RELAPSE

Last week on Thursday a patient of mine tragically died of a heroin overdose in his room at the facility.

The young man, 28 years old, was doing well with his program. He had graduated from intensive inpatient level 3.5 care to level 3.1 low intensity inpatient care, he was employed in a managerial position, he attended all required groups and made a habit of attending optional groups if he could, he had no verbal or written citations and displayed stellar behavior, he dug deep in counseling sessions and completed all assigned work with quality and critical thought, and he had not had a single positive UA indicating that he was struggling with relapse. He was set to graduate 3.1 moving on to outpatient 1.0 level of care in two weeks where he would've left the inpatient facility to move into transitional housing. He was succeeding beyond expectations, then this.

Death of a patient in the facility is something that we as professional care providers know to be a harsh reality. However, it is the very last thing the families would ever fathom. My heart goes out to his family during this more than difficult time. I'm sure they were relieved knowing that he was sober and safe in treatment, taking the steps necessary to heal and better his life. Then this. They thought he was safe, and then this.

Even if we were to perform strip and cavity searches, if a patient wants to smuggle drugs into the facility they are going to do just that. Drugs can be easily swallowed and excreted for later use bypassing even a full cavity search. It is sad to say it, but no treatment facility is fully safe. And there no safeguards existing that can stop an addict who wants to get high.

This evil and beguiling disease has taken yet another beautiful soul. My heart is heavy and in pain. Though I can rest easier in knowing that his heart no longer is, he no longer has to suffer and struggle. Peace be with you eternally, brother.

These words are true to an extent, but they have a shaming and damaging connotation to them that discourages many of us...

There remains this notion in substance abuse treatment and recovery culture that states that you have to really and truly want to get and remain clean before you’re able to achieve it.

This notion heavily implies that those who are still in active addiction have no desire to be clean and this is false and damaging, with the propensity to keep some people suffering in active addiction longer than they may have had this notion not existed the way it does.

It’s based on the premise that an individual can’t want to get high and want to be clean at the same time, but anyone who is an addict that has had any time clean has experience indicating the opposite.

The addict who has had any amount of clean time, brief or enduring, has experienced the desire to get high whilst remaining clean. This fact of recovery alone debunks the idea that you can’t want to get high and want to be clean simultaneously.

I’ve met so many people who have a strong desire to get clean whilst also experiencing a strong desire to get high. By the same token I have met many others who have no desire to quit using and stay clean, they aren’t at that part of the journey yet, and sadly may never be. That’s one of the harsh realities of addiction. But for those who do have a desire to quit using and stay clean, there is hope. Regardless of the fact that they still want to get high too.

I’ve also been that person, and on many days I am still that person today after 20 months clean. I wasn’t entirely ready to get clean when I decided to get clean this last time. I don’t think anyone ever truly is. And the notion that you have to be before you can quit using and retain sobriety discourages so many people who do not need yet another thing to be discouraged by.

You have to have a desire to get clean for it to work, but you don’t have to be 100% committed and you don’t have to have a lack of a desire to use. You may want to get clean and you may want to get high, wanting neither thing more than the other and in those moments you’re posed with a difficult choice. It’s always easier to go with the choice of most familiarity and comfort which is why people who have a desire to get/stay clean will still use. Not because they don’t want sobriety enough.

It’s not a matter of what you want more. It’s a matter of brain functioning and behavioral patterns that we are all trying to defy and change which does not happen through linear progress. It does not happen based off a singular desire or a singular choice. It happens through restructuring of neural pathways over time.

For the addict that has tried to get clean once or maybe a handful of times but continues to relapse many of us say “they must not really want it”. But for a person to stay clean even one day they obviously want it. Otherwise why the fuck would they not use?

When I hear “they must not really want it” or “they must not be ready” I get angry. Because I’ve heard it said about people I know and love, knowing that the statements made against them were not true. They did want it. More than anything. But this disease has it’s own beguiling agenda which sadly supersedes our own oftentimes. Not because we didn’t want it enough, but because we are sick.

Saying that you have to really want it otherwise you can’t get and remain clean is like saying we are responsible for the symptoms of our disease.

