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newslettercompilation
Compilation
Newsletter No 1
A
selection of articles and poetry from previous issues.
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In
this Issue:
Look
Between the Lines.
Methadone.
Let
Go . . .
Do
We Have A Drug Problem?
Third
Annual Turning Point Oration:From Tears To Hope─10/12/99
Melbourne.
Parenting
A Heroin User.
Miss
Heroin.
Getting
Off The Grass:Research On Cognitive Behaviour Therapy
For
Cannabis Dependence.
Is
Naltrexone A Cure For Heroin Dependence?
Ambivalence.
I
Voyager.
Home
Detox for Heroin.
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Look
Between The Lines
I am involved in a `Drug Support' telephone line. Week
after week I listen to and console parents regarding
their wayward kids. It's heart-rendering. I listen
to parents or the users express their fears and concerns.
The sheer chaos that comes down the phone line is so
distressing. For about half an hour I have a brief insight
into what people are experiencing.
Not
that I don't know. I have had the benefit of 18
years' experience using drugs, all types of drugs, but
mainly heroin. I have never been clean in my life
until now. Now I have 12 months up. I am not so
far away from drugs that I don't remember. I remember
the personal battles it caused me. I remember the
daily guilt. I will never forget the pain I caused
to those who loved me. And I don't pretend to forget
the enjoyment I thought those toxins gave me.
I
always thought that I loved heroin. Heroin gave me pleasure,
didn't it? Heroin was my release, wasn't it?
I
think in the beginning this was exactly what heroin
did. In the beginning . . . But later and
not so very much later heroin was not so much creating
pleasure as it was stopping pain.
My
problem was I couldn't distinguish between the two.
Everytime I had a taste I thought `this is pleasure'
when in fact the only pleasure that I actually felt
was the cessation of pain. It got to be that I didn't
know the difference. Try and imagine that. The only
happiness you will ever experience is when you stop
the pain.
All
of this I understand better in hindsight. Through most
of my using life I never considered stopping, not because
I didn't want to but because I couldn't. I mentally
and physically could not fight heroin. I had tried,
really tried, only to fail and go through all
that hard work and be back where I started. So I stopped
trying. What was the point of battling mind over body,
heart over soul, to go through all that pain and stress
to start again at the beginning? I imagine there are
a lot of users out there who feel the same.
I
was lucky. I know I was lucky. I stayed alive;
I didn't get AIDS; I didn't go to jail (God knows I
could have). My kids are healthy and my relationship
is intact.
Even
though I haven't been clean long, I have been clean
long enough to know real joy─real happiness─enjoyment
from living, not just existing. Laughing and taking
pleasure from the simple things in life─like a
sunrise─like the smell of flowers─a brilliant
star-filled sky. The sun on my back and most importantly,
waking up like I've always wanted to─bright and
fresh and healthy with my only worry being whether it
will rain or not . . . Like a child.
I
know I will never use drugs again. I have had distance
from them. I can feel now and I can see way into
the distance rather than just tomorrow. It's a beautiful
life. I know it's early but drugs don't even tempt
me these days. I can do things I never believed
were possible. Like walk through Cabramatta with a pocket
full of money.
When
I think of drugs now they frighten me─the way
they should have but didn't when I was young. They scare
me because they represent taking from me all that I
now hold precious. I don't feel guilty anymore.
I don't have to guard secrets and watch what I
say anymore. I feel useful. I feel worthwhile.
I have learnt to love myself a lot and forgive
myself a little.
I
wish I could give you the answers. When I think back
on it, I have to wonder: Why did I get clean? How
did I get clean? I've spent a long time thinking about
this one. There is no `one size fits all' answer. Part
of the solution for me was that I wanted to be clean.
The other part of me had no idea what clean was─but
somewhere deep down I knew there had to be more to life
than this. I was sick for weeks and sometimes I
felt like I was going backwards. But I had a good doctor
and I was surrounded by good people who believed in
me, so eventually I got better─without using.
But
that's me. What about all the people who are stuck there.
I talk to them. I hear from their relatives.
I know how the user feels and I don't underplay
it. And I know how the parents feel. I am able
to sit on both sides of the fence. I tell each
of them what I know. I tell the user there is hope.
I tell the parents not to give up hope. Their addict
is a person, a person who only acts badly because they
are most likely stuck in a rut. They are angry with
themselves for feeling weak; they are angry because
deep inside they hate hurting the ones they love. They
are truly defenceless and their anger is their only
weapon. It's a way of pretending that they are happy
with their life, and their biggest burden is just you
and your interfering ways. They can't change─like
I couldn't change─so the best offence is to pretend
they don't want to. And frankly, some of them truly
don't want to.
I
don't tell people who I am or what I've done. I'm not
sure how relevant it is. I try to diffuse their
anger and their frustration. I offer sympathy and
empathy for those who can discern the difference. I offer
a shoulder to cry on. I try to give out hope to
the most wayward of causes. I believe in what I
say and I hope that that in itself will convey my story.
I wish I could travel down the telephone cord to
those most desperate of families to see them, to touch
them, to hold them, until they are spent─to show
them that my concern is real and not just a distant
voice on a phone.
Each
time I finish a shift on the wires I literally feel
a bit broken. It's almost like I'm carrying some of
the burden. I don't mind. I think it's important.
If the people who ring me hang up and feel just a little
bit lighter it's all worthwhile. When I put the phone
down I just relax and think about each of my calls and
go over it in my mind. Could I have said more? Have
I helped? I convince myself that this is so and then
I am able to let go of you all. If I didn't always feel
this way, if I didn't feel a bit bruised, I would
not believe that I had connected with you and I would
believe my effort was useless.
I
never used to feel this way but where there is life,
there is hope. Sometimes I admit the burden can become
far too overwhelming to carry. When this happens, it
is necessary to let go. Your addict may be trying to
destroy all those in his path. He may be too angry to
live with. Sometimes for your own sanity and the well-being
of your family you must step aside. This doesn't mean
you will stop loving him; it merely states you need
a break. Families become very fragile when you live
with drug abuse.
You
let them know exactly that─that you love them
no matter what. You will support them in their darkest
hour and you will always be there, but you need respite.
