Note: This module has not been updated since the original Addictionary (1992). Much of the information is probably obsolete.
To many people, heroin is the prototype of the illegal or street drug. Its image ﬁts their stereotype of the drug addict: lower class, dirty needles, AIDS, and a state of war with tough cops. These are the images that come from dozens of action movies like The Man with the Golden Arm (1955) to media coverage from just a few years ago when cocaine edged out heroin as the “baddest” drug in town.
Heroin is a derivative of opium, like morphine, codeine, hydromorphine (Dilaudid), and oxycodone (Percodan). These drugs ﬁt the same receptors as the natural painkillers, the endorphins, enkephalins, and dymorphins. It makes sense that they would be effective at reducing anxiety, increasing tolerance to pain, and promoting a feeling of well-being.
There are still many older, higher class, more responsible heroin addicts. Many who burn out on cocaine, other stimulants, and “life in the fast lane” have overtaxed their body’s natural neurochemical balances. When they try heroin, they may ﬁnd a satisfaction they have been missing for a long time. They begin by using heroin or another opiate in the classic sense of a medication, to soothe the abnormal “dis-ease” caused by years of substance abuse and other excesses.
Edward Khantzian, a psychiatrist with Harvard Medical School, has interviewed hundreds of addicts. He is convinced that opiate addicts’ life histories are ﬁlled with uncontrolled rage and anger, and that they use the opiate as medication. As Milkman and Sunderwirth (1987) point out, however, “The doctor who treats himself has a fool for a patient.” As we have mentioned in the module on Chronic pain, prolonged use of analgesic drugs, like heroin, causes the body to produce less of its own natural opiates, and to reduce sensitivity to any opiate neurotransmitter.
The drug “works” until a tolerance develops, and then the addictive cycle takes over. The drug is progressively less successful, and eventually the addict is using the drug to keep from feeling terrible.
It is in the later, degenerative stage that the addict experiences most of the consequences of drug addiction.
Therapeutic communities provide an alternative to typical chemical dependency programs. Scattered around the United States are groups of people, often self-managed, who provide a drug-free therapeutic community for addicts who are willing to tough it out. They are based more or less on the highly confrontive programs like Synanon and Daytop Village that developed in the late 1960s.
These programs are like a boot camp for recovery. Confrontation and honesty are major tools. Residents learn to stay straight, learn a skill (if necessary), and to carry their own weight. The programs claim ﬁve-year success rates of up to 92 percent for graduates (although many leave without completing, and some of those come back later). Most programs advocate Twelve-Step program membership for support after treatment. There is often a small professional staff, augmented by graduates supervised or trained by more experienced staff.
A residence of two to four years is common, with adolescents making up most of the longer stays. Most are nonproﬁt, and some are true communes, where the only cost is your entire productive labor for the time you are there.
Others operate on a sliding scale. They are an option for those with lots of desire for recovery and few ﬁnancial resources. Two of the larger therapeutic communities are Daytop Village with sixteen facilities in New York, two in California, and one in Texas; and Delancey Street, with a facility in San Francisco, one in New York, one in South Carolina, and one in New Mexico that also accepts adolescents.
54 West 40th St.
New York, NY 10018
2563 Divisadero St.
San Francisco, CA 94115
For an excellent self-help program for heroin addicts, see the module on Narcotics Anonymous.
Addictionary 2 by Jan & Judy Wilson
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