Tuesday, 7 July 2015

Breaking the bond: four heroin addicted mothers tell their stories

Alicia is a heroin addict. She is also a mother of two. Terrified of losing her children into care if her addiction is discovered by the state, she chooses not to seek the help of drugs services or register for methadone or buprenorphine substitute therapy. To look at Alicia, you would not guess that she has been addicted to intravenous heroin, on and off, for twenty years. She's dressed elegantly in a long, khaki linen skirt, suede boots and a white faux fur jacket. She appears confident and she smiles warmly as she hugs me and kisses each of my cheeks continental style. She is a graduate of the Royal Northern College of Music and has an MA in the same discipline. She has a hectic schedule of rehearsals and performances with her jazz trio, for which she plays piano.

'I started using heroin when I was in my teens, and I swear nicotine's harder to quit.' Alicia states, as she blows vapour from her electric cigarette. I ask her what flavour she has and if she's successfully switched from 'analogue' cigarettes.

'Oh, I used to smoke twenty, thirty- I dunno, maybe forty cigarettes a day. I smoked rollies, so I never counted. But I smoked a lot. I used to play piano with a cigarette dangling from my mouth and I ruined the keys with fag burns. I'll have one or two a week now, tops, and I'm telling you, they taste disgusting now. I have to clean my teeth afterwards, else my mouth tastes like a sewer.'
I pull out my secret stash of rolling tobacco along with my own e-cig and we laugh conspiratorially.

'They'll probably find out one day that these things are even worse for you and then I'll either try to quit or go back to smoking fags,' Alicia continues. 'I love this flavour: it's black jack. Like those sweets you had as a kid- you remember them?'
I agree, laughing, remembering the halfpenny chews I'd buy with my friends from the local old fashioned sweet shop and general store. Alicia and I are around the same age and started using heroin for very similar reasons.

'I was sexually abused from as young as I can remember. He was a family friend. My mother didn't believe me over him. I went off the rails and ended up in care for a while. That type of pain doesn't go away. I tried antidepressants. So many different kinds. Therapy; counselling; group therapy...even yoga and meditation. But nothing works. Heroin works. It helps you cope with the pain, with the trauma, you know?' I nod. 'But you know, it's illegal. And then there's the stereotype- the thief, the prostitute. People judge you. They think a heroin addict is so out of their face that they can only sit there and gouch. I've always looked after myself. I have all my teeth. But I never use enough to get a gouch on: not since I had my kids: I use to survive. To get through life.'

I ask Alicia why, if she's happy to use a nicotine replacement product, what's so different about switching from heroin to subutex, suboxone or methadone. As she talks, she plays with the zipper on her coat.

'I'm a mother. Maybe I'd try it if I hadn't got kids, but I'm not willing to take the risk. I don't want to quit. I'm happy when I'm using.'

It may not make a lot of sense, if any, to someone on the outside, but to a survivor of severe childhood trauma like Alicia, it is a perfectly logical explanation. She has been using heroin to mask symptoms of the depression, anxiety and post traumatic stress she suffers from, and amongst heroin users, this is far from unusual. Recent government policy strongly encourages total abstinence, which usually means fast reductions, even for long term maintenance patients on high doses. This results not only in painful physical symptoms, but mental health issues which frequently include debilitating depression, insomnia and panic attacks. And, for many, a return to heroin use. On the Methadone Alliance's discussion boards, the hottest topics focus on forced reductions faced by growing numbers of methadone clinic clients across the UK. Combined with the government's austerity measures, which include funding cuts and closures of many organisations which previously supported heroin addicts, such as Manchester's Lifeline, things are not getting any easier.

'Some people aren't confident enough to speak out when their reduction isn't working for them. I would need maintenance permanently if I ever switched. When you start using heroin at a young age, your brain never develops the same ability to produce endorphins and dopamine that someone who didn't use develops. I've been using for more nearly three quarters of my life. But maintenance rather than reduction: that's all changing. Policy has changed. Besides, methadone and subs are way harder to get off than the gear. They're different drugs from heroin. They have different effects. A lot of people can't stick to their scripts. They use on top and get double addictions. What if it didn't work for me? Plus the rattle is twenty times longer because of methadone and subs being long acting. It's really drawn out. Then there's the paws (post acute withdrawal syndrome). I need to be there for my kids. I need to be able to perform. The stigma could jeopardise my job. I can't afford to get ill again. Every time I quit, I was having terrible flashbacks, nightmares, panic attacks. I couldn't leave the house. I need the emotional stability that heroin gives me.'

