In my last blog post, I started to look at the research of Patrick Biernacki, conducted in the US in the mid-1980s, which involved interviews with 101 people who had recovered from heroin addiction without treatment.
This research indicated that once people who have become dependent on heroin decide to stop using the drug, they are often unsure about what they should do with their lives instead. They may know what they do not want to do, but they are less certain about what they do want and how they can go about getting there.
This problem is greater for those who have immersed themselves in the world of addiction. They may have no money, no place to live, and no friends (other than other heroin users) and family to help them get out of their situation.
Resolving the uncertainties and self-doubts that users have when considering giving up the drug can occur in a variety of ways, some of them selected deliberately by the individual, some occurring fortuitously (e.g. through an accidental social encounter).
Whilst nearly all of the participants in the Biernacki study considered treatment as a possible alternative, it was rejected by all of them. When asked why they did not use treatment, 35% said they thought they could take care of themselves, 19% did not believe that treatment would work, 14% thought they would be stigmatised, 10% said treatment was not available, and 9% had a negative image of treatment programmes.
Moving towards abstinence generally entails literal or symbolic actions taken to sever connections with heroin and the heroin-using world. Biernarki provided examples of symbolic breaking away: the person who presented himself as a non-user to his drug-using friends, and the woman who presented herself as a born-again Christian.
Some people are not confident enough to maintain their resolve to quit, so they lock themselves in their homes and do not answer the door or telephone. Others feel that they have to change geographical location if they are going to stop using heroin.
Following a period of withdrawal, former users face a basic problem of filling their lives with activities to fill the time they had previously devoted to their drug use—in some cases, this may have involved a full day of shoplifting, selling the goods, buying the drug and using.
Filling time with new activities may not be a great problem to a person who had maintained strong relationships in normal society, but is much more difficult for a person who lived almost exclusively in the world of addiction and may have been taking the drug from an early age.
In the Biernarki study, interviewees described a period in which the activities that filled this void—work, child care, religion, politics, or physical exercise—’became almost the exclusive focus of the addict’s life and are fervently performed.’ During this time, which may last as long as a year, ‘a moratorium takes place on what might be considered a ‘normal’ round of life. The abstaining individual rarely ventures beyond the safe confines of the group or activities with which he is engrossed.’
During the time that the former user has removed himself from the drug scene, either literally or symbolically, changes gradually occur that increase the likelihood the person will remain abstinent. This can, however, take a long time, and some former users will not reveal their past lives to straight people.
Former users share social experiences with non-users, and these experiences can provide the basis for a commonality of discourse. This can help ex-users overcome their fears that they cannot get along with non-addicts because they will not be accepted by them.
At the same time, ex-users may be forging new friendships, possibly a new intimate relationship, and acquiring material goods and a liking for a drug-free life. They start to gain a personal stake in the new things they have acquired since giving up heroin, and they do not want to jeopardise this by going back to heroin.
Biernacki also pointed out that the changing drug scene can increase the likelihood a former user will stay abstinent. He described heroin social circles as often changing as members drift away for various reasons, are jailed, hospitalised or die. A person might return to their usual drug scene to find it completely changed and find it more difficult to obtain drug. This difficulty may be sufficient to dissuade them from starting to use again.
As time goes on, the ex-user acquires emerging stakes in staying abstinent. ‘The social relationships, interests and investments that develop in the course of abstinence reflect the gradual emergence of new identities and corresponding new perspectives. Now the abstaining individuals know what they do not want to do but also what they would like to do and become. They can begin to plan and work for a future unrelated to drugs.’
Recommended Reading: Patrick Biernacki (1986) Pathways from heroin addiction: Recovery without treatment. Temple University Press, US.
The photograph used in this blog post was by Rachel Cook and has come from Unsplash, a great resource of free high resolution photographs.