Everyone needs respite even those who are addicted.
Try
and remember that no matter how bad life gets, no matter
how ugly your addict becomes, he is still a person─only
this person has lost his dreams. He never feels good
unless he has the drug. The drug allows him to dream,
if only for a moment. But he pays a price. He doesn't
always know this because he lives on borrowed credits,
always promising to cash in on another day, a better
week. This is the nature of the drug, not the person.
But
if you look very closely, underneath that metal armour
which every user needs to wear, you will see a semblance
of someone you use to know. Just look between the lines.
Anonymous
(March 2000 issue)
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Methadone
Extract
from Paul Little's Arrested Development: The Aaron
Cohen Story
Liquid handcuffs addicts resentfully call it,
with their penchant for making things just a little
more dramatic than is necessary, but also reflecting
the view that treating heroin dependence with methadone
is merely substituting one addiction for another. The
term refers to the fact that methadone normally can
be obtained only in one- or two-dose amounts and thus
requires drug users never to be more than 24 hours from
their source, severely limiting their freedom of movement.
But
the phrase also acknowledges that the use of methadone
is closely linked to the confusion between drug addiction
as a criminal problem or a health problem.
One
of the reasons addiction is still not well managed is
that doctors do not want to manage it. With good reason.
Buried in the ancestral memory of the medical profession
is the aftermath of the Harrison Narcotics Act of 1914,
which made prescription of opiates illegal in the United
States.
Most
addicts then were middle-class white women, and doctors
attempted to continue to supply them. The authorities
set about to make an example of these doctors, and many
were convicted, struck off or jailed. Pretty soon, even
the medical schools quietly ceased any discussion of
the treatment of addiction. Once addiction became predominantly
a problem of the black population, interest in it fell
away completely.
Today,
doctors who specialise in addiction are seen as─and
act as though they are─on the fringes of their
profession. (This is where you will find the doctors
who still smoke cigarettes.)
In
1914, as now, prohibition alone did not work. Addiction
became and remained a criminal problem.
Methadone
made it possible for that attitude to change by providing
a workable medical treatment for addiction. The drug
was developed near the end of World War II when Nazi
scientists, running low on morphine, developed it as
a form of pain relief. For a long time that was seen
as the extent of its usefulness.
If
any one person was responsible for discovering there
was more to it, it was Dr Marie Nyswander, the founding
mother of methadone maintenance treatment for the relief
of opiate addiction and author, in 1956 of The Drug
Addict as a Patient, a book which, as its title
made explicit, radically rethought the problem of addiction
and its treatment.
Nyswander
stumbled upon the effectiveness of methadone by accident.
She and Dr Vincent Dole had been working with addict
inmates in Lexington, Kentucky, trying to find levels
of an opiate─any opiate─that would maintain
them in some sort of equilibrium. The experiment seemed
to have failed, and her team decided to detox the patients
and end it. To achieve this they gave them high doses
of methadone.
And
a remarkable thing happened─the focus of the subjects'
days started to shift from obsessing about where their
next dose of drugs would come from. They began to talk
about hobbies, work, education and other interests.
The methadone had ended both their craving and their
need for a high.
Better
yet, it turned out, it also blocked their opiate receptors
so that heroin, or any other opiate, would have no effect
if taken. Methadone literally sits in the receptor and
stops the heroin getting in. It is this attribute which
makes it so effective.
There
are those who will say that the main difference between
heroin and methadone is that the former is illegal but
the latter is not. They have a point. Any drug that
can be used can be abused and methadone is no exception.
Despite the inferior quality of the stone that can be
obtained from it there are still people─drug experimenters
at the so-dumb-they'll-try-anything end of the spectrum─who
will take it `recreationally'. The difference between
its effects and those of heroin for the user is roughly
the same as that between calf's liver and foie gras
for the gourmet.
This
is how people abuse methadone. If you don't have a prescription,
you need someone who does to get it for you. They will
go to the chemist for their orally administered dose
and, by sleight of mouth, either dribble it into a phial
around their neck or go outside and expectorate it into
a container.
Most
would-be abusers swallow it. Some─doubtless seeing
themselves as purists─insist on injecting it.
This can cause large pullulating abscesses on their
arms due to the extra bacteria they have shot up along
with their treat.
But
for addicts on a responsibly managed methadone maintenance
program, the effect of the drug is in its own way as
much of a life-altering experience as heroin. It is
safe─when it hasn't been diluted with orange juice
and left where the kids can get it. (Although people
can overdose on methadone the risk is low because, unlike
street smack, it comes in reliably measured doses.)
Unlike heroin it tends not to increase tolerance so
that bigger doses are necessary to achieve the same
effect. It improves intellectual and sexual functioning,
allows people to have jobs and relationships, improves
general health, lets people experience emotions and
respond empathically to fellow humans, even restoring
the normal relationships which were sundered by addiction.
It allows people to feel pain, and to be prescribed
effective pain relief.
For
a portion of non-drug using members of society, methadone
is an acceptable treatment not because it improves the
lot of junkies but because it improves their own quality
of lives by reducing the crime committed to feed addictions
and, in the days before needle exchange programs, it
reduced the risk of HIV/AIDS transmission in the community
by obviating the use of needles.
Methadone
has indeed saved more lives than those of drug users─people
who weren't murdered in the course of burglaries committed
to feed habits, family members who weren't driven to
despair by addicted children or parents, children who
were born and raised by addicts who otherwise would
have struggled constantly just to maintain their habits.
Recently,
other pharmaceutical treatments─notably Naltrexone
and Buprenorphine─have been advanced as superior
remedies for addiction. They may indeed have the capacity
to end addiction once and for all. But as of now they
have their own drawbacks and await further research
and possible improvement.
Methadone
is not a cure. There is a high level of relapse into
opiate addiction from people who attempt to go off it
in any but a rigidly controlled manner. But at this
time, methadone, for all its failings, is still the
best hope an addict has of leading anything like a normal
life.
