Cover story
The
Fear
Inside
A study of people who used
heroin in prison gives vital
clues on reaching out to this
significant and vulnerable
cohort. Lana Durjarva shares
her findings
R
ecent reports on drug use in prison have highlighted the increased use of
new psychoactive substances; however heroin is still a significant
concern and tends to be used for longer periods than other drugs such as
cocaine and amphetamine. Additionally, prisoners often present with
dual diagnosis and polysubstance addiction, which amplify problems
associated with their wellbeing and raise concerns for staff and prison security.
Heroin use carries multiple health, legal and social implications, such as
increased risk of blood-borne viruses, infections, injecting-related complications,
poor health, risk of overdose, social isolation and engagement in criminal activities.
In a prison setting it carries additional challenges, with individuals often engaging
in riskier behaviour due to contextual factors such as unsafe environment, limited
availability of harm reduction services and a climate in which they have to hide
their drug use to avoid punishment for failing mandatory drug testing.
Incarceration has an overwhelming impact on everyday life. It brings multiple
losses, some of which are irretrievable – loss of liberty, relationships, opportunities,
time, and control over one’s own life – and heroin use is one of the means of coping
with these losses. The prison environment, with its climate of hostility, suspicion
and unpredictability, means regular exposure to feelings of isolation and threats of
violence.
The prison population in England and Wales has doubled in the last 25 years due
to increases in custodial sentencing and sentence lengths. This has resulted in a
population comprising many more prisoners with mental health problems,
substance use disorders and histories of self-harm and suicide attempts.
‘HEROIN MADE ME BULLETPROOF’
A qualitative study was conducted with former prisoners who had experienced
heroin addiction while inside. The aim was to gain better understanding of
psychological and social aspects of the phenomenon, and to explore how to support
people in this situation to achieve recovery most effectively.
Compulsive heroin use is generally the result of a number contributing factors;
however all participants in the study said that one of the main purposes of their
heroin use was to regulate overwhelming emotions. Heroin use was an attempt at
self-regulation and management of difficult emotional states, with the ever-present
theme being an attempt to disconnect from reality and achieve a state of numbness.
6 | drinkanddrugsnews | May 2018
‘It kept my emotions stable. Constantly when I was on gear, I'd feel composed, I
don't get angry, I don't get upset, I just deal with stuff, I feel pretty much
invincible when I am on it…
‘It's not always easy sitting in prison and thinking who's my missus sleeping
with now, who's trying to play dad to my daughter, what does my daughter
think of me, who's driving my car... Cos you know you lose everything every
time you go to prison. You don't get a chance to sort your stuff out, you just
lose everything.’
(Ben)
T
he conceptualisation of heroin use as an emotion regulator and coping
mechanism, which people resort to because they have failed to develop
adaptive responses to stress and negative emotional states, is not
something new. It matches the self-medication hypothesis, which argues
that a person who is more sensitive to emotional distress and who has a
lower ability to self-regulate is at greater risk of progressing from experimental to
dependent drug use as a means to cope. Indeed, the results of this study showed
that participants used heroin to self-medicate.
Ability to self-soothe in times of distress is essential for healthy emotional
functioning and to prevent the person from becoming emotionally overwhelmed.
Being unable to do this is commonly connected with the problem of internalisation
– not learning how to regulate emotions from a primary caregiver at an early stage,
which would have allowed someone to practise effective self-care. People who are
addicted to heroin have often been described as having disturbed global ego
function, turning to the drug to self-regulate.
Generally speaking, a person’s choice of a particular drug is not accidental and
different drugs are chosen to cope with different forms of emotional distress. With
its characteristic ability to kill physical and emotional pain, heroin appears to be a
magic drug, ideal for coping with the pain and loss associated with imprisonment.
‘It helped me deal with emotions I guess, I mean it helped me suppress them. It
made me feel numb and that was what I needed at the time cos life was
overwhelming otherwise. I felt depressed and all, but then I took heroin and
did not feel anything at all. I could forget the mess I was in, I mean I lost my
kids and all and I didn't really care or feel anything about it when I was on
heroin.’
(Mark)
‘IT’S MY OBSESSION’
This study also aimed to explored participants’ relationship with heroin – a
relationship that was characterised by obsession and ambivalence and was
prioritised above individuals’ interpersonal relationships. Participants manifested a
strong attachment to the drug, which was experienced as a secure base and safe
haven. They perceived it as an attachment figure, gravitated towards it in times of
distress and used it as a source of comfort and safety.
‘…I felt I had no control or power over it and it was running me – my missus
once said to me that she had a dream I was having an affair and that affair
was with drugs, and that was true. I did not understand that back then but it
makes sense today.’
(Simon)
This tallies with previous research on attachment and heroin addiction, which
argued that due to its neuro-biological properties, the drug was used to compensate
for the absence of satisfying relationships. It was previously shown that heroin is
chosen to serve specific emotional and social needs; so one possibility is that people
who experience problems in forming close and trusting relat