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What Heroin Addiction Tells Us About Changing Bad Habits

241 points by juanplusjuan 12y ago

josefresco 12y ago
Unfortunately, most addicts are unable to change their circumstances drastically enough to use this technique. To use an analogy from the article, a smoker can't stop going to work because walking by the entrance stirs cravings. Would like to see practical tools that addicts can employ that use this theory, short of flying across the world.
- patmcc 12y ago
  It's interesting, quitting a job and drastically changing your life could actually make financial sense if it got you to quit smoking. Assuming: 1 pack/day, $10 a pack (this is close in my province), 5% interest, over 30 years, has a present value of $55k. I wouldn't be surprised if the numbers for alcoholism or heroin addiction are similar. Addiction is hugely expensive to the people afflicted and society at large (barring the usual discussion of smokers saving health care dollars by dying early). If flying across the world/country and making other drastic changes really does stop the cycle with a high rate of success, we should consider funding it.
  - arthurcolle 12y ago
    Not to mention opportunity cost of that money (buying textbooks instead of 15 packs) and health costs of smoking.
  - mathattack 12y ago
    Alcoholism is much higher. It's not hard to spend $100+ on a good bender. Add in the associated health issues (true for smoking too) and the NPV of healthy behavior is much higher.
    - ibebrett 12y ago
      most alcoholics i know don't spend money this way. they buy cheap vodka and drink alone, not out going from bar to bar.
      - genericuser 12y ago
        It really depends on the budget of the alcoholic from my experience. Alcoholics have a way of making their alcoholism fit/fill their budget.
    - Nanzikambe 12y ago
      Bar hoppers are alcoholics in training, most countries don't have bars open 24/7 - and $100 buys a lot more alcohol from the off license or whatever. I'm no doctor, but if a person is able to "exist" for half the day or more without their buzz, I'd suspect they've not yet built very any/much physical dependence.
      - DanBC 12y ago
        Alcohol withdrawal can be dangerous. In England you get a medically supervised withdrawal if you drink more than 40 units per day. Very roughly this is 32 US Fluid ounces of 80 proof liquor per day. (One litre of 40% spirits).
        mathattack 12y ago
        Let's convert this to #s I understand... 80 proof = 40%. BigBeer (Budweiser) ~= 5% CraftBeer ~= 8% with some variation So this means 16 pints (or ~21 12oz bottles) of Budweiser or 10 pints (should never be drunk in 12oz bottles) of Craft Brew a day. For a small person, that's almost enough to be perpetually buzzed. I think the Drink Alone vs Bar Hopping is just a matter of being a functioning vs non-functioning alcoholic.
  - OvidNaso 12y ago
    "If flying across the world/country and making other drastic changes really does stop the cycle with a high rate of success, we should consider funding it." In addiction circles this behavior is comingly attempted, and considered so unsuccessful, that it has a *A-ism, "Doing a geographic".
  - Devthrowaway80 12y ago
    I'm an alcoholic who's been sober for about 3 months. I would have been ecstatic if I managed to get by for $10 a day. I'd easily drop a couple hundred dollars at the bar on drinks for myself in a single night. Even if I was drinking at home, a bottle of hard liquor does not go for $10 in Canada.
  - PhantomGremlin 12y ago
    One of the first FORTRAN programs I wrote, as a kid about 45 years ago, generated a table that showed, based on cost of cigarettes, interest rate, number of years, how much money my father's cigarette addiction was costing him. Of course I couldn't find that output today. But one thing I remember quite clearly is the cost of cigarettes. They were about $0.30 per pack back then. I'm sure I wouldn't have gone over $1.00 per pack in my table. Even allowing for inflation, someone is making a lot of money off the back of addicts.
    - droopyEyelids 12y ago
      Thinking like that leads you into the tricky realm of the government profiting off vice. A huge part of the $10 price tag is tax. But at least the government doesn't advertise cigarettes, like it does with the lottery.
- davemckenna01 12y ago
  Maybe if you adopt enough of the small changes, like smoking with your non-dominant hand, you're environment will be different enough to make a dent.
- weeksie 12y ago
  That depends. If you happen to be moving houses it might be a good time to try to quit smoking as well, for instance. For heroin? Maybe it's worth moving to a different town.
- Osmoticat 12y ago
  My parents are smokers, and have been for decades. When they out of the house they have little trouble not smoking. It's when they're stuck at home in front of the television when they find themselves smoking a lot. Ironically, the high price of cigarettes means they can't afford to go out very often.
  - totalrobe 12y ago
    Does it cost a lot in your area to go for a walk?
    - Osmoticat 12y ago
      It costs them a lot of pain, since they both have arthritis.
    - deleted 12y ago
      [deleted]
- wefarrell 12y ago
  I quit smoking recently. There were a lot of positive habits associated with smoking. I got to go outside, clear my head of of work for a few minutes, and take regular breaks. So I took those things and did something in place of smoking that would let me get the same benefits. When I would normally take smoke breaks I would go outside (through a different exit) and take a walk. Or I'd stay inside and stretch or do simple exercises. When it's not possible to change surroundings, it's important to replace bad habits with good ones.
