Heroin addiction is a difficult subject for me for personal reasons...in fact, I am currently on state probation for possession of it in 4 years ago.
I become addicted to numb the pain of my mother's passing and my 13 year marriage ending, although there is, of course, no excuse.
It started with prescribed Oxycontin and progressed from there. "Why buy overpriced synthetic molecules designed not to really get you high when you can get the natural ones cheaper and feel better?" I can still remember my engineering-mind thinking.
I have been off it now for about 3 years after getting clean, literally, on a cell floor in a county jail...cold turkey...the first time I ever successfully kicked it. After that, I checked myself into a South Florida inpatient rehab (called the Hanley Center...please, do yourself a favor and give them a call if you need help), and with the help of some amazing people, got better.
I'm convinced the only reason I finally kicked was simply because there was no other option; jails have pretty much no supply of heroin. To this day I thank the stars for that county jail...it saved my life.
The best way to summarize the experience was with a "joke" (it was no joke BTW) I came up with to try to explain how I felt near the end...
What's the best thing about heroin? After you do it, you don't feel anything.
What's the worse thing about heroin? After you do it, you don't feel anything.
Firstly, a really big well done for getting clean. That is no mean feat.
The last two lines of your comment really rung true. I lost a dear friend a few years ago, in relation to a serious heroin addiction (it wasn't actually an overdose that killed him, but a cheap, adulterated bad 'dose').
I watched a confident person struggle to emerge, only to recede every time lift dealt a blow, and end up trying to find things to remove the pain he felt in life.
I am glad that his story actually helped stop one more life being lost - I worked with someone who though life was all about experiences, after blissful weed, there was the high of cocaine, and finally he considered opiates. A trip to the grave, to the family left behind, to the doctors who actually tried to save my friend's life, worked. Sobered him up, so to speak.
Love will set you free. It's taken me a long time to find the kind of love for myself that allowed me to live. I hope with all my heart you find it, brother.
My girlfriend was recently prescribed Norco for a sore throat. I was flabbergasted.
I don't know why you were prescribed Oxycontin, but there is definitely a problem with the way doctors prescribe drugs these days... prescription drugs kill more people than illegal drugs. And your kind of story is very common (my brother has / had a heroin addiction).
Do prescription drugs kill more people relative to their popularity? With an branded pill like an Oxycontin 20mg, you know what you're getting. With assorted powders, you've got no idea and people are often too lazy to do test shots. Opiates themselves are relatively safe, with a fair therapeutic index. But taking random quantities of drugs seems like a poor idea all around.
After personally meeting quite a few people (the unusual suspects...not teenagers) develop a serious addiction to the opiates that were prescribed to them... I would have to say we might want to reevaluate how things are done.
You don't prescribe cough-suppressing opiates for a soar throat, the same way you don't prescribe a guillotine for headache.
Cough is a symptom, meaning there is a problem in the patient's respiratory system the doctor should be looking into. Suppressing it is the equivalent of pasting a post it with a happy face over the fuel gauge when the needle is approaching the Big-Red-E.
> there is definitely a problem with the way doctors prescribe drugs these days
Why? Painkillers have a clear function and are useful in many scenarios. Most people using them have no problem quitting when it is time. The minority of people abusing painkillers do it because they have an addiction problem (which is the actual issue to target) and obtain them through the black market.
> prescription drugs kill more people than illegal drugs
Or, as about 3 seconds of searching would've told you, yes they do. (53% of drug deaths were prescription drug deaths in 2012[1])
> > there is definitely a problem with the way doctors prescribe drugs these days
> Why? Painkillers have a clear function and are useful in many scenarios.
Yes, they do, and they are. But unless you wish to argue that the level of pain that requires opioid pain killers has consistently been increasing and almost tripled since 1991[2], you'll have to face the idea that maybe doctors have gotten quite a bit more liberal with the rx pad. 207 million opioid prescriptions per year really seems a bit over the top, no?
