There is a war in the inner city. Addictions wreak havoc. Families are breaking down. People are dying. Gangs run wild on the streets and in the colleges of our city. The problems of our inner city do not have a pop solution. We want to tackle the problems of drug addiction, gang members and prostitution, teenage pregnancy, and street lives.


Steps

1. Understand what heroin is. Heroin (Diacetylmorphine or Diamorphine) is a drug of the opiate family, a group of pain killing drugs (analgesics) derived from the Opium poppy. Heroin is made from the sap of the opium poppy, Papaver somniferum, which had been the most effective painkiller known to medicine for at least 7000 years. Heroin is a very addictive drug which can be used in many ways, the main being smoking, injecting or snorting. Within a week or so of starting to use the drug a person will become physically addicted, making it very hard for them to stop no matter how much they might want to.
2. Understand the effects of heroin. Heroin exerts its primary addictive effect by activating many regions of the brain; the brain regions affected are responsible for producing both the pleasurable sensation of "reward" and physical dependence. Together, these actions account for the user's loss of control and the drug's habit-forming action. It mimics certain chemicals in the brain that are already present (i.e. endorphins) that block pain and induce feelings of pleasure and contentment.
   • Soon after using, heroin crosses the blood-brain barrier. In the brain, heroin is converted to morphine and binds rapidly to opioid receptors. Users typically report feeling a surge of pleasurable sensation, a "rush." The intensity of the rush is a function of how much drug is taken and how rapidly the drug enters the brain and binds to the natural opioid receptors. Heroin is particularly addictive because it enters the brain so rapidly. The effects are almost immediate and the user may initially feel sick. A feeling of calm and warmth spreads through the body and any troubles or pains seem very distant and unimportant. At higher doses the user slips into a dreamlike state where they are not asleep or awake, but somewhere between.
   • After a ‘fix’ users will feel warm, happy and content with themselves and the world around them. All negative feelings disappear and they have no worries. Time goes very quickly. This will continue until the effects wear off and the heroin is finished. The user will then need to start thinking about where to score and/or where to get the money from for the next hit.
   • As well as being a very powerful painkiller, heroin also depresses the central nervous system activity, making the heart rate and breathing slow down, suppressing the cough reflex and depressing the activity of the bowel, causing constipation. Some blood vessels dilate, releasing heat through the body, giving a feeling of warmth. Opiates can change the brain stem, an area that controls automatic body functions and depresses breathing; the limbic system, which controls emotions to increase feelings of pleasure; and can block pain messages transmitted by the spinal cord from the body.
3. Acknowledge that this is a problem. It is always hard to learn that your loved one is using heroin. You will feel angry with them for doing it, ashamed by their life choice as well as many other things. If you share the problem with others, their advice might be to cut them loose and have nothing more to do with them. Do not do this.
   • Remember the person that they were and can be again. Remember that the longer it goes on the harder it is to stop. If an addiction is stopped early, the withdrawals will be easier and not last as long as they will with a long term addict.
4. Propose immediate treatment. A promise from the person to stop the problem activity or to seek treatment later is not good enough. Explain what kind of treatment you have in mind.
   