(August
2000 issue)
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Let
Go . . .
to
`let go' does not mean to stop caring,
it
means I can't do it for someone else
to
`let go' is not to cut myself off,
it's
the realisation I can't control another
to
`let go' is not to enable,
but
to allow learning from natural consequences
to
`let go' is to admit powerlessness,
which
means the outcome is not in my hands
to
`let go' is not to try to change or blame another,
it's
to make the most of myself
to
`let go' is not to care for, but to care about
to
`let go' is not to fix, but to be supportive
to
`let go' is not to judge,
but
to allow another to be a human being
to
`let go' is not to be in the middle arranging all
the outcomes,
but
to allow others to affect their destinies
to
`let go' is not to be protective,
it's
to permit another to face reality
to
`let go' is not to deny, but to accept
to
`let go' is not to nag, scold or argue,
but
instead to search out my own shortcoming and correct
them
to
`let go' is not to adjust everything to my desires,
but
to take each day as it comes and cherish myself
in it
to
`let go' is not to criticise and regulate anybody,
but
to try to become what I dream I can be
to
`let go' is not to regret the past,
but
to grow and live for the future
to
`let go' is to fear less and love more.
Anonymous
(September 1999 issue)
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Do
We Have A Drug Problem?
Tony
Trimingham
Living
with a drug user can be a long and difficult process.
From the early stages of experimentation which can cause
confusion in the family─you probably recognise
the symptoms─sleeping in the day time, staying
up all night, secret bedroom sessions with friends,
secretive behaviour, eating lots of munchies, moodiness,
not talking, phone calls from strange sounding people.
Are they on drugs? or just adolescents acting like adolescents.
The
adolescent `rite of passage' is a key time and it is
important families allow the transition by accepting
and respecting change, differences, boundaries, personal
space and seemingly bizarre behaviour. Never an easy
time and of course these days drug experimentation may
be central in the teenager's lifestyle. In `doing the
right thing' in allowing the transition time to occur
by not intervening in a controlling or directing way
we may of course unwittingly be allowing the germination
of more dangerous drug use developments.
It
is a `damned if you do─damned if you don't' scenario
because coming the heavy will usually meet with resistance,
underground activity and more of the negative activity
you are trying to prevent. It is important to understand
that over 90% of all teenage drug experimenters do not
become long term users and abandon drug use as they
take on the responsibilities of adult life.
Most
of you reading this article will not fall into this
category. Unfortunately you will belong to those for
whom the problems associated with drug use have escalated.
At some point the negative impact of the drug use will
become apparent and all the worrying behaviour can be
explained. The discovery that drug taking is the cause
of the negative behaviour may raise more fear and anxiety
than that caused by the previous state of denial.
`We
knew there was something wrong, he never had any money,
looked terrible and stopped talking to us─we even
discussed drugs but he always convinced us he wouldn't
take hard drugs. We even found a needle once and he
convinced us it was his mate's diabetic syringe. Then
a summons arrived for him─I couldn't help
myself─I tore it open and discovered he was
charged with possessing heroin. What the hell are we
going to do?'
Our
society, despite the prevalence of drugs, still lives
in denial. It is always someone else's problem─nothing
prepares us for the realisation that it is happening
to us. `It happened so quickly ─last summer we
were a family having days at the beach─she was
having fun─normal and healthy. She went back to
school within weeks she had changed─different
friends, moodiness, ignoring me and her sisters. One
day she was asleep on the sofa and as her arm hung from
the edge I saw the needle marks.'
The
immediate shock gives way to a realisation of two aspects.
1. One
of their children is a drug user─how is this
to be dealt with?
2. This is seen as a reflection on the parents
as an individual/couple. `Where did we go wrong?'
The
other major aspect of this stage of realisation is how
little we know about drugs and drug taking. We have
read and seen the media─simplistic messages, stereotyping,
negative labelling. Suddenly the `War on drugs' means
our children are the enemy.
Anxiety
becomes our constant companion. Will they be all right?
Will they get sick? Will they die? Will they end up
in jail? Will they deal, steal, prostitute themselves?
Will they ever be the same again? Will our family survive?
This sort of anxiety can produce severe physical, psychological,
and behavioural symptoms that can detrimentally affect
relationships. Worry can give way to chronic stress
that needs attention.
In
most families these early stages take place secretly.
Shame and embarrassment are key factors and there is
a normal tendency to keep it `within the family'. Even
other family members─parents, siblings and close
friends are kept in the dark because of the shame factor.
(December
1998 issue)
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Third
Annual Turning Point Oration:
From
Tears To Hope─10/12/99 Melbourne
Tony
Trimingham was invited to give the Annual Turning Point
Oration following in the footsteps of Deputy Police
Commissioner Neil Comrie and then Premier Jeff Kennett.
Thank
you for your kind invitation to give this talk. I only
hope I will be around in 12 months' time, unlike one
of my predecessors.
Last
Tuesday I was driving to an appointment in Sydney─it
was a beautiful summer's day, the radio airwaves were
full of Australia's successes in the Davis Cup and the
cricket against Pakistan. It seemed incredible that
I was actually going to an event at NDARC that would
see Australia collect another championship─this
one we could do without─the releasing of figures
which stated that we had the highest rate of heroin
overdose deaths in the world.
It
seems incredible, doesn't it─the paradox of everything
that is good about Australia and the fact we are losing
more of our young people than ever to drugs, suicide
and alcohol-related traffic accidents.
Seven
hundred and thirty-seven deaths in 1998, in the population
15 to 44, with every indication that the figure will
hit over a thousand in 1999. I now want to show some
pictures of Damien's life because when we quote statistics
it's easy to lose track of the fact that we are actually
talking about real people: someone's son or daughter,
partner, brother sister or friend.
Damien
was 23 when he died. He was white, Anglo-Saxon and I
guess, middle-class. He could have been female, 14 or
40, black, Asian or European, from a poor or rich family,
from Toorak, Dubbo, Alice Springs or Cabramatta. If
you remember nothing else about this morning I hope
these images will remain with you─especially when
you hear comments about junkies which reinforce the
stereotype. The most sickening thing for me to hear
is that 2500 people have died since he lost his life.