We discuss the trials for prescription injectable diamorphine, and Alicia rolls her eyes. She won't get it, she believes. If she could, it would be the answer to her prayers. But her fear of losing her children keeps her account with her long term friend and dealer ticking over like a beautifully maintained Rolls Royce.

'I've met women, I know women who've had their kids put into care and even adopted because they couldn't stop using heroin occasionally on top of their script. If they'd never gone on a script, who'd have ever known they were using? Jane, well she was on a script and after she lost her partner, she relapsed a few times. The court took her kids. She never came back from that, not after her baby was adopted and they stopped her visitation rights. It was just too painful for her. She uses more heroin now than she ever did before. She's careless, chaotic. She was never like that when she had her kids. She was really careful. She only used enough to keep her stable. Those kids were her life. They were clean, well fed. Had plenty of toys. She had a full time job. She's lost that job now. She was a brilliant mum. Now, she's just an empty shell. She's got nothing left to live for. And the kids have lost their mum: can you imagine that kind of trauma? Now they're that much more likely to go on the gear themselves when they get older, to cope with the pain of losing their mum. All that on top of losing their Dad. He overdosed. They'll think she doesn't love them. But my god she loves those kids. She's lost without them. Their world has been turned upside down.'

Alicia pulls a tissue from her pockets and blows her nose, her tears smudging her carefully applied make up. I can almost feel the fear radiating from her. It seems, listening to Alicia's heartfelt words, that it is not so much heroin that has broken Jane's family, but that the very services who are in place to help parent addicts like her who have failed them.

'She wouldn't overdo it when she had her kids with her, you know?' muses Alicia, composing herself and stuffing her tissue back into her bag. 'But since her youngest was adopted: I mean, adopted- not just in care: that's so final, and the other two had contact with her stopped. Well, she's overdosed twice on the gear mixed with benzos and booze. She wasn't even drinking before. It was just the gear before. She's a mess now. It's horrible.'

According to the Saving Mothers' Lives report, almost two thirds of women starting replacement treatment for heroin addiction are mothers. Only half of them live with their children. Typically, after registering with the drugs service, there is a minimum wait of two weeks before a prescription, or 'script' can be written. Each service user will be assigned a keyworker who will meet with them once every few weeks to a month for half an hour aside from the initial assessment. There is also an preliminary assessment from a prescribing doctor, followed by appointments to stabilise the patient, who will subsequently see the doctor monthly. All other support, such as groups, classes or acupuncture are voluntary. However, there are very rarely crèche facilities: in most establishments, they are absent, and many sessions are placed at inconvenient times for parents, for example, during school pick up, resulting in parents in treatment with far fewer options for support than their counterparts without dependant children.

Sara only had to wait two weeks for her script when she first registered with Addaction for methadone treatment, but she told me that those two weeks were far harder to get through when she was faced with the fear of a possible referral to social services.

'I was injecting at the time and they told me to stop injecting or they'd call social services. I broke down crying and couldn't stop. Then they told me they might make a referral to social services because of my mental health. I thought to myself, I wish I'd never walked through this door and I told them so. I was lucky I was having counselling at the time because I told them I had that support and they didn't make the referral in the end. Plus my friend gave me some methadone. Bless her, that was really kind of her, because how else would I have managed to stop injecting? I couldn't afford to be smoking the gear and I wouldn't have been able to look after my kids if I'd gone into withdrawal. I think, as I remember, I did inject a couple of times before she gave me the juice, but do you think I told my keyworker? All social workers see is a heroin addict. They judge you. They don't see you as a person. If you're late for an appointment, they think you're out scoring, even if you had to wait a long time in the chemist: they never believe you.' She laughs, taking a long drink from the cappuccino she's nursing. 'I probably won't sleep tonight after all the coffee I've had.'

So, how did Sara cope with the transition to methadone?

'It was horrible. They say ten ml is equivalent to one bag (of heroin), but it's not. Well maybe it is when you smoke it. I was using three bags a day and the thirty ml just didn't hold me at all. I ended up on sixty, but it was horrendous before I was stable. I barely slept a wink. I was sweating and aching for a few weeks. My nose was running like it had missed the bus.'

All new service users are put on a daily supervised script, which is consumed in front of a pharmacist every day. Methadone is a long-acting synthetic opioid, but because different people's bodies metabolise it at different rates, a lot of people wake up each morning feeling the initial stages of withdrawal.

