Expert: Peter L. - 2/25/2010

Question
Hi
My 20 year old brother does heroin.  I know he started out taking pills, then moved on to snorting pills, and now this.  Anytime my family and I have confronted him about it he tells us he's not addicted, he just does it once or twice a week because of anxiety and low self esteem stuff like that (which, he has had a problem with since a kid)  He says that if he needs to stop he can. Would we rather him go out and get drunk every night? And I know he did stop doing heroin for a few months because he got a job that drug tested him regularly over the holidays. He never showed any signs of withdrawal. The first time we comfronted him I know he stopped the heroin for a while and just took pills. (My mom was drug testing him) still no withdrawal symptoms.
 It's difficult for us because he's completely functioning,(yet lazy) my mom knows when he does it because she can tell, but no one else would ever know. And she can tell when he hasn't done it from his eyes, but not because he's showing any withdrawal signs.  Can that be possible?
 My question is, he got arrested for possesion. If they send him to rehab, I'm afraid he'll just sit there thinking, "none of this pertains to me because I don't have a problem" and he'll just get through the probation and start again. Even if it's just with pills again. Is there something we or he or they can do to prevent that line of thinking?  I'm almost hoping he gets jail time for it.

Thanks for your time,
J.

Answer
Hi Jaime,

You are seeing first hand the nature of addiction and addictive behavior.  It's a tough thing to break.  

In my field of addiction treatment, we reluctantly have to face the fact that consequences are the driving engine of change when it comes to addiction.  In other words, someone will not stop an addictive behavior unless the pain and difficulty of maintaining it exceeds the rewards they are getting from it.  The question is: when will that happen for any one individual?

I've worked with many, perhaps hundreds of individuals who are very clearly "not ready" to give up their addictive behaviors.  They are in treatment, saying what we want to hear, attending groups, but somewhere inside they're saying, "I can't wait to get high again."  Sometimes clients will complete mandatory counseling requirements and start using substances immediately after. That sounds like how you are describing your brother.  Some clients will try to sneak the use of substances under our noses, or under their probation officer's nose, and the use will only be revealed by a urine screen.  Much of the time, even then they will deny the positive urine screen.

Your mother has a particular type of radar that she's developed that alerts to the fact that your brother is using.  We see these nuances of appearance and behavior all the time, and usually it is because there is, or has been, use of a substance.

Many of my clients -- including one yesterday -- say they would would have died unless they were put in jail.  It's almost as if one has to be physically stopped from using substances. When it comes to opiates like heroin, the addictive urge is very strong, and these drugs set up very powerful cravings.  Sounds like your brother could use opioid replacement therapy, specifically Suboxone or Methadone, to help him control the cravings.  Many, if not most opioid addicts need this kind of medication to fight off the extreme cravings.

Anyway, good luck and I hope this helps!

Peter