Preferred Name: Helen
At the time of the interview Helen wasn’t working as she had been injured in a motorcycle accident. She has a teenage child, is single and lives alone. She describes her ethnic background as ‘Celtic’: she was born in Southern Europe and her parents were born in the United Kingdom.
Helen began taking heroin with friends in her twenties, and continued to take it during her thirties, while completing her university degrees and working full time in Australia and overseas. Over the years, when her income was limited and she couldn’t afford to take heroin regularly, she attended residential detox and treatment programs, and participated in opioid pharmacotherapy treatment programs (methadone maintenance treatment [MMT] and Suboxone®, a combination of buprenorphine and naloxone). After experiencing financial and personal difficulties during her forties and early fifties, she decided to ‘cut right back’ on her heroin consumption. She is now on Suboxone® and takes heroin only occasionally.
In her mid-thirties she went on methadone maintenance treatment for several years. During this time she became pregnant and at the recommendation of her doctor, she remained on MMT. When the baby was born however, she says, the medical staff at the hospital treated her baby ‘really differently’ as a result of the baby being diagnosed with neonatal abstinence syndrome (a newborn’s withdrawal from a drug that the mother used regularly during pregnancy).
A few years later Helen stopped MMT. She found it to be ‘a really horrible thing to detox from’, taking ‘months to come out of [her] system’, and this ‘discouraged’ her from taking it again. During her forties she continued to take heroin while working interstate and overseas. When she returned to her home city, she experienced an overdose and was admitted to a psychiatric hospital. She then decided to go onto Suboxone® to reduce her heroin use. However, when she resumed work that required overseas travel, she found it more difficult to get Suboxone® from the service she’d been attending. Unable to access Suboxone® regularly, she stopped taking it and continued taking heroin.
Helen’s work overseas ended around a year before the interview, when she was in her early fifties, and she returned to Australia. Soon after, she had a motorcycle accident, which ‘stopped [her] from getting around’ the city and seeing her child. She says she began feeling ‘quite depressed’ and ‘isolated’ and taking heroin helped her to ‘feel more capable of just doing [her] day-to-day things’.
Helen says she feels that having ‘a habit on heroin’ has become ‘exhausting’. She now wants to ‘cut right back’ to a level of consumption she ‘can afford’ and is ‘comfortable with’. Recently she completed a detox and a residential rehabilitation program, during which she resumed taking Suboxone®. She now plans to stay on Suboxone®, and have heroin only ‘every now and then’.
Helen feels ‘really positive’ about the future and is planning to begin a new course of study, continue writing, and resume working overseas. She also plans to spend more time with her child and go travelling.
Helen (F, 53, not working due to injury, heroin) says that drug addiction involves physical withdrawal symptoms and cravings. (Played by an actor)
With something like heroin you do have very acute withdrawals […] If you’ve had it in your system for long enough to become habituated to it. And you’re going to feel absolutely terrible if you don’t have it. To me, that’s addiction. People can say they’re addicted to TV or gambling or food, or whatever, but to me, like my experience of addiction has been that kind of fear of feeling awful, as well as the attraction of the good feeling [and] not wanting to feel sick […] When it comes to heroin […] you do get cravings and you do experience withdrawals.
Helen limits her heroin consumption to a level where she can function and still enjoy its benefits. (Played by an actor)
Personally, I don’t really use [heroin] to get really stoned […] I mean I do have a much nicer sleep on it but I find actually it makes me feel more capable of just doing my day-to-day things. So it gives me more energy. I can go for really long walks or bike rides, or play with the kids, or do things that require a lot of stamina that normally I’d feel too tired to do. And if I end up using more than I mean to, I feel stupid, like I’ve wasted my money and now I’ve got to wait for it to wear off again. So I try to keep it at that level where I’m functioning on it.
Helen recently completed a residential detox as a ‘preventative measure’ to ensure her consumption didn’t increase while a friend was visiting from out of town. (Played by an actor).
I’ve tried to [detox] with a partner. I’ve tried to do it by […] travelling overseas or [going] somewhere else […] My last detox was just last week actually at [a facility]. I’d done a [residential] rehab at the end of last year and I hadn’t been using every day, so I thought it was more of a preventative measure [in that] a friend of mine who uses a lot was in town and I could just see things getting out of control so I went into [the detox facility]. But after two or three days, I was just really, really sick [withdrawing], so I decided to go back on buprenorphine maintenance.
Helen finds the highly structured nature of residential rehabilitation programs can make it hard to return to everyday life afterwards, suggesting a need for aftercare and community integration programs. (Played by an actor)
I think there’s a lot of problems with the whole rehab system here […] They’re incredibly structured environments and I don’t think they really set people up for the real world afterwards. You meet people who have been through three or four rehabs. They’ve spent the last 10 years of their lives in and out of these places, and it hasn’t really achieved anything […] There’s not enough focus, I don’t think, on putting all those parts of your life together: accepting that a lot of people who are using drugs also have issues around mental health, homelessness, stuff around their kids, abusive partners. All sorts of other issues are going on that need to be dealt with holistically, like the whole person […] Just taking someone out [of their normal life] and putting them in a rehab, where everything’s lovely and the meals come three times a day, the washing gets done for you. It’s a very unreal environment […] It’s like people who come out of jail who have become institutionalised, they have nowhere else to go but the environment that put them in jail in the first place, with the abusive junkie partner, and the screaming kids.
Helen says that Suboxone® gives her a very long-lasting opioid effect and the naloxone in it means that if she took heroin, she would get sick which discourages her from taking it. (Played by an actor)
At the moment I’m on Suboxone so there’s not much point [in] using heroin until you haven’t had [Suboxone] for a couple of days […Taking] Suboxone means that if you are going to use [heroin] you really have to plan it, which means you are inevitably either going to use less or jump off the [Suboxone treatment] program. And it has such a long-lasting effect that, you know, even the fourth day you don’t feel that awful. Whereas if you miss a day of methadone, you start feeling uncomfortable and feeling like you’ve got to have a shot [of heroin…] I think [being on Suboxone] I’ll probably end up not using at all because once you’ve got Suboxone in your system, you’re really talking a week before you’d get the same effect from a shot [of heroin] that you did before. And by then you’d have been kicked off your program. So like I’m already finding that […] it’s starting to become pointless [taking heroin].
According to Helen, the ‘gulf’ between alcohol and other drug workers and clients contributes to the shame and stigma surrounding drug use. (Played by an actor)
It’s funny, because I feel much more ashamed of [my heroin use] now. I feel that shame and guilt and embarrassment, and the stigma around using much more now. Whereas in the past when I was quite functional, I didn’t disclose it to people because I didn’t think I needed to […] It’s a bit ironic that it’s when I’m trying to stop using that I feel more stigmatised because I’m disclosing it more.
I don’t know if things have changed over the years but I feel like people in organisations that work with drug users now are encouraged to be professional. So it’s sort of ‘us’ and ‘them’. Like when I used to work in outreach programs and NSPs [needle syringe programs…] I don’t remember much distinction being made between clients of the program and people that worked at the program. But now there’s a complete gulf, they are not the same kind of people at all. So yeah, I don’t like standing behind the bullet proof glass and being the client, and being seen as a drug user and that’s all there is to me, you know. And that’s how I’m being dealt with.