'They had me on supervised for far too long. I'd wake up feeling like I'd been run over by a bus and then having to get my son ready to come with me when I was feeling that ill was horrible. It was hard to get to the chemist at the same time every day and because I don't drive, I'd have to walk with him to the chemist six days a week in all weathers. It just wasn't fair on him. And he'd be asking me why I had to go every day. They make it really hard for mothers. I used to love Sundays, because the chemist was closed, and I got to take home that day's dose. When I was using (heroin), my dealer used to just pop round for a coffee and a chat when I needed to score.' Sara smiles and whirls her finger around in what's left of the chocolatey froth. 'I love my coffee. I think I'm just as addicted as I am to the methadone. Well, my son didn't know she was bringing me anything. She was always very discreet. I never used in front of him. Never talked about it in front of him. You hear about people who do, but I've never witnessed it- it sounds like an urban legend to me: the junkie mother with a filthy house, bags of heroin open on the table and dirty needles strewn around. What sort of mother would behave like that? I think films like Trainspotting and Pure have gone a long way to contribute to the stereotype people have of us. I'm not saying stuff like that doesn't happen. But that wasn't me. It isn't me. I love my boy.'

Sara tells me that since starting on the methadone programme, that she has not used any heroin. She's incredibly proud of her achievement, and even more proud of her son, who was Pupil of the Week at the local primary school the previous week.

'He gets it from his mum', she jokes.'But seriously, it's my boy I have to thank for keeping me off the gear. If I hadn't had him, I
wouldn't have been strong enough to do it. He kept me going. He keeps me going, alright- I never stop!'

But when I speak to Angela, she tells me that some service users feel they have to play the system in order to stay on a script and be allowed to continue taking home their medication. Unlike France's methadone programme, where writer, Shane Levene, describes success as being measured not on abstinence, but decreased use, UK drug services create a situation where some service users trick the system or simply lie about their use of heroin whilst on a script. If a service user gives a positive sample for opiates, they are unable to take their medication home and must remain supervised. If a long term patient who has been picking their medication up on a weekly basis gives a positive sample, they are immediately returned to a supervised script from either a three times, weekly, twice weekly or the maximum for newer clients, a weekly take home script.And of course, for mothers, there is the threat of social services.

'I've done it myself, I'll be honest with you,' Angela states, shrugging her shoulders. 'I've not used (heroin) for a while, but I'd know when I had my appointments and when I was likely to be tested, so I'd just work around those dates and inject in places no one would notice. I was going through a really tough break up. It was really on and off and because my ex, my kids' dad, he still uses heroin, every time I saw him, it was so hard to stick to my script. It was him who told me not to tell them I'd used. He said social services would take the kids if I did. They don't support you. They're supposed to be there to help you, but they seem to use all their funding to take kids into care. Just because you're a heroin addict doesn't make you a bad parent. There are people who are not addicts out there really abusing their kids and social services turn a blind eye. They target us because it's easy. As soon as the judge hears the word “heroin”, you don't stand a chance. At the CDT, some of the staff are really prejudiced. They'll use any excuse to make a child protection referral. Just crying at an appointment is enough. It's disgusting. People with attitudes like that shouldn't be allowed to work with heroin addicts. It lowers your self esteem.'

Surely these parents' fears of losing their children and the reality which backs up those fears is counterproductive to their treatment. Were the system in place more empathetic, parent-centred and less punitive, honesty about using whilst in treatment would result in help, for example, an increased rather than a reduced script for those who need more, and extra, longer sessions with keyworkers.

'If I'd have said to them “my script isn't holding me, I need an increase,” well I doubt they would have given me more unless I'd told them I'd used on top. But because I was so scared they'd call social services on me, how could I take that risk? So I went through the withdrawals on my own. I did it on my own but it would have been a hell of a lot easier with some support there instead of that nagging fear of social services getting involved and the stress of that fear of my kids going into care making me want to keep on using heroin to cope with the stress. It's a vicious circle. You see a lot of them that go in there (Addaction) selling their scripts and buying heroin and crack. Because they don't see their kids anyway or they haven't got any kids, it doesn't matter to them if they get kicked off. They probably feel relieved not to have to go traipsing down the chemist every day to be honest. But it's different when you have kids. You're fighting against the stereotypes. They call heroin addicts “junkie liars": but because of that, you have to lie to people and pretend you're not an addict because a lot of people wouldn't let their kids play with your kids if they knew. A lot of employers will hold that against you and give the job to someone else. My kids would get bullied if any of the other kids in their school found out I'm on methadone. They'd say things like “Your mum's a dirty junkie”. I keep my house spotless. I don't know if that's an obsession I got because of the concept of “getting clean”, but I do. I hate that concept. Just because someone uses heroin doesn't make them dirty. It's a painkiller. No one calls pain patients who need diamorphine or morphine dirty, yet they're also addicts. They're killing pain. I'm killing pain. The only difference is that my medication was illegal and I'd prescribe it to myself.'