  - soylentcola 12y ago
    Good move! The other side of this is that people smoke for the (at least situationally) positive effects of the active chemicals. Nicotine is a stimulant that a lot of people use for the clarity, focus, and relaxation it can provide in the short term. By using exercise as your replacement, you aren't just distracting yourself from the lack of a psychoactive drug but you're maintaining many of the positive results without the toxic delivery method. In my situation it's less feasible for me to do much exercise (at least not enough to compensate) every time I feel the need to clear some brain fog and tension but I did switch to a nicotine delivery method that doesn't rely on inhaling burning tobacco and the health risks associated. In the process I dramatically lowered my usage but at the least I'm just getting the mild stimulant (similar to how many people use coffee) without the hazardous stuff that goes along with smoking as the delivery method. Either way, congrats! Making the effort to change habits to remove unhealthy aspects seems pretty worthwhile from my experience with this.
    - drinchev 12y ago
      Can you give some more details on your nicotine delivery method, I'm trying to quit smoking this year ( actually today is day No. 8 since I haven't put nicotine in my blood ) but I'm super interested in the side effects. I work from home and it seems I can't focus on developing so easily and get distracted even more these days.
- Nanzikambe 12y ago
  Though I agree with your main point; in my experience the smoker-at-the-office analogy actually doesn't work. Most businesses won't let you smoke near entrances for obvious cosmetic reasons. There's either a smoker's corner or folks duck out some back entrance. I quit whilst working by avoiding places that were part of that "ritual": the cafeteria, fire escape/stairwell & pedestrian entry to the garage. Disclosure: I've long since started again, I work from home now :-P
bdamm 12y ago
This could be useful for informing addiction recovery within institutionalized individuals, such as soldiers or prisoners, but not within the general public. The addict is unlikely to change their entire life structure to defeat the addiction since they know that would defeat the addiction, and that's not what the addiction wants.
- k__ 12y ago
  I think you're right, but for other reasons. First, most people don't like or can move far away. Second, if your habits revolve around more abstract stuff than "seeing the office entrance where you smoke every day", you can end up changing some concrete circumstances and end up with the same abstract ones.
- equoid 12y ago
  That is silly. Most addicts don't have the resources to change their life structure, where would they go? what would they do? how would it be paid for?. It is only the rich who can check to a rehab clinic.
  - bdamm 12y ago
    It's a mistake to think that the only people who are addicts are the poor and destitute. There are plenty of addicts, perhaps the majority, who haven't managed to destroy their lives (yet).
danmaz74 12y ago
I remember a famous animal study about heroin addiction with mice. Almost all mice that were in a very stressful environment and had easy access to heroin became addict. But if mice were living in a pleasurable environment, most mice would not become addict. So, even if it looks very likely that the association between a habit and an environment was at work here too, I wonder how much the low relapse rate was linked not just to a change of environment, but also to a change from an incredibly stressful situation (war) to a much more satisfying one.
- garrettgrimsley 12y ago
  https://en.wikipedia.org/wiki/Rat_Park https://en.wikipedia.org/wiki/Rat_Park
  - canvia 12y ago
    Excellent cartoon version of this story: http://www.stuartmcmillen.com/comics_en/rat-park/ http://www.stuartmcmillen.com/comics_en/rat-park/
- btilly 12y ago
  I wonder how much the low relapse rate was linked not just to a change of environment, but also to a change from an incredibly stressful situation (war) to a much more satisfying one. Based on other things I've read about heroin, the change of environment is the only thing that mattered here. Heroin is in a class of drugs that create strong links with experience so that, even years later, a reminder of the experience immediately brings back the craving. A sample anecdote from one book I read on drugs and addiction was a person who had kicked heroin, been clean for 10-15 years, and had become a successful executive. He then made the mistake of going to a movie with a scene of someone seeking his next hit in a drug den. Simply seeing the drug den was enough to trigger a relapse - he walked out of the movie to find some and several days later realized how much trouble he was in. Examples like this have convinced drug researchers to conclude that long term treatment (eg taking methadone to block heroin) is the only reliable way to keep an ex-addict from being one unexpected environmental cue from becoming a current addict.
domdip 12y ago
The relationship between drugs and environment is so strong that (in mice, at least) you can trigger an "overdose" simply by changing the latter. http://people.whitman.edu/~herbrawt/classes/390/Siegel.pdf http://people.whitman.edu/~herbrawt/classes/390/Siegel.pdf
