The Second Floor Bathroom

Drug Abuse

 

One week ago three hours after I left the all-male halfway house where I am a substance abuse counselor, one of my clients overdosed in the bathroom on the second floor of the house.  At 6’3″ his body twisted into a space the size of a small closet.  A really small closet.

Not being in recovery myself, I’m still learning how to spot the pinpoint pupils of a person high on heroin.  My co-workers, all recovering addicts themselves,  and the residents, the majority recovering  heroin addicts,  can spot this in a split-second.  I can easily tell when one of them is smashed from drinking (usually a lot of crying and staggering not to mention the reeking of booze that can be smelled from feet away) but someone on heroin, other opiates, and some of the newer synthetic marijuana, not so easy for me.  When I started all the guys who looked tired I generally thought were high.  I would ask my co-workers if so-and-so looked high to them, they would go and take a look, and come back with a definitive assessment of “No.  Not high.”

On my very first day of work, the house manager who has fifteen years clean, was staring at one of the guys who was picking over his food.

“He’s high,” he said.

I asked him how he could tell and he told me that he’s never seen him pick at his food before.  He was given a quick-cup (an on-the-spot urine sample) tested positive, and was discharged from the house.  I was amazed that that one subtle nuance tipped my co-worker off.  I had a lot to learn.

Since then, I’ve been taught to pay attention to broken patterns.  I had a client who came home from work every day at 2:00 on the dot.  Every day.  When one day he didn’t show up at this usual time, I called him in a slight panic.  “Gayle, I’m fine.  I had to go to the registry to renew my license.   It’s all good.”  Another day, when a guy didn’t show up for a mandatory house meeting the same co-worker said “He’s not coming back.”  And he was right.  He didn’t.

With the guy who overdosed, even I could tell he was high.  He was wearing glasses for the first time.  His speech was different.  My other co-worker had seen him first and made a beeline to the three staff in the office and said “________ is high.” Three hours later, he was minutes from death in the bathroom.

When I came into work the next morning I heard the details from the other guys:

  • A resident noticed that the water was running for a long time behind the locked bathroom door.
  • He went into his room and said to his roommate “Is someone dead in the bathroom?”
  • Roommate has a light bulb go off and runs to the door with a pen and tries to pick the lock.
  • Lock is picked but the aforementioned 6’3″ body is sprawled in a way that his legs are blocking the door making it impossible for anyone to get in.  A guy who had been there just one day turned into the Incredible Hulk and threw his body repeatedly against the door in an attempt to break it down.
  • Somehow, the door opens just enough to allow the lankiest guy in the house to get in, see that my client has banged his head on the toilet and that blood is everywhere.  He manages to lift the client just enough so that his legs are no longer blocking the door.
  • In the meantime the other residents are running around grabbing Narcan that hangs in bags on every floor of the house.  Lanky client doesn’t know how to use Narcan so another resident steps in and administers it, bringing the client out of his overdose.  Client is mortified and ashamed, sobbing and apologizing to the other 29 guys.
  • Ambulance arrives and the others walk him down with a leg and ankle injury sustained from the frantic pushing of the door.  The other guys stand on the sidewalk and watch him get whisked away.  From what I understand, this entire event unfolded in about three minutes.

The next morning I made sure to check-in with the men on my caseload and urged them to process what they were feeling.  The alcoholics who had never seen anything like this were the most rattled.  One said that it was the most terrifying thing he had ever seen.  The other heroin addicts were either triggered by the sight of the needle or were grateful that it wasn’t them.  The youngest on my caseload had an anxiety attack.

I called my client in the hospital the next day to see how he was doing.  The first thing he did was apologize and to say how embarrassed he was.  The next thing he said was that he had no idea where he was going to go next.  He doesn’t want to get into the never ending cycle of detox, program, relapse, detox, etc.  One of the other guys has said that he’s stopped texting and posting on Facebook.  That’s a pretty tell-tale sign that he’s on a run, perhaps using on the streets, where unfortunately, there won’t be 29 other guys around to save his life.

 

 

“Hi, I’m Gayle”: Two Hours in a Church Basement

churchbasement

Last week I attended my first AA meeting.  I was told by the men in my halfway house who go to this particular meeting regularly to get there early if I wanted a seat.  They all knew that I was attending to hear “Bryce,” the very first client on my caseload as a substance abuse counselor, who would be sharing his story in celebration of his one year clean from alcohol and drugs.

