Help Someone Overcome a Heroin Addiction

Heroin is an illegal drug from the opiate family that is extremely addictive. Because people quickly develop a tolerance for heroin, it is easy to overdose, which can have fatal consequences. Quitting heroin cold-turkey can also cause life-threatening side effects. Helping someone overcome a heroin addiction can be incredibly difficult. However, social support is a key component of the recovery process, and you can help provide that. It's important to understand the different facets of heroin addiction in order to fully comprehend what lies ahead as a friend, relative, or colleague of a person addicted to drugs. Only then can you provide the empathy and support the person needs to stay committed on the path to recovery.

Steps

Confronting the Person

1. Reframe your language. Unfortunately, even though substance addiction is a medical and mental health condition, it is still the subject of immense social stigma. Many people use language that dehumanizes people who are addicted to substances, such as calling them "drug addicts," "smack-heads," "dirty," or similar. This language increases the stigma surrounding addiction and will not help your loved one. Addiction is a highly complex phenomenon that is not entirely within a person's control. Do not define a person by her disorder.
   • Always use language such as "a person addicted to drugs" instead of things like "drug addict."
   • When you speak with the person, always frame her addiction as something she has, not something she is. For example: "I'm worried that your drug use is harming you" is appropriate. "I'm worried that you're a junkie" is not.
   • Avoid using words such as "clean" to express being drug-free and "dirty" to express using drugs. These further the stigma and can increase your loved one's sense of shame about her addiction, which could lead to further drug use.
2. Get outside support. A qualified counselor who specializes in addiction can help you and other friends or family consider your options when it comes to dealing with a person addicted to drugs. Counselors are objective third-parties who have little personal stake and so can provide a much-needed outside and rational voice. In addition, counselors are trained to provide empathy, support and encouragement, which may be hard to get from other people who are concerned about the person and are too inside the situation to see clearly -- which could include you. Try to find a counselor in your area or consider consulting your primary care physician for recommendations.
   • Alternatively, if therapy is not a good option for you, you can attend Nar-Anon meetings, which are designed to be safe spaces for the families and friends of people addicted to drugs.
   • A substance abuse professional may also be able to provide guidance on how to help the person. Be prepared to provide detail about how often the person uses heroin and how much, whether she uses any other drugs, the duration of the addiction, symptoms and behavioral patterns and the like.
   • For more information on drug addiction in general, consult the Substance Abuse and Mental Health Services Administration or the National Institute on Drug Abuse.
3. Approach the person directly. Make an attempt to talk to the person about your concerns about her drug use. Make sure the person is not using when you have this conversation; if the person is using or has recently used heroin when you try to have this conversation, try again later. Avoid blaming, preaching, lecturing, and moralizing and instead tell the person plainly about your worries.
   • Come ready to offer specific instances of the problem behavior that has you concerned. Bring up past incidents, such as "When you cancelled our plans last week..." instead of "You always break your promises." Use "I" phrases, such as "I noticed" or "I'm worried," since these sound less blaming and are less likely to place your loved one on the defensive.
   • Focus on the effects of the person's heroin addiction on the things she cares about the most, whether that be career, friends, children, parents, etc. This may help the person realize her actions do not only affect her.
   • You can also conduct an intervention, a professionally directed process in which the person addicted to heroin meets with friends, family, employers, etc. An intervention can be helpful because it can aid the person in connecting her drug problem to the problems in her life. Ninety percent of interventions done with a trained interventionist result in the addicted person making a commitment to get help. Contact your local National Council on Alcoholism and Drug Dependence (NCADD) for more guidance.
4. Avoid emotional appeals. Upon learning about the person's addiction, your first reaction might be to convince her to stop by threatening, pleading or begging. This won't work – heroin is too strong an influence over the person's life for her to be able to stop just because you want her to. Heroin users will only stop when they are ready to. Although it might be tempting to launch heavy-handed threats, this isn't actually feasible and won't help her unlearn the behavior and treat the triggers that have led her to use heroin.
   • Keep in mind that emotional appeals could backfire in that they may only make the person feel guilty and engage in further substance abuse.
   • Sometimes an individual with a long-term addiction will have to hit 'rock bottom' (a personal low point in one's life marked by desperation and hopelessness or a major occurrence such as an arrest) before the person decides to quit. However, most people do not need to bottom out to want to get help.
5. Tailor how you open the conversation. How you talk to the person will depend on her relationship to you. Is the person a family member, good friend, or co-worker? Consider writing down how you want to open the conversation in advance to mentally prepare yourself. Here are some potential "opening lines" that can help you approach the person in the appropriate manner:
