I know that there may be no magic answer, but my question remains: What is the best possible thing that we can do following her backslide this week?

We are afraid that we are going to find her dead some day. We don't trust anything that she says. She really needs help.

Any advice would be deeply appreciated.
posted by anonymous to Health & Fitness (16 answers total) 1 user marked this as a favorite
It's very hard even for well-meaning loved ones to help an addict. She has to be willing to help herself, and nothing you can do will really fix her.

With that said, lots of people do manage to kick the habit, including a person very close to me. This person lied, stole, lied and stole some more, and never let anyone help her. She eventually saw death coming for her and that got her attention. It took her 4 tries to get clean, and that's after she got serious about it.

I'm going to mostly suggest things you can do for yourself, because I know how painful it is to love an addict. Go to Al-anon. See a therapist. Keep your valuables locked up, and never give cash to an addict, no matter how compelling her story. Be prepared to lose the love of the addict, or feel that you don't love her anymore because of her actions.

Best wishes to you in your own journey.
posted by S'Tella Fabula at 1:07 PM on October 14, 2011 [7 favorites]

This is the kind of question that shouldn't be asked anonymously, because there are so many things we need to know to give you a good answer. Anyone dealing with this in the future, please create a throwaway account.

Rehab is not one type of treatment. Some rehab has higher success rates than others, but you can't really talk about if "rehab works" when looking at how to treat someone. Some people need a lot of social therapy so that they're socializing with people who aren't part of their drug use community. Other people don't do drugs socially, and need medical help to get through withdrawal.

What resources are available in your area? You can call the addictions intake of your local mental health resource to get an idea of what kind of assistance you can give someone here.

Heavy opiate use is Very Very Hard to beat. Why did she start using again? Was she going through a high stress event? Did she see her dealer for the first time in three weeks? Were the physical symptoms too much for her?

You're not going to find the solution here on AskMe, given how generic the question is. You need to find local health care or addictions counselling who can give you evidence-backed information on the kind of treatments that are available in your area.

What is the best possible thing you can do? Guide her to the help that's available, hold her hand, don't make commitments lightly, and seek out a support group for yourself while you're seeking resources out for her.
posted by Jairus at 1:11 PM on October 14, 2011

The #1 best thing you can do for her is to go to Al-Anon. I don't say that lightly. I have spent many hours in those rooms and I am absolutely convinced that it's the only thing you can actually do for an addict or an alcoholic.

Also: Every Al-Anon meeting is different. If you go to one and don't like it, try another.

It is the hardest and worst thing to acknowledge, but you've said it: YOu might find her dead one day. But what it comes down to is this: The only person who can get her sober is her. You don't need to know why she used, or how she used, or where she got it, etc etc. You can educate yourself about the resources available in your town. You can do quite a bit. But you can also wear yourself to the bone worrying, making plans, etc, when none of it will be of any use until she wants it for herself.
posted by BlahLaLa at 1:18 PM on October 14, 2011 [8 favorites]

Seconding that she's got to want to help herself before any kind of treatment will be lasting. My brother went to detox and rehab several times, with varying lengths of time being clean in between. I think he's still clean, but it's quite possible he's not. I wish I had more helpful advice as to what works, but I think it's very individual on top of it being an extremely difficult drug to kick.

I mostly wanted to say that I know what it's like to fear that today will be the day you hear your loved one is dead. I used to dread picking up the phone when my parents called for that reason. And also not trusting someone you love and the pain of knowing they're lying to you (and also in my case, stealing from you and other family members). Definitely look into therapy and/or support groups for yourself. You're not alone in this.
posted by radioaction at 1:21 PM on October 14, 2011

Go to Al-anon. They have a lot of life-hacks that will help you deal with this in a way that will not make things worse, which is what happens as often as not when people are trying to help the people they love.

She will quit when she quits and it will be better for you if you haven't run through all your patience, money, trust, and small valuables before that. It will be normal for her to have tried her damnest to burn all her bridges before she gets clean. Don't let her- protect yourself and your loved ones so that you'll be able to be there for her when she gets serious about getting clean.

Also, the comments on this post might give some perspective.
posted by small_ruminant at 1:30 PM on October 14, 2011

I am so, so sorry for your situation. I've been where you are. It's one of the most heartbreaking experiences there is.

Rehab often does not work. My loved one went to a very high-end, expensive rehab (after going to several cheaper, shorter-stay ones) and he kept saying every time afterwards that he was absolutely, positively determined to kick his habit and improve his life. He did seem to do better for a year or so afterward, but one night had a slip and died at age 29.

