Heroin addiction can devastate a life and turn it into a very painful and lonely one. It is as though one initially sees a beautiful garden turn slowly into a parched, barren desert. There are no two ways about it, heroin destroys people: physically, psychologically and emotionally. It leaves only a bleak shadow of what could have become character, personality and individuality. The process is the same for all. Heroin destroys all there is to destroy.

Naltrexone treatment, however, is a way of dealing with the heroin problem, and has helped many a heroin addict turn over a new page in his/her life. Heroin and Naltrexone cannot co-exist, and thus when Naltrexone is taken daily, it blocks off opiate receptors in the brain. Consequently, heroin will have no effect on the brain and will not generate the usual feeling. This is a great deterrent for the addict, who will now be aware that heroin intake is useless.

This medication was first used in Malta in June 1996. At Sedqa, the administration of this treatment has been integrated within a programme which in 2005 alone welcomed 32 participants. This programme, referred to as the Nalcom Programme, provides a heroin addict with an alternative means to restore himself/herself as a person.

Naltrexone is not a magical potion, and the addict still needs to put in his part of the effort too. Clients are prepared individually before initiating this programme, and various sessions are held on a one-to-one basis with key workers from Sedqa’s Drug Community services. These help enhance motivation, check that the client fits the criteria for the programme and give all the necessary information. This preparatory work is also done with the parent/partner/significant other person providing support during the programme. This person will have a very important role to play in the heroin addict’s recovery.

James’ story

James* had been struggling with drug addiction for a number of years. He arrived at a point where he realised that he really could not handle this problem alone anymore. He contacted Sedqa.

James became more and more determined to do all he could to fight his heroin habit. Out of the various options, James, together with his keyworker from the Drugs Community services and the doctor, decided that the Nalcom Programme suited him best.

He met the criteria required – he was over 18 years of age, had a full-time job (this could also have been part-time or a course to further his education), he was not involved in other illegal activities, had attended sessions at Sedqa regularly and had adequate support from his mother (this could have been his father/partner/significant other).

As part of his care plan, James was given the date when he could go to Dar L-Impenn, Sedqa’s Substance Misuse In-patients unit, for detoxification where he could be given the necessary medical assistance in order to help control physical withdrawals and make them more bearable.

He spent five days there. It was not as difficult as he had anticipated and, moreover, it was less painful than his friends had told him it would be. On the fifth day, he was started on Naltrexone. After this, James was ready to go home. He had no contact whatsoever with anyone outside Dar Impenn during these days, so when he stepped out of the door he felt that he was also stepping out into a new beginning.

This was the first battle he won. There were more battles to be conquered after this, especially the psychological cravings. But James knew that Naltrexone would also be helping him with this aspect of his addiction. He felt much freer now that he was not compelled to make use of heroin to pacify his withdrawals.

His parents attended the fortnightly Nalcom groups for support providers and found them very useful, especially because they could ask questions about Naltrexone and share their experiences with others. James also attended preparatory groups every fortnight together with other clients who were also undergoing Naltrexone treatment. These groups would help prepare these clients for the subsequent formative groups, and are spread over six months in all.

The preparatory groups help the clients with their initial queries about Naltrexone while also challenging their personal, interpersonal and communicative skills. Heroin isolates them from the rest of the world for too long and therefore here they can express themselves in a group, share feelings and experiences and most of all – start off and keep a commitment. At the conclusion of these preparatory groups, James felt he had really bonded with the other clients and together moved to the final phase of their programme.

In the meantime, James continued to attend weekly sessions at the Drugs Community Services with his keyworker. Part of this service is regular urine testing. In fact, a contract had been signed at the onset of the programme, and James had given his authorisation for the results to be communicated to his mother. This made him more accountable and safeguarded against non-compliance with the regulations set out in the contract.

At this point, the final 12 formative sessions were due to begin. There were six clients in all in James’ group, who had already known each other from the preparatory groups. They felt proud that they had made it so far. Some had not. Whenever someone dropped out, the group experienced a tinge of sadness.

The formative groups were constructed in the style of a life skills course and James found topics such as conflict management, problem solving, decision-making, relationships, and emotions interesting and useful. They gave him practical issues to work on. Now it was not so much about heroin but more about himself. He also realised what heroin was robbing him of. Now that he was clean from drugs, he could dedicate more attention to self-discovery, which would lead to his personal growth.

This process had stopped when he started using heroin, and James realised that he lacked some of the basic skills in life, which helped deal with everyday situations, stressful situations, difficulty in expressing himself and communicating his needs to others assertively. Some of these difficulties, in fact, had contributed to his heroin abuse in the first place.

With this programme, now James felt less isolated and alone. He felt better about himself: less uncomfortable in his own company. He regained respect from others, and most importantly he recovered self-respect. His relationships improved. He tasted a new aspect of life and a new sense of freedom. This is what freedom is all about… the freedom to make choices.

As he grew stronger, he could say a stronger “no” to others and to his own negative inclinations. He felt alive again, and felt that he was part of the world around him and not in a world of his own. He now came to realise that the instant feeling he felt with heroin use, which he became addicted to, was just a momentary illusion for which he had paid a very high price.

At the end of the Nalcom programme, James was awarded a Certificate of Attendance and Commit-

ment. His parents and all those involved in his recovery were there. Words could not express the joy felt by all present. His parents had been through bad times because of James’ drug problem but this occasion gave them hope for the future. The certificate that James held in his hands was indeed a priceless opportunity.

The Nalcom programme had ended for James, but the battle would still go on… with a difference. Today he is more equipped to deal with his difficulties. He knows that there is a way out of the spiral of drug addiction because he has seen the light at the end of the tunnel.

Last week, another six clients successfully concluded their Nalcom Programme and were awarded their Certificate of Attendance and Commitment. We, at Sedqa, wish them every success in their new heroin-free life.

* James is a fictitious name to protect identity

Vicky Scicluna is a Sedqa Drugs Community Worker. Agenzija Sedqa forms part of the Foundation for Social Welfare Services, which also incorporates Agenzija Sapport and Agenzija Appogg. Further details about Agenzija sedqa and

its services from www.sedqa.gov.mt and www.mfss.gov.mt.

Sedqa Helpline 151