First, following your first link, I found the CDC bullet point that says 53% of drug overdose deaths in the US in 2012 were "related to pharmaceuticals". Note that doesn't say "were prescription drug deaths" as you did.
"Related" includes those deaths in which someone who had a legal prescription for a drug used something with it that was fatal - a simple example would be alcohol combined with many of the opiate painkillers, but it would also include somebody on the antidepressant drug selegeline who ate a tyramine-rich food like bleu cheese or sausage and died of hypertensive crisis. There are many other examples of deaths "related to pharmaceuticals" that would not involve painkillers, nor other pharmaceuticals used as directed. I recommend you do the analysis needed to see what's actually going on, not merely that which may constitute confirmation bias for your views.
Second - of course there are externalities that could well account for the increase in painkiller prescriptions since 1991.
Just one example - we have an aging population. When people age, they encounter illnesses that hurt. Osteoarthritis, for example - it is common for those who have it to be unable to do something as simple as remove a twist-off jar lid because of the pain involved. Ditto climbing three or four steps because of pain in their feet and knees. Nevermind diabetic neuropathy, and other such painful, age-related diseases. Have you explored the increase in our aging population and projected the numbers of people who could reasonably be expected to need painkillers to remain functional as they age? What did you find?
Further, one reason for the increased level of painkiller prescriptions could well be that analgesia has been underprescribed due to irrational prejudice against it and we're finally realizing it. In the US, opioid pharmaceuticals seem be regarded as "The Great Satan" by some Americans and by American law enforcement. Consequently, pain relief - which should be a straightforward (if complex) medical issue - is demonized, hindered, and encumbered with useless transactional friction.
So, yes - it's certain that our aging population has increased the need for painkiller prescriptions since 1991. How much, I don't know. If you look into it quantitatively, please let us know. But from what I've seen in the medical profession, the increase could well be independently explained by the recognition that pain relief is critical to quicker recovery from acute illness and equally critical for prolonged productivity and quality of life, and the shedding of prejudices that have blocked such recognition. I understand YMMV.
> "Related" includes those deaths [...] for a drug used something with it that was fatal
No, it does not. Full quote: "In 2012, of the 41,502 drug overdose deaths in the United States, 22,114 (53%) were related to pharmaceuticals.[6]"
So, 53% of drug overdose deaths. Not drug interaction. Nor pharmaceuticals used as directed.
> I recommend you do the analysis
So far, I've provided data, and you arguing semantics. Since you seem to imply deeper insights, I'd appreciate it if you shared your data sources/analysis.
> In the US, opioid pharmaceuticals seem be regarded as "The Great Satan"
I'm not buying that argument, given the amount of opioid usage in the U.S. compared to the rest of the world. (IIRC, close to 100% of hydrocodone and 80% of oxycodone are used in the U.S). Not exactly a "Great Satan" kind of treatment.
> we have an aging population.
Yes. But the aging population is not three times as big as it was '91.
> and the shedding of prejudices that have blocked such recognition
I am all for shedding prejudices that block recognition of useful medication. But for opioid usage, there are questions that are simply not answered:
* Why do >45% of Americans supposedly suffer chronic pain? Compared to ~20% in Europe?[1]
* Why do we require 203M opioid Rx to treat this? That would indicate that the vast majority suffers from severe pain, treatable only with opioids. (Compare to ~30% of pain suffers in Europe[1])
* Why is the amount of overdose deaths 7x bigger than in Europe? [2] (With a larger population in Europe!)
And we need to answer them if we want to use opioids safely & without prejudices. I don't condemn opioid use per se, but I'd really like an explanation of these discrepancies.
Why? Because the last I heard, doctors wrote like 300 Million prescriptions for pain killers last year. So, one prescription for every man, woman and child.
You might say that if all are medically necessary than who cares, but why the ramp-up over the last decade?