cheshire_cat 12y ago
It's common practice to tell addicts that they should move to another city after therapy and therapists are certainly right to do so but I think this is only a part of the truth. The soldiers in vietnam were under great stress from (war) that went away when they returned to the US. If you start doing drugs or any other coping mechanism because of some emotional problem the problem will travel with you. You can't run away, the only way to break those habits is to learn other coping mechanisms or to get to the root of your internal trauma and come to terms with it.
- jdcarter 12y ago
  This is a huge point I was hoping the article would address, but failed to. The war wasn't just a matter of location, it was a matter of stress (in a huge way) and a whole way of living (as a GI vs. civilian). If you're an alcoholic and you move from one town to another, that other town is going to have bars and liquor stores just like the one you left. Your location may have changed, but there are so many things that are effectively the same, I can't see it having quite the same impact when compared to returning from 'nam.
  - click170 12y ago
    This is more true for alcohol than it is for black market drugs. While still generally easy to find, its a bit harder to go up to a random sketchy looking person and ask them for drugs in a new city that you don't have a network of friends and contacts in. This makes me wonder if "pulling a geographic" is more successful for people with substance abuse problems that do not stem from alcohol.
- jqm 12y ago
  Maybe they had more trouble scoring dope when they got home? It's certainly one way to clean up, and I didn't see this possibility addressed in the article.
swamp40 12y ago
The last two sentences are fairly profound. (I didn't quite understand what she was saying until I had read it a few times.) We think of ourselves as controlling our behavior, willing our actions into being, but it's not that simple. It's as if over time, we leave parts of ourselves all around us, which in turn, come to shape who we are.
- junto 12y ago
  This is cool because once you realise that you can break habits, you realise you can also form them too. Habits are about frequency and ritual. Thus I can use the same process to start good habits that make me a better more effective person.
  - aswanson 12y ago
    "We are what we repeatedly do. Excellence, therefore, is not an act but a habit."
- bostonvaulter2 12y ago
  It's as if over time, we leave parts of ourselves all around us, which in turn, come to shape who we are. This is a powerful thought and could be used to make a very interesting video game.
  - suyash 12y ago
    or a movie or even a novel
- crimsonalucard 12y ago
  Profound yet simple. Essentially this article is saying: By changing your environment you can dramatically change your behavior to the point where it can literally kick a heroin habit.
  - equoid 12y ago
    I would turn this round. Your habitual behaviour comes to be associated with your environment. By removing yourself from that environment you find that those habits become weaker and may vanish. Behaviour isn't changed so much as behavioural cues can be eliminated.
cubano 12y ago
Heroin addiction is a difficult subject for me for personal reasons...in fact, I am currently on state probation for possession of it in 4 years ago. I become addicted to numb the pain of my mother's passing and my 13 year marriage ending, although there is, of course, no excuse. It started with prescribed Oxycontin and progressed from there. "Why buy overpriced synthetic molecules designed not to really get you high when you can get the natural ones cheaper and feel better?" I can still remember my engineering-mind thinking. I have been off it now for about 3 years after getting clean, literally, on a cell floor in a county jail...cold turkey...the first time I ever successfully kicked it. After that, I checked myself into a South Florida inpatient rehab (called the Hanley Center...please, do yourself a favor and give them a call if you need help), and with the help of some amazing people, got better. I'm convinced the only reason I finally kicked was simply because there was no other option; jails have pretty much no supply of heroin. To this day I thank the stars for that county jail...it saved my life. The best way to summarize the experience was with a "joke" (it was no joke BTW) I came up with to try to explain how I felt near the end... What's the best thing about heroin? After you do it, you don't feel anything. What's the worse thing about heroin? After you do it, you don't feel anything.
- MarkPNeyer 12y ago
  congrats on getting clean. thanks for expressing this publicly and confidently.
- last_call_x12 12y ago
  Firstly, a really big well done for getting clean. That is no mean feat. The last two lines of your comment really rung true. I lost a dear friend a few years ago, in relation to a serious heroin addiction (it wasn't actually an overdose that killed him, but a cheap, adulterated bad 'dose'). I watched a confident person struggle to emerge, only to recede every time lift dealt a blow, and end up trying to find things to remove the pain he felt in life. I am glad that his story actually helped stop one more life being lost - I worked with someone who though life was all about experiences, after blissful weed, there was the high of cocaine, and finally he considered opiates. A trip to the grave, to the family left behind, to the doctors who actually tried to save my friend's life, worked. Sobered him up, so to speak.