   • Helping a family member - "Mom, you know how much I love you, and that's where what I have to say next comes from, from a place of love. You've been away a lot lately for days at a time, and we know you've been using drugs. You even missed my graduation last week. I miss you, Dad misses you, and we love you. Will you sit down with us to talk more about this?"
   • Helping a good friend - "You know, Jennifer, we've been friends since we were little kids, and I consider you to be like a sister. While I know you have a lot going on, I have noticed that you've been cancelling a lot of our plans and showing up late and high. You also don't seem to be getting along with your family as much as you used to. I'm worried and concerned about you. I care very much about you and want to talk more about this."
   • Helping a coworker - "Dale, you're one of the best thinkers in this office but you've been missing a bunch of work lately. And just this week, I couldn't submit my report because I was missing your section. Lately you just haven't seemed to be yourself, and I know you've been using drugs. If you're having any problems, I wanted to let you know that I'd be happy to help you get the assistance you need. You're valuable addition at this company, and I don't want this to affect the security of your job."
6. Propose immediate treatment. Once you have explained your concerns, broach the topic of getting help and treatment with the person. A promise from the person to cut back or stop the problem activity is insufficient; treatment, support, and new coping skills necessary to overcoming addiction. Explain what kind of treatment you have in mind. As with other chronic diseases, the earlier addiction is treated, the better.
   • Do your research before recommending a treatment plan or center. There are many different varieties and cost is not always indicative of treatment effectiveness. Treatment typically depends on the severity of the addiction. You'll need to think about cost, of course, along with other factors such as the type of therapy offered (group, individual, combination, drug, etc.), the type of facility (outpatient, residential, etc.), and gender dynamics (co-ed or same-sex environment), among others.
   • In most cases, outpatient or residential rehabilitation programs are needed to end heroin addiction. Prescription medication is usually necessary to help the person detox safely. After this, researchers have found that 12-step programs are useful as an inexpensive and effective way of maintaining abstinence from drug and alcohol addiction.
   • Note as well that most people who are addicted to drugs, especially ones that can be expensive such as heroin, cannot financially pay for their own treatment so you will likely need to assist in that regard. There are also some state-funded treatment centers, available through SAMHSA.
7. Offer your love, help and support. No matter what the person's response is to your confrontation, let her know that you are there for her when she is ready to get help.
   • If your friend agrees to treatment, be ready. Call the local number for NA to get a schedule of meetings for your area, for example. You could also talk to someone at a nearby treatment center so that you can have the name of a place and contact ready. Let the person know that you will accompany her to the institution, meeting or specific individual that you have recommended.
   • Your friend may respond with anger, rage or indifference. Denial in particular is one of the symptoms of drug addiction. Don't take it personally and avoid responding emotionally in kind. Instead, assert that you are trying to help her.
8. Prepare in case the person refuses treatment. The person may not think she needs the assistance you have suggested. Don't feel as though you have failed; you have at least planted a seed of recovery that can grow in the person's mind. However, if the person refuses treatment, you should be ready with a plan for what's next.
   • What will you do if the person refuses? This may involve cutting the person off from money and other resources (so that you are no longer enabling the addiction) or even asking her to leave your home (particularly if you have other friends or family members who may be at risk due to this person's addiction).
   • It is not easy to let a loved one who's addicted to drugs go. However, stay in touch and make it clear to the person that if any point she opts to reconsider treatment, your door is always open. Remember, you are helping the person to heal. Sometimes, we need to endure the pain of a friend or loved one in order to provide her with the help she needs to get well. This is why it's called tough love - because it is not an easy way to help someone but you may be able to save someone's life.
9. Mean what you say. You must be careful with your own behavior and your attitude towards the person struggling with addiction. Be consistent and mean what you say to them; don't make empty promises or threats. For example, following through on an offer to "Do whatever I can to help" may be interpreted in a variety of ways. Does this mean helping the person find a local chapter of Narcotics Anonymous (NA) or giving her money (which the addict could then buy drugs with)? Be very clear about your intentions to avoid confusion. The same goes for consequences. If you tell the person that next time she is caught using, she will be kicked out, you need to be prepared to follow through.
   • Always make sure you stick to what you say – this is the most important rule because it shows the person that you are trustworthy and that what you say holds weight. If you say you will do something for the person in return for something she has done, then do it. If she fails to do what you asked, don't do it. If you give her a warning, carry it out if she doesn't listen.
   • Creating and maintaining an environment of trust is of critical importance. Avoid trust-breaking behaviors, like screaming, nagging, lecturing and making promises and threats.