The guys were so excited that I’d  be there, as if I had RSVP’d ‘yes’ to their version of a party.  They were also very moved by my wanting to be there to hear Bryce, a favorite graduate among staff and the other residents.  I told them not to tell him because I wanted it to be surprise, and when I got there early positioned myself right in front of where he would be speaking so I’d be within his direct line of vision, beaming with pride, kind of like watching your child in the lead of an elementary school play.

I watched as people walked down the stairs into the drab and vast basement in the bowels of a beautiful church.  I didn’t like that it was so unwelcoming but as people started spotting their friends, hugging each other as if they were family, it became the most welcoming place in the world.

There were at least 70 metal chairs set in a wide circle of three rows.  When my guys rolled in in small batches and spotted me, they surrounded me, their queen bee.  The ones who came in a bit later stood around in groups, some who had never even met Bryce but who were there to represent the house.  It moved me beyond words to see at least six who were on my current caseload, one who had just gotten to the house that day.  Five former clients, all with clean time of their own, sat on the periphery and my heart swelled a little bit at the people they had become in their sobriety.

When Bryce saw me he smiled a wide smile and came over to give me a hug.  He told those around him who I was and the role I had played in his recent life.  As he began to share, rather nervously, he’d look at me every once in a while for my silent encouragement.  I know his story of struggle and I wanted to mouth some of the critical things he had forgotten but he held his own hitting some major highlights of his trajectory into heroin abuse.

When he finished people who knew him from the meeting paid tribute to him with beautiful words.  One burly man, clearly a regular at this meeting commented on how on the surface of things he and Bryce had nothing in common (Bryce has pink and blue hair and random piercings) but after hearing his story, they had everything in common.

I knew all day that I would speak and when I raised my hand and said, “Hi I’m Gayle,” a chorus of men and women joyfully said, “Hi Gayle,” as I know is customary in all AA and NA meetings.  I said that I wasn’t in recovery and glanced around the room to make sure they weren’t hissing and pointing at me, silently banishing me to get the hell out of their sacred place.  I went on to say, “Bryce was my very first client as a substance abuse counselor,” and continued on in praise and pride.  When other guys in the house said beautiful words to him, I was reminded, yet again, of the bonds that will never be broken between them.

I had to leave the meeting a bit early and as I quietly gathered my things and walked towards the door Bryce yelled out, in front of a crowd that had swelled to ninety or so, “I love you Gayle!”  “I love you too honey,” I said back, knowing that this was an uncustomary occurrence, loving every second of it.

The next day at work the guys asked me what I thought of the meeting.  I told them how moved I was to have been there.  One of them came up to me and said how it proved to all of the thirty guys in the house how dedicated I am to all of them and how they all were talking about it after the meeting and back in the house.  I told him that his words, when he shared his own tribute to Bryce were magnificent and meaningful.  I answered that most of all I am honored to be welcomed into their fold every single day and at how they allow me these glimpses into their own unique world and unbreakable bonds.

 

 

 

 

 

Recognizing My Talents: How I Discovered What I Was Meant to Do

therapysession

When I began a new career as a substance abuse counselor in an all-male residential program, I had no idea what I was walking into (other than a really cool turn-of-the century former Governor’s mansion.)  I had absolutely zero experience but had clearly dazzled my now boss into taking a leap of faith when offering me the job.

For 20 years I was a pretty high-level non-profit fundraiser.  I worked as a sort of “matchmaker” between the very rich and the very poor.  The populations I raised money for consisted of homeless women and their children, children who nobody wanted and young people from the poorest cities in the state.   My passion for these people translated into substantial gifts from local philanthropists, but in the end, I became much more interested in the disenfranchised than in actually raising money.

While between jobs I networked my way into an opportunity to volunteer with incarcerated women in the local House of Corrections.  I threw together a creative writing curriculum and after observing just one group, found myself standing in front of 25 or so women in prison jumpsuits.  I fumbled my way through my first week and then for the next  2 ½ years, having gained enough confidence to make these women laugh, and often cry, I knew that there was no turning back in what eventually led me to where I am today.

The large majority of these women were in for drug-related crimes.  They were mostly addicts who would do absolutely whatever it took to support their raging drug habits. They dealt drugs, sold their bodies and stole from wherever there was money.  They never once denied their intense shame and the endless amount of pain they had caused others in the process.