ribs 12y ago
A few years back I came across some emails from the previous user of a computer I was given. (They really should have wiped the hard drive...) They were messages to his family back in India. The guy had been using heroin, and had kicked it once or twice. But he fell back into it, and it was when his old friends rolled into town. That was the trigger for him.
code_duck 12y ago
I've had similar experiences with cigarettes. I've stopped and then decided to start several times. I've found the easiest way to quit, which makes it so simple but I don't even have to think about it, is to dramatically change my circumstances and daily habits, like a new job, new roommates, or moving.
deleted 12y ago
[deleted]
tmp-20150107 12y ago
So, I have been a heroin user (addict) for a long time, about fifteen years. I have a great job, as a senior engineer in a start-up, and have worked almost continually in IT while maintianing my habit. I've tried to quit, several times, and found it incredibly hard. As the article sugests, a change of scenery really does help, though. So, when I've been working overseas, or travelling to speak at conferences, then I find it's much easier to stop. I would take some methadone with me, and wean myself gradually off using it, over only a week or two. I have actually done this several times, and found that after a month I am essentially clean. However, when I return home I have always relapsed, usually pretty quickly. This is something I currently have a huge problem with, and I don't really know how to solve it ;( I'm trying to stop again, and wonderining if maybe a change of location would be the right way to do this properly?
- pstuart 12y ago
  Changing locations to get clean is called "pulling a geographic" by the 12-step folks (at least those I was hanging out with). Obviously getting away from bad influences helps. Glib suggestion: perhaps replacing that addiction with the addiction of exercise might be worth exploring?
  - tmp-20150107 12y ago
    Hm, makes sense. I think hobbies in general can be used to take the place of an addiction. I should probably cycle to work more, though ;) However one of the major problems with heroin addiction is the actuall process of quitting. You can't keep a job during withdrawl, i.e. cold turkey. There are clinics that offer 'five day detox' under sedation, but that's expensive (GBP 5K plus) and good luck getting NHS or health insurance to pay. They offer naltrexone implants, which prevent opiates from working altogether, which removes the option of relapse completely... Getting a methadone prescription in the UK is also tedious to say the least - you are supervised when taking your daily dose, must report for 'assessment' regularly and so on, which is hard to fit in to a working schedule. And forget about getting enough to take away with you on a business trip for a couple of weeks. I generally have to purchase on the black market when required, which is ridiculous. I'd love to be able to ask my GP for help, and simply be given a repeat prescription for a week or two's supply to take home, but that's never going to happen because they're afraid of it being sold. So I have to buy it from others, which doesn't make sense...?!
mturmon 12y ago
It reminds me of "Going to Chicago", an evocative blues about heroin addiction, habits, and place, sung by the great singer Joe Williams: https://www.youtube.com/watch?v=uPcHVqKHkKo https://www.youtube.com/watch?v=uPcHVqKHkKo In the intro to the song, he sets up the background: "He had a woman with a heroin habit, a monkey woman, a monkey on her back...so he got some fresh money and said, I'm going to take another city..."
tomphoolery 12y ago
"It's as if over time, we leave parts of ourselves all around us, which in turn, come to shape who we are." I like that.
somberi 12y ago
A related and useful article from The Economist (Link at the end). I have reproduced parts of it that I found interesting (Heavily edited for telegraphic brevity): "Like many of America’s new generation of users, Ms Scudo's ddiction began in 2000 when, after a hip injury, a doctor prescribed her ... a high dose of OxyContin.. Her prescription was later reduced, but she was already hooked. On the black market OxyContin pills cost $80 each, more than she could afford to cover her six-a-day habit; so she began selling her pills and using the proceeds to buy cheaper heroin. As if from nowhere, Ms Scudo had become a heroin addict." "last year 11m Americans used illicitly-acquired prescription painkillers, more than the number who used cocaine, ecstasy, methamphetamine and LSD combined." "Though Afghanistan accounts for 80% of global opium production, America gets most of its heroin from Mexico. Mexico is now the world’s third-biggest producer of opium, after Afghanistan and Myanmar." "More than half are women, and 90% are white. The drug has crept into the suburbs and the middle classes. And although users are still mainly young, the age of initiation has risen" http://www.economist.com/news/united-states/21633819-old-sickness-has-returned-haunt-new-generation-great-american-relapse http://www.economist.com/news/united-states/21633819-old-sic...
Cilike88 12y ago
Interesting to think about the obstacles we unintentionally set in place for ourselves in living out our good intentions. Emphasizes the need for living with mindfulness.
talles 12y ago
I love articles like these that take a holistic view on human behavior, that's the way to do it.