Does Angela feel she may feel the need to use heroin in the future?

'The last time they reduced me, they put me on a two ml a fortnight drop and told me I wouldn't notice it. By the end of the month I could hardly sleep. I was aching all over, had terrible stomach cramps. I felt like I had flu, yet my keyworker was like, “it's all psychological, you shouldn't feel any different when it's such a small drop”. They dropped me two ml again when I asked them not to. I wrote to the manager, and they left it at that, but they never put my dose back up and I'm still feeling rough after a few months. So, yeah, if it carries on like that, it's going to be a pretty big temptation. They say it's good for my kids if I get off my script, but I'm so much less irritable and tense when I feel okay. Who isn't? I don't want to be a stroppy mother. I need my medication. That's my right, surely? To be able to have enough medication to keep me well. Why would they take that away from me when they know without it I can't function properly?'

Is the simple fact that a parent uses heroin enough to remove a child into care? Drug addiction does not mean that a parent is by default uncaring or neglectful. It is possible to be a loving, supportive and responsible parent and be a heroin addict just as it is possible for a non addict to inflict abuse, neglect and harm. Alicia speaks to me about Jane, the mother who lost her kids to adoption.

'She was unlucky because the she just didn't click with the social worker. She showed me some of the reports they'd written and they were putting two and two together and making seven. I remember one part which described a visit where the social worker noticed Jane hadn't done the dishes or folded the laundry. The carpet hadn't been hoovered for a couple of days and she made a comment about the house being filthy...and if they thought the house was “filthy”, then they presumed she was leaving drugs and works all over when she wasn't. I know she wasn't, because I was there. It wasn't pristine, but it wasn't filthy either. They wrote in the report that was used in court, “Jane neglects the housework and leaves dirty dishes all over the worktops. My concern is that she may be leaving drug paraphernalia laying around which could cause significant harm to her children.” There was a lot of stuff like that in the report. How can they take away someone's kids on a false assumption? I would understand if she had been- that would have been understandable- but she hadn't. The woman's just found her husband dead- and they're criticising her for not washing up. If she wasn't an addict and the house was a mess, they'd be understanding- even paid for some help with the cleaning. I supported her through the whole ordeal. It was horrible. In the end she was telling me to meet her in secret because she was scared they'd start on me if they knew I was still seeing her. She became really isolated, really depressed. She talked about ending her life. They could have helped her, but they didn't. There's help for people with physical disabilities, but with hidden disabilities? Nothing but judgement. They'd visit once a week and send a family support worker round once a week. She sat for an hour drinking tea and talking: how is that practical support? Jane needed practical support. But the whole time, they were writing a lot of negative stuff down in their reports and not giving any practical help. If she'd had a different social worker, who understood and saw her for who she really is, things would have turned out different. Her kids didn't want to go into care. They became really clingy, started wetting the bed. They used that against her, when the reason they were wetting the bed was because they were scared of being taken away like their new sister was. They didn't wet the bed before social services got involved. All this because she gave a few positive samples. That was just the tip of the iceberg.'

I wonder how many more women there are like Jane, and how the effects of Jane's reaction to her partner's death had on her children was weighed up by agencies against the effects of being taken into care and later, denied access to their mother. Or if the only thing the family court judge read in the report was that Jane was a pregnant heroin addict with a partner dead from an overdose. Considering the fact that children who grew up in care are far more likely to become addicts themselves than those who are raised by a loving parent, Jane can only hope that her baby's adoptive parents provide a warm, loving home. Her older two children were not so “lucky”, and are in two different children's homes.

I spoke to Sunshine, the adult daughter of a now-recovered heroin addict, about her experiences of growing up with an addicted parent. She lived between her two parents as a child, her father, who is not an addict, and her mother, with whom she spent around thirty percent of her time. She has a lot of compassion for her Mum, although there have been difficult times.