Opioids are being used more frequently in the management of non-malignant chronic pain.[9][10][11] This practice has now led to a new and growing problem with addiction and misuse of opioids.[3][12]
I saw a documentary a few months ago. It was saying how many herion users got first addicted to the medicine prescribed from their doctor. They resorted to herion when they couldn't get more from their doc and they were hooked. They had this doctor saying how back in the 90s drug companies encouraged prescriptions of their pain relievers for chronic pain and talked about how safe they were. They played a few of those ads.
I only caught it in passing for a little while, but is interesting if true.
I can't find the source right now, but what I've learned of heroin is that most people could actually safely try it out, and it would likely cause nothing but some mild discomfort.
The people who end up wanting to keep using heroin are typically those who don't have their life in order due to heavy stress, sadness or something similar. The thing that heroin does is that it makes even the shitty moments feel not-shitty, and doesn't really get you wasted like many other drugs.
I'm not surprised that soldiers in a war might seek comfort from heroine, but once they return to their normal lives they no longer need heroine to help make life feel okay again.
My feeling when it comes to addiction is that it becomes a comforting or at least comfortable thing.
When we feel stress, we tend to act irrationally, in a way that comforts us or puts us into a more comfortable situation. If someone is irritating you, you yell at them, not because yelling initially comforts you, but because when you yell at them, maybe they go away. That behavior though starts to change your perception, and soon just yelling at people on its own starts to make you feel more comfortable. Even if yelling at people doesn't make them go away or reduce your stress, you're not acting rationally, your brain is basically taking the shortcut to what it has learned long ago will make it go away.
Drug addiction works similarly, except especially with something like heroin, it gets special teeth. You stop, and not only does stress trigger your compulsion to seek that comfort, even if you're not otherwise feeling stress, you now start to feel pain, or fear feeling pain from withdrawal symptoms.
The article talks about changing environments, and I absolutely agree, but I think a big thing that's overlooked is that these people have been taken out of one of the most horrible warzones, and brought back home. There's a big relief of stress from that. Adding back the fact that you're no longer around the people who used, the places you got your drugs, and the things that made you think about wanting to do it definitely helps. But if you come back to a more or less safe and stable life from being in a hellish situation, you would be less driven to take it up again.
On the other hand, had they transferred you to a different unit in Afghanistan instead of sending you home, even if you lost all of those environmental cues, I bet you would see more relapse just because you're in a highly stressful situation.
Congratulations on getting clean. I agree there's no excuse, but I also don't think you need to worry about whether there is an excuse. Stressful situations like you had to endure do make it more likely. It happened to you. It's a cycle that is hard to break. You got help and managed to break it. The fact that you became addicted isn't a failing, it's just an incident. It's more like you can say "I saw that side of the world, and I have to be careful to stay away from it." instead of being naive and thinking it couldn't happen to you.
It's a part of your life now. It's not good or bad, but you've seen a part of how our mind works that some other people haven't, and maybe hope they never have to.
My feeling when it comes to addiction is that it becomes a comforting or at least comfortable thing.
Yes.
The article talks about changing environments, and I absolutely agree
A huge part of the inpatient treatment program had to do with an extended aftercare and halfway-house plan for up to two years.
Since my addiction occurred mostly out West, being back "home" had much the same effect, so I was able to skip the half-way house (but of course not the aftercare)
The state-of-the-art in addiction care completely recognizes the absolute importance in removing addicts from their environments.
> Drug addiction works similarly, except especially with something like heroin, it gets special teeth. You stop, and not only does stress trigger your compulsion to seek that comfort, even if you're not otherwise feeling stress, you now start to feel pain, or fear feeling pain from withdrawal symptoms.
This is absolutely on the button. It's a vicious, vicious circle, and incredibly hard to break out of. I have a good job, and own my own home, and I find it difficult to quit heroin, and still haven't managed. I know that's 100% up to me, but fuck if it doesn't _feel_ like the drug is in control much of the time.
