Ask a Junky: So Your Friends a Junky

The first post for Ask a Junky is in response to a non-user who asked how she could help her heroin-using friend. This is probably a question everyone who's ever loved a heroin user has asked. I thought it was an important one and deserved to be addressed first :)

So you've found out your friend uses heroin. Maybe in the spirit of friendship they disclosed this information to you. Maybe you found out through a friend of a friend. Maybe they got into some trouble with the law and their secret was exposed. Maybe their drug use got the better of them and it became apparent. No matter how you found out, this new piece of information has you concerned. This is a typical response. Whether you have personal experience with drugs like heroin or have never even been exposed to hard drug use, it’s natural to be worried and want to help, especially when the media irresponsibly bombards us with sensationalized stories “exposing” the horrors of heroin addiction and the deadly consequences of its use. The last thing you want is for your loved one to wind up living on the streets, a shell of a person, stealing to support their habit and risking overdose each new day. If you care at all about your friend, you’ll want to do anything you can to prevent them from destroying their lives and replacing the person you love with a new, junky criminal version who cares about nothing but the poppy. Your first instinct might be to put heavy pressure on your friend to stop, appealing to their good sense. You may have even considered staging an intervention - for their own good. But let’s stop for a moment, take a deep breath, exhale, and take a step back. If you seriously want to help your friend, for their own good, not as an activist for the anti-drug crusade, there are a few things you need to know about heroin, its users and your friend. Without a complete understanding of the situation, any help you proffer will be met with resistance and will most likely backfire.

Stigma not only hurts, it kills. Stop the hate.

First, what is your intention? Do you truly want to help your friend have the best life? Or are your instincts a reaction to your political beliefs? If you approach your friend with forceful talk about rehab and NA, spouting media propaganda and textbook anti-drug rhetoric, their defenses will go on red-alert. You will now be considered “one of them”. And you’ll most likely lose their friendship forever. If the bulk of your heroin knowledge comes from news stories or D.A.R.E. presentations, I would suggest performing a complete system re-boot on your brain. In order to look at the big picture subjectively, let’s wipe the slate clean and start from scratch. Pretend you know absolutely nothing about heroin and drop all preconceive notions. Addiction comes with its own stigma. But let’s try to wipe that slate clean as well. Just for this exercise, let’s remove the substance or behavior of choice out of the equation, in this case – heroin. If your friend was addicted to coffee, would you try to send him to rehab? Would you stage an intervention for your girlfriend with too many shoes? I know what you’re thinking, “No, of course not. But a shoe or coffee addiction isn’t damaging to anybody.” You’re right. But at this point, we don’t know what your friends drug use looks like. We don’t know if it’s damaging to them or not. Until we get some more facts, we are in no position to make any assumptions. There are two main questions you need to ask before trying to help.

1. What type of heroin user is my friend? (There are three types, which I will clarify in a moment.)
2. What are my ultimate intentions for my friend?

I’ll address these questions in order The first thing you need to understand, and this may seem basic, but it’s crucial, is that not all heroin users are created equal. The way I see it, there are three types of heroin users.

Type 1: Use heroin sparingly, saving it for weekends and special occasions. They do not use enough to develop a physical addiction and use it solely for recreational purposes.

Type 2: Use heroin daily and are physically addicted. However, they are functional users. They use within their means, are successful in their careers, do not let it interfere with their families or personal life, avoid trouble with the law. In short, they do not allow it to complete control life, despite the fact that they are addicted.

Type 3: Also use heroin daily and are physically dependent. But they are unable to control their use and subsequently use beyond their means, exposing themselves to unnecessary risk and allowing it to control every aspect of their existence. This type of user has potentially been in and out of addiction treatment, been in trouble with the law and often turns to crime as a means to support their habit. Heroin related health problems like AIDS and Hepatitis C are most common for this type, although not exclusive. The worst cases may find themselves living on the streets.

One’s preferred route of administration does not necessarily reflect the category they fall into. If you’re on the west coast, 98% of heroin users inject, simply because black tar is extremely wasteful any other way, unless you've really master Chasing the Dragon. On the east coast many Type 3 addicts choice never to inject. (Route of Administration is another topic I will cover in Ask a Junky shortly.)

It might seem logical to base the severity of your friend’s problem on the quantity of heroin they use. But this alone is not is not enough information. One person could be using 3 grams of heroin a day, but has a successful career, the means to support his habit, maintains his health and keep social engagements. While his neighbor who use three grams of heroin a day had to mortgage his house, lost his family and got fired from his job. They are both chemically addicted to the drug. They will both go through equally painful withdraws. But one is able to function within the normal parameters of society, while the other has sacrificed his life and relationships for the drug.