241 points by juanplusjuan 12y ago

Unfortunately, most addicts are unable to change their circumstances drastically enough to use this technique. To use an analogy from the article, a smoker can't stop going to work because walking by the entrance stirs cravings. Would like to see practical tools that addicts can employ that use this theory, short of flying across the world.

patmcc 12y ago
It's interesting, quitting a job and drastically changing your life could actually make financial sense if it got you to quit smoking. Assuming: 1 pack/day, $10 a pack (this is close in my province), 5% interest, over 30 years, has a present value of $55k. I wouldn't be surprised if the numbers for alcoholism or heroin addiction are similar. Addiction is hugely expensive to the people afflicted and society at large (barring the usual discussion of smokers saving health care dollars by dying early). If flying across the world/country and making other drastic changes really does stop the cycle with a high rate of success, we should consider funding it.
- arthurcolle 12y ago
  Not to mention opportunity cost of that money (buying textbooks instead of 15 packs) and health costs of smoking.
- mathattack 12y ago
  Alcoholism is much higher. It's not hard to spend $100+ on a good bender. Add in the associated health issues (true for smoking too) and the NPV of healthy behavior is much higher.
  - ibebrett 12y ago
    most alcoholics i know don't spend money this way. they buy cheap vodka and drink alone, not out going from bar to bar.
    - genericuser 12y ago
      It really depends on the budget of the alcoholic from my experience. Alcoholics have a way of making their alcoholism fit/fill their budget.
  - Nanzikambe 12y ago
    Bar hoppers are alcoholics in training, most countries don't have bars open 24/7 - and $100 buys a lot more alcohol from the off license or whatever. I'm no doctor, but if a person is able to "exist" for half the day or more without their buzz, I'd suspect they've not yet built very any/much physical dependence.
    - DanBC 12y ago
      Alcohol withdrawal can be dangerous. In England you get a medically supervised withdrawal if you drink more than 40 units per day. Very roughly this is 32 US Fluid ounces of 80 proof liquor per day. (One litre of 40% spirits).
      - mathattack 12y ago
        Let's convert this to #s I understand... 80 proof = 40%. BigBeer (Budweiser) ~= 5% CraftBeer ~= 8% with some variation So this means 16 pints (or ~21 12oz bottles) of Budweiser or 10 pints (should never be drunk in 12oz bottles) of Craft Brew a day. For a small person, that's almost enough to be perpetually buzzed. I think the Drink Alone vs Bar Hopping is just a matter of being a functioning vs non-functioning alcoholic.
- OvidNaso 12y ago
  "If flying across the world/country and making other drastic changes really does stop the cycle with a high rate of success, we should consider funding it." In addiction circles this behavior is comingly attempted, and considered so unsuccessful, that it has a *A-ism, "Doing a geographic".
- Devthrowaway80 12y ago
  I'm an alcoholic who's been sober for about 3 months. I would have been ecstatic if I managed to get by for $10 a day. I'd easily drop a couple hundred dollars at the bar on drinks for myself in a single night. Even if I was drinking at home, a bottle of hard liquor does not go for $10 in Canada.
- PhantomGremlin 12y ago
  One of the first FORTRAN programs I wrote, as a kid about 45 years ago, generated a table that showed, based on cost of cigarettes, interest rate, number of years, how much money my father's cigarette addiction was costing him. Of course I couldn't find that output today. But one thing I remember quite clearly is the cost of cigarettes. They were about $0.30 per pack back then. I'm sure I wouldn't have gone over $1.00 per pack in my table. Even allowing for inflation, someone is making a lot of money off the back of addicts.
  - droopyEyelids 12y ago
    Thinking like that leads you into the tricky realm of the government profiting off vice. A huge part of the $10 price tag is tax. But at least the government doesn't advertise cigarettes, like it does with the lottery.
davemckenna01 12y ago
Maybe if you adopt enough of the small changes, like smoking with your non-dominant hand, you're environment will be different enough to make a dent.
weeksie 12y ago
That depends. If you happen to be moving houses it might be a good time to try to quit smoking as well, for instance. For heroin? Maybe it's worth moving to a different town.
Osmoticat 12y ago
My parents are smokers, and have been for decades. When they out of the house they have little trouble not smoking. It's when they're stuck at home in front of the television when they find themselves smoking a lot. Ironically, the high price of cigarettes means they can't afford to go out very often.
- totalrobe 12y ago
  Does it cost a lot in your area to go for a walk?
  - Osmoticat 12y ago
    It costs them a lot of pain, since they both have arthritis.
  - deleted 12y ago
    [deleted]
wefarrell 12y ago
I quit smoking recently. There were a lot of positive habits associated with smoking. I got to go outside, clear my head of of work for a few minutes, and take regular breaks. So I took those things and did something in place of smoking that would let me get the same benefits. When I would normally take smoke breaks I would go outside (through a different exit) and take a walk. Or I'd stay inside and stretch or do simple exercises. When it's not possible to change surroundings, it's important to replace bad habits with good ones.
- soylentcola 12y ago
  Good move! The other side of this is that people smoke for the (at least situationally) positive effects of the active chemicals. Nicotine is a stimulant that a lot of people use for the clarity, focus, and relaxation it can provide in the short term. By using exercise as your replacement, you aren't just distracting yourself from the lack of a psychoactive drug but you're maintaining many of the positive results without the toxic delivery method. In my situation it's less feasible for me to do much exercise (at least not enough to compensate) every time I feel the need to clear some brain fog and tension but I did switch to a nicotine delivery method that doesn't rely on inhaling burning tobacco and the health risks associated. In the process I dramatically lowered my usage but at the least I'm just getting the mild stimulant (similar to how many people use coffee) without the hazardous stuff that goes along with smoking as the delivery method. Either way, congrats! Making the effort to change habits to remove unhealthy aspects seems pretty worthwhile from my experience with this.
  - drinchev 12y ago
    Can you give some more details on your nicotine delivery method, I'm trying to quit smoking this year ( actually today is day No. 8 since I haven't put nicotine in my blood ) but I'm super interested in the side effects. I work from home and it seems I can't focus on developing so easily and get distracted even more these days.
Nanzikambe 12y ago
Though I agree with your main point; in my experience the smoker-at-the-office analogy actually doesn't work. Most businesses won't let you smoke near entrances for obvious cosmetic reasons. There's either a smoker's corner or folks duck out some back entrance. I quit whilst working by avoiding places that were part of that "ritual": the cafeteria, fire escape/stairwell & pedestrian entry to the garage. Disclosure: I've long since started again, I work from home now :-P

