Written by Humphrey Kyamba (@kyamphrey)
My curiosity and concern were peaked upon meeting an old friend, Simon (not real name), whose physical appearance left me confused. He was an almost unrecognisable skeleton of the person I had known for years. Simon had come from a comfortable home, lived in an affluent suburb and attended upscale schools but here stood a shabbily dressed shadow of this former self with prominently chapped and darkened lips, skin sunk into his bones. After hastening to catch up, he asked for a small amount of money for a pool to fix a car that had been involved in an accident. The request was followed by the promise of a mobile money reimbursement a few hours later. I obliged with UGX 10,000 and took out a pen and sticky notes on which we exchanged numbers, as he explained that his phone was charging somewhere.
Later, upon asking around, I was told that this friend was on heroin, or “Kachwiri” in the local slang.
A quick google search takes me to a BBC Africa story from South Africa about a drug called “Nyaope” – a highly addictive cocktail of low-grade heroin powder sprinkled or “laced onto” marijuana cigarettes. In Uganda, that concoction is known as Kachwiri. Heroin is what is known as an “opiate” – a drug derived from the active narcotic components of the opium poppy plant, and until recently heroin addicts were the thing of Hollywood movies, documentaries and news stories and unheard of in Africa.
I speak to Andrew, a 29-year-old immigration officer at a foreign International Airport and is a Public Relations & Media Management graduate from Cavendish University Uganda. He is a recovering heroin addict who was in the throes of it for 3 years and 4 months. “I started using in November 2013 and stopped in March 2017,” he explains through a series of voice notes exchanged through the mobile messaging app, WhatsApp.
The oldest of four children born to an engineer father and a retired banker, Andrew attended GreenHill Academy for primary school, Kings College Budo for O-Level and finished his A-Level back at GreenHill. At university, he studied Procurement and Logistics Management for one and a half years before dropping the course for a transfer to his Alma Mater. “Before I had my addiction problem, I used to think of myself as a recreational user,” he explains, “I drank alcohol but never too much as it was never my thing – I was more of a weed smoker, which I indulged quite a lot. But I didn’t think I had a problem. We never think we do until the addiction progresses.”
Two of the prevailing motivations behind people’s gravitating towards substances are; as a form of recreation and escapism or to cope with trauma, frustration, disappointment and adversity. Andrew, on the other hand, maintains that he started smoking weed recreationally mostly out of peer pressure and could go days or weeks without it. “Most times, I would use it to motivate myself, or to liven up my time in the gym or how I did my research while reading,” he recalls.
Andrew’s foray into heroin use began as a suggestion from a close friend with whom he smoked weed. “While we attended Cavendish University, we would go to an area in Kampala called Kibuli to score weed after class, smoke it then either go out or indulge whatever plans were made for the day. Over time, I think he got in touch with some people that gave him this cocktail. He told me it was weed that was laced with brown sugar. At the time, neither of us knew that it was actually heroin, so I took a few puffs and did not like it at all. This was peer pressure and bad judgement.”
Like Kibuli, slums like Kisenyi, Kikubamutwe in Kabalagala and Bakuli are hotbeds of drug activity as hordes of unemployed youth reside within and thus indulge in all forms of illicit behaviour such as drug proliferation, theft and sex work.
Sometimes people know they’re getting weed laced with other things and actively pursue it for a more powerful high. Other times, however, they are unaware. One of the motivations behind this is the drug dealer’s intention to get the user addicted to heroin for the repeat business.
Andrew painfully recalls that this friend, Max (not real name), is still an addict by the time of this conversation (January 2019), a reaction I construe as survivor’s guilt. It is a fairly common reaction among those that are succeeding in addiction recovery while the people that they care about still struggle. It imparts feelings of guilt over the survivor’s being able to control their illness as well as helplessness over being unable to help their loved one. “He’s still suffering out there. I’ve been trying to help him and have tried some ways, but he’s still suffering,” he laments.
A week or so after being introduced to the cocktail, Max would insist that Andrew had taken the brown sugar wrong and bought more to have the joint laced the right way. “The second time,” Andrew says, “I inhaled slower and with more precision and liked it. This high was stronger than a regular weed high. The effect was way more than what I was used to. It was a nice and calming feeling.”
In an attempt at a detailed description of the drug’s effects, Andrew explains that Kachwiri is a ‘downer’. “It slows your heartbeat and calms you down. You go into slow-motion. I won’t lie, it feels really, really good and is the most addictive high I have ever come across. You’re beyond relaxed, which explains why most users are usually dosing off,” he says. Additionally, he explains that users usually take “crack” first (the much cheaper and most potent form of cocaine and an ‘upper’), which hypes them up then follow it with Kachwiri to come back down.