I had addicts and alcoholics in my orbit.  My best friend had developed a fierce crystal meth habit that scrambled his brain, never to be repaired.

I successfully parlayed all of this into a pretty impressive resume and 9 months ago began what has become the most meaningful and unexpected journey into a world that many would be afraid to dip their toe into.

Most of the men I counsel are heroin addicts having run through the very common trajectory of childhood trauma to an addiction to opiates in the form of pills, and onto the cheaper and easier to find heroin.  Most tell me that never in a million years would they be sticking needles in their arms, sleeping on the streets, stealing from their parents and grandparents not only money but precious jewelry to pawn, breaking into houses and robbing people at gunpoint to get the money for their next fix.  When they talk about it they are disgusted and even though they say they never wanted or want to be that person again, they know that there is the looming risk (unfortunately often an inevitability) that they will be.

What I see every day is an intense loyalty that these men have towards each other.  Phone numbers get entered into smartphones right away, and even the most disparate of men will call each other if they sense that something is wrong.  Guys with barely anything will whip out a ten dollar bill when another resident is desperate for a pack of cigarettes.  If a guy who has come from a homeless shelter or jail comes in with nothing, a resident with a job will take them shopping.  They get it.  They’ve been there.

They cycle in and out of the 6-month program, sadly, much more due to relapse than to completion.  I have been with these men who make me laugh until I cry who are dead less than 24-hours later.  Unfortunately the surviving men have become inured to these deaths, having experience countless numbers of them, and after they get quiet for a few seconds, they quickly move on.  This is their lives.

I’m the only staff member who isn’t in recovery.  The only thing I’m even close to being “addicted” to is coffee.  They don’t judge me for this and never once has one of my clients doubted that I can help them.  They adore my quirkiness and my loyalty to them.  They sense my compassion and lack of judgement.   Even without training I have seen their vulnerability as they break into tears with me in front of them, peeling away at layers they’ve never known were there.

There is more laughter than tears but every day when I pull up to the house I brace myself for something horrible, a relapse or a death.  It’s the one occupational hazard of this career but as long as I keep on learning from these incredible men, I’m in it for the long haul.

 

Resisting The Numb

heroin (1)

Last week one of the residents of the all-male sober residence where I work came into the main office, shut the door behind him and began to weep.  Still a few years from thirty, he grew up in one of the toughest, whitest projects in Boston, using drugs and committing crimes since the age of 14, so, seeing him in this vulnerable moment was a bit jarring.

At moments like these my coworkers and I are generally waiting for a confession of relapse.  Instead, he told us that he had just found out that his father, diagnosed with a very aggressive cancer, had three weeks to live.

This resident was not used to having these sorts of feelings.  His impulse, and the impulse of almost all of the men in the residence, was to inject, drink, snort, smoke and swallow their feelings away.  That lure is always there, everywhere.  The immediate goal for their lives, is to resist that desire to be numb.  They have to learn what it’s like to “sit with their feelings.”

The first thing we made sure was that he wouldn’t use.

“I can’t do that to my father.  He has watched me my whole life as an addict.  Out of respect for him, I won’t.”

His vulnerability was so innocent, so childlike in a way.  He is well-loved in the house but doesn’t want the other guys to know what’s going on.  I’ve urged him to talk to a select few, but he hasn’t.  We as staff, though, continue to check-in on him, see how he’s doing and know that the worst is yet to come.

The past few weeks have been heartbreaking at the house.  One of the young men I got very close to, relapsed a day after graduating the program, after 180 days clean.  Another, only weeks from graduating was found with a needle in his arm, fresh blood drops on the floor of the bathroom, so fucked up he couldn’t stand up straight.  And then, the worst of them all, one of the guys on my caseload who got discharged for using less than a month ago, was found dead at his girlfriend’s house.

Coming into work the day after this young man’s death I talked to a lot of the guys to see how they were processing the information.  Each one, many who had known him and liked him, said that they had gotten so used to this, yeah, it sucks, but it’s the nature of the beast.  One went through the contacts on his phone and ticked off at least 15 names of people he knew who had overdosed in the last six months.  Many said that their Facebook feeds has become their version of an obituary, being their source of information like this.  The overarching theme was “Better him than me.”

