Heroin use as a passive behaviour.

Tony White

Abstract - This paper initally examines the nature of symbiosis and how heroin can
play a part in a symbiosis at least in the users mind. Then it examines how heroin
can become an integral part of relationships and how two people get on and
structure time. Finally an analysis is made of how heroin effects or touches the soul
or spiritual part of some people.

INTRODUCTION
In the field of addiction studies many models of addition have been presented
over the years such as the disease model, the pharmacological model, the moral view
and the social learning model. Also there is the view that addictions to drugs is
paralleled by addictions in human relationships. For example, Moss (1982) in his
article on relationships and dependency states that addiction in human relationships
precedes addictions to drugs. If we have addictive love then we can become addicted
to drugs. One correlates to the other. Others§ who support this model are:
Halpern(1983), Ausubel(1961) and Wilkinson and Saunders(1996). The first part of
this article concurs with this model and discusses a particular type of addiction
where this correlation appears to be borne out. The second part of the article
presents two further observations of heroin users.
PASSIVE BEHAVIOURS
In Transactional Analysis theory an individual displaying passive behaviours
is wanting to form a symbiosis with another person. A relationship where both
parties are dependent on each other. They need each other to psychologically exist
or at least get along in day to day life.
White(1997) has clarified the nature of symbiosis by noting that there are
two aspects to a symbiosis - a transactional symbiosis and an attachment. See
diagrams 1 & 2 below.
 Diagram 1.
Transactioanl Symbiosis
(White. 1997. P 300)

Diagram 2.
Attachment (White, 1997. P 301)