“I also occasionally used cocaine and crack in addition to Valium, Xanax and Codeine syrup. Those were the substitutes whenever I couldn’t get Kachwiri,” he says. He would use the drug first thing in the morning, have breakfast then run a few errands, after which he would use some more and also right before he went to bed.
Two months into using, Andrew would do his own research and realise that it was low-grade heroin he was hooked onto. That was when he painfully discovered the withdrawal symptoms associated with quitting. He says, “I would feel the pains whenever I would not use, and that’s when I realised that I was in serious trouble.”
Opiate addiction causes real changes in certain areas of the brain. Once introduced into the body, opiate molecules cling to and activate receptors in the brain which trigger the release of the neurotransmitter, dopamine (“dope”). Dopamine offers a rewarding and pleasurable sensation, which in turn encourages continued use of the drug.
“The fact is the heroin in Uganda is not 100% pure. It is knockoff heroin. Really dangerous stuff,” he explains. “Physically, the first thing you notice about addicts is the extreme loss of body weight. The immune system, liver and kidneys are also damaged. At rehab, medication is given to help detoxify these organs whose job is to remove toxins from the body and they explain what it does to the brain. There are also painful withdrawal symptoms – called ‘turkeys’.”
Over time, the brain adapts to this increased availability of dopamine and transitions to functioning normally when the substance is present, and abnormally when the drug is unavailable. This unavailability is what triggers withdrawal symptoms.
Andrew says these symptoms affect people differently, depending on how much is used and its purity. “Normally, the drug lasts around 6-8 hours in the body after which you’ll need more and when you don’t, in come the cold shivers, vomiting, running nose, diarrhoea and general body aches. It is one of the most painful and uncomfortable feelings ever, which is why most people find it hard to kick a heroin addiction. Every time I would think about going through the withdrawal symptoms, I would be forced to do anything to make sure I used again. Between using again and going through that pain, I opted for the former.”
Once the dependence is established, it gets harder to hide from those closest to the individual. Andrew, however, maintains that he hid it so well that his family didn’t notice until a year and two months into his addiction. He says, “They started noticing around January of 2015. During my last semester at university, a classmate revealed to my sister that I wasn’t attending class. Upon being confronted, I reacted by being defensive and aggressive towards them. On the 30th of July that year, I went to my personal doctor to whom I opened up about everything, expecting confidentiality. He, however, told my dad everything and recommended I get help immediately. I was checked into Serenity Center a week after that.”
On the day of his admittance into rehab, the family gathered to discuss his changes in behaviour. With his bank accounts drained, he had started dipping into a joint account held with his brother as well as asking for money from whomever he could find. This was revealed to the family as aimed at funding the addiction and he agreed to get checked into rehab, albeit reluctantly.
“I was in rehab for 3 months but was not motivated to put in the work necessary for recovery. I was out in November and stayed clean up to February of 2016 when I started using again. This time, my using was worse than before I’d gone into rehab because before, I was doing ok financially. This time, however, my family was especially frugal with the money and I started to pawn most of my property as a result. My mum took the car I was using out of fear that I would sell it. My accounts were frozen, and I was given a small weekly stipend. I did manage to sit my final exams in spite of using heavily.”
Andrew stresses that going into rehab reluctantly only leads to a much stronger urge to use than before. He went as far as asking for money from relatives abroad, who called home out of concern and eventually the rest of the family, grandparents included, got to know. “I went ballistic – I hated my mum, dad and siblings and told them so. My mother was hurt the most. She had been the harshest and believed that this was the attitude that would solve the problem, which just increased the animosity I held towards her. My dad, however, still believed that I could kick the addiction and as such would occasionally give me a little money. My mum would say he was enabling me and that angered me even more and pushed me further away from her.”
In a chilling testament to the devastating effect that addiction can have on families, Andrew says, “We fought all the time and that caused a rift so deep it culminated in my dad’s leaving home for a few months. The people that suffered the most, though, were my mum and younger siblings because they saw my violent side.”
In June of that year, Andrew’s dad suggested another approach. They got a counsellor to see and talk to him at home, as well as a doctor to detoxify his system for about a month. Still, neck-deep into the addiction, he would leave home right after the counsellor or doctor did and go right back for a fix. When that failed, he went to rehab again for a two-month stay and was clean for a month before relapsing again. “That was the cycle,” he says. “Get out, get clean, go for meetings, relapse. And I still didn’t think I had a problem.”