'She turned up for the birth of my first child off her face on heroin. She was falling asleep on the chair next to my bed. But she was there. At least she was there. She was a very liberal mum and yeah, sometimes she was in trouble. Sometimes she'd be ill. But then I'd be able to go to my Dad's. If I'd not have been allowed to see her, that would have been far tougher. It would have been far more difficult than dealing with all her ups and downs. She was never abusive. I always had a cooked meal and I have some great memories from my childhood with her. She's a brilliant Nan to my boys, just brilliant. Even if she spoils them rotten. I'm so proud of her for getting clean. She's a support worker for addicts now. It makes my heart smile to see her happy.'

With her own experiences of being a heroin addicted mother, Sunshine's mother Liz is able to understand what the women she helps are going through. Although there are some social workers and drugs workers who are ex addicts, many have the qualifications, but not the life experience.

'It's great here. We have an anonymous drop in, which I do two days a week. I see a lot of mothers who are scared of losing their children because of their addictions and a lot of mothers who I'm helping turn their lives around so that they can begin the process of getting their kids back home. I'm lucky I didn't lose Sunshine, but her Dad was always there for her if I couldn't cope. A lot of these women are totally alone with no support from ex partners. Some of them have partners in prison. Some of them grew up in care. Some have been through domestic violence and with legal aid being stopped for divorce, it's even harder for those individuals. It's not easy, but if I can help them with practical things, give emotional support, a lot of them will come to the point where they know for sure that using heroin and crack to cope with their situation is only going to make things worse. Once your mentality changes and you find new ways of coping, like the acupuncture and meditation we do here and the relapse prevention groups, it's easier to begin your recovery from a stronger place. The women who still have their kids at home tend to do better with their recoveries than those who have their kids in care, although there have been a few happy reunions. It makes my job worthwhile seeing families reunited. They're not bad people. They're just doing what they can to cope with tough lives, but with street drugs, first there's the cost. Then there are the health risks.'

Liz is angry that the government's funding cuts have hit so many organisations which support women like those she helps.

'The fact is that the government don't seem to realise that it's going to cost them more in the long run. Harm reduction, maintenance substitution scripting and support are really important tools. Not everyone recovers from addiction: in fact the percentage is pretty small. That's only going to get worse now so many services have been axed. There used to be free counselling for child survivors of domestic violence: that's gone. They've cut the funding for services for rape survivors. If you don't get the support you need in the early stages you're much less likely to be able to cope and much more likely to end up using substances to cope with the trauma. You see poverty, unemployment, homelessness. You see suicide. We've lost a few of our clients here over the years to suicide. It's devastating.'

It seems fitting that the day I'm due to meet Jane that there's a sudden downpouring of hail as I run across the road to the café where we've arranged to meet. I'm feeling slightly anxious. It's going to be hard for Jane to talk about what's happened to her and I'm beginning to think she won't turn up. After my second coffee. I pick up my phone to try her number one last time. It's switched off. It reminds me of all the times in the past I've waited for dealers. The switched off mobiles. The phone boxes stinking of piss with their receivers smelling of spit, stale tobacco and perfume. The standing in the rain for hours, waiting, and I decide to give her a little longer. I remind myself she wanted her story told. I'm beginning to think I'll be kicked out if I don't buy something else, and consider either leaving (I've been here nearly an hour) or buying the cheapest thing available, which is a piece of fruit for twenty six pence. As I make my way towards the counter, I hear the bell on the door ring as it opens, and I turn to see a small, dark haired woman in skinny jeans which wrinkle in places they should cling, and a grey hooded top. She walks towards me with a slight limp and I guess she's been injecting in the most painful areas of her feet. She's wearing no make-up and her shoulders are hunched. She makes brief eye contact with me and smiles without her eyes, which have the look of deep, unresolvable pain about them.

'I'm sorry I'm late. I thought you wouldn't be here.' She shuffles from one foot to the other, her eyes taking in her surroundings. I ask her what she'd like to drink and I ask the proprietor for an energy drink for Jane, another coffee for me, remembering Alicia's words about not sleeping. I'm tired too, having had a restless night going over the questions I want to ask Jane without making her feel worse than she already does. I needn't have worried. Jane answers everything and more without me even having to ask much at all.