One of the four types of passive behaviours is incapacitation. Examples of

incapacitation include - getting sick, fainting, migraines°, having a 'nervous
breakdown', vomiting - when these have primarily an emotional basis rather than a
physical aetiology.
Generally speaking when one is incapacitated eventually, somebody or some
organisation comes along and picks them up and makes sure they are OK. Some one
else takes charge. This then can become the basis of a symbiosis. If one wants to be
looked after or have someone take charge of them, they can incapacitate.
RECREATING SYMBIOSIS
In childhood, children are 'incapacitated'. That is they are incapable of
looking after themselves both physically and emotionally. So a symbiosis naturally
exists in childhood between parent and child.
One of the goals of incapacitation and symbiosis formation in adulthood is to
re-establish the original archaic parent-child relationship. When the original
childhood relationship was in some way disrupted then the individual in adulthood will
repetitively seek to redôo it, in an attempt to have the original issues successfully
resolved. By incapacitating, one has a means to re-establish and redo the original
parent-child symbiosis again in the hope of getting the original unmet needs met.
Occasionally this spontaneously does happen but unfortunately most times it does
not and thus we can get into repetitive self defeating relationships and behaviour.
That is, games.
Clinical observation seems to show such a pattern here with some types of
heroin use. In those instances where there tends to be exclusively heroin use,
rather than poly drug use. Also when the drug use is symptomatic and dependent use
rather than experimental or recreational use [Comm. Dept. of Human Services and
Health (1991)]. In these types of heroin use the user in one sense forms a
symbiosis with the drug. This obviously is modifying the explanation of the
transactional symbiosis. Heroin is merely a∆ chemical substance with pain killing
properties. It does not have ego states. As a result the diagram in diagram 1 could
not be used with the addict being the Child ego state and the heroin being the Adult
and Parent ego states. There is a misperception on the addict's behalf. He or she
perceives the effects of the heroin to fulfil the Parent and Adult functions in
solving the Child ego state's problems and needs.
The drug is perceived to take care of the user. It does this by providing the
user with relief from what can be a horrible existence such as all the day to day
worries, any inner emotional turmoil that may exist, and provides good feelings and
euphoria.
This is what parents are supposed to do with young children. They are
supposed to provide for them so they do not have to worry about going out and
earning a living, to allow them to get relief from emotions such as fear and anger,
and provide niceness and care such that one can experience´ the utopia of childhood.
The amount this is provided in childhood of course varies from parent to
parent. Unfortunately in some circumstances the utopia of childhood occurs very
little and the child is left to fend for itself emotionally and at times physically. [ie.
it is neglected].
This is what heroin can do in some instances. It provides a fake utopia or
fake protection. It works for a little while. It meets the addict's needs by
providing a utopia and easing all the worries, but it does not last. In this sense it
also neglects the user. It does not provide long term physical and emotional support.
The addict forms a symbiosis with the drug in the hope of finally getting the
unmet needs met. And they are met by the heroin - in the short term. However as
mentioned before many of us will compulsively repeat self defeating behaviour that
stops us from getting the archaic needs met, [ie. play games]. Heroin fits here
alsoØ, if the user was neglected in some form. Heroin is very much a neglectful
'parent'. Obviously it provides no long term solution to ones physical and emotional
needs and hence the neglect occurs.
Initially the heroin offers so much hope for the user to meet the perfect
parent who will provide the needs they have sought for many years. But in the end it
provides just another repetition and replay of the deprivation they initially
received. The deprivation game is again compulsively repeated.
FEATURES OF NARCOTICS USERS
The idea that heroin users are seeking to form a transactional symbiosis and
attachment with heroin is supported by some of the research on personality
features that are commonly found in such users. O'Connor(1996) notes that addicts
exhibit a failure, "...to self-regulate their behaviour"(P13). Bell(1996) states that
the use of opioids is based on their "...capacity to attenuate or abolish dysphoric
moods, partiécularly anger and fear, and to replace them with a sense of calmness
and well-being"(P41). Later on he also states, "People vulnerable to dependence lack
the capacity to soothe and modulate their own distress."(P42). Finally Ausubel(1961)
notes that common characteristics of drug addicted individuals include such
features as passivity, dependence, irresponsibility and motivational immaturity.
These features clearly describe common features of the Child ego state. They
need others to help them solve their difficulties. Heroin does this in the short
term. In fact, with an intravenous injection of heroin it takes about 10 seconds for
the drug to begin acting in the brain. In 10 seconds it 'solves' the individuals
painful feelings of anger, panic, or depression. It regulates their behaviour, it
abolishes dysphoric moods and provides them with a sense of calmness and well-being,
it soothes and modulat«es their distress. All this in just 10 seconds with a simple
injection. That is potency! What therapist or therapy can match that potency. They
do not even get close. Thus one can see the attraction to the very potent Parent
qualities of heroin.
SUMMARY OF PASSIVE BEHAVIOURS
This section of this paper presents the notion that some forms of heroin use
are a passive behaviour. They allow the user to incapacitate and feel like they are
establishing a transactional symbiosis and attachment with the drug.
If symbiosis formation is one of the psychological motivations for this
particular type of heroin use. Then it should lend itself readily to a transferential
treatment modality. Such 'addicts' should readily develop transferential feelings in
the therapy setting. Should time and circumstances permit, then a transferential
relationship with the therapist should weaken the attraction of the heroin to the
user. Thus another group of treatment options become› available.
TWO OTHER OBSERVATIONS OF HEROIN USE
In working with heroin users and addicts there has been two other
