Abstinence as a treatment for heroin addiction

What is good about straight abstinence as a treatment for heroin addiction?

The good part about abstinence is that the problems of using heroin go away. If it works, the problem is "solved" by the simple personal resolve to put down the drug and not pick it up again.

If you are currently using heroin, and are still at the point where you have the will power to put it down, then take my recommendation -- you should do so immediately. Continued use of heroin should be considered extremely hazardous, particularly in the current environment where it is illegal, the quality and dosage is uncertain, and there are severe criminal penalties with limited treatment options. For most people, it is not a question of IF you will develop problems with continued use, it is only a question of WHEN.

What is bad about straight abstinence as a treatment for narcotic addiction (or any other addiction, for that matter)?

The bad thing about abstinence is that it simply doesn't work for most people. That is just a hard, cold fact. Although people should stop their drug abuse, they just don't. You can tell them to stop, and they may promise to stop, but the simple fact is that many of them just won't. 

If you want the odds for a person in your family being successful with it -- figure that about five percent of people with a drug problem will "cure" their addiction and be able to become totally abstinent in any given year. If your family member is in that five percent, then total abstinence is the best way to go. However, the odds are about 19 to 1 against it being a success this year.

Some people will blame that failure on moral weakness in the individual. Others will blame it on psychological, medical, or genetic factors. Still others will say that the person simply has a bad habit, not much different than biting their nails, and they should just make up their minds to quit, and then really do it. While these are all interesting ideas, and they will each be discussed later in this FAQ, these kinds of judgments don't really solve the immediate problem. 

If the heroin user is a family member, the first goal is to do what is necessary to keep them alive long enough that you can deal with the problem -- whatever you believe it to be.

My personal opinion is that drug abuse has a lot to do with psychological stress. As proof of this, most surveys of female heroin addicts show that they suffered an extraordinarily high rate of sexual abuse as children. Soldiers in Vietnam were also known to have had high rates of heroin use -- much of which stopped as soon as they got home. (See for example: Heroin on the youth drug scene - and in Vietnam) Unless you deal with the underlying causes of why they started in the first place, then you aren't going to solve the problem. Problems will continue, but in other areas.

Even if they stop using heroin, that doesn't mean that they stopped using and/or abusing other drugs. One of the hallmarks of regular heroin users is that they don't just use one drug. Through the course of their drug-using career many -- if not most -- have used and/or abused just about every drug you can name. Moreover, many of them continue to use other drugs on a daily basis -- including tobacco, alcohol, and big cups of coffee -- while they use heroin.

The problem for them isn't heroin really -- it is a need to keep using drugs of some sort to deal with whatever issues they have. Indeed, the compulsion to use other drugs is so strong that some heroin addiction treatment programs don't even try to get their clients to quit smoking tobacco because they know it is futile. Ironically, in the long run, tobacco kills about 100 times as many people as heroin does.