Just imagine what it must be like if you're unemployed and homeless...
I would turn this round. Your habitual behaviour comes to be associated with your environment. By removing yourself from that environment you find that those habits become weaker and may vanish. Behaviour isn't changed so much as behavioural cues can be eliminated.
So, I have been a heroin user (addict) for a long time, about fifteen years. I have a great job, as a senior engineer in a start-up, and have worked almost continually in IT while maintianing my habit. I've tried to quit, several times, and found it incredibly hard.
As the article sugests, a change of scenery really does help, though. So, when I've been working overseas, or travelling to speak at conferences, then I find it's much easier to stop. I would take some methadone with me, and wean myself gradually off using it, over only a week or two.
I have actually done this several times, and found that after a month I am essentially clean. However, when I return home I have always relapsed, usually pretty quickly. This is something I currently have a huge problem with, and I don't really know how to solve it ;( I'm trying to stop again, and wonderining if maybe a change of location would be the right way to do this properly?
Changing locations to get clean is called "pulling a geographic" by the 12-step folks (at least those I was hanging out with). Obviously getting away from bad influences helps.
Glib suggestion: perhaps replacing that addiction with the addiction of exercise might be worth exploring?
Hm, makes sense. I think hobbies in general can be used to take the place of an addiction. I should probably cycle to work more, though ;)
However one of the major problems with heroin addiction is the actuall process of quitting. You can't keep a job during withdrawl, i.e. cold turkey. There are clinics that offer 'five day detox' under sedation, but that's expensive (GBP 5K plus) and good luck getting NHS or health insurance to pay. They offer naltrexone implants, which prevent opiates from working altogether, which removes the option of relapse completely...
Getting a methadone prescription in the UK is also tedious to say the least - you are supervised when taking your daily dose, must report for 'assessment' regularly and so on, which is hard to fit in to a working schedule. And forget about getting enough to take away with you on a business trip for a couple of weeks. I generally have to purchase on the black market when required, which is ridiculous. I'd love to be able to ask my GP for help, and simply be given a repeat prescription for a week or two's supply to take home, but that's never going to happen because they're afraid of it being sold. So I have to buy it from others, which doesn't make sense...?!
There are options aside from Methadone. I've had experience with this in my family as well. To me soboxone looks like a miracle drug. It gave me my friend back.
There are much better options in the UK. I have been attending an evening clinic once a month for the past couple of years where I'm given 2 x two-week prescriptions for buprenorphine which are dispensed by a pharmacy once a week. When I first attended I had to collect the prescription every day - which I did after work - but after a month or so they trusted me enough to move to once-a-month. It doesn't affect my job as it's all done in the evening and the only time I had to visit during the day was my first session there where I met with a doctor to assess my condition and that was a saturday.
I've also been on holiday a number of times and they provide enough to cover me while I'm away as long as I give them 2-weeks notice and provide proof of the holiday and it's duration.
I have been slowly reducing my daily dose and I'm now close to stopping entirely and it's been totally painless. The staff are always friendly and I can't express how much they've changed my life.
But there's no point in quitting if you don't have a plan for how to live your life not addicted. Fill it up with good stuff and drain out the pus of emotional pain that put you there in the first place. Good luck!
Are you using needles? Do you need to involve yourself with criminals in order to buy it? Do your colleagues know or suspect anything at all? Do you have a normal house or does it look like the apartments you see in Black Tar Heroin?
Sorry for all the questions but I'm genuinely interested and fascinated when you say you have a job as as Senior Software Engineer while being addicted to heroin.
With the caveat that I'm an absolute idiot, and if you try and emulate any of this, you're even more of an idiot, then why not...