Providing Social Support Throughout Recovery

1. Don't enable the behavior. Break out of a cycle of dependency whereby the addict relies on you and, in turn, your assistance inadvertently helps the person keep up the addiction. This is called negative enabling. Learn to say "no" and commit yourself to it; it is perhaps one of the most important components of bringing about transformation in an addict. It's also important to note that the addict will likely not respond well to your commitment to saying "no" since she may be used to getting what she wants and when.
   • If the person is a family member or friend, you'll need to think about money in particular. Decide if you are willing to lend the person money or not. Many people don’t like to lend money knowing that it will be spent on drugs, whilst others see it as stopping the addict from perhaps committing crime and getting into further trouble if she is caught. Make up your mind about this matter and stick to it. If you don't want to lend money, firmly let the person know the reasons you are unwilling and don't waver. If you are willing to lend to the person, have her sign debtor's notes for each loan and let her know that you plan to pursue any unpaid debts. If the person does let you down, stop lending to her.
   • In addition, don't enable the behavior or try to keep up with the person by joining in the drug use. You need to keep yourself safe first and foremost.
2. Don't make excuses for the person. Avoid covering up or making excuses for the person's behavior or taking over the person's responsibilities (whether they be work, family, or otherwise). Doing so shields the person from the negative consequences of her behavior. She needs to learn that what she is doing has adverse consequences.
3. Prepare for relapses. Very few people addicted to heroin manage to complete a detox and remain clean on their first attempt. If your loved one does relapse, don't lose faith and do something drastic like disown her or kick her out. Remember that most people relapse a few times before they make it. Even when the person is past the withdrawal stage, recovery is not yet a certain thing as it encompasses much more than just getting rid of the person's physical dependency on heroin.
   • Heroin addiction is not all physical. When someone is trying to recover from heroin addiction, they also need to deal with the mental aspects of their addiction and the triggers that led the person to engage in the behavior in the first place. Even though the withdrawal symptoms might have gone, the mental addiction will still be there, urging her to use again. Thus, treatment will have to involve dealing with those underlying issues in order to truly remove the impetus to relapse.
   • If (or when) the person fails, don't take it as a personal insult and instead offer support for the next time she tries.
4. Show empathy and patience. Be supportive and try not to be suspicious of the person all the time; appreciate that it is hard to overcome a heroin addiction and show compassion for this trial. Instead of nagging the person when she slips or falls on the path to recovery or trying to control her every move and behavior, offer understanding and empathy. The very fact that the person wants to try to get better and beat the addiction is encouraging.
   • Remember that recovery is not linear, like going simply from point A to point B. There are lots of ups and downs. Don't keep asking the person if she is still clean or lecturing her about not starting again. If you're constantly nagging the person, she will begin to lose trust and comfortability with you and may even start keeping things from you.
5. Engage in positive reinforcement. Offer provide praise and encouragement when the person does something to further her recovery or as a way to mark a milestone on the path to recovery (such as one-week sober or 30 days sober). This is also called positive enabling, which refers to behaviors that encourage change in a person addicted to drugs.
   • Enable the person to continue her recovery and her path of change by reminding her that you love her and that you too are committed to her betterment.
6. Remain present throughout recovery. Once the person is receiving treatment, whether that be by entering a rehabilitation center, seeing a therapist, or going to meetings, remain an active part of their recovery process. Getting the person to get help and treatment with only the first stage of recovery. Your loved one will need your support in order to carry on with the treatment and be successful in beating the addiction. Show the person that you are invested in her and her long-term recovery.
   • One way to stay involved is to try to attend therapy sessions or meetings that allow guests of people addicted to drugs. This may also help you build understanding and empathy as you will come to learn about heroin addiction and how it affects people.
   • Inquire about the person's recovery. However, rather than ask the person in a Q-and-A format or other style that resembles an interrogation rather than a conversation (e.g. "Did you go to a meeting today?";"Did you talk in therapy today?", etc.), consider asking open-ended questions that allow the person to shape the narrative they want to tell (e.g., "How have the meetings been going?" and "Have you learned anything new about yourself throughout this process?").