You may be able to deduce the seriousness of your friend’s problem simply by observing their life. Are they employed? Do they follow through with their social commitments? Have they been trying to borrow money? Have they been arrested? Supposing you are still on good terms and haven’t tried to shove them into a rehab yet, other questions you can learn by asking. Are they physically addicted? How often do they use? Do they have any diseases? How do they support their habit? When digging for information, it’s important to never come off as being pushy, judgmental, pitying or parental. Unless you demonstrate otherwise, all user assume non-users know absolutely nothing about heroin. They assume you've been brainwashed along with the rest of country. Approaching the subject with open-minded curiosity can go a long way towards showing you haven’t bought into the media hype and are willing to get it straight from the source. If you can do this, most users will be happy to talk with you about their habit.  Once you get answers for most of these questions, you’ll have a good idea of what type of user they are.

Once you've determined what type of heroin user your friend is, you need to ask yourself what your intentions are. If complete and total abstinence from heroin is the only acceptable outcome for you, despite what category your friend falls into or what his goals are for himself, then the only advice I can offer is, be prepared to end the friendship. It doesn't matter what type of user he is or how good your intentions are, no user wants to be scolded, threatened, bullied or forced into anything they don’t want to do, especially from someone who has no real understanding of heroin or addiction. Down the line, they may choose for themselves to quit, but if you try to push the issue before they’re ready, you will most likely lose them.

It could be that you’d rather lose a friend than be friends with a junky. You have you that right, the same way your friend has the right to use heroin. If this is the case, my advice is to say your piece and end it cleanly. I've had friends who have said it to my face and friends who simply refused to return my phone calls. I respect the ones who had the guts to try one more time to get me to quit and tell me to my face why they could no longer be friends with me.

If you don’t want to lose your friendship, then this is most important advice I can give. There is nothing that your heroin user friend will appreciate more than being treated the same as always. I don’t mean ignore the fact that they now use and once didn't. If you want to talk about it, talk about it. The same as you would any other issue you've dealt with. But realize that you are dealing with the same person. Most of the time, when people find out that someone uses heroin, the whole dynamic of the relationship changes. Most interaction are laced with pity, disgust or any number of other undesirable reactions. I can count on less than 5 fingers the number of friends I have who have been able to look past the fact that I’m a user. They don’t avoid the topic, sometimes it comes up frequently, sometimes rarely. They realize that it’s part of my life, but it doesn't define who I am. And if the time comes when your friend wants to quit and get help, you will be the one they will turn to as a trusted friend. If your dynamic changes, you will eventually lose them. We pick up on these things and don’t want to be around people who can’t see past our use. So whether you want it or not, that friendship is eventually doomed.

The next thing I would suggest, no matter what type of user they are, is to have a conversation and get to know the reasons why they use and how their use affects their life. Every drug user uses drugs for a reason. It could be as simple as “It makes me feel good”, or a heavy as “I’m trying to forget an abusive past.” The user is getting some benefit from heroin. Once you know what the benefit is, you can suggest healthier, more productive ways to achieve the same thing. My psychologist does this with me all the time and it’s wonderful because it demonstrates that heroin is not the Alpha and the Omega. Be clear that you’re not trying to take heroin away, just supplementing it with healthier activities. It helps train the brain to not be so dependent.

In addition to finding out why your friend uses, it’s important to find out what their goals are. Do they want to quit somewhere down the line? Are they ready for rehab now, but don’t know where to start? Do they ever want to give up heroin? This is where approaching the conversation with an open-mind and without judgment really becomes critical. Heroin users know that 99% of non-users and even many users believe that ultimately, to achieve long term happiness, they will have to give up heroin at some point. It may be all fun and games right now, but eventually, it’s going to have to come to an end. Whether the user believes it themselves or not, most of the time when talking to someone who does believe it, they will blow smoke up your ass and tell you want you want to hear just to placate you and avoid being judged as the ultimate failure. Hear them out. Make it clear you want their honest answer. Don’t try to add your two cents. Don’t try to poke holes in their junky logic. Don’t try to gently steer their thought process towards more rational thinking. At this point in time, you are building your foundation as someone who can be trusted. There will be plenty of time to speak your mind down the road. You might be pleasantly surprised by what you hear or your might be heartbroken. But at least you’ll know their true intentions as of that moment (chances are they are going to change their mind at some point in time, so don’t think that whatever they tell you is set in stone.) But for now at least, you’ll know what you’re dealing with and two of you will be on the same page.

If your ultimate goal is to make sure your friend is using as safe as possible and limiting risk, try to get a couple more details, like how they buys heroin and how they administer it. That will tell you how much risk they are exposed to. Do they buy from a dealer or on the street? Do they inject? If so, do they share needles? How do they support their habit? Do they have a good doctor they can talk to about heroin related health concerns? If you see that they are exposing themselves to unnecessary risk in any of these areas, work with your friend and try to come up with ways to limit or eliminate these risks. Encourage them, or even help them, find a good doctor who is sympathetic to drug users.