As
well as showing pictures of Damien's life and death,
I am including at the end some photos of people who
have died in the last 12 months. These are loved ones
of attendees at our recent Memorial Service in Sydney.
As
you can see from these slides, Damien was a talented
person. State champion athlete, elite footballer, prefect,
house captain, actor, poet and musician. He was loved
by all his friends─and their parents. He was at
times a person who lived close to the edge─he
was fearless on the football field. In past eras he
would have been first in line to enlist for battle etc.
He had many fine qualities but he was certainly no angel,
often getting into strife in his adolescence. The first
substances he used were alcohol and tobacco as a young
teenager and he used his share of cannabis. When he
left Chatswood High School in 1992 there was no heroin
in or around that school─something which, I found
out on a return visit to speak last year, has changed
dramatically. Two 13-year-old girls admitted to me they
were using. Up to the time that he was introduced to
heroin along with his girlfriend about 16 months prior
to his death, he had been in a stable job as manager
of a service station and his girlfriend of three years
was employed as a hairdresser.
Damien
had often expressed his negativity to hard drugs and
so when I saw signs that caused concern─change
in eating and sleeping habits, constant lack of money,
niggling health problems and, when I questioned him
and got the answer, `don't be stupid, Dad. Do you think
I'm crazy!', I breathed a sigh of relief. What I didn't
know until June 1996 was that he had developed a severe
habit over an eight month period. Another couple, including
Damien's best friend, had persuaded them to try it and
what started as a social experiment quickly developed
into a costly and isolating activity.
When
we finally found out about everything we discovered
that he and his girlfriend had been using about $600
a day. They had gone through their combined savings─about
$30,000. Sold all their property of value and borrowed
extensively from friends and strangers. They had stopped
paying their rent and bills and I believe they were
probably one step away from crime when his girlfriend's
father discovered their debts and confronted them. I
returned from a trip to England to find Damien on my
doorstop with his sad and sorry tale.
Like
most parents I was totally unprepared and unable to
deal with the news. My emotions were a mixture of disbelief,
anger and most of all fear. Unable to get much help
or support from the services that I contacted, I packed
him off to my daughter's place in the Blue Mountains.
I had no idea what I was putting her through─somehow
she and Damien managed to survive a cold turkey withdrawal.
At that time I was using all the normal but negative
coping strategies─denial, anger and self-blame.
My
major denial came shortly after─ when I thought
that because he had stopped using, we were through most
of the danger. It's common in these situations for families
to breathe a sigh of relief and think their problems
are over. For the next eight months Damien was largely
drug-free, occasionally drinking heavily and weighed
down with guilt and a sense of failure. He felt he'd
lost all his friends. There were often times of optimism
─he started mountain climbing, took up rugby training
and had developed a new relationship.
What
I didn't discover until reading his diary and journal
after he died, was that in times of bleak despair he
would take off for the city, secure some heroin, use
it in a sordid isolated place like a back alley or public
toilet, sleep it off and then return to the mountains.
It was on the third or fourth of these trips that he
died in February 1997.
After
an argument with his girlfriend, a heavy drinking session,
he drew his last $50 out of his bank account and caught
the 7.30 train from Katoomba. Getting off at Central
Station he walked to Bourke Street Pharmacy at Taylor
Square where he bought his needle fits. This pharmacy
normally turns over 8000 syringes in a week─the
week of Damien's death was Gay Mardi Gras week and they
supplied 15,000 that week.
He
was discovered by a security guard in the stairwell
of St Margaret's Hospital, Surry Hills─ironically
the hospital of his birth. By the time the guard called
for back-up and then called an ambulance, Damien had
died.
It
was to be three days before I was informed of his death─by
telephone. Three months later when I got the autopsy
report it told me how healthy he was. Not a thing wrong
with any of his vital organs─he had the body of
an athlete.
To
lose a child to an early death is devastating─to
find that the death was totally preventable is tragic.
On top of this, to realise that in the eyes of the law
and our society he died a criminal is heartbreak beyond
belief. Three Families a day in Australia are going
through this kind of heartbreak.
In
the part of my grief process, about six months later,
when I was in a real trough of depression, with no appetite
for anything and nothing to look forward to, just going
through the motions of living, Justice James Wood handed
down the findings of his Royal Commission into Police
Corruption, Paedophilia and drugs in NSW.
I could not believe the reaction of politicians from
both sides to his recommendations regarding heroin,
such as injecting rooms and heroin trials. It all seemed
just too difficult for them. One evening, after listening
to a politician ducking and weaving, I couldn't sleep.
I got up at three in the morning and wrote a letter
to the Sydney Morning Herald. After the letter was published
there was significant media interest and eventually
our story featured in the TV show `Witness'.
My
phone started ringing and didn't stop for a week. Letters
from parents were forwarded on from the newspaper. Most
of the phone calls and letters were from family members
of drug users. One of the first people who contacted
me was the only child of the great Doc Evatt. She shared
with me the fact that her 19-year-old daughter had died
some years earlier from a heroin overdose. Others talked
of the shame and stigma─one woman from Queensland
had lost three children to heroin. The common thing
about these phone calls was that the people were decent
people from all walks of life who had done their best
in dealing with the drug use. There were common themes:
no immediately available detox beds or rehab places;
lack of support and even discounting of families by
professionals; lack of strategies for coping with all
of the issues surrounding the drug use. One woman from
a small country town rang about the recent death of
her 16-year-old daughter. She talked about her isolation
and grief; she talked about the gossip: her daughter
was a prostitute, she'd been murdered─all totally
untrue. She had become agoraphobic because of her fear
of confronting her uncaring community. She was also
angry that another family in the town who had lost a
child in a rail accident had received emotional and
financial support from that same community.
Rev
Bill Crews from Ashfield Uniting Church, a man with
a history of ministering to minorities, contacted me
and said, `Invite all these families to a public meeting.'
With little notice we held a meeting at his church─450
people came and Family Drug Support was formed.