'I grew up in care,' she begins. 'And now my kids are going through the same. I'm scared shitless they'll be sexually abused like I was in care and I'm powerless to do anything to protect them. It's my worst nightmare become reality. My last daughter was born addicted. The doctor told me it could kill the baby if I stopped. The withdrawals can kill the foetus you know. So they put me on methadone and I was doing fine. I was doing really well, reducing really slowly. Everything was going to be alright. My eldest daughter was seven at the time, and my boy was four. I was clean when I had them both. I was happy. Me and my boyfriend were both clean. Then we drifted back into using after my son was born. But then I got pregnant again. We hadn't planned to have any more kids but I was over the moon when I got pregnant again. We both were. I wasn't using much before I went on my script. The kids didn't know. Why would they?.' Jane ponders her question for a moment, picking her nails. They are short and bitten, but not dirty. She picks them throughout our conversation, cleaning out dirt that isn't there. 'And then he died. He overdosed. Their Dad. I found him in the bathroom. He'd taken brown, white, benzos, vodka, super. He'd done a snowball (a mixture of crack and heroin) on top of all that and some of my juice (methadone) was missing. He'd had a massive heart attack.'

She hugs her arms around herself and rocks backward and forward, squeezing her eyes tight. I ask her if she wants to stop. We don't have to do this. We can talk about something else and meet up another day if she wants to.

'No, I'm okay. It's okay. Do you smoke?'
The hail and rain have stopped now and we stand in the tiny courtyard behind the café, where Jane pulls out a can of Tenants Super from her pocket and cracks it open, offering me first swig. I shake my head and say thanks as she takes a long drink and stands the can between her trainers. We both roll cigarettes and debate on whether it would be better to sit at one of the two tiny tables that are crammed into the tiny, half-sheltered space. The chairs are wet and Jane wipes hers down with her sleeve.

'I thought I'd have a nervous breakdown after I found him, but I didn't. I feel awful saying it, but in some ways I thought it was going to be easier bringing up just two kids instead of two little ones and a grown up one. And I still feel so fuckin guilty for even feeling like that, but...I shouldn't be saying this. It hurt like hell. Of course it did. We lived together for eight years. You have your ups and downs when you're together that long don't you? But I'm still angry with him. I know he did it on purpose. Fuckin coward.'

'You think it was suicide?'

'I know it was.'

A study conducted by the National Treatment Agency for Substance Misuse entitled Parents with drug problems: how treatment helps families states that, statistically, parents who live with their children have far fewer drug related issues and are also far more likely to stick to and complete their treatment programmes than those who do not live with their children, and Jane's story makes this all the more poignant. She strongly believes that if her children had not been removed from her care, that she would have been able to stabilise on her methadone and even possibly come off her script, eventually. But as things stand, she has no desire to ever stop using heroin. Not unless she's able to make contact with her children again. The 'stronger foundation on which to start their recovery and build their lives' which having children at home creates, according to the same study, has been taken away from Jane, perhaps forever. There are tens of thousands of looked after children of addicts in the UK, the vast majority of whom are from poor backgrounds. There is little known of the lives of the children of fully functional addicts simply because their parents are so functional. They hold down jobs; they run their own businesses. Amongst them are professors; lawyers; estate agents; entrepreneurs; salespeople; teachers; surgeons; bank staff; anaesthetists; medical professionals. They are anonymous. The stereotypes simply do not apply, save, perhaps, for the anaesthetist or the doctor prescribing their own diamorphine: they don't shoplift; they don't work as street prostitutes; they don't hang around with other addicts in the street, waiting to score. They are utterly unrecognisable as heroin users.

They inhabit the eclipsed arena of the heroin world: they are invisible. Unless they seek treatment. Or unless they are caught. And because they are generally otherwise law-abiding, this is not a huge risk in the world of the internet where 'clean, fresh urine' is discreetly and freely available. It is this comfortable invisibility which heroin addicts like Alicia feel protects them by interference from the State. They are off the radar. The dire consequences of the stigma of addiction keeps them hiding. And, frequently, also keeps them from seeking treatment, should they wish to take this route.

Jane held down a regular job as a care assistant in a residential home for adults with learning disabilities until her partner died. Her partner worked as a boiler engineer, and between them, they were comfortable. Yet he had been hiding stacks of unpaid credit card bills from Jane as well as the fact that he'd been missing mortgage repayments and their home was due to be repossessed. Jane feels her partner took the easy way out and left her in an impossible situation. Before his suicide, she may have been using heroin until she discovered she was pregnant and sought treatment, yet she planned to reduce her methadone and be off the script before the baby was born. But life does not always work out as planned.