bdamm 12y ago

This could be useful for informing addiction recovery within institutionalized individuals, such as soldiers or prisoners, but not within the general public. The addict is unlikely to change their entire life structure to defeat the addiction since they know that would defeat the addiction, and that's not what the addiction wants.

k__ 12y ago
I think you're right, but for other reasons. First, most people don't like or can move far away. Second, if your habits revolve around more abstract stuff than "seeing the office entrance where you smoke every day", you can end up changing some concrete circumstances and end up with the same abstract ones.
equoid 12y ago
That is silly. Most addicts don't have the resources to change their life structure, where would they go? what would they do? how would it be paid for?. It is only the rich who can check to a rehab clinic.
- bdamm 12y ago
  It's a mistake to think that the only people who are addicts are the poor and destitute. There are plenty of addicts, perhaps the majority, who haven't managed to destroy their lives (yet).

danmaz74 12y ago

I remember a famous animal study about heroin addiction with mice. Almost all mice that were in a very stressful environment and had easy access to heroin became addict. But if mice were living in a pleasurable environment, most mice would not become addict. So, even if it looks very likely that the association between a habit and an environment was at work here too, I wonder how much the low relapse rate was linked not just to a change of environment, but also to a change from an incredibly stressful situation (war) to a much more satisfying one.

garrettgrimsley 12y ago
https://en.wikipedia.org/wiki/Rat_Park https://en.wikipedia.org/wiki/Rat_Park
- canvia 12y ago
  Excellent cartoon version of this story: http://www.stuartmcmillen.com/comics_en/rat-park/ http://www.stuartmcmillen.com/comics_en/rat-park/
btilly 12y ago
I wonder how much the low relapse rate was linked not just to a change of environment, but also to a change from an incredibly stressful situation (war) to a much more satisfying one. Based on other things I've read about heroin, the change of environment is the only thing that mattered here. Heroin is in a class of drugs that create strong links with experience so that, even years later, a reminder of the experience immediately brings back the craving. A sample anecdote from one book I read on drugs and addiction was a person who had kicked heroin, been clean for 10-15 years, and had become a successful executive. He then made the mistake of going to a movie with a scene of someone seeking his next hit in a drug den. Simply seeing the drug den was enough to trigger a relapse - he walked out of the movie to find some and several days later realized how much trouble he was in. Examples like this have convinced drug researchers to conclude that long term treatment (eg taking methadone to block heroin) is the only reliable way to keep an ex-addict from being one unexpected environmental cue from becoming a current addict.