I both shoot up and smoke. Particularly when I'm working it helps to have injected at lunchtime or in the morning, and that'll keep me going the rest of the day. Smoking (chasing the dragon) on foil is much more of a time consuming thing, and I'd do that at home in the evening, where it will last all night. Also it's not possible to use that way in public ;)
The kind of people I buy from aren't the 'street' type dealers who are as likely to stab you as provide product. I have regular suppliers who have a much more stable lifestyly, and I either meet them or they will deliver. Yes, they're criminals, but the drug dealing is likely the only criminal activity they're involved in, they may even have a trade or job on the side as well.
Whether colleagues suspect is _always_ a worry. I think as long as you do your job well, employers will tolerate a fair bit. In my case, producing code is hopefully good enough to keep everyone happy. And with code in GitHub as open source and speaking at conferences, you can't hide; everyone can see how productive you are. The biggest problem is probably if I run out of heroin, meaning I can't work due to withdrawl, which is often hard to explain.
But yes, it is quite possible to maintain a full-time job as a software engineer along with a full-time heroin addiction, Cf. functioning alcoholics. Bear in mind that many start-ups often have a number of 'eccentric' and socially awkward types already, so spotting someone with a heroin addiction is probably going to be quite hard, - as long as they're not falling asleep at their desk every day ;)
Of course there are downsides. You'll probablym have no spare money (GBP 40 at least and up to GBP 100 per day, not sure about the USA) and no social life with your colleagues (you can't go drinking with them because you have to go home and score and then shoot up or smoke) and it's hugely emotionally draining. It takes a lot of work hiding things from people. Another big problem I have is that although I consider myself (fairly) intelligent and (somewhat) talented, I feel like heroin use has sapped about 10-20 IQ points, and my short-term memory has also taken a hit. This is a big reason for wanting to quit - I'm getting older and I worry about the cumulative effect on my mind and my productivity.
So there you go. It's actually been sort of cathartic to write this, but I really have to emphasise that what prompted me to create this throwaway account is that I'm trying to _quit_ - not to encourage anyone to start! Heroin has been very comforting in the past, but it's not something I want in the future. Recently, successes at work have been driving me to think that I just don't need the crutch of my addiction anymore. If I can stop this, that'll be the best thing I've achieved in a long time, and I hope it'll help me and the company I work for achieve even more...
Thank you very much. That was a really interesting read! I don't think anyone would be encouraged to live your life, least of all me (my best friend died from an overdose). So I find it really tragic but I hope and believe you will find a turning point. When you've passed all this maybe you can reflect back and write a book or something. I would definitely read it.
I remember a famous animal study about heroin addiction with mice. Almost all mice that were in a very stressful environment and had easy access to heroin became addict. But if mice were living in a pleasurable environment, most mice would not become addict.
So, even if it looks very likely that the association between a habit and an environment was at work here too, I wonder how much the low relapse rate was linked not just to a change of environment, but also to a change from an incredibly stressful situation (war) to a much more satisfying one.
The author of that study (Bruce Alexander) wrote an incredibly in-depth book about the relationship between environment and addiction. It covers not just drug addictions, but also other addictions such as overeating and excessive consumerism.
I wonder how much the low relapse rate was linked not just to a change of environment, but also to a change from an incredibly stressful situation (war) to a much more satisfying one.
Based on other things I've read about heroin, the change of environment is the only thing that mattered here. Heroin is in a class of drugs that create strong links with experience so that, even years later, a reminder of the experience immediately brings back the craving. A sample anecdote from one book I read on drugs and addiction was a person who had kicked heroin, been clean for 10-15 years, and had become a successful executive. He then made the mistake of going to a movie with a scene of someone seeking his next hit in a drug den. Simply seeing the drug den was enough to trigger a relapse - he walked out of the movie to find some and several days later realized how much trouble he was in.
Examples like this have convinced drug researchers to conclude that long term treatment (eg taking methadone to block heroin) is the only reliable way to keep an ex-addict from being one unexpected environmental cue from becoming a current addict.