Understanding Heroin Addiction

1. Understand what heroin is. Heroin is a narcotic that comes from the opiate family, a class of pain killing drugs (analgesics) derived from the Opium Poppy (Papaver somniferum). For 7,000 years, this plant was the most effective painkiller known to medicine. Typically sold as a white or brown-colored powder that is "cut" with sugar, starch, powdered milk or quinine, heroin can be used in many ways, including through intravenous injections, smoking and snorting.
   • Smoking heroin has become more popular since the 1990s due to fears of HIV infection through intravenous needle-sharing. Smoking is also the major method of using heroin in Asia and Africa.
2. Learn about the addictive effects of heroin. Heroin exerts its primary addictive effect by activating mu-opioid receptors (MORs, similar to the endorphin and serotonin receptors which are responsible for happiness) in the brain. The brain regions and neurotransmitters affected by heroin are responsible for producing the pleasurable sensation of "reward", the relief of pain, and physical dependence. Together, these actions account for the user's loss of control and the drug's habit-forming action. In addition to being a powerful painkiller, heroin also depresses the central nervous system activity, making the heart rate and breathing slow down and suppressing the cough.
   • Soon after using, heroin crosses the blood-brain barrier. Heroin is converted to morphine in the brain and then binds to opioid receptors. Users report feeling a "rush" or surge of pleasurable sensation. The rush's intensity is tied to the quantity of drug taken as well as the quickness with which the drug enters the brain and binds to the 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 then spreads through the body and any troubles or pains seem very distant and unimportant.
   • This "high" will continue until the effects wear off, usually 6 to 8 hours after a hit. The user will then need to start thinking about where to score and/or where to get the money from for the next hit before physical withdrawal sets in.
   • Know that heroin users can talk and think coherently. Even with doses sufficiently high to produce euphoria, there is little change to coordination, sensation or intellect. At higher doses the user slips into a dreamlike state where she is not asleep or awake, but somewhere between. Pupils become tiny (pinned) and the eyes roll back. This is referred to as 'nodding' or 'halucinodding' or opium dreams.
3. Be aware that addiction happens fast. Within as little as a week of usage, a person can develop a physical dependence on heroin. Although some users may take it occasionally, heroin offers most people 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 three consecutive days of heroin 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 one to two weeks after beginning consistent daily use. After this amount of time, stopping will result in obvious withdrawal symptoms.
   • Once someone becomes addicted, finding and using heroin becomes her main goal.
4. Understand heroin withdrawal. When helping a person addicted to heroin withdraw, it is important to know the facts and symptoms. Withdrawal occurs a few hours after taking the drug, once the effects start to wear off and the body has broken down the heroin in the blood stream. 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 fetus of a pregnant addict. Symptoms include restlessness, muscle and bone pain, trouble sleeping, diarrhea, vomiting, cold flashes, and restless legs.
   • For short term users: 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 second day without a hit. This is the worst day, with things slowly improving from the third day onwards. These acute symptoms are usually greatly improved by the fifth day and are largely gone in seven to ten days.
   • For longer term users: Acute withdrawal (which is considered the first 12 hours without heroin) is followed by a "protracted abstinence syndrome" or 'PAWS' (post acute withdrawal syndrome) which can continue for up to 32 weeks afterwards. The symptoms that continue over this time are: restlessness; disturbed sleep patterns; abnormal blood pressure and pulse rate; dilated pupils; feeling cold; irritability; change of personality and feeling; and, intense craving for the drug.
   • Often the hardest part of detox is not the withdrawing itself but staying off it altogether. To remain drug-free, 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 the drug are among the things that have to change as well as wanting to stay clean.
5. Know that battling addiction is not easy. Addiction to drugs is a lifetime struggle. It takes willpower and endurance to make changes. Sobriety may be achieved, but the person may always face tremendous temptation to use. It is difficult to change your whole life, since fighting a drug addiction also means having to change other habits and parts of a person's life, such as where they go and who they see socially. Even "normal" activities like watching television are totally different when you're clean. This is why so many people get clean and then relapse.
   • It is also worth remembering that many people use heroin to escape or cope with personal problems, such as a history of abuse or assault, low self-esteem, and depression, among other reasons. A person addicted to heroin has to fight through the agony of withdrawal only to then be faced with all the same problems she was escaping from in the first place, but now with the added burden of heroin cravings to deal with.

Tips

• Keep in mind that many people addicted to heroin eventually stop using drugs, and that there is no time limit dictating how long a person is addicted to heroin.
• People will stop using heroin when they are ready to stop, no matter what you do or say to them. They will have to stop on their own. The person will have to experience being very tired of losing.
• Consider getting some assistance for yourself as the friend or loved one of a person addicted to heroin. Al-Anon and Nar-Anon (not the same as AA or NA, which are for addicted persons themselves) are for friends and family of people addicted to drugs. These organizations host meetings that can help you maintain boundaries and will provide you with support as you deal with someone else's addiction.

Related Articles

• Recognize Enabling Behaviors
• Say No to Drugs and Alcohol
• Quit Using Heroin
• Tell Your Parents You Smoke Marijuana
• Help Someone Overcome Marijuana Addiction
• Tell Your Friend They Have a Problem with Drugs
• Deal With Someone Who Is Having Problems With Drugs or Drinking
• Change Enabling Behaviors
• Understand Why People Use Drugs
• Deal with a Loved One with an Addiction

Sources and Citations

See also

• Cope with Oxycodone Withdrawal
• Help a Drug Addict
• Help a Friend Quit Doing Drugs
• Withdraw from Methadone
• Help Someone Overcome Marijuana Addiction
• Deal With a Drug Addicted Family Member or Loved One
• Stop Smoking Pot/Weed
• Overcome a Meth Addiction
• Quit Using Heroin
• Deal With HPPD

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• Become a Drug Abuse Counselor
• Recognize Enabling Behaviors
• Use Subutex or Suboxone