observations that have come to light. The first relates to a drug taking pattern and
its role in the interpersonal relationships of addicts. Consider these case notes of a
client called Mitch
"Mitch is not what can be seen as the true heroin addict. It was one of those
situations where he meets a girlfriend who is a heroin user and they start using
together. The heroin becomes an integral part of the relationship. They always get
stoned together, they score together, they deal in drugs together, they scam for
drugs together. Just like the couple who are in the same profession. The
psychotherapist who marries psychotherapist. They can eat, live and breathe
psychotherapy. Mitch and his girlfriend were no different, except their profession
was heroin".
Often in cases like this one or both parties prior to meeting has non-
dependent heroin use. Often poly drug use≤. When they get together they start to
use heroin more and more exclusively and it finally becomes dependent use. Often
there will be a number of attempts to give up together, but one eventually relapses
and then they both start using again. The drug becomes part of the structure of the
relationship. The prognosis can be good for the non-dependent pre-relationship
user[s]. When the relationship finishes, they tend to go back to non-dependent use
or no use.
DIAGNOSING THIS CONDITION
The DSM-111 and the DSM-111-R discuss a condition known as the - Shared
paranoid disorder. "The essential feature is a persecutory delusional system that
develops as a result of a close relationship with another person who already has a
disorder with persecutory delusions"(P197) [DSM-111]. The DSM-IV discusses the
shared psychotic disorder. A 'Folie a Deux' - "...a delusion that develops in an
individual who is involved in a close relationship with ano”ther person (sometimes
called the "inducer" or "the primary case") who already has a Psychotic Disorder
with prominent delusions". (P305)
Mitch had a "shared substance use disorder". He had a heroin habit because of
his close relationship with his girlfriend. He did not have one before knowing her and
since she left he has detoxified himself and only uses heroin occasionally. There has
been no dependent heroin use since the relationship with her ended.
As mentioned before the prognosis for a shared substance use disorder is
good if the relationship ends. That is, it is good for the pre-relationship non
dependent user. One of the treatment goals could be for the user[s] to see that the
relationship only leads to further heroin use. Often the client is fully aware of this
and presents as a treatment goal the need to extract themselves from the
relationship. They are often quite aware that the heroin addiction is just causing
them numerous problems in terms of theirƒ health, legal consequences, financial
difficulties and familial problems.
This is OK if the relationship is a fairly casual relationship. However if the
parties are married, have been together for some time and there are children, then
there are further problems if the therapist is to suggest the ending of the
relationship. If neither wants to finish the relationship then the prognosis is worse
than the single heroin user. It goes to the lowest common denominator. If they
detoxify together then it usually only takes one to relapse and then they are both
using again in a short time.
HEROIN AND THE SOUL
Finally I wish to comment on another feature of heroin use that appears from
time to time. Consider these two recent comments by clients who were both
dependent heroin users. The first is from a female who has been using heroin
regularly for three years and the second a male who has been using regularly for ten
years.
Susan - "One of the most intense‡, intimate things that I can do with my boyfriend
is that we both go and score together, and then we come home and inject each other.
The whole ritual of the thing. It is almost a spiritual thing and a real turn on".
John - "Heroin gets your soul, it kills your spirit unlike speed which gets your mind.
Heroin addicts are like the walking dead. Unlike other drugs heroin attacks and kills
the soul - your very essence".
This has been mentioned elsewhere such as by Stewart(1987). He notes that
heroin users can become people whose souls are lost (my italics). Heroin has often
been compared as a lover. He also notes that heroin has always had a mystique that
has been used by pop stars, writers and musicians. It is sought out by publicity and
is seen as glamorous.
This would indicate that for some users, heroin attacks or touches some part
of the personality that some other drugs do not. [ie the soul or the spiritual part of
us.] It should be noted that the use of drugs for spirituÈal reasons has been well
documented, Bell(1996). An example is the use of wine in Christian ceremonies. In
addition the use of marijuana along with LSD and peyote have a long history of use
for mystical and sacred reasons, Andrews & Vinkenoog(1972).
Thus it appears that some drugs are capable of accessing the spiritual part
of the personality, or our soul as it has been referred to. Heroin it appears is one
of these at least to some users. However heroin may eventually have a particularly
destructive effect on the soul or spirit, unlike it appears the hallucinogens do. With
heroin users who report this effect of heroin it would seem to indicate a treatment
approach which addresses the soul or perhaps each individuals meaning such as with
Logotherapy, Frankl(1959). Alternatively one could examine a Transactional Analysis
approach similar to what James(1973) calls dealing with the spiritual self.
CONCLUSION
This paper presents three observations of heroin users. It should be noted
thatÿ people use heroin for a wide variety of reasons. So the observations
presented here are not meant to be true for all heroin users. The first observation
is that some addict's heroin use is a passive behaviour. By incapacitating with the
use of the drug the user can let the drug solve all his problems. It achieves this in
the short term. Then however the drug becomes a very neglectful parent.
Secondly, it is observed that some couples use heroin as a important part of
the structure of their relationship. Hence the clarification of a shared substance
use disorder.
Finally it is observed that heroin can attack or destroy the soul of the
addict. This provides some insight into possible treatment planning where the
individual's essence or meaning can be addressed.

Biography.
Tony White is a psychologist in private practice who runs a TA training programme.
He also works part time in a drug rehabilitation centre.
136 Loftus Street, Leederville, 6007. Western Australia
emŸail: agbw@ozemail.com.au

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