Andrew was employed by his father since finishing high school and all through his addiction. Most of this work involved travelling and as such his father wanted him out of the environment that enabled his addiction – Kampala. Between Northern Uganda, Rwanda, South Africa and so on, he developed a routine: detox to fight the withdrawal symptoms, travel, get back and use heavily upon returning, as he would get paid.
The heroin addiction cycle. Image Source
An integral part of fighting addiction hinges on the attitudes and reactions of those closest to the addict. A limited understanding of what substance addiction entails mostly fuels a large number of relapses. “My getting worse was a direct result of my mum’s reaction to relapsing after the first stint in rehab.” Andrew explains, “Upon getting out, everyone was overjoyed and thought rehab would be an instant fix, without fully respecting how difficult addiction is to beat. It was realistically explained in rehab that there were high chances of our relapsing. Going back down that rabbit hole put her in a bad place and this, in turn, made me weaponise my heroin use against her while unknowingly hurting myself in the process. Her side of the family berated my parents for having done so much for me – good schools, a good life and private rehabilitation centres. It was, therefore, their opinion that I was wasting time and belonged in jail, which would teach me a lesson. By continuing to use I was responding to this point of view. To prove to my mum that there was nothing she could do, that it was my life and she should mind her own business.”
Andrew’s dad, on the other hand, never bought into the idea of imprisonment. “He always believed that I would beat the addiction, no matter how long it took and I won’t call that enabling. Whenever I would ask for money, he would understand that I wanted to use because of the withdrawal pains and suggest we go to a doctor for detox or talk to a counsellor. For a long time, I fought to get clean because of how he responded to my addiction. I got arrested and into fights in ghettos and he always picked me up. It actually surprised me as not many dads could do that, but rather disown then kick you out. He uplifted and encouraged me and for a long time, I thought, if this guy is fighting for me like this, I can also do it. I believe this approach is what helped me finally beat the addiction, even if it took a while. He had consulted so many people who explained how big a problem addiction is and as a result, he helped me fight it.”
A moment comes when an addict hits the proverbial rock bottom. For some, it is a near death experience while others face the grim reality of having lost everything – family, friends, careers, wealth or all the above. For Andrew, what started as a mission to pawn a DVD player and speakers to sort out some particularly bad withdrawal pains morphed into his almost becoming the victim of street justice over a ride he had taken on a boda-boda motorcycle and not paid for. What saved him from that fate was a gentleman that was familiar with his father insisting on his being taken to the area police station.
“Once there, I realised I had hit a new low – almost getting beaten by boda-boda drivers then arrested for stupid and shameful things. I called my mum who said she was tired of me and jail is where I belonged. When I called my dad, he arrived within 30 minutes. I thought of the hell I had put him through, but he still showed up. The police officer proposed what my family already had – that I am thrown in jail for some time, which would sort me out. My dad explained how that was the wrong approach to dealing with addiction. Addiction is not fought by punishing the addict, but by getting to the root cause of the problem. He bailed me out and said to be frank about what more he could do, given we had tried everything. He asked me to look at where addiction was taking me. He assured me of his willingness to help no matter what, but this journey would lead to one of three destinations: jail, a permanent institution or death. I thought about all my messes and yet he still picked me up. He then called a doctor, I got the detox, as the next week I would accompany him to Rwanda for a fortnight. It was then that I resolved to fight the addiction. I asked for Derrick Miganda-Etooma, who is 8 years into long-term recovery and runs a Rehabilitation Center. I received counselling at home on a daily basis and realised that talking about the problem helps greatly with recovery. So many times, we bottle things up but my opening up and talking about my problem taught me to deal with it. I went from a week to a month, to two months clean. Even when I got the urge to use, I had at least developed the willpower to say no. I am beyond grateful for my dad’s refusal to give up as it has driven my recovery. I have been sober for a year, nine months and twelve days (as of 9th January 2019).”
He, however, explains that the first months were no easy feat. “There were times when I wanted to pop a pill or sneak out to buy alcohol, but it got easier over time. I stayed home for three straight months to build the willpower to say no, during which time I only left the house with my immediate family.”
Throughout our interaction, Andrew mentions his membership in a Narcotics Anonymous (NA) group. NA is a fellowship or society of men and women which brings together recovering addicts that meet regularly and help each other stay clean. NA, like Alcoholics Anonymous, utilises twelve steps to achieve this goal and one of these – making amends to all the people that were harmed or wronged as a result of the addiction – was pivotal to Andrew’s journey.