I've read about very encouraging (though not universal) results of Ibogaine treatment, and heard similar first-person anecdotes. But drug researchers can hardly research that, because Ibogaine is not legal (despite having basically no addictive, enjoyable or otherwise recreational properties).
Current drug research is limited by irrational policy (well, at the very least, it is irrational if your aim is to cure addiction). I wouldn't trust it.
I was curious about the subject back in the 90s and have not followed up. I had not heard about Ibogaine, but it does sound interesting.
The book I read (whose title escapes me) reported on another drug that was similar to methadone, except that it suppressed heroin for a week instead of a day. This would be a significant improvement in lifestyle for addicts, allowing them to do things like take short business trips without having to disclose their treatment. (Doctors are reluctant to simply give patients a few days supply because methadone has street value for its ability to suppress heroin cravings.)
I forget the name of that drug but it is moot. Research hit a dead end because the medication was not under patent, and therefore there was no way for anyone to recoup the high cost of seeking FDA approval.
(There are a number of promising treatments which have suffered the same fate.)
I doubt it since the author of the book I read was the person who studied the drug in question and he said that research was discontinued due to FDA issues.
Another anecdote in the same book was that the same researcher was funded to study side effects of a drug for insomnia. He found it did an excellent job of helping people sleep, and was puzzled about why people weren't interested. Turns out that the drug company funding him was testing a competitor's drug and were hoping to find side effects so that they could get the FDA to take it off the market. :-)
It was an excellent book that I read 20 years ago, and if I could remember the title I'd buy it in a heartbeat just to refresh my memory.
Interesting. This is what happens in cities and stressful work places all the time.
Also why meditation and mindfulness work, because then the environment is no longer an issue. You can create your own environment, inside you, and this becomes the way to handle every situation, with inner reflection, instead of external reflection on what surrounds you.
There were a lot of positive habits associated with smoking. I got to go outside, clear my head of of work for a few minutes, and take regular breaks.
So I took those things and did something in place of smoking that would let me get the same benefits. When I would normally take smoke breaks I would go outside (through a different exit) and take a walk. Or I'd stay inside and stretch or do simple exercises.
When it's not possible to change surroundings, it's important to replace bad habits with good ones.
Good move! The other side of this is that people smoke for the (at least situationally) positive effects of the active chemicals. Nicotine is a stimulant that a lot of people use for the clarity, focus, and relaxation it can provide in the short term.
By using exercise as your replacement, you aren't just distracting yourself from the lack of a psychoactive drug but you're maintaining many of the positive results without the toxic delivery method.
In my situation it's less feasible for me to do much exercise (at least not enough to compensate) every time I feel the need to clear some brain fog and tension but I did switch to a nicotine delivery method that doesn't rely on inhaling burning tobacco and the health risks associated. In the process I dramatically lowered my usage but at the least I'm just getting the mild stimulant (similar to how many people use coffee) without the hazardous stuff that goes along with smoking as the delivery method.
Either way, congrats! Making the effort to change habits to remove unhealthy aspects seems pretty worthwhile from my experience with this.
Can you give some more details on your nicotine delivery method, I'm trying to quit smoking this year ( actually today is day No. 8 since I haven't put nicotine in my blood ) but I'm super interested in the side effects.
I work from home and it seems I can't focus on developing so easily and get distracted even more these days.
It's interesting, quitting a job and drastically changing your life could actually make financial sense if it got you to quit smoking.
Assuming: 1 pack/day, $10 a pack (this is close in my province), 5% interest, over 30 years, has a present value of $55k. I wouldn't be surprised if the numbers for alcoholism or heroin addiction are similar. Addiction is hugely expensive to the people afflicted and society at large (barring the usual discussion of smokers saving health care dollars by dying early).
If flying across the world/country and making other drastic changes really does stop the cycle with a high rate of success, we should consider funding it.
"If flying across the world/country and making other drastic changes really does stop the cycle with a high rate of success, we should consider funding it."
