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Heroin, Cutting, & The scars that bind 

Cutting had been Mia’s first addiction, but she concealed it with ironclad secrecy. 

She had been doing it since age eleven. She cut when her parents divorced, cut when her first boyfriend cheated on her, cut when she didn’t make the varsity team in high school, cut when her best friend fought with her, cut when the depression flared, cut when the anxiety felt unbearable–really, Mia cut whenever she needed to feel that sudden and short-lived release of tension. 

It was her private ritual, and she hid it well. She only knew one other person who cut, and that girl had been teased mercilessly for being a melodramatic emo girl, for being a pathetic teenager starving for cheap attention. So, Mia, terrified of the same stereotyping, wore long sleeves, plastered on a toothy smile, and moved throughout adolescence without suspicion. 

Later, she would replace her razor with a needle. Later, she would discover that meth and heroin generated an even better release of tension and sense of euphoria. Until that point, though, sitting at the edge of the bathtub after school, she would cut. Swiftly and slickly- so sly that the untrained eye would think it was an accident. 

By early adulthood, through street fights, jail sentences, and stoic attempts to demonstrate utmost apathy, Mia became tough. As she described the gritty persona cultivated through years of hardened trauma and anguish, she summed it up as, people don’t fuck with me. And, yet, in our sessions, as she clutched her knees and fidgeted with her hair, as she struggled to make eye contact and anxiously tapped her feet, I knew I was looking at that fragile eleven-year old girl desperate for approval and attachment. 

This arrested development and perplexing dichotomy exists in many of my clients–their exteriors exude strength and invincibility, but underneath lies emptiness and brokenness. Some just show deeper cracks in the surface than others. 

She didn’t tell me about the cutting at first. The shame was too overwhelming. Track marks from years of IV drug use did not bother her. All her friends had them, and in the dark alleys of her drug world, they strangely mimicked a tattoo of armor, an obvious darkening and tainting of the soul. But her self-harm scars? They are signs of insanity, she told me, the signs of a crazy girl, the person you didn’t want to touch with a ten foot pole. 

Track marks seemed inevitable- a righteous milestone even, but the cutting seemed childish and petty. And, indeed, she felt more comfortable candidly talking about craving heroin than she did talking about the craving to run a blade across her arm.  It felt more acceptable to talk about losing herself to drugs than to talk about losing herself to herself.

Getting sober makes perfect sense, Mia told me. Drugs tore apart my family, led me to jail and the streets, have worked their way into destroying everything I loved. I’m exhausted. I’m done. 

Though she entered recovery with gusto and enthusiasm, she still feared letting go of her oldest and truest friend- that razor blade- because, to her, it meant letting go of that last safety net, that last comfortable route for escape. In this way, self-harm mirrors addiction. It is a similar compulsive cycle of reward and punishment, a runaround of highs and lows, a very brief pause from insanity. By and large, it is a way to manage when things just feel unmanageable. 

Mia cut because she didn’t know how else to cope with uncomfortable emotions, with fear or anxiety or anger. She also cut because it felt good and provided a sense of relief, and this gave her a slight perception of control and freedom. She used drugs for the same reason.

She lives where I do, in a society that fails to equip people with the appropriate skills to manage stress and take care of themselves. She is a representation in the growing epidemic of drug addictions, self-harm, eating disorders, and all other compulsive illnesses- a person just coping in the best ways she knew how.  

For Mia, quitting self-harm felt far more complicated than quitting the drugs. By nature, it was more insidious and sneaky, easier to rationalize and justify. A razor blade was nothing compared to meth and heroin, right? What was a bit of nicking and blood compared to speedballs and potential overdoses? Cutting was her bargaining chip- her last escaping vice. Was it really so bad? 

Measuring the degree of bad misses the point. Mia was evidently bothered by her cutting, and rightfully so. Through self-harm, she was still punishing herself, still a victim of her own emotions and her own defenses. Getting sober was only one of her puzzle pieces; to wholly heal, she needed to shift her energy away from compulsion, away from self-destruct. This, of course, included moving away self-harm. 

Her healing process moved the way it needed to- at her pace. Because cutting had been warped with so much shame, even talking about it took several sessions. Mia needed to see, time and time again, that I was not going to run away or yell or react with even the slightest flinch. She needed to know, with absolute truth and certainty, that I was not going to leave her. Sometimes, she needed that reassurance multiple times a session, and that also okay.

We reviewed the standard skills and interventions. Snap a rubber band on your wrist. Rub ice. Run a Sharpie, instead of a razor. Practice deep breathing. Meditate. Call a friend. Take a warm shower or bath. Write in a journal. I could go on- there are infinite ways to cope. With enough practice, implementation, and willingness, anyone can replace one habit with another. The same techniques one applies for drug triggers and cravings can apply to any other compulsive action.

Mia eventually found some that worked for her. Some days were better than others. She slipped- many times- and she learned how to process and open up about her feelings when it happened. She had been doing this for over half her life. We all need to be conscious that change can happen slowly, if it even happens at all. 

Most importantly, Mia began working towards releasing her primal expression of self-hatred. She began working towards embracing recovery as multidimensional, as more than just the absence of drugs, and began understanding that she deserved to act for the sake of her health, rather than for the sake of perpetuating sickness. It wasn’t easy for her- it isn’t easy for most. 

But any step away from self-induced punishment and any step towards self-love is always a step worth taking. 




*While these are based on true experiences, all reasonable efforts have been made by this writer to protect utmost client and treatment confidentiality. Because of this, names, ages, features, and identifying details in this piece have been changed, omitted, and/or embellished.