Death shouldn’t be the norm for twenty and 30 year-olds.  People in their seventies and eighties are the ones who should be scanning obituaries, sighing and feeling a pang of sadness when they learn that someone they know has died.

I knew this job would be tough, but I couldn’t have possibly imagined how tough.  Death and relapse will be a part of my life.  I look at the thirty names of the guys left in the house and wonder how many will make it the 180 days.  I fear for them, for those who can’t resist the numb, the ones who need to escape the pain of feelings, feelings that most of us know how to process, sober, or with one glass of wine, with people who will listen and help to take that pain away.

“Why Do I Keep Doing This?”

pint-of-vodka

Yesterday at the men’s sober living program where I am a case manager, I witnessed the implosion of one of our residents.  To me, he was always the most intriguing and one who I knew the least.  He wasn’t on my caseload but I had read his file and learned about his ongoing struggles.  He is very tall, very handsome, very articulate, is (was) a lawyer.  He is also an alcoholic, one of the few in the program who isn’t a heroin addict.  When I would do rounds, part of the job to essentially make sure none of they guys has overdosed in their beds, I noticed that he was reading Philip Roth’s “American Pastoral,” a book that has been on my list for years.

The men in the program are required to find a job after 45 days of their admittance and he had taken a job at a Jiffy Lube, a far cry from practicing law.  Most of the men are just happy to actually FIND a job and are humbled, not necessarily bitter about their new reality.  On days off, they can do whatever they want–go to the beach, movies, whatever, as long as they’re back in the house at a certain time.  There are random urine checks and the knowledge that our eagle-eyed staff, all in recovery except for me, can pick out a relapse from a mile away.

Yesterday, at around 4 in the afternoon, this resident was a bit wobbly going up the stairs to the house.  He apparently reeked of alcohol and was immediately given a breathalyzer.  His levels were off the charts.  He LOOKED so different, his face sort of doughy, his eyes red.  He came into the office that I share with my two coworkers and sunk to his knees.  We gave him the obvious space he needed to process how his life had just changed dramatically, knowing that he would be discharged from the program immediately.  For the other guys in the house, seeing someone in that state could be a real trigger.

With his head in his hands he repeatedly shook his head, and asked to none of us in particular, “Why do I keep doing this?  What am I going to do NOW?” He had begun to sob.  It was excruciating and tragic for me to watch. His case manager, clean for 15 years from a raging heroin addiction, just let him ask the questions.  He suggested that he immediately go to a detox, which had become a never-ending cycle for him.  The resident chose not to do that, asked for his savings that all residents are required to pay, and said that it was inevitable that he would buy more vodka, and check into a downtown hostel for the night.  He’d make the bigger decisions the next day.  His case manager tried to talk him out of that, but there’s nothing we can do.  He couldn’t stay and as painful as it was for him, my coworker handed over his money.

After he was allowed to take a shower he came back down to the office and asked for another chance, fully knowing that that couldn’t happen.  He shook my hand last, a strong powerful shake, and said “I’m sorry you have to see me like this.”

I pray that he has made it through the night.  I pray that his helplessness hasn’t lead to something even more tragic.  I pray that he can eventually end this cycle of pain and walk past a liquor store like it was just another Subway or dry cleaners. This will not be the last time I witness this.  I know that the odds of most of these guys making it through this six month program are pretty low.  I look at my caseload and try to guess who will be next, who might be seen by another guy in a heroin haze.  I hope that I will never become inured to the horrors of addiction, that I will always pray for each and every one to stay clean who will never have to ask again, “WHY DO I KEEP DOING THIS?”

“Here Son, Try This”

cocaine

Part of my job as a case manager in a residential program for recovering addicts is conducting an intake within hours of them walking through the front door.  I always apologize for the litany of questions I’m required to go through because I know, as they’ve been shuffled from detox to other residential programs, they’ve been asked the same hundred or so questions upwards of ten, twenty times before.

The first page or two of the intake form consists of fairly standard demographic questions from “What ethnicity are you?,” to “What is your primary language?” to  “Do you have any sources of income?”  Without much of the equivalent of a “transitional” sentence, the questions abruptly move onto a checklist of substance of choice, everything from pot to alcohol, to opiates to crack to “club drugs.”  I record if they’ve ever tried a particular substance on the list, their age at first use, and the frequency of use.   I’ve become so used to hearing that these men have often begun their road to a serious opiate addiction at around the age of 14 or 15, that when they tell me that they first injected heroin at 19 I’m surprised at how late that seems.

