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Practice, plus it’s always the same person so they get familiar with their body, unlike a medical professional who would usually poke someone they have never seen before.
As an ex junkie, sometimes we don’t always hit it. And some junkies are actually quite bad at it and need lots of help.
But, as other commenters have pointed out, it’s a combination of practice and knowing your own body well.
Practice and despair will be my guess
and motivation