(The night before he died, he asked if he could stay at my house. Recognizing that he was slipping, I told him no; he then went to a hotel where he passed out and stopped breathing. Had someone been with him, he might not have died, but I do not feel guilty about what happened at all.)

Outpatient is absolutely useless, because it's so easy to get drugs while not being confined. Do NOT let this person try to convince you otherwise.

Be prepared for years, if not decades, of more heartbreak, stealing, lying, chaos. I'm not saying that this will 100% be the case, but be prepared for it. Lock up your valuables, repeat "No, I'm not lending you any money/my car/phone etc. at least a million times, and then a million times more. Be prepared for her death, it's a very real possibility.

(I remember a blog that was written by an ambulance driver, and he wrote that he never, ever saw a heroin addict, recovering or otherwise, over the age of 50, because they never lived that long.)

Do any of her family members have addiction problems? Addiction is inherited, and there's absolutely nothing you can do about that.

Data point: I found Al-Alon to not be very helpful, because 1) I was just hearing the same old story a dozen different ways from a dozen different people, and 2) my being there wasn't going to contribute at all to his actually kicking his habit. But then, I prefer to do my self-help by reading books, obviously other people have found value in it and YMMV.
posted by Melismata at 1:34 PM on October 14, 2011

I want to echo what was said above, it is impossible to help someone who doesn't want help. I've heard that you should go to 6 Al-anon meetings before you decide if you like it or not.

She has to want to quit. And for some people rehab is really helpful, but usually only if they really want the help. 12-step meetings, as well as the community around the meetings can be extremely helpful. AA is great, but many drug addicts find NA more useful.

It is good that you know not to trust her, it is important that you learn to have boundaries, and let her hit her bottom. I am a recovering alcoholic who has been sober almost a year, and just last night I nearly had to call the cops on my younger brother who is an opiate addict. It's not that I don't love him, but I don't want to protect him from the consequences of his actions. I hope that jail, or homelessness, or something will "wake him up" but I also have to accept that he might die without ever getting well.

One more thing, I think of addiction as an illness. When my brother is manipulating and lying, I know that his disease is speaking and acting for him, that is the part of him that values drugs above everything else. I have seen him clean for short periods of time and he has the ability to be a very caring, and loving and honest person. But the need for drugs surpasses everything else in his life. It really helps me to try and remember that he is sick and that I want to see him well. Feel free to memail if you'd like to talk more.
posted by thankyouforyourconsideration at 1:34 PM on October 14, 2011 [1 favorite]

Oh whatever. "Wanting to quit" is not enough - not by a long shot, not by a country mile. That's why we call it addiction. Heroin is the hardest drug in the universe to kick. Really understand that - your friend is trying to do the hardest thing in the universe, something you yourself would likely fail at, repeatedly.

Instead of wailing about the fact that she fell off the wagon last week, you might focus on all of the days she's been clean since, and help her to focus on them to. That's why the NA slogan is "just for today" - because recovery isn't binary. It's not a switch, like you were an addict and now you're not. It's a day to day thing and we count one day at a time. 24 hours is a milestone. 7 days is a milestone. 30 days is a milestone. 3, 6, 6,9, 12 months are major milestones. If you fail to understand that, you fail to support your friend in her recovery at the most fundamental level.

Al-anon for you, NA for her.
posted by DarlingBri at 1:45 PM on October 14, 2011 [2 favorites]

my somewhat disjointed/rambly thoughts:

Rehab, detox, therapy, anything involved in the recovery process - none of these things will ever work until she's ready to MAKE them work. It's not something you can do TO someone, unless you plan to keep them incarcerated in a lock-in rehab for the rest of their lives. (I assume this person is not a minor who can be subject to a PINS petition.)

It's hard to say which is more debilitating - physical addiction or psychological addiction. Both of them will eat away at her until she either takes a hold of her life and says FUCK THIS SHIT I CAN DO IT, or until she dies. And I'm so sorry, but there's not much you can do aside from offering as much love and support as you can, for as long as you can.

Until she realizes that her life is, comparatively, total shit, she's not going to care about anything or anyone except getting high. And this will hurt you, and it's okay to feel hurt, and angry, and frustrated. It doesn't make either one of you bad people.