Not
only did we start an advocacy campaign for families─writing
to newspapers and politicians, educating the community,
fighting for the rights of users and their families─we
also decided to try and address some of the gaps that
families were identifying as needing to be filled. Since
then we have held our support groups which are an alternative
to the 12-step groups like nar-anon and other more directive-orientated
tough-love groups. Starting with three groups, we now
run twelve a month in Sydney and have others running
in country areas like Albury and Wagga. Our bulletin
heroInsight, which started as a two-pager, is
now a 36-page booklet which goes out bi-monthly to 1800
families across Australia, and contains good up-to-date
articles, poems and stories. This issue contains the
recent `Call to Consciousness' message to his fellow
judges by Justice Wood. We have developed a parent education
kit `A Guide to Coping' which contains information and
strategies for families with drug problems.
Our
major project has been the establishment of our Telephone
Support Line, manned 24 hours a day, seven days a week.
This 1300 number receives more than 25 calls a day at
an average call length of 34 minutes from all over Australia.
Not a counselling, information or advice service, this
is purely there to lend support and be a listening ear.
In eighteen months we have run 12 training courses for
120 volunteers. Most of these volunteers have been personally
affected themselves─either having lost children
or gone through all the traumas associated with drug-use.
Prior
to my involvement in drug and alcohol matters, I had
been a counsellor and group leader. For over 20 years
I have counselled people with relationship problems
and had a lot of experience in assisting people going
through separation and divorce. There is a definite
process in divorce recovery. Although it was far from
apparent at first, I gradually started to observe the
process of adjustment and change that occurred for people
going though drug crisis. Like myself, the majority
of families generally cope inadequately and negatively
when first becoming aware of drug problems.
`Control
and direction' is often the common strategy used. Fathers
want to solve the problems quickly─mothers often
become over-responsible and sometimes collude with the
drug user to keep things secret from Dad. Relationships
get strained, siblings become antagonistic and family
systems start to crack. All of these aspects make the
feelings of helplessness, confusion and sense of failure
even greater. The lure of a `cure' is ever seductive─naltrexone
being the most recent `magic bullet'. Just last week
I had a sad conversation with a mother who had thought
she was home free after rapid opiate de-tox and naltrexone
maintenance seemed to have solved all their problems.
The side effect of deep depression led him to an overdose
death ─she is now tormented by the question of
whether it was deliberate or accidental or whether pushing
him into the treatment was the right strategy.
I
discovered from our earliest group sessions that simple
education on things like `The Stages of Change' model,
combined with a safe environment to `tell their story',
and support, enabled attitudes to change and they started
to report positive outcomes and strengthened relationships.
Over time I saw fathers whose initial reaction to their
sons' activities was to order them out of home, gradually
change their attitudes and become supportive and guide
them through lapses and other difficulties. I also saw
mothers who had previously reclaimed property form hock
shops to `keep the peace', start to construct boundaries
and engage their user into contracts with workable consequences.
In
recent times I have been developing a closed group follow-up
to the less formal support group that provides a road
map through the process. This group will be called `Stepping
Stones to Coping' and will incorporate accepted drug
and alcohol theories, like motivational interviewing,
combined with the `collective wisdom' of the group members
in a model that is easy to understand and interactive.
And
wisdom they've got, maybe not in the academic aspects
of this issue, but certainly in pain, in perseverance
and in unconditional love; some of us with great hindsight,
knowledge of intervention and strategies that may help
others.
One
of the most difficult things for families to come to
terms with is that their preferred goal of `getting
them off drugs' may not be achievable as quickly or
as easily as they would like. Explaining the reality
of the `long haul' ─it may take many years to
get through the drug-using process─without ever
taking their hope away is the most difficult task. Some
families enjoy successful outcomes relatively quickly.
I know three families whose daughters were entrenched
in drug use three years ago. Their similar stories include
prostitution, crime and chaos─one young lady is
now stable on the methadone program, another totally
drug free after getting pregnant and the third enrolled
initially in a buprenorphine/methadone double blind
trial in Sydney. When she discovered after six months
that she was on a high dose of methadone, she determined
to get off and in six months had reduced to nil. Other
families struggle for years through the ongoing cycle
of hope and despair with little apparent progress.
I
recently spoke to a Melbourne mum whose son died last
November at the age of 31 after eleven years of heroin
use ─the astonishing thing was he had de-toxed
41 times in that eleven years. Now here was a young
man who wanted to give up but just hadn't been able
to! Success is relative with this chronic relapsing
condition. Families often ring our line in despair saying
they have been trying to get him or her into de-tox
for months. He finally went in on Saturday and left
after six hours! Their despair turns back to hope again
when I say, `Isn't it good that he walked in? Maybe
next time he'll stay a bit longer!' Family support seems
to be a common denomination in the success stories I've
seen.
I
want to finish by telling two stories─ one that
illustrates the distance we still have to go in overcoming
prejudice and stereotyping, the other to illustrate
why we must never give up hope and also why, among resourcing
prevention, education, treatment, pharmocotherapy and
supply reduction, we just have to make some resources
available to maintain life.
I
spoke to a lady yesterday who rang me in great distress─her
son facing a robbery charge because of his drug use
had started a methadone regime. Duly convicted, he went
into Long Bay Gaol. His methadone dose was 2O mls,
which he reported to the prison drug clinic. At his
first dose he was mistakenly given 90 mls and needed
two shots of narcan to revive him. While waiting to
hear of his progress at the prison hospital, a prison
guard, who knew she was his mother, spoke loudly enough
for her to hear, `Why didn't they just let the junkie
die!'
The
other story concerns a woman who rang me a while ago
and asked me to meet her for coffee. She was a woman
in her early 40's who explained to me that she was a
general practitioner. To my amazement she confided that
up to the age of 29 she had been a heroin user. A prison
sentence, two broken marriages, children taken away
and attempt at every form of treatment available had
got her nowhere. She explained to me that for her the
single fact that at 29 she wanted to go to University
did it for her. She has never used heroin since. I am
sure there are thousands like her who with family support
eventually reach their personal `magic moment'. My son
never had the opportunity to reach his. We must put
in place strategies that allow as many people as possible
to remain alive to reach this point. If it takes things
that are distasteful, like injecting facilities, heroin
trials or even prescription heroin, then for God's sake
let's have the courage to do it.