“The minute I started talking to my family and friends again, I improved tremendously. 3 or 4 months into recovery, I was good friends with my mum despite the nasty words exchanged and the fights with my younger siblings. I apologised profusely and explained that I was under the influence of heroin addiction. I think you start to settle when the animosity between you and your family is lifted. I started talking to the friends I’d neglected, kept in constant contact with my recovery coaches or counsellors like Derrick and found that talking within the NA group keep me going,” he says.
On why he thinks rehab didn’t work for him twice, he explains, “From my perspective, I think the best way anyone suffering from addiction can heal is by getting the message directly from a recovering addict. They have been to that place and better appreciate your struggle, which gives them the tools necessary to guide you through it. In my opinion, a professional counsellor or psychiatrist won’t appreciate the problem as well as a recovering addict would. Despite my valuing the professionals’ opinions, I’ve found that sharing stories and understanding that this person is 7 or 8 years clean gives you unquantifiable hope that you too can do it.”
I ask where he thinks we have fallen short as a society when it comes to substance dependence and he takes a short while before responding, “I think the whole thing is messed up from the very top. Prominent individuals within the establishment are bringing this stuff in and monitoring its distribution. While I was using, whenever there was a raid coming, police officers would call and warn the dealers. Those supposed to stop the proliferation are in connivance. Those are the people that are deliberately failing our society. This stuff is going to get even more dangerous as people are losing productive years of their lives and others their lives.
Secondly, the attitude towards addiction needs to change. People look at addicts a different way. At that moment, better judgement is impaired by the drug. Addicts should not be punished by being taken to jail. They will be incarcerated for a month or two, come out and use again, which will not have solved the problem. When got, addicts need to be pulled out of the lot – for instance, an addict who steals to feed his addiction – and rehabilitated.
The stigma around rehabilitation is also strong. It is perceived as a bad place when it’s a place of reflection. The first assumption made when a person has been to Butabika Hospital is that they have gone insane, which is not the case. Butabika has a section for addiction treatment and recovery – the Alcohol and Drug Unit (ADU). People that cannot afford private facilities need to be educated more about it.
Society also needs to reexamine where the problem is centered. The thinking is that opiate addiction is reserved for bayaye, low-income earners or people in the ghetto. No. It’s the people from well to do families that are getting addicted to this stuff as it’s expensive for those in the ghetto to sustain the habit and society have turned a blind eye to it. If you go into rehab facilities, you will find – doctors, lawyers, radio presenters, musicians. People high up in society.”
I ask his opinion on psychiatric medications and their use in the treatment of substance addiction.
He explains, “I’ve been prescribed Aldo, Amitriptyline, Chlorpromazine, Diazepam and Valium for short periods of time to minimise the risk of my body developing a tolerance. Tolerance for these medications would require higher doses for them to be effective and this affects a patient over time. In rehab, I would use them and be off within a month, but because I would have these medications prescribed at home for appetite, insomnia, or to fight the depression for months, my body had developed a tolerance. For example, people take one or two valiums in order to sleep. I would take 8 to achieve the same goal. There were times when it was administered intravenously, and still, in spite of how strong that injection was, I couldn’t sleep. I had to wean myself off of them and find different tactics to, say, fight depression. In western countries, people use prescription meds for depression or anxiety constantly. In my opinion, they should be used short-term and in tandem with other treatment options. I think, for me, finding and addressing the root cause of the anxiety as well as talking to people works better than burying it in medication.”
As we wrap up, he sends a message to those still under the control of various addictions:
“I know so many who are still in that dreadful place. To you, I say that what you’re dealing with now isn’t the end of the world. There are so many stories of recovery if you look, and I found Robert Downey Jr.’s particularly moving. Most addicts give up after hitting rock bottom, especially since those closest gave up on them first. Understand that addiction is an illness and you are being controlled by the need to use the drug. One day at a time. It might take a long while. You could get clean and relapse over and over again. You must never stop fighting, though. That is what it will take.”
Due to his being away from home, there isn’t much Andrew can do to help the friends who are still battling addiction, Max most especially. He still reaches out, however, and whenever he can. And although few have kicked the addiction others haven’t. He, therefore, refuses to give up on them because he knows the value of having someone sticking with and fighting with you. A strategy that he would like to see adopted by the families of addicts.
Note: If you know or are someone who is struggling with addiction, do not give up on them. It might seem futile but please do not give up on them.