In addiction circles this behavior is comingly attempted, and considered so unsuccessful, that it has a *A-ism, "Doing a geographic".
One of the first FORTRAN programs I wrote, as a kid about 45 years ago, generated a table that showed, based on cost of cigarettes, interest rate, number of years, how much money my father's cigarette addiction was costing him.
Of course I couldn't find that output today. But one thing I remember quite clearly is the cost of cigarettes. They were about $0.30 per pack back then. I'm sure I wouldn't have gone over $1.00 per pack in my table.
Even allowing for inflation, someone is making a lot of money off the back of addicts.
Thinking like that leads you into the tricky realm of the government profiting off vice. A huge part of the $10 price tag is tax. But at least the government doesn't advertise cigarettes, like it does with the lottery.
Alcoholism is much higher. It's not hard to spend $100+ on a good bender. Add in the associated health issues (true for smoking too) and the NPV of healthy behavior is much higher.
Bar hoppers are alcoholics in training, most countries don't have bars open 24/7 - and $100 buys a lot more alcohol from the off license or whatever.
I'm no doctor, but if a person is able to "exist" for half the day or more without their buzz, I'd suspect they've not yet built very any/much physical dependence.
In England you get a medically supervised withdrawal if you drink more than 40 units per day. Very roughly this is 32 US Fluid ounces of 80 proof liquor per day. (One litre of 40% spirits).
80 proof = 40%.
BigBeer (Budweiser) ~= 5%
CraftBeer ~= 8% with some variation
So this means 16 pints (or ~21 12oz bottles) of Budweiser or 10 pints (should never be drunk in 12oz bottles) of Craft Brew a day. For a small person, that's almost enough to be perpetually buzzed.
I think the Drink Alone vs Bar Hopping is just a matter of being a functioning vs non-functioning alcoholic.
I'm an alcoholic who's been sober for about 3 months. I would have been ecstatic if I managed to get by for $10 a day. I'd easily drop a couple hundred dollars at the bar on drinks for myself in a single night. Even if I was drinking at home, a bottle of hard liquor does not go for $10 in Canada.
My parents are smokers, and have been for decades. When they out of the house they have little trouble not smoking. It's when they're stuck at home in front of the television when they find themselves smoking a lot.
Ironically, the high price of cigarettes means they can't afford to go out very often.
That depends. If you happen to be moving houses it might be a good time to try to quit smoking as well, for instance. For heroin? Maybe it's worth moving to a different town.
Though I agree with your main point; in my experience the smoker-at-the-office analogy actually doesn't work. Most businesses won't let you smoke near entrances for obvious cosmetic reasons. There's either a smoker's corner or folks duck out some back entrance.
I quit whilst working by avoiding places that were part of that "ritual": the cafeteria, fire escape/stairwell & pedestrian entry to the garage.
Disclosure: I've long since started again, I work from home now :-P
It's common practice to tell addicts that they should move to another city after therapy and therapists are certainly right to do so but I think this is only a part of the truth.
The soldiers in vietnam were under great stress from (war) that went away when they returned to the US.
If you start doing drugs or any other coping mechanism because of some emotional problem the problem will travel with you. You can't run away, the only way to break those habits is to learn other coping mechanisms or to get to the root of your internal trauma and come to terms with it.
This is a huge point I was hoping the article would address, but failed to. The war wasn't just a matter of location, it was a matter of stress (in a huge way) and a whole way of living (as a GI vs. civilian).
If you're an alcoholic and you move from one town to another, that other town is going to have bars and liquor stores just like the one you left. Your location may have changed, but there are so many things that are effectively the same, I can't see it having quite the same impact when compared to returning from 'nam.
This is more true for alcohol than it is for black market drugs.
While still generally easy to find, its a bit harder to go up to a random sketchy looking person and ask them for drugs in a new city that you don't have a network of friends and contacts in.