In
responding to Tony's speech Professor Margaret Hamilton,
Director of Turning Point, Drug and Alcohol Services
in Melbourne, said, `Thank you, Tony, for your quite
calm messages─for us it was a chance to stop and
listen, share and gain some renewed energy at the end
of a hectic year when people maybe are a bit tired and
jaded. Your way of allowing Damien to speak to us is
potent. Damien was not somebody's son ─he was
your son. He had a loving supportive family. He had
all the attributes and chances for resilience. He should
have been low risk for illicit drug trouble─yet
he is dead.' Margaret then went on to make a personal
apology to families she may have discounted or hurt
in her thirty years of work in the field. She agreed
that including families in the process was a definite
necessity for all professionals.
|
|
Parenting
A Heroin User
For
years now, my daughter has fearlessly─and stupidly
(in my opinion)─ridden the back of a heroin addiction.
The irony is that I'm a better parent for it.
While
she has succumbed to a dangerous, unfocused, total abandonment
to this drug, I have come to completely accept her,
love her, and continue to believe in her. I see her
not as I would like her to be, but as she is: A person
with a serious problem with drugs.
There are many contradictions in parenting someone
who is dependent. I feel an excruciating sorrow over
losing her, yet I am at peace, I stay present for her
while at the same time I have let her go. And although
my heart is heavy with depression, I feel the lightness
of our love for each other.
For
a time I struggled to understand my daughter's heroin
problem. Finally I discovered─and ultimately accepted─the
fact that her dependence makes no sense. I made mistakes
but I accept that with my knowledge and awareness at
the time I did the best that I could.
For
my part, I want to look back at these troubling times
and feel at peace with the kind of parent I was. In
the meantime, I want to be the kind of parent my dependent
daughter needs most right now.
What
I believe she needs most is a parent who is stable,
resilient and down to earth. She needs a mother to soothe
the many bruises on her arms and on her heart. She needs
a father to help her focus on her reality. Mine is a
still, calm, wise type of parenting that waits for an
opportunity to be of real help. In the process, I create
the space for my child to seek effective help from other
people. This is a gentle parenting that welcomes the
Spirit to move and transform both of our lives. Soon
I may see my daughter completely recover and prosper.
Most
of all, this is a brand of parenting that sets an example
for my daughter and can help her decide in what way
she can be a good parent to herself.
(October
1999 issue)
|
|
So
now little man─
you've
grown tired of your grass
And
someone pretending he is your friend
Said
`I'll introduce you to Miss Heroin'
Well
honey before you start fooling with me
Just
let me tell you of how it will be
For
I will seduce you and make you my slave
Believe
me we sent stronger men to the grave
You
think you could never become a disgrace
And
end up addicted to poppy seed waste
You
start by experimenting one afternoon
And
end up asleep in my arms very soon
Then
once I have entered deep in your veins
The
craving will drive you nearly insane
You'll
need lots of money as you have been told
For
darling, I am worth more than gold
You'll
swindle your mother just for a buck
And
turn into someone who's vile and corrupt
You'll
mug and steal for the narcotic charms
Then
feel so content when I'm in your arms
Then
you'll realise the monster inside you has grown
And
you solemnly swear to leave me alone
But
if you think it's easy, that you've got the knack
Then
sweetie, try getting me off your back
The
vomit, the cramps, your gut in a knot
The
jangling nerves screaming for one more shot
The
hot chills, the cold sweat at the withdrawal pains
Can
only be saved by my little white grains
So
now you return (just as I pretold)
And
I know you'll give me your body and soul
You'll
give me your morals, your conscience, your heart
And
now you are mine till death do us part.
Anonymous
(July 1998 issue)
|
| Getting
Off The Grass:
Research On Cognitive Behaviour Therapy For Cannabis
Dependence
Vaughan Rees, PhD
Although the number of treatment options and the effectiveness
of treatments has gradually increased over the past two
decades, there has been a traditional lack of effective
clinical interventions for cannabis users. This is possibly
because cannabis has been viewed as non-dependence forming
and, relative to some other drugs of abuse, less harmful.
However, there appears to be a big demand for an effective
treatment service for cannabis users who would like help
in quitting. Anecdotal evidence from cannabis users seeking
help suggests that they are discouraged from attending
drug treatment agencies and units where preference is
given to users of so-called harder' drugs. Some cannabis
users have even reported attempting to join 12-step programs
such as Alcoholics Anonymous or Narcotics Anonymous, but
are often disappointed to find that these organisations
are not oriented to meet their specific needs.
The
need for appropriate clinical interventions for managing
cannabis problems has been promoted by several recent
lines of research.
Firstly,
there has been increasing recognition of the harms associated
with long-term, heavy cannabis use. As well as clear
evidence for certain medical and psychological problems,
there is also evidence that long-term users have a substantial
risk of developing symptoms of cannabis dependence (Hall,
Solowij & Lemon, 1994).
The
major criteria for diagnosing cannabis dependence include
the development of tolerance, evidence of withdrawal
symptoms upon cessation of use, cannabis taken in larger
amounts or for a longer period of time than intended,
unsuccessful efforts to cut down, much time spent using
or recovering from its effects, neglect of important
social, occupational or recreational activities, and
continued use despite knowledge of the onset of medical
or psychological harms.
While
different treatment options for cannabis cessation have
been tried over the past two decades, there has been
very little systematic research towards developing a
`best practice' model for treating cannabis dependence.
To put it simply, we still do not know the most effective
and efficient way to provide treatment for cannabis
users who want help to quit.
There
has been recent promising research on the use of cognitive-
behavioural therapeutic techniques in the treatment
of cannabis dependence. Cognitive behaviour therapy
(CBT) has been demonstrated to have efficacy that is
at least as good, if not more effective, that comparable
treatment modalities (Andrews, 1991; Barlow & Hofmann,
1997). This includes treatment for abuse and dependence
of alcohol and other drugs (Mattick & Jarvis, 1993;
Project MATCH Research Group, 1997). The major aim of
CBT is to assist clients to manage or overcome the primary
problem, i.e. repeated drug use, by developing and using
specific skills or techniques. Cognitive techniques
assist clients in changing certain thought processes
that underlie drug dependence such as control of urges
and cravings, improving confidence in resisting drug
use, challenging outcome expectancies or beliefs regarding
the perceived benefits of drug use, and learning control
over irrational or intrusive thoughts that trigger negative
emotions and promote drug use. Behavioural techniques
generally involve self-monitoring of drug use behaviour
and its antecedent mood and craving states, developing
alternative activities to drug use, and the adoption
of effective coping strategies that can be used when
threatened by a high risk or potential relapse situation.
