It is not impossible to overcome an addiction to heroin, but the road to sobriety will be a long one for many addicts.

Support from family and friends is critical, said Betty Barr, a substance abuse counselor at Centerstone.

“You have to have somebody you care about who wants you to get better,” she said.

The nonprofit Centerstone offers mental health services and substance abuse treatment. Barr started working at Nashville’s branch in 2005.

In the first nine years, she saw only one person who was addicted to heroin. Mostly, she saw addictions to alcohol, methamphetamine, prescription medicine and marijuana.

That has changed.

“I would say in the last year-and-a-half it has spiked in a shocking way,” she said about heroin addiction.

Barr said limited access to prescription medicine for addicts has led to an increase in heroin use. The dealers know people are withdrawing and that they are looking for a “fix.”

“A lot of the pill people have gone to heroin now because they can’t get pills anymore,” she said. “Who would have predicted this would happen? Somebody is a good marketing person. Somebody knows what they’re doing.

“We already have a whole county of people who are addicted to oxycodone, hydrocodone or Vicodin. They can’t get it, and they’re in withdrawal and they’re desperate. They will do whatever they have to do,” she said.

“A person who would have never considered a needle or considered heroin is suddenly desperate.”

Like Barr, nurse practitioner Tania Frederick of Nashville Family Medicine did not hear much about heroin five years ago. She heard more about methamphetamine, ecstasy and cocaine.

Now she has multiple patients dealing with heroin addictions.

“What was surprising was who it was. I would never have guessed,” she said. “It could be anyone.”

Immediate aid

People in jail are addicted mostly to methamphetamine and heroin, said Carrie Foley, a substance abuse counselor at the Brown County jail. Some combine the two.

“The combination thing is probably the most serious. It’s hard to imagine what that high must be like,” she said. “One’s an upper; one’s a downer. You mix them together and they kind of counteract each other.

“It’s so dangerous, because you can’t tell the effect of either one. The risk of overdose is even higher.”

Foley said heroin by itself has a greater risk of overdose than methamphetamine because people don’t know what the drug might have been “cut,” or diluted with, or the overall purity of the drug.

Heroin use has become so severe in Indiana that Gov. Mike Pence signed a law April 17 allowing anyone to obtain and administer overdose intervention drugs.

Those drugs, which include Naloxone, under the brand name Narcan, can save people who have overdosed on opioids, including heroin. Prior to the law, only health professionals could administer them.

Brown County sheriff’s deputies do not carry Narcan or Nalaxone, Sheriff Scott Southerland said.

Columbus Regional Hospital EMS responders have carried Narcan for “a long time,” said Adam Hoskins, manager of ambulance services for CRH.

He called overdose cases rare in Brown County, so it is difficult to determine an accurate number of how many lives have been saved using that drug, he said.

Addiction science

Foley visits the Brown County jail twice a week to meet with male and female inmates as part of the START program. It provides treatment while helping them transition to a drug-free lifestyle.

But she usually does not see addicts in counseling right away. First, they have to get through withdrawal.

In jail, addicts do not receive medicine for withdrawal symptoms, but they are usually seen by a health care professional within the week.

Withdrawal from opiates of any kind is extremely uncomfortable. Symptoms include nausea, vomiting, diarrhea, anger, body aches, sweating, anxiety and abdominal pain.

“It doesn’t kill you, but you may feel like you will (die),” Frederick said.

Sometimes addicts need to take medicines used to treat opiate addictions, like Buprenorphine (Suboxone), Methadone or Naltrexone.

An opiate like heroin causes a sense of euphoria in the brain, Frederick said.

“Then, your body starts to need it rather quickly because you want that euphoria, and if you don’t get the heroin, you go into some pretty severe withdrawals,” she said.

When people inject heroin, they are more likely to become dependent on the drug since it is being injected directly into the bloodstream. By the second or third use of the drug, people become addicted.

“Eventually you’re going to want it more and more and more and more. Then you start doing things that you would never, never would have done in order to get it,” Frederick said.

Getting hooked

Symptoms of heroin use include sleeping more than normal, not getting up and going to work, behavior changes, dilated pupils and marks on the arm if the person is injecting and not snorting heroin, Frederick said.

Young adults from their late teens to early 20s are getting hooked.

“When we’re young, we feel like we’re immortal. We want to have fun. We want to try something. When you’re 18, 19 years old, you don’t think you’re going to get addicted to something. You don’t think you’re going to get older and have to face consequences,” Barr said.

“Certainly, humans, we role model our behavior; and when somebody sees someone they kind of like doing a behavior, it seems safe to them,” Barr said. “It seems normal.”

If a teen has a friend who uses, and that friend has yet to get in trouble, that teen may be willing to try drugs especially if he or she already has an addiction, like to nicotine.

A teen who is already attending parties, drinking alcohol or smoking marijuana has lower inhibitions, Barr said. “If somebody breaks out a new drug, a person is much more likely to just give it a try,” she said.

It’s easy to say a person first used heroin because of poor choices, but that’s not always the case, Foley said.

“Nobody goes out and intends to become addicted,” she said.

“You can kind of turn around and change your friends, not go someplace. But that choice part, that addiction part, really, it’s happening when you no longer can control it. You take something and you want to keep taking it.”

Some may believe a mental disorder like depression or anxiety could lead to drug use, but Foley said it sometimes happens the other way around.

“It’s easy to look back and say, ‘Why did I do that?’ Frankly, parents and loved ones, they want to believe that you didn’t just choose to party and screw your life up deliberately,” she said.

“Alcohol and opiates, they’re terribly depressing. That’s their effect on the mind, that they sedate the brain. They already bring you down. If nothing else, they’re causing depression.”

Getting clean

The best thing someone can do to help an addict is to calmly let that person know you care and encourage that person to get help, Barr said.

A variety of help is available in Brown County.

Centerstone accepts insurance, but the agency will see people who do not have it.

“Everybody that comes in without insurance, we try to get them on the road to figuring out what their insurance (options are),” Barr said. “If you come in without resources, we will see you and we will work with you.”

An intake fee of $15 is available for low-income patients. Addicts wishing to get help can call Centerstone and set up an appointment for an initial evaluation.

“We do a thorough approach to looking at any kind of symptoms the person has — addiction or mental illness or stress, anything. We cover all the bases, and then from there we can make a recommendation,” Barr said.

Those options could be to attend a program at Centerstone, another program in the county or a program outside the county.

Barr also conducts a dual-recovery program for people with addiction and mental illness.

Other programs in the county include meetings at the Silver Linings Women’s Shelter where Foley is the executive director.

Alcoholics Anonymous, Narcotics Anonymous and Al-Anon meetings also are led at various locations and times throughout the week.

Al-Anon meetings can teach family and friends of addicts how to set boundaries and “use detachment with love,” Barr said. The program also can teach people how to do an intervention.

Barr said it is important for family members to know they cannot stop a loved one from using.

“If you try, you will sink,” she said. “What we want to do is take really good care of ourselves and set an excellent role model for health, eating right and exercising. Be the role model of the universe.”