domdip 12y ago

The relationship between drugs and environment is so strong that (in mice, at least) you can trigger an "overdose" simply by changing the latter. http://people.whitman.edu/~herbrawt/classes/390/Siegel.pdf http://people.whitman.edu/~herbrawt/classes/390/Siegel.pdf

cheshire_cat 12y ago

It's common practice to tell addicts that they should move to another city after therapy and therapists are certainly right to do so but I think this is only a part of the truth. The soldiers in vietnam were under great stress from (war) that went away when they returned to the US. If you start doing drugs or any other coping mechanism because of some emotional problem the problem will travel with you. You can't run away, the only way to break those habits is to learn other coping mechanisms or to get to the root of your internal trauma and come to terms with it.

jdcarter 12y ago
This is a huge point I was hoping the article would address, but failed to. The war wasn't just a matter of location, it was a matter of stress (in a huge way) and a whole way of living (as a GI vs. civilian). If you're an alcoholic and you move from one town to another, that other town is going to have bars and liquor stores just like the one you left. Your location may have changed, but there are so many things that are effectively the same, I can't see it having quite the same impact when compared to returning from 'nam.
- click170 12y ago
  This is more true for alcohol than it is for black market drugs. While still generally easy to find, its a bit harder to go up to a random sketchy looking person and ask them for drugs in a new city that you don't have a network of friends and contacts in. This makes me wonder if "pulling a geographic" is more successful for people with substance abuse problems that do not stem from alcohol.
jqm 12y ago
Maybe they had more trouble scoring dope when they got home? It's certainly one way to clean up, and I didn't see this possibility addressed in the article.

swamp40 12y ago

The last two sentences are fairly profound. (I didn't quite understand what she was saying until I had read it a few times.) We think of ourselves as controlling our behavior, willing our actions into being, but it's not that simple. It's as if over time, we leave parts of ourselves all around us, which in turn, come to shape who we are.

junto 12y ago
This is cool because once you realise that you can break habits, you realise you can also form them too. Habits are about frequency and ritual. Thus I can use the same process to start good habits that make me a better more effective person.
- aswanson 12y ago
  "We are what we repeatedly do. Excellence, therefore, is not an act but a habit."
bostonvaulter2 12y ago
It's as if over time, we leave parts of ourselves all around us, which in turn, come to shape who we are. This is a powerful thought and could be used to make a very interesting video game.
- suyash 12y ago
  or a movie or even a novel
crimsonalucard 12y ago
Profound yet simple. Essentially this article is saying: By changing your environment you can dramatically change your behavior to the point where it can literally kick a heroin habit.
- equoid 12y ago
  I would turn this round. Your habitual behaviour comes to be associated with your environment. By removing yourself from that environment you find that those habits become weaker and may vanish. Behaviour isn't changed so much as behavioural cues can be eliminated.

cubano 12y ago

Heroin addiction is a difficult subject for me for personal reasons...in fact, I am currently on state probation for possession of it in 4 years ago. I become addicted to numb the pain of my mother's passing and my 13 year marriage ending, although there is, of course, no excuse. It started with prescribed Oxycontin and progressed from there. "Why buy overpriced synthetic molecules designed not to really get you high when you can get the natural ones cheaper and feel better?" I can still remember my engineering-mind thinking. I have been off it now for about 3 years after getting clean, literally, on a cell floor in a county jail...cold turkey...the first time I ever successfully kicked it. After that, I checked myself into a South Florida inpatient rehab (called the Hanley Center...please, do yourself a favor and give them a call if you need help), and with the help of some amazing people, got better. I'm convinced the only reason I finally kicked was simply because there was no other option; jails have pretty much no supply of heroin. To this day I thank the stars for that county jail...it saved my life. The best way to summarize the experience was with a "joke" (it was no joke BTW) I came up with to try to explain how I felt near the end... What's the best thing about heroin? After you do it, you don't feel anything. What's the worse thing about heroin? After you do it, you don't feel anything.

MarkPNeyer 12y ago
congrats on getting clean. thanks for expressing this publicly and confidently.
last_call_x12 12y ago
Firstly, a really big well done for getting clean. That is no mean feat. The last two lines of your comment really rung true. I lost a dear friend a few years ago, in relation to a serious heroin addiction (it wasn't actually an overdose that killed him, but a cheap, adulterated bad 'dose'). I watched a confident person struggle to emerge, only to recede every time lift dealt a blow, and end up trying to find things to remove the pain he felt in life. I am glad that his story actually helped stop one more life being lost - I worked with someone who though life was all about experiences, after blissful weed, there was the high of cocaine, and finally he considered opiates. A trip to the grave, to the family left behind, to the doctors who actually tried to save my friend's life, worked. Sobered him up, so to speak.

