"SICK"

To understand a heroin addict there are a number of facts to take into account. First and foremost is our fear of withdrawal or being 'sick' as we call it. This response to not having enough opiate to take the edge off our withdrawal is the motor that drives all the other behaviour. The first reason for this is simple to understand. Withdrawal from heroin is the natural result from not having enough of the drug in our blood, and the syndrome that occurs when this lack is present is very unpleasant. For a heroin addict reading this last sentence there is almost certain to be eye rolling and exclamations that add up to "yeah, right" and "no shit Sherlock". In the culture of heroin addiction, being sick is the boogie man that haunts our dreams. Some cultures have Zombies, some have the devil or the Golem. We have "sick".

While acknowledging that withdrawal from heroin is very unpleasant it is also important to acknowledge how much of a role the fear plays in the strength of the response. Heroin or other opiate withdrawal is a function of adrenaline or speed -like substances that naturally occur in the brain. Everyone has these chemicals in their head.

For understanding why being 'sick' is so powerful for us it means we need to take a look at how people become addicted to heroin or any other opiate such as morphine, methadone, hydrocodone, oxycodone, oxycontin or hydromorphone.

When heroin is introduced to the blood by injection, snorting, skin-popping or any other mode of use, the respiratory system is impacted. This is the system that has to do with your blood pressure, heart rate, galvanic skin response and breathing. Without these functions going on in your body you have a Republican or at least someone who is dead and does not do much thinking (that was a joke if a poor one). The body basically freaks out and presses an emergency button that is designed to help a person survive these moments. The button is labeled "neuroadaptation" and responds to the lowering of our respiratory system by performing a trick.

First a little brain background. The cells in our head are called neurons and perform the job of being a brain just as the cells in our skin perform the job of being skin and so on. These cells branch out all over the place and touch each other . Where certain parts of them come close to touching is called a synapse and the space between these almost touches is called the synaptic cleft. It is in this cleft that chemical messages are passed back and forth. Heroin blocks the neurotransmitter or chemical that regulates our respiratory system and when it blocks the chemical our blood pressure, heart rate and other functions go down. In other words our heart rate lowers and so does everything else that keeps us alive or liberal ( I do know the jokes are not funny but it is my blog).

Here is where the trick happens. The brain, sensing extinction, makes the cells receiving the neurotransmitter despite heroin blockage, more sensitive, thereby doing the job of all the cells. This "neuroadaptation" is normal and healthy. However, it does not go away after the use of the drug has stopped. Instead all the receiving parts of the cell (called receptor sites) remain hypersensitive. Even the ones that were blocked and that means any of the speed like chemicals from our brain that normally regulates the respiratory system`is doing the job at an increased rate. The result is a brain flooded with adrenaline- like chemicals and a person whose experience is similar to a person on speed. No sleep, no appetite, cold skin, increased heart rate, high blood pressure, wide pupils, sweating, and very much caught up in swinging emotions. The time for the worst part of this to wear off is called withdrawal and the time it takes for all of it to go away as much as possible is called post-acute withdrawal. Time frames for this vary depending upon length of use, age, health, quality of dope and use of any other substances. It can vary from 3 days to three weeks for the first part and up to two years for the second.

The response I have been referring to is also known by the name of "fight or flight". When a person is faced with a danger the brain pumps out a lot of adrenaline to help us fight for our life or run to save it. The important link is this. Fear means more adrenaline. More fear more of the signs of fear in the body. These signs include wide pupils, cold skin, sweating, anxiety, no chance of sleep, nausea and others. They are almost identical to the signs in heroin withdrawal. So here is the punch line. Stick with me now because this is important. A heroin addict is afraid of withdrawal because it is very nasty. Any sign of withdrawal will cause a fear response which will mimic withdrawal signs causing more fear, increasing withdrawal symptoms which causes more fear and so on... A heroin addict can come very close to scaring themselves "sick" in the with drawl sense.

This mechanism becomes more problematic when you realize that any up and down in life will feature some adrenaline producing moments. A fight with one's boss or love interest can cause feelings of unease that the addict will unconsciously translate as withdrawal which will create more fear, leading to the response of most heroin addicts to this feeling which is to fix.

The final bit that fits into this subject is called 'somatic awareness'. Soma means body so this breaks down as body awareness. Everyone has it to some extent but heroin addicts have it as a part of who they are. Addicts are used to paying attention to the level of heroin in their blood. If they do not plan well the penalty is withdrawal. Upon waking our mind goes to how we feel physically which means how far away is withdrawal. Years and years of this leave an addict with an automatic somatic register. It does not go away in recovery to any extent for a long time if ever. So we end up with this population of addicts as people who notice everything that happens to them physically and puts all emotional turmoil on to the physical plane. For instance, a fight with the kids may translate as a tight shoulder which leads to a headache. The addict knows how to get rid of this problem but if they are going without they say no to themselves and are left with an ambivalence that leads to more tension and more discomfort, once again begging a chemical solution.

Much of treatment's focus is on the past history of the addict, and this may well have its place in the greater scheme, but in the beginning the addict's most powerful enemy is their brain and the conditioning it has undergone. Becoming a heroin addict is a learned experience. If you do not believe that drop a normal citizen into a drug area and tell them to go buy heroin. They will be lucky to leave with their pants on.

Heroin is a drug of comfort. Think of the beautiful poppy swaying in warm winds, bending at the stalk and going where the world wants to take it. Heroin addicts are addicts to comfort.

Heroin is from the poppy and so is morphine, opium, mehtadone and codeine. Methadone is synthetic but is based upon the poppy's molecular formula. Pain killing is the primary purpose of all of these drugs. There is even a God named for it called Morpheus, the God of dreams. Heroin addicts are addicted to no pain.

There is also a sureness in the world of the heroin addict. If the drug is good so are you. This is a certainty. No grays or shades between black and white. Life is not complicated. A supply of a good amount of strong heroin is a treasure beyond money. It is the guarantee of happiness and the rest of life seen through rose coloured lenses. We are addicted to certainty and rose coloured views.

Every day has a mission. Ther is no boredom or deadly repetition. No 'why am I doing this?' or 'maybe I'l try something else today'. I get up and Use. If I do not have it I go on a mission until I do have it. Then I use. After that I do it again and each time is just as important as the last. I am addicted to a sense of importance and being on a mission.

I am tearproof, waterproof, bloodproof or however you want to put it. Despite my ability to pretend, charm, lie, profile or front, once I have a good fix in me my main goal in life is satisfied. Many of the caring ones regret coming second but this is a misunderstanding. They are not second. Heroin is.

If I am not sick I am well
If I am not sick I am well I care so little for the others
If I am not sick I am well

Inside here I snuggle up to the warm
I watch you with what you want
I judge what you want or need
I do my best to give it

I do my giving from the warmth
I do my best from the warm place
If I am not sick I am well
And I am warm

Can I help You?
Who Can I be for you?
What illusion can we spin?
How long will this dream last.

I pray for it to last forever
For all time to the end of all
To be well and well and well
In the clutch of Morpheus

My love grasps at me
as I float
My family
grasps at me
as i float
The cat curls up and purrs
I love the warmth