Oftentimes the men will be eager to share their back story, the origins of their drug dependence.  Many are somewhat “standard—“ a prescription for pain meds due to a legitimate injury that snowballs into heroin addiction, raiding their parent’s liquor cabinet, flipping a dormant switch into full-on alcohol abuse.  Other stories go something like this:

“In 10th grade I was having a hard time staying awake studying for a history test.  My father came in, saw that I was struggling, left the room for a minute, and came back with a few lines of coke on a mirror and said, “Here son, try this.” He showed me what to do, and the rest is history.”

The first time I heard something equally as appalling was as a volunteer at a local women’s correctional facility.  A woman, clearly beaten down and defeated shared with the class I lead that her mother injected her with heroin when she was 10-years old.  At that time, my daughter was ten.  I felt heartsick for this woman and intense rage against her mother.

The majority of the men I counsel have been surrounded and immersed in a nuclear and extended family of addicts.  There have been their fathers who have murdered their mothers, drunk driving deaths and life sentences for one thing or another.  90% of the time their siblings and parents are all addicts, some with long-term sobriety under their belts, others enduring the same agonizing cycle of detox and relapse.

When I see or hear people who deride and judge those struggling with the enormous monster of addiction, I often feel the need to remind them that no one says, “I want to be a drug addict when I grow up.”  I am surrounded and reminded every day of the anguish and helplessness it creates.  It doesn’t come from nowhere.

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Don’t Dream It, Be It: Imposing My Own Dreams on Substance Abusers

 

dreamit

“I’m a substance abuse counselor.”

When I heard those words come out of my mouth when someone recently asked what I did for work, I said it assertively, as if I had been one for my entire career,  simultaneously thinking to myself, “Oh my God, I’m a SUBSTANCE ABUSE COUNSELOR.”  Those words had become my end-point, I was living my dream.

It wasn’t until about five years ago that this career was even on my radar.  For 20+ years I was a non-profit fundraiser, spending the majority of my time asking rich people for money.  I burned out, got lazy, and found that I really hated the lack of authenticity when I was in front of the wealthy, having to make small talk that had such transparency that they were just waiting for the ask.

When I found myself between jobs I fell into an opportunity to volunteer with newly incarcerated women.  Every Friday for two years I went “behind the wall”  and lead a group on goal-setting, instilling as much hope for women who had none.  About 80% of those women, and later, in a part-time job where I also worked with men newly released from prisons all over the country, were drug addicts or in prison for drug related crimes.  In addition, my best friend at the time was struggling with a 3-year crystal meth addiction, a drug so insidious that he became a completely different person.  It was in my orbit everywhere I looked and it was then that I knew that what I wanted to be was a substance abuse counselor.

I am not an addict but that didn’t stop my wonderful new boss from taking a chance on me, seeing my passion and understanding of the challenges that this population faces every day.  I now have a caseload of 15 men in a sober living residence, a place I look forward to going every day. The cycle of their lives are almost always identical–overdose, detox, halfway house, relapse, overdose, and on and on.  In the process, they’ve lost sight of whatever dreams they’ve had.  They’ve become too clouded, murky, shrouded in despair.

One of the most compelling men on my caseload, a 27-year old rough-around-the-edges but completely soft on the inside, had wonderful and candid conversations with me on Friday afternoons when he’d come home from work, covered in dirt with a single hammer hanging from his tool belt.  He was wise and without delusion about where his life was and where it was going.  He had been through our program before, had achieved almost 2 years of clean time before he was sucked back into the vortex of abuse.  In theory he knew what he had to do to avoid the suck of addiction, how he had to stay away from his ex-girlfriend.  He had helped raise her daughter, now 6 who he absolutely adored.  After 42 days out of the 180 days it would have taken to complete our program, and a day after one of these conversations, he left to go back to her.   Right before he went into detox his probation officer let him call me.  “This was the conversation I was dreading the most,” he said to me.  I’m so sorry.”

During several conversations I told him what I wanted for him.  I wanted him to have a wife, some children, a family to come home to and eat dinner with.  A wife to cuddle up next to on the couch when their children were finally settled.  My dream is to secretly walk by a cute little house with a big tree that I can duck behind in the yard, look in a big picture window, and see him hoisting his child over his head, making faces, and having this be his dream realized.