ribs 12y ago

A few years back I came across some emails from the previous user of a computer I was given. (They really should have wiped the hard drive...) They were messages to his family back in India. The guy had been using heroin, and had kicked it once or twice. But he fell back into it, and it was when his old friends rolled into town. That was the trigger for him.

code_duck 12y ago

I've had similar experiences with cigarettes. I've stopped and then decided to start several times. I've found the easiest way to quit, which makes it so simple but I don't even have to think about it, is to dramatically change my circumstances and daily habits, like a new job, new roommates, or moving.

deleted 12y ago

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tmp-20150107 12y ago

So, I have been a heroin user (addict) for a long time, about fifteen years. I have a great job, as a senior engineer in a start-up, and have worked almost continually in IT while maintianing my habit. I've tried to quit, several times, and found it incredibly hard. As the article sugests, a change of scenery really does help, though. So, when I've been working overseas, or travelling to speak at conferences, then I find it's much easier to stop. I would take some methadone with me, and wean myself gradually off using it, over only a week or two. I have actually done this several times, and found that after a month I am essentially clean. However, when I return home I have always relapsed, usually pretty quickly. This is something I currently have a huge problem with, and I don't really know how to solve it ;( I'm trying to stop again, and wonderining if maybe a change of location would be the right way to do this properly?

pstuart 12y ago
Changing locations to get clean is called "pulling a geographic" by the 12-step folks (at least those I was hanging out with). Obviously getting away from bad influences helps. Glib suggestion: perhaps replacing that addiction with the addiction of exercise might be worth exploring?
- tmp-20150107 12y ago
  Hm, makes sense. I think hobbies in general can be used to take the place of an addiction. I should probably cycle to work more, though ;) However one of the major problems with heroin addiction is the actuall process of quitting. You can't keep a job during withdrawl, i.e. cold turkey. There are clinics that offer 'five day detox' under sedation, but that's expensive (GBP 5K plus) and good luck getting NHS or health insurance to pay. They offer naltrexone implants, which prevent opiates from working altogether, which removes the option of relapse completely... Getting a methadone prescription in the UK is also tedious to say the least - you are supervised when taking your daily dose, must report for 'assessment' regularly and so on, which is hard to fit in to a working schedule. And forget about getting enough to take away with you on a business trip for a couple of weeks. I generally have to purchase on the black market when required, which is ridiculous. I'd love to be able to ask my GP for help, and simply be given a repeat prescription for a week or two's supply to take home, but that's never going to happen because they're afraid of it being sold. So I have to buy it from others, which doesn't make sense...?!

mturmon 12y ago

It reminds me of "Going to Chicago", an evocative blues about heroin addiction, habits, and place, sung by the great singer Joe Williams: https://www.youtube.com/watch?v=uPcHVqKHkKo https://www.youtube.com/watch?v=uPcHVqKHkKo In the intro to the song, he sets up the background: "He had a woman with a heroin habit, a monkey woman, a monkey on her back...so he got some fresh money and said, I'm going to take another city..."

tomphoolery 12y ago

"It's as if over time, we leave parts of ourselves all around us, which in turn, come to shape who we are." I like that.

somberi 12y ago

A related and useful article from The Economist (Link at the end). I have reproduced parts of it that I found interesting (Heavily edited for telegraphic brevity): "Like many of America’s new generation of users, Ms Scudo's ddiction began in 2000 when, after a hip injury, a doctor prescribed her ... a high dose of OxyContin.. Her prescription was later reduced, but she was already hooked. On the black market OxyContin pills cost $80 each, more than she could afford to cover her six-a-day habit; so she began selling her pills and using the proceeds to buy cheaper heroin. As if from nowhere, Ms Scudo had become a heroin addict." "last year 11m Americans used illicitly-acquired prescription painkillers, more than the number who used cocaine, ecstasy, methamphetamine and LSD combined." "Though Afghanistan accounts for 80% of global opium production, America gets most of its heroin from Mexico. Mexico is now the world’s third-biggest producer of opium, after Afghanistan and Myanmar." "More than half are women, and 90% are white. The drug has crept into the suburbs and the middle classes. And although users are still mainly young, the age of initiation has risen" http://www.economist.com/news/united-states/21633819-old-sickness-has-returned-haunt-new-generation-great-american-relapse http://www.economist.com/news/united-states/21633819-old-sic...

Cilike88 12y ago

Interesting to think about the obstacles we unintentionally set in place for ourselves in living out our good intentions. Emphasizes the need for living with mindfulness.

talles 12y ago

I love articles like these that take a holistic view on human behavior, that's the way to do it.