It also won't make you a bad person if, one day, you realize you've had all you can take, and need to step back from this person's life to save your own sanity. No matter how much you love someone, there are limits to what people can take, and situations involving addiction tend to push those limits farther than you'd ever thought possible.

It can be very helpful for an addict to know that they've always got someone to count on no matter how bad things get; unfortunately, it can also be extremely enabling and prevent their recovery. And it's hard to tell how it will play out until it's already playing out. A lot depends on the individual addict.

Finally, one of the most valuable things you can do right now is for yourself - find a support group for family and friends of addicts. You don't have to do this alone.
posted by elizardbits at 1:45 PM on October 14, 2011

Just wanted to add that if she's in a period of sobriety and she wants to go to a meeting with you, you guys can search out "double winners" meetings in your area -- those are combined meetings for Al-Anon/Alcoholics Anonymous/NarcAnon.
posted by BlahLaLa at 2:09 PM on October 14, 2011

The only way I've ever seen anyone kick heroin (or meth) is to relocate to a completely new place where they don't know anyone ideally a place where they also have a support network. Even if its just one person letting them stay for a while. After they've been clean for years and years maybe they can move home but honestly its a bad idea. The more physically different the new place and the more sunshine the better

That and no internet - Craigslist is a marketplace.
posted by fshgrl at 2:13 PM on October 14, 2011

Ibogaine is worth investigating .
posted by hortense at 2:13 PM on October 14, 2011

Mod note: From the OP:
throw away email address
posted by jessamyn (staff) at 2:16 PM on October 14, 2011

Well speaking as a friend of a heroin addict, the only thing that worked for him was to be arrested. I don't know if this will work in your situation. For him it was all about secrecy, he had kicked the habit several times and then was afraid to disappoint everyone. The arrest let everything out in the open and allowed him to seek help without questions or judgment.

I will also say though that if she doesnt genuinely want to quit there is nothing you can do except to stop enabling her. This is a tragic fact but that makes it no less true.
posted by boobjob at 2:54 PM on October 14, 2011 [1 favorite]

Being arrested almost always does more harm than good: it sticks you with a criminal record that lowers employment odds (meaningful employment is one of the best correlates of long term recovery) and puts you in with a crowd more likely to want to use than get clean.

Also, the research is clear that methadone and suboxone have superior outcomes to rehab and detox than abstinence-oriented treatment (AKA rehab). So, I'm not sure what the problem she's had with these options is, but using on top is better than using after a period of abstinence in terms of death risk because these medications maintain tolerance. She may actually need a *higher* dose to cut cravings— if her dose isn't "holding" her, it may well be too low. Many American programs underdose people with methadone and suboxone has a "ceiling" (if you raise the dose too high, it has the opposite effect). So, if she needs a higher dose, methadone may be needed instead.

Using on top is *not* treatment failure, it is typically part of the recovery process.

If she *wants* abstinence, then she needs to be prepared to go for about a year feeling really shitty. 12-step or other support groups and antidepressants if needed can help with that, but the bottom line is that people self-medicate with opioids because they feel lousy without them and stopping them produces a period of feeling even worse than pre-opioid normal. Most U.S. rehabs are basically some version of 12-step treatment anyway: if you want to learn more about the options, my book, Recovery Options: The Complete Guide, which you can get on Amazon and which is co-written with an MD, PHD from Penn may be useful.

The notion of "enabling" / "codependence" isn't really supported by research — if you want to help someone get into recovery, check into an approach called CRAFT Family Therapy. Twice as effective as confrontational and potentially backfiring (sometimes with deadly results), "interventions."

Also, get a hold of some naloxone: this can reverse an overdose instantly and is good to have around if someone is not in stable recovery.

Finally, I'm here to say that recovery is possible: I've been abstinent since 1988. Antidepressants made a huge difference to me in terms of dealing with the oversensitivity and self hate and inability to feel love that I previously medicated with heroin. In my first 5 years, I also found 12 step programs helpful, but they are not for everyone and people shouldn't be forced to accept this approach.
posted by Maias at 4:08 PM on October 14, 2011 [7 favorites]

First of all, what maias said.

Second, I echo the question about what her problems were with methadone and suboxone. If she has access to either of them again, it's more effective for most people to be on one of them while working through this process. Methadone clinics can be kind of sucky places, which is why some people prefer suboxone from a doctor's office.

Third, learn to recognize the signs of an overdose and get naloxone and learn how to use it. This is the best source of information on what's available in your state.
posted by gingerbeer at 5:14 PM on October 14, 2011

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