   
   • Realize that they may not agree that they need the type of assistance that you propose.
   • Be prepared for this to be difficult to observe, as it may cause them to burst into tears or go into a rage. They might have what seems like a tantrum. Even if your loved one is sobbing with all their might, be steadfast and do not weaken. You are trying to save them.
   • Your loved one will likely deny anything you say and will resent your saying it. Keep on your path of assistance to the one you are concerned about, because in order to reach the problem, you have to knock down the shell that has built around it.
   • Remember, you are helping the person to heal. Sometimes, we need to endure the pain of a loved one in order to provide them with the help he needs to get well. This is why they call it tough love- because it is not an easy way to help someone. It is indeed tough - but you might be saving the user's life.
5. Be supportive and avoid suspicion – appreciate that it is hard to detox from heroin and not everyone is successful. If they fail don’t take it as a personal insult, offer support for the next time they try. Remember that most people relapse a few times before they make it. Don’t keep asking them if they are still clean or lecturing about not starting again; if you're constantly nagging them, they will keep things from you.
6. Know that someone who uses heroin can talk and think coherently, although at high doses, the user becomes drowsy and starts gouching (nodding off into a sleep like state). Pupils become tiny (pinned) and the eyes roll back. Even with doses sufficiently high to produce euphoria, there is little change to coordination, sensation or intellect.
   • Although some users may take it occasionally, heroin offers most users an unparalleled state of mind and once used, most find it difficult not to keep going back for more. It has been documented that it only takes 3 days of constant use to become addicted, remembering that there are different levels of addition and withdrawal. Most people will not notice the subtle withdrawal symptoms after this short a period and may put it down to feeling a little down, getting a cold, etc. The two issues with addiction are the length of use and the average morphine content in the body. Usually though, people will notice that they have become addicted between 1 - 2 weeks after starting constant use. After this amount of time, stopping will result in obvious withdrawal symptoms.
7. Do not be too harsh on them. Upon learning about your loved one's addiction, your first reaction might be to convince them to stop by threatening, pleading or begging. This wont work – heroin is too strong an influence over their lives for them to be able to stop just because you want them to. Heroin users will only stop when they are ready to. You might be able to force them by locking them in a room, but sooner or later you will have to let them out and they will start using it again. Nothing is then achieved apart from them being more devious and sneaky, to ensure that you don’t find out about their relapse and force them to quit again.
8. Remember that not many addicts manage to complete a detox and remain clean on their first attempt. If the addict does relapse, don’t go crazy and disown them. Try to understand how hard it has been and help them to start again. Think of when you have tried to stop something or given yourself a resolution, did you always succeed first time? Heroin addiction is not all physical, as there is the mental addiction to cope with. Even though the withdrawals might have gone, the mental addiction will still be there, urging them to use again.
9. Understand heroin withdrawal. When helping an addict withdraw, it is important to know the facts and symptoms. Withdrawal occurs a few hours after taking the drug, once the effects start to wear off and the body has broken down the heroin in the blood stream.
   • After the last dose, users will normally start experiencing mild withdrawal symptoms around 4-8 hours later. These will get worse until they peak on the third day. This is the worst day, with things slowly getting better from this day onwards. These acute symptoms are usually greatly improved by the fifth day and are largely gone in seven to ten days.
   • For longer term users, that isn't the end of it! This acute withdrawal is followed by a "protracted abstinence syndrome" which can continue for up to 32 weeks afterward. The symptoms that continue over this time are: restlessness; disturbed sleep patterns, blood pressure & pulse rate; dilated pupils; feeling cold; irritability; change of personality and feeling; as well as an intense craving for the drug.
   • Heroin and other opiate withdrawal symptoms are extremely uncomfortable and are not likely to be fatal or lead to permanent injury, but can cause death to the fetus of a pregnant addict.
   • Often the hardest part of detox, is not the withdrawing itself but staying off it altogether. To remain clean, a whole change of life is required. New friends, keeping away from areas where you used to score, and finding things to relieve the boredom and time you would have spent using, are amongst the things that have to change, as well as wanting to stay clean.
10. Know that what the addict is going through is not easy. It is difficult to just change your whole life - never seeing your friends, starting to go out all the time when you're used to staying in, etc. Even things like watching television are totally different when you're clean. This is why so many people get clean and then relapse. It is also worth remembering that many people use heroin to escape personal problems. Such a user has to fight through the agony of withdrawal only to then be faced with all the same problems they were escaping from in the first place, but now with the added burden of heroin cravings to deal with.
11. Treat them the same as before – many people start treating users like children, speaking down to them or not even trusting them to go to the shop for milk in case they disappear with the money. Unless they do something to warrant your suspicion, let the person know that you trust them.

Tips

• Remember the difference between lapse and relapse - after completing a detox, trying heroin for the first time is classed as a lapse. Don't jump down their throats about failing etc. Try to encourage them to think of it as a minor mistake, one NOT to be repeated. Only if they continue to use will it turn into a relapse.
• Keep temptation out of the way – most addicts would never steal from their friends and family, although some do it easily. However, to save it from happening ensure that you don’t put them into a situation that is too tempting.
• Be honest – speak to them about any worries you have without lecturing them. Let them know you are concerned.
• Keep in mind that most heroin addicts do eventually get and stay clean, and that the average length of time that someone stays addicted to heroin is about three years.

Warnings

• Don’t break all contact because your loved one is a user. They won't come to you when they need help and the best way to succeed at getting clean is with support. Let them know that they can turn to you and that you will do what you can.
• Make a rule about money – decide if you are willing to lend them money or not. Many people don’t like to lend money knowing that it will be spent on drugs, whilst others see it as stopping the addict from perhaps committing crime and getting in further trouble if they are caught. Make up your mind about this matter and stick to it. If you don’t want to lend money, let them know the reasons you are unwilling and also that the rule wont be changed. This will save them begging you in the future and you falling out. If you are willing to lend them cash, let them know that they will have to pay it back and that you will only lend money again if it is repaid. If they do let you down, stick to what you said and don’t lend them money again.
• Keep temptation out of the way – most addicts would never steal from their friend and family, although some do it easily. However, to save it from happening ensure that you don’t put them into a situation that is too tempting. Don’t put them in charge of large sums of money to show you trust them, or leave them looking after your house whilst you are away. Think about the possible outcomes of situations before you jump in.
• Be honest – speak to them about any worries you have without lecturing them. Let them know you are concerned – it will let them know that you care and they also might be able to reassure you on certain things your worried about.
• Stick to what you say - this is the most important rule. If you say you will do something for them in return for something they have done, then do it. If they fail to do what you asked, don't do it. If you give them a warning, carry it out if they don't listen. For example, don't say that next time they will get thrown out of the house and then not do it. Stick to what you say. If you do need to throw them out, start with a day or two. The next time they disobey make it a week, and so on. They have to know that they are crossing the line and that there will be consequences.