'After he died, it was so hard not to go back on the gear. And I didn't go back on it: like I told them over and over again, I only used it sometimes, in minuscule amounts, because they were nearly finished reducing my script and I felt unable to cope with that so fast. I'd nearly made it. But they didn't believe me. We lost our home and most of our things. We were put in a one room bed and breakfast. I was heavily pregnant by then, with two kids in this room with only two single beds and a push out sofa. I found I couldn't carry on reducing my script. People can judge me and ask me- didn't I think of the baby- of course I did, but until something like that happens to you, you don't know how you'll cope. I don't think anyone has the right to judge unless they've been in those shoes. I had to carry on looking after my children, who were suffering the death of their dad, the loss of their home. We lost everything at once. Ironic as it sounds, heroin helped me cope. I don't think I could have carried on looking after them if I hadn't used on the occasions I did. I was trapped between a rock and a hard place. That's quite apt, isn't it?'

Jane's baby was taken away from her at birth because she consistently failed to provide clean urine samples. She believes that if she had been given the chance to keep her baby, with the right support, she would be on the road to recovery by now.

'It was like every bad thing you can possibly imagine happening at once. I didn't cope at all well with my baby being taken. It's the cruellest punishment. All I needed was support and time. That's all I needed. But with her gone, I fell apart. I started using more, in order to cope. They kept saying I didn't need an increase in my script, but I did. By the time I got it, it was too late: they'd already started proceedings for an interim care order. I fought for those kids tooth and nail through the courts. I tried so hard to hold it together for my kids. So hard. Telling them their sister would come home. But instead I lost them all.'

It's difficult for me to listen to Jane's story and a deeply tragic reality for her. She reassures me that she's told it many times already and she hugs me for a long time before she excuses herself to go to the bathroom, leaving me with a huge wad of papers to look through. They are her court files which contain reports from the social workers who made the decision to place her two older children in long term care and her baby for adoption. The file is thicker than two London telephone directories and as I flick through them, I see that Jane has made notes and highlighted phrases and paragraphs in fluorescent marker pen throughout the entire document.

'They took my baby off me. I wasn't even allowed to breast feed her. The methadone in my milk would have helped her with the withdrawals, but they didn't listen. I was hysterical when they wouldn't bring her back to me after the birth, and that went against me. They didn't understand that if they just listened to me instead of making these decisions that I couldn't cope with that I would have coped better. When someone tells you you're having your baby taken off you, you're going to be broken. You're going to be angry. You're going to cry...scream. You're going to shout at them. Anyone who just sits back and lets someone take their baby. Well that woman doesn't exist or she's already dead.'

Does Jane understand the harm that she caused her baby by continuing to use heroin whilst pregnant?

'Because she never knew me, she'll never know, will she, unless they tell her. But yeah, they're unlikely to portray me in a positive light if they do. I know it was irresponsible. A lot of heroin babies are stillborn or premature, underweight. They can die from the withdrawals. I could have lost her like that which would have been a lot worse. But I wasn't using heavily. Just a bit now and then because I wasn't coping and didn't have a lot of support. I can't justify what I did but I didn't do it because I wanted to hurt her. But they just kept on reducing my methadone and I needed something to hold myself together because I had my other two to care for. You can't do that when you're in permanent tears. The antidepressants they gave me made me feel so ill I was like a zombie, so I stopped taking them, and the next ones and the next ones were no better. They made me worse. I mean, on the advice labels it warns against their use in pregnancy, so...what were they doing to my baby, the tablets the doctor gave me? I didn't drink a drop of booze when I was pregnant. Not a drop. Not until they denied me access to my other two kids.'

Jane shows me one of the social worker's reports and points out some highlighted words.

'Risk of emotional harm. Risk of significant harm. Their Dad dies and they become homeless in the space of a week. Then to top it off, they have their new sister taken off them. Isn't that enough significant harm for them? Not according to the social workers, no. Apparently, shoving them into a children's home is gonna fix that. Not. Do they honestly think that's the solution? Do they honestly think that was the right thing to do?'

She points to a paragraph on an A4 sheet towards the bottom of the ream of papers. It reads 'Jane presents at contact as hostile towards staff and is clearly of a volatile temperament and emotionally unstable. In spite of the fact that she has had two clean urine samples recently, the fact that previous samples were positive cannot be overlooked. I recommend stopping contact until she is engaging well with children's services and Addaction, has stabilised on her methadone with regular clean samples, has completed six months of Cognitive Behavioural Therapy, and has as her mood swings pose a risk of emotional harm to her children.'