This makes me wonder if "pulling a geographic" is more successful for people with substance abuse problems that do not stem from alcohol.
A related and useful article from The Economist (Link at the end). I have reproduced parts of it that I found interesting (Heavily edited for telegraphic brevity):
"Like many of America’s new generation of users, Ms Scudo's ddiction began in 2000 when, after a hip injury, a doctor prescribed her ... a high dose of OxyContin.. Her prescription was later reduced, but she was already hooked. On the black market OxyContin pills cost $80 each, more than she could afford to cover her six-a-day habit; so she began selling her pills and using the proceeds to buy cheaper heroin. As if from nowhere, Ms Scudo had become a heroin addict."
"last year 11m Americans used illicitly-acquired prescription painkillers, more than the number who used cocaine, ecstasy, methamphetamine and LSD combined."
"Though Afghanistan accounts for 80% of global opium production, America gets most of its heroin from Mexico. Mexico is now the world’s third-biggest producer of opium, after Afghanistan and Myanmar."
"More than half are women, and 90% are white. The drug has crept into the suburbs and the middle classes. And although users are still mainly young, the age of initiation has risen"
It reminds me of "Going to Chicago", an evocative blues about heroin addiction, habits, and place, sung by the great singer Joe Williams: https://www.youtube.com/watch?v=uPcHVqKHkKo
In the intro to the song, he sets up the background: "He had a woman with a heroin habit, a monkey woman, a monkey on her back...so he got some fresh money and said, I'm going to take another city..."
This could be useful for informing addiction recovery within institutionalized individuals, such as soldiers or prisoners, but not within the general public. The addict is unlikely to change their entire life structure to defeat the addiction since they know that would defeat the addiction, and that's not what the addiction wants.
First, most people don't like or can move far away.
Second, if your habits revolve around more abstract stuff than "seeing the office entrance where you smoke every day", you can end up changing some concrete circumstances and end up with the same abstract ones.
That is silly. Most addicts don't have the resources to change their life structure, where would they go? what would they do? how would it be paid for?. It is only the rich who can check to a rehab clinic.
It's a mistake to think that the only people who are addicts are the poor and destitute. There are plenty of addicts, perhaps the majority, who haven't managed to destroy their lives (yet).
A few years back I came across some emails from the previous user of a computer I was given. (They really should have wiped the hard drive...) They were messages to his family back in India. The guy had been using heroin, and had kicked it once or twice. But he fell back into it, and it was when his old friends rolled into town. That was the trigger for him.
I've had similar experiences with cigarettes. I've stopped and then decided to start several times. I've found the easiest way to quit, which makes it so simple but I don't even have to think about it, is to dramatically change my circumstances and daily habits, like a new job, new roommates, or moving.
Interesting to think about the obstacles we unintentionally set in place for ourselves in living out our good intentions. Emphasizes the need for living with mindfulness.
I become addicted to numb the pain of my mother's passing and my 13 year marriage ending, although there is, of course, no excuse.
It started with prescribed Oxycontin and progressed from there. "Why buy overpriced synthetic molecules designed not to really get you high when you can get the natural ones cheaper and feel better?" I can still remember my engineering-mind thinking.
I have been off it now for about 3 years after getting clean, literally, on a cell floor in a county jail...cold turkey...the first time I ever successfully kicked it. After that, I checked myself into a South Florida inpatient rehab (called the Hanley Center...please, do yourself a favor and give them a call if you need help), and with the help of some amazing people, got better.
I'm convinced the only reason I finally kicked was simply because there was no other option; jails have pretty much no supply of heroin. To this day I thank the stars for that county jail...it saved my life.
The best way to summarize the experience was with a "joke" (it was no joke BTW) I came up with to try to explain how I felt near the end...
What's the best thing about heroin? After you do it, you don't feel anything.
What's the worse thing about heroin? After you do it, you don't feel anything.