Together, cognitive and behavioural techniques provide
a powerful `package' for assisting clients to quit drug
use, as well as maintaining abstinence in the longer
term by preventing relapse (Jarvis, Tebbutt & Mattick,
1995; Marlatt & Gordon, 1985).
Recent
research in the United States by Roffman and Stephens
has provided the first demonstrations of the effectiveness
of CBT in helping long-term users to quit. They used
a group-based CBT approach and compared a longer (14
weekly sessions) intervention with a brief (2 sessions)
intervention. Both interventions were effective in assisting
clients to reduce frequency of smoking or to abstain
from cannabis, compared with a no-treatment control
group over a 12-month period.
The
present research being carried out at NDARC in Sydney
was developed in order to meet the demands of the increasing
need for effective treatment for cannabis dependence
in an Australian context. Our challenge is to develop
an intervention that is brief and effective, as well
as being appealing to prospective clients. CBT provides
promise on all of these counts: it is by nature a briefer
form of intervention, and is consistently shown to be
of at least equal efficacy to other effective treatment
options.
Therefore,
we have developed two CBT programs: one of six sessions,
and a brief intervention of just one session. There
is now a good deal of evidence from the alcohol and
tobacco treatment fields which indicates that brief
interventions of one session can have considerable impact
on an individual's substance use, and compare favourably
with multiple sessions interventions (e.g. Heather,
1989).
The
present study, which is still in progress, is a randomised
controlled trial of the two brief CBT interventions.
The purpose of the study is to:
·
demonstrate
the effectiveness of CBT treatment in helping long-term
users to quite; and
·
compare
the effectiveness of the six-session CBT program against
the one-session intervention.
The
trial involves allocating clients on a random basis
to one of the two CBT treatments, or to a control group
in which treatment is delayed until after a six-month
follow-up interview.
The
success of the treatments will be determined by smoking
status six months after finishing treatment, as well
as by reductions in:
·
level
of cannabis use (self-report and urinalysis);
·
severity
of dependence;
·
global
cannabis-related problems; and
·
adverse
psychological symptoms.
Both
CBT interventions deal with the person's thoughts, feelings
and behaviours that are connected with heavy cannabis
smoking. The therapy focuses on the context in which
the individual's smoking typically occurs and allows
clients to develop skills or strategies for changing
the problematic thoughts and behaviours that perpetuate
cannabis dependence. These cognitive- behavioural techniques
are designed to enable permanent change in the individual's
use of cannabis.
At
the conclusion of the program, clients are given a booklet
which outlines the general details of the session and
provides a resource for future reference. This was intended
to ensure that clients continued to work on their quit
strategy after finishing therapy. (This booklet will
be available from NDARC in the near future, as a self-help
guide for individuals wishing to quit smoking cannabis.)
The
present study is still in progress and so final results
are not yet available. At the present stage, over 220
clients have been assessed and either provided with
treatment or placed on the waiting list. Follow-up interviews
are currently taking place for those clients who have
reached the six month time lapse since concluding treatment.
Clients
on the waiting list who have completed the follow-up
interview are being invited to commence the program
and are given the option of receiving either one or
six sessions of CBT. Observing clients' preferences
for a brief intervention or longer program will also
provide us with more information about the attractiveness
of the interventions on offer. Ultimately, we hope to
be able to provide additional treatment options, with
proven effectiveness, for cannabis users who want to
quit. Furthermore, users should be able to know which
of the two treatment options will be more suitable for
clients based on their smoking pattern and readiness
to commence quitting.
(May 1998 issue)
|
| Is
Naltrexone A Cure For
Heroin Dependence?
Source:
Medical Journal of Australia
The
evidence so far is not promising
(Med.J.Aust.,
1999, 171:9-10)
ince
July 1997, the Australian media have uncritically reported
therapeutic claims that naltrexone, an orally well-absorbed,
long-acting opioid antagonist, can be used to `cure'
heroin dependence. Naltrexone displaces heroin from
opioid receptors in the brain, blocking the effects
of any opioid agonists while the patient continues to
take it. It has no opioid agonist effects and hence
is `non-addictive'.
The
current media enthusiasm ignores the reported modest
success of naltrexone maintenance in the treatment of
heroin dependence over almost 20 years. Research has
shown that induction onto naltrexone is difficult, compliance
poor, treatment retention disappointing and abstinence
an uncommon outcome. More than 20 years ago, the consensus
was that naltrexone maintenance has a limited role in
treatment of opioid-dependent street users, although
it may be useful for drug-dependent professionals and
parolees.
Renewed
enthusiasm for naltrexone was based on the claim that
it can be used to accelerate withdrawal from heroin
and other opioids, allowing immediate induction onto
naltrexone maintenance. Because naltrexone may precipitate
distressing withdrawal symptoms, naltrexone-accelerated
withdrawal is performed under general anaesthesia or
light sedation (using benzodiazepines and other symptomatic
medications). Induction is followed by naltrexone maintenance
for six to 12 months.
Media
enthusiasm for combined naltrexone-accelerated withdrawal
and maintenance has not been shared by many addiction
specialists in Australia, the United Kingdom or the
United States. They have been concerned that this type
of induction adds to the expense and possibly reduces
the safety of a relatively ineffective maintenance treatment.
However, professional scepticism was overwhelmed by
the media's recitation of yet to be published claims
that the combined procedure achieved abstinence rates
of 70-80 percent at three months.
The
article by Bell and colleagues, in this issue of the
Journal, is the first peer-reviewed Australian report
of naltrexone-accelerated withdrawal under light sedation,
followed by naltrexone maintenance. It is a pilot study
of 30 patients who were followed up for three months.