Openly talking with your friend on a regular basis about harm reduction is always a good idea. If they assure you they diligently practice harm reduction 100% of the time, they will have no problem with you checking in every once to confirm they’re still being diligent. They’ll probably be happy that you care so much to talk about it, rather than avoiding the issue as though it didn't exist. If they try to blow you off or give you the run around and act like harm reductions is not that big a deal, that’s a problem. Harm reduction is a huge deal and it needs to be taken seriously. It doesn't matter if they use six times a year or six times a day. If they use with other people, some are probably much heavier users. It’s never okay to share needles, even with long term friends. You just never know.

My advice to anyone who suspects their friend or loved one is not practicing harm reduction religiously is to do the research for him. Find out the location of the closest needle exchange. If there isn't one close by, find out how and where he can procure clean needles. Most harm reduction centers offer free Narcan, the overdose prevention drug. Narcan should be in the most of every heroin user, especially Type 1 users who haven’t built up a tolerance. Sit him down and have a harm reduction intervention. This is the only time I advocate forceful intervention with a heroin user. It won’t work if you are trying to get someone to quit who isn't ready. But harm reduction should be taken seriously by every drug users who values life. If you really want what is best for your friend and aren't simply trying to control his life, then knowing that he’s virtually eliminated all risk of disease and drug-related health problems should make you extremely happy.

 

Part of harm reduction is drug education. Make sure your friend is not mixing alcohol and heroin or benzos and heroin and knows the risks associated with these deadly combinations. Almost every single overdose is due to either benzos or alcohol, mixed with heroin. If you refrain from spouting nonsense about how heroin kills everyone eventually, and addressing legitimate concerns like dangerous drug combinations, you can prove to your friend that you are putting his safety above all else. You aren't acting as a soldier for the anti-drug crusade, you just want to make sure he is being a safe and responsible user. It will also help give you peace of mind.

If your friend is a Type 1 user, the only other thing I would suggest is to monitor his use. I don’t mean grill him every time you talk about how much heroin he did on the weekend and constantly try to keep him in check. But keep your eyes open for warning signs of a developing problem. If the answers to any of your preliminary questions change, it could mean that his use is escalating and he’s changing categories.

If your friend is a Type 2 user, keep them in check. If you see that heroin is beginning to interfere in a certain area of their life, let them know. If you see they are in denial anywhere, point it out. Don’t be aggressive or condescending, they’re still heroin addicts. But call them out on their bullshit. Make sure that if they are slipping into a Type 3 user, they do it with their eyes open. Not so that you can say “I told you so” but so they have the option to take control and turn things around before it’s too late.

If your friend is a Type 3 user, you will need to look out for yourself as well. These are the stories you hear about on the news, the broken families and shattered lives. It may seem the person you were friends with is gone, but that same person is still there. Heroin has a way of making you believe it’s the only source of true happiness and anyone who isn’t actively shoving it up your arm is out to take happiness away from you. This is where rock bottom happens. I've been there, and it’s not a fun place. It may seem that forced rehab is the only way to save a Type 3, but I would still council against it. A heroin user has to be ready to quit for any long term success. But many Type 3’s do wind up in jail or get fed up with their lives and decide to make a change themselves. You don’t have to be a part of their daily life. But let them know you’ll always be there when they want help. It may seem hard, but try to remember they are the same person they were and always will be and try to treat them that way. They deal with the worst kind of discrimination from every corner of society. You could be the only person who treats them like a human being and they will love you for it.

No matter what type of user your friend is, there is going to be little you can do to stop them from using if they aren't ready to quit. Reducing their exposure to law enforcement, ensuring they practice diligent harm reduction, making sure they have access to proper medical care and, most importantly, extending your unconditional friendship are the best things you can do. But I do have some good news for those who want complete and total abstinence. Most heroin users do decide to quit at some point. Unfortunately, many have to hit rock bottom before that happens, but everybody’s rock bottom is different. With your support, it might not be that bad.

The last thing I have to say is, many addicts who decided to clean up opt for a maintenance program. It may seem to some that they are just replacing one drug with another. While technically that might be true, the mindset is completely different. It takes just as much guts and willpower and determination and courage to be on a maintenance program as it does to quit outright. Different things work for different people. Trying to encourage early termination of a maintenance program could have catastrophic results. Let them take the time to recover anyway they choice. I can promise you, whether on Suboxone or Methadone, they aren't getting high. It takes long time to reprogram the brain and body to not crave heroin. They’ll probably want to wean themselves off the maintenance program eventually. But in the meantime, realize that this isn't a recreational substitute, they don’t expose themselves to legal or heath risk and they are being extremely courageous taking this step.

I know it’s not easy to love a junky. Some have it harder than others, but no one has it easy. Deciding to remain friends with a heroin user also takes guts and courage. It would be much easier to write your friend off and avoid any heartache. You could justify it ten ways till Tuesday. But thank you for choosing the road less traveled and sticking it through. I appreciate it on behalf of all heroin users, and I know your friend will appreciate it more than you’ll probably even know.

Peace, Love & Rock 'n Roll D_D