Addict in the Family
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Addict In The Family

by Dr. Andrew Byrne

Chapter 1: Finding Out



So, you have just found out that a family member or close friend is a heroin addict. It may come as quite a shock. It may also explain a lot of unusual observations over a long period.

This may happen by chance or when suspicious goings on are looked into. After following some initial clues, investigations by a parent or other loved-one may reveal the evidence. This might include the actual drugs or drug-using equipment such as a smoking bong, needle, syringe, tourniquet, sterile water containers or a burned spoon, foils or spent rubber caps. Alternatively, it may occur in the context of a crisis such as an overdose, serious legal charge or the discovery of medical problems such as thrombosis, HIV or hepatitis.

In yet another scenario, the drug user may just come out and say, 'Look, I'm a junkie! Please take me as I am. I am sorry for all the trouble I have caused and I want to give it another try.'

Loved-ones often overlook the evidence of drug use. They may ascribe things to 'a difficult time', nerves, growing pains, work troubles, illness or other more palatable shortcomings.

The discovery of unequivocal proof of drug use may be devastating. Reactions vary from rejection and hostility to even further denial of the problem. With time, patience and understanding, most of these tensions can be overcome and previous harmonious relationships restored and even improved.

The majority of addicts by this stage have deceived people around them and some have committed robberies or other schemes to generate income for drugs. Few of them are proud of it, but some try to justify such behaviour. Society, they say, has placed them in the untenable position of being addicted to a drug which is illegal.

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A Classification of Common Psychoactive Drugs
(Common Names in Parentheses)
Narcotics (Opiods): Hallucinogens: Relaxants & Depressants Sympathomimetic Stimulants: Other Stimulants:
  • di-acetyl morphine (heroin)
  • morphine (MS Contin)
  • pethidine ( US: demerol)
  • monoacetyl morphine ('home-bake')
  • dextromoramide (Palfium)
  • oxycodone (Endone)
  • buprenorphine (Temgesic)
  • methadone (Physeptone)
  • pentazocine (Fortral)
  • propoxyphene (Doloxene)
  • codeine phosphate
  • dihydrocodeine
  • diphenoxylate (Lomotil)
  • poppy seeds
  • lysergic acid diethylamide ('LSD')
  • magic mushrooms
  • mescalin (peyote cactus)
  • alcohol
  • benodiazepines
  • methaqualone, barbiturates
  • cannabis leaf, hashish resin
  • amphetamine
  • methamphetamine
  • methyl phenydate (Ritalin)
  • methylene dioxymethamphetamine ('ecstasy')
  • ephedrine
  • pseudo-ephedrine
  • cocaine
  • crack (free-base cocaine)
  • nicotine
  • caffeine
  • betel nut
  • coca leaf

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A small number of addicts first received narcotics in the context of medical or dental treatment. Finding the medical profession unable to treat their addiction, they may have moved to illicit drugs.

The commonest illicit narcotics in Sydney are heroin and black market methadone. In Western Australia and New Zealand 'homebake' is most commonly found. Raw opium is popular in India while brown impure heroin is found in Russia. In Poland, a codeine based mixture called 'compot' is the most frequently used opioid. For discussion and explanation of individual drug categories, see appendix at the end of this book.

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It is important not to tell too many people about someone's addiction. Number one, they may not understand, and secondly it may be none of their business. The stigma is very hard to lose with some people who have fixed ideas about addiction. One reason for this is the poor results from previous approaches to treatment with the experience of repeated relapses to drug or alcohol use. Modern enlightened therapy is more likely to result in an integrated patient much earlier than traditional approaches which often emphasise segregation for extended periods.

Doctors use numerous euphemisms for drug addiction. One common term for a heroin addict is an intravenous drug user (IVDU) although this term may also be applied to users of other injected drugs such as amphetamine and cocaine. Other terms used in medical classification are 'nervous disorder', 'substance abuse', 'chemical dependency', 'morphinism' and 'compulsive self medication'. The legal terms 'self administration', 'possession', 'narcotic trafficking', 'personal use', and the like all have certain definitions in different jurisdictions.

The old term 'nervous breakdown' is not a single medical diagnosis, but is used by some to mean a temporary inability to function due to psychiatric illness. Such conditions include depression, obsessive compulsive disorders, schizophrenia, alcoholism and drug addiction. These may have their origins in disorders as varied as migraine, stroke or shingles.

Heroin addicts should always be frank with their own doctor about what drugs they are using. Drug addiction itself is a treatable condition and its complications may also require medical intervention. The physician should know the full drug history, social circumstances and previous interventions. An examination and pathology testing will reveal important information about suitability for treatment, work or travel. It will also help with the prognosis of infectious diseases.

All doctors are familiar with of the nature of narcotic use and its medical consequences. A small number may be unsympathetic and judgemental. Another group will simply be unfamiliar with drug addiction or its treatment since, until recently, this has not been covered in the medical course. Most doctors are open minded and willing to learn. They also have access to drug and alcohol specialist services and will be guided by their advice.

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The answer to this question is simpler than it may appear. One should behave exactly as one would on learning of any other serious problem involving a loved one. Just as if the person had diabetes, angina or HIV, it is important not to panic. Try not to judge, even if you have been hurt. The addicted person probably also hurts for previous transgressions. Learn what you can about the condition. When seeking expert help, be aware that this is a field where there are a lot of self-styled 'experts'. Trained addiction specialists are attached to most large hospitals and most psychiatrists are also familiar with this area.

It is often helpful for relatives or loved ones to attend such a specialist, counsellor or self help group together with the addicted person. This gives an important opportunity for associates to assess the nature and quality of the treatment being considered. They can ventilate any misgivings with the parties involved and ask questions. It should also give them confidence in treatment directions and how they can help to assist in these efforts.

There are self-help groups for family members. Nar-Anon and Al-Anon members' lives have been affected by drugs and alcohol abuse of others. They use each other's experiences to gain strength and resolve by example and faith. While these groups follow abstinence orientated philosophies, there are equally genuine groups supporting 'harm minimisation' philosophies (ie. accepting continued use of drugs in a more controlled manner). Methadone support groups and 'controlled drinking' or smoking are further examples of this.

Help for family members is also to be had from the local doctor. There are also many pharmacists who are familiar with this field. Drug and alcohol counsellors may be found at some community care centres.

It is best for relatives and others who are close to the addict not to offer advice, however tempting it may be. In our effort to understand, it is best to offer support and sympathy, even when these do not come readily. If circumstances are such that this is not possible at the time, it is best to be frank about one's feelings, but still to leave the way open for future reconciliation.

Do not worsen the situation by giving money which could be used for drugs. If possible, offer assistance with transport, bills or arrangements which are documented to be for treatment purposes, and always pay by non-negotiable cheque or credit card authority.

Do not be enticed into debates about whether abstinence is the best philosophy. Each type of treatment is 'correct' for the right person at the right time. Equally unrewarding are arguments about why someone originally used drugs or what made them relapse on this occasion.

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How To Help A Heroin Addict In The Family
Offer sympathy and support Do not panic or pity
Assist with housing and bills Do not give cash to the addict
Be honest about prejudices Do not judge morally
Seek expert advice Do not set unrealistic goals
Consult others 'in recovery' Do not cut off dialogue
Assist with chosen treatment Do not influence treatment type

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Dr. Andrew J. Byrne received the prestigious Marie Award at the 2006 national conference of the American Association for the Treatment of Opioid Dependence.
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