Although there was no comparison group, the results
reinforce the concerns expressed by addiction specialists
about the efficacy and safety of naltrexone-accelerated
withdrawal and maintenance. Three months after treatment,
seven patients (23%) were still abstinent from opioids,
only two of whom were still taking naltrexone. One patient
had died of a heroin overdose, while most returned to
heroin use or methadone maintenance. Of the six (20%)
who were still taking naltrexone, four engaged in the
risky practice of using heroin after briefly interrupting
the naltrexone maintenance.
Patient
selection may be one explanation for the marked discrepancy
between these results and those reported in the media.
Most of the patients in Bell and colleagues' study had
long histories of heroin dependence, and half were in
methadone maintenance treatment. Although none of these
characteristics is said to exclude patients from naltrexone
treatment, patients treated in private clinics appear
to have much shorter dependence careers and stronger
family and social support.
The
death observed in this case series, and other deaths
overseas, raise concerns about the safety of naltrexone
maintenance. These concerns have been dismissed by promoters
of naltrexone-accelerated withdrawal, who assert, without
evidence, that naltrexone is life-saving. The overdose
fatality rate in treated heroin addicts has been estimated
at a little less than 1 percent annually. There is no
evidence that mortality rates in naltrexone-accelerated
withdrawal and maintenance are better than this; they
may well be worse, as has been reported in one controlled
study.
Strong
conclusions should not be drawn about the efficacy of
the procedure on the basis of Bell et al's data, even
though favourable reports from less rigorously conducted
studies have been accepted uncritically. The role of
naltrexone (and other agents to assist in opiate withdrawal)
in opioid dependence should be clearer on completion
in 2001 of controlled trials of the combined procedure,
with and without anaesthesia, as part of the National
Evaluation of Pharmacotherapies for Opioid Dependence.
In
the meantime, thanks to an uncritical media, aggressive
marketing and political intervention, Australia is in
the midst of a large, uncontrolled experiment using
naltrexone-accelerated withdrawal and maintenance to
treat unselected opioid-dependent people in the absence
of systematic national monitoring of efficacy, safety,
or adverse events. It is of particular concern that
we have no way of monitoring overdose deaths that may
occur when patients discontinue naltrexone maintenance
and relapse to heroin use, when research indicates that
most unselected patients do return to heroin use.
There
are lessons to be learned from the introduction of naltrexone-accelerated
withdrawal and maintenance in Australia. Firstly, decision-making
about research and service provision for illicit drug
dependence requires the same rigour and evidence demanded
elsewhere in medicine. In the absence of this evidence,
false expectations of cure will continue to be raised
and dashed, scarce research and treatment funding will
be wasted, and little progress will be made in improving
treatment outcomes. Management of drug dependence has
more in common with a marathon than a 100m sprint. Secondly,
all new interventions in medicine should be assumed
ineffective and possibly unsafe until proven otherwise.
No good evidence has yet been presented to challenge
the assumption that naltrexone, however packaged, is
at best, modestly
effective,
and at worst, unsafe in management of unselected cases
of opioid dependence.
Wayne D Hall
Professor
of Drug & Alcohol Studies
National
Drug & Alcohol Research Centre
University
of NSW, Sydney, NSW
Alex
Wodak, Director
Alcohol
& Drug Service
St
Vincent's Hospital, Sydney, NSW
(September
1999 issue
|
|
Ambivalence
Embroiled
in a drug-filled haze
Melting
Defence
Got
lost in the maze
Lost
to my own desire to hurt
Lost
to the girl
And
a white powdered dirt
Confused
the emotion of pleasure and pain
Playing
my life
Like
playing a game
Caught
in my own
Self
spinning web
Fighting
a war that exists in my head
The
inner child has lost to the man
That
couldn't see past
An
indifferent plan
Lost
every rational thought in my mind
Caught
in a shell
With
nothing but time
And
now as I watch
Yet
I'm shielding my eyes
With
a needle protruding
I'm
feeding the lies
A
memory, a thought
A
relinquishing sigh
A
decision to make
To
live or to die
To
be
or
to be not, said the guilt-ridden Dane
To
find out the truth
and
finish the game
Watching
the screen now my battle's been won
But
what of the kids
Whose
battle goes on
Understand,
educate and never be blind
To
a drug that steals
Health,
spirit and mind
Damien
Trimingha
|
|
I
Voyager
I
am a voyager, passing through the intimate lives of
a thousand families, touching on the tribulations of
ordinary folk. I hear the lies, see the anger, feel
the grief, taste the saltiness of the tears and smell
the death.
For
a lifetime I have worked with persons using substances.
But the people with whom I have worked are those who
come to me with lives chaotic and out of control. I
see few of those many people who can maintain stability
in their lives along with their use of substances.
I
see the brothers or sisters, sons or daughters, and
spouses of people desperate to understand the cause,
and desperate te find the cure. I see parents determined
to hold together a fragmenting family, desperately binding
the wounds of the family while its life-force bleeds
away.
It
strikes me as ironic that in all of the chaos the caring
and the anguish associated with the public face of drug
use, it is often near impossible to obtain the access
to, and diversity of, treatments which may reduce the
chaos and bring the drug use under control. The irony
is that in my experience, the most frequent opponents
to treatment centres are often parents themselves, parents
concerned about the influence that such centres might
have on their lives and those of their children.
I
am a fixer of people's broken lives. I am asked to put
together the fragments of a person or of a family. In
that regard, my capacity and ability to rebuild is counterfeit,
for I can only provide the means and the opportunity
for the real architects to rebuild-if this is what they
truly want. I have no cure, no certainty of success.
for these come from within the person with the addictions.
Nor should any parent believe that they must fix this
broken vessel, or find the cure, or take the blame for
another's actions. They are fixers like me, using means
and opportunity to permit those affected by drugs to
bring order to a chaotic life.
I
am a sounding board for those seeking answers, for both
the users of the substances and those around them. Those
who use and those who are concerned are insatiable in
their questioning, often for opposing reasons. Solutions
sought are to deal with the immediate─the problems
that brought the drug use to notice, when the ideal
shoul | |