'I wasn't hostile: I was angry and bereaved. And because I was angry, because I was upset and hurting like hell, I'd cry when I saw my kids. I never showed my kids how angry I was: but I did shout at the social worker a few times before or after I had contact, because they weren't listening to me. I was telling them my kids were begging me to come home. The woman who was in there with us supervising the contact knew that. She was sympathetic. But the social workers, they didn't listen to me and they didn't listen to my kids when they were asking me, “please mummy I want to go home.” Instead of helping me to get to the place where that was possible, they reduced the risk of significant harm by stopping contact. I didn't ever get housed in a place where my kids had bedrooms so they could start visiting me. I ended up in a women's hostel. And I ended up being told I only had third party contact. That means birthday cards, Christmas cards, basically. Didn't they realise how much that was hurting my babies? Don't they understand why I'm like I am? Everyone got me wrong. Interpreted what I said wrong. All I ever wanted was to have a happy family. Instead of that, I never saw my kids again.'

There are many, many women with similar stories to Jane. Amongst them are many victims of domestic violence who are using heroin in order to cope with their situation. But in Austerity Britain, there is little hope of things changing. There is not enough funding for organisations which could offer full support to women and their children. Women's Aid refuges are not only underfunded, but according to their website, don't have the resources, support workers or facilities to house women who use drugs. If a woman admits to drug use, they are not given a place in a refuge. There are far fewer refuges available which accept women who are on methadone programmes, and those that do only have sufficient staff to support one woman per refuge. Applicants also must have been on the programme for a period of time and must prove that they no longer use drugs. Solace Women's Aid in Southwark, London, offers a service which assists drug dependent women in ending their dependency and offers their children therapy and support, but considering the widespread nature of the problem, Britain desperately needs far more more organizations to follow in the footsteps of this pioneering programme. So in cases which involve domestic violence, it is no wonder that most women trapped in violent relationships and addicted feel they have nowhere to turn. Whilst women like Alicia continue self medicating in the hope that they will not be discovered by the authorities, many mothers who would like to start on substitution programmes feel the barriers to seeking treatment are just too much of a risk to take. What can be done to make services more accessible to those mothers who are scared to seek help? Liz says:

'We're not going to call social services unless there is a genuine risk to a child. Just the fact that a person is using drugs isn't a risk in itself. There are a whole host of factors involved which could contribute to a child being subject to a care plan, such as the risk of overdose, especially when a person leads a chaotic lifestyle and is using heroin in combination with crack, benzos or alcohol. A lot of addicts also suffer from mental health issues, and their children can sometimes end up becoming their carers. Children's Services runs a young carers group so those kids can get some support and take part in group activities. It's not always a situation where a child has to be taken into care. Some parents leave young children alone and go out scoring. Getting on a script helps people get their lives together. It's always going to be there, and there's support where people need it. Parents wishing to start their journey into recovery must know that so long as they're taking the right steps, recovery is always going to be easier than to carry on using.'

But until the stigma of heroin addiction is gone, the work being done by workers like Liz will always be undermined. Heroin addicted parents will continue to lose their children, will not seek treatment and will continue to keep their addictions secret for fear of consequences which can include, amongst many injustices: loss of access to children; mistreatment by medical staff; courts allowing contact with violent ex partners simply because a heroin addict holds the stigma of being a 'lying junkie'.

It's dark when I leave Jane's office. As I cross the road, I realise that I forgot to ask her about the forced reductions after she mentioned that a script was “always going to be there”, and I wonder how, and if, she would be able to help someone like Jane find her 'happy reunion'.

Outside the methadone clinic across the road, a group of people huddle together, smoking. They have a look about them of desperation, like they're looking for something, yet don't even know what it is, moving from leg to leg, hugging themselves against the cold. One of them is crouched in a near-foetal position, looking like he's in the initial stages of withdrawal, and another strides away from the group and begins shouting into a mobile phone.

'If that were three fuckin bags then I'm a fuckin ballerina. Yeah I'm sayin you're a lying fuckin cunt. There was only two bags in there. Yeah, two fuckin bags. Two. TWO! There was NOT fuckin three.' He flings his arm up in a wild attack on nothing and hurls his fag end into a scrubby, dog shit bag-strewn bush before shouting again, so loud this time, his voice cracks.'Yeah you will fuckin get down here now with another bag or I'll fuckin break your fuckin legs.'

The wind picks up, blowing leaves around crushed, empty super-strength lager cans, cigarette
butts and empty, torn rizla packets as it begins to rain and I walk away.