When I’ve seen myself, a close friend, or a patient cry because they so badly want to be clean but can’t seem to maintain, I know that the notion we are discussing is not true.

This notion hurts people, making them think they are the reason they can’t become healthy again. There is some level of personal responsibility involved in recovery from addiction I am not refuting that, but it is wrong to shame the addict for the symptoms of their disease. Especially when they want to get better.

Over 85% of people who are in their first year of recovery will relapse.

In the second year of recovery this number drops to 40%.

This trend of more time clean causing a decrease in the likelihood of relapse continues the longer an individual stays clean, though the percentage never hits 0%.

Though our odds of continued success continue to get better with time, we are never truly out of the woods.

Whether you have 30 days clean or 30 years clean you still live with the disease and are susceptible to relapse.

This is why it is so imperative that we never cease working on our recovery, even when we relapse. For that’s the time in which we must work the hardest!

It started innocently enough.

At the age of 11 I started smoking marijuana. I liked the way it made me feel. For a kid who suffered a great negativity, who was always on guard, whose mind was always racing and never about anything pleasant... it was great to feel all the tension and hostility dissipate. Marijuana allowed me to be creative, have fun, interact with other children on a child’s level, and enjoy the spoils of being a child.

This newfound jovial disposition that marijuana allowed me to experience did not last long, however, until things took a swift and sharp turn leading me into a seeming adulthood earlier than any individual should ever be forced.

To have more of that spirited carefree feeling wholly preoccupied my brain. Each day I needed more marijuana and by the age of 12 I was drinking alcohol fairly regularly.

By age 13 I had shot up heroin for the first time.

How did I acquire heroin at such a young age, well, with the prevalence of the drug in the town in which I live it was pretty simple.

I was at an all ages heavy metal show downtown, and I met an older guy who was a user and also a seller of the drug. It seemed to escape me at the time, but looking back it’s plain to see that the man was a pedophile. But at the age I was the thought of it being off did not cross my mind. I thought it was cool that he liked me and wanted to hang out with me and be with me.

Not only was the attention I was getting from this older guy intoxicating, the prospects of what this drug he was into could do was enticing to say the least. Knowing what marijuana and alcohol accomplished for me, I couldn’t wait to see what I thought of as the ultimate drug could do.

Did I realize heroin was dangerous and addictive? Yes. There were rock musicians whom I idolized who had met their demise due to the drug. We learned about the different kinds of drugs in school and their potential to be very dangerous. I wasn’t a stupid kid by any means. I know heroin was bad.

I was apprehensive to want to try it the first couple of times me and this guy hung out. I knew the dangers and in all honesty I was a little scared. But it didn’t take long for me to talk myself into it. I rationalized my decision to try it by reminding myself that my mother had dabbled in drugs in her past and never got addicted. I thought I was going to be like my mother; unfazed by the addictive perils of drugs. Boy, was I wrong!

At the tender age of 13 I became a heroin addict. Of course, I would’ve never admitted that to myself at the time. Heroin was just like marijuana and alcohol for me; I always wanted more, and more wasn’t a problem.

Fast forward 2 years to when I was a sophomore in high school at age 15. I had a job as a prep cook at a restaurant where I met a coworker who was a man in his late thirties that introduced me to meth. I didn’t like it nearly as well as I liked heroin, and I didn’t use it often. But the meth thing will be important later.

Fast forward 4 more years to when I’m 19 years old, graduated from high school, and a college flunky. I managed to get clean off heroin by myself by weaning myself through the method of tapering my dosage of OxyContin and Dilaudid pills until I quit taking them altogether. I like to claim I quit heroin cold turkey, but was it really cold turkey if I just replaced it with OxyContin and Dilaudid? Not exactly I suppose. But nonetheless I was very proud of myself. Having failed my entire first year of college was unacceptable and I knew something had to change, so, I took the initiative to quit using and would re-enroll in classes.

Upon quitting use of opiates I earned my associate’s degree in criminal justice in 2016 despite a growing problem.... Since being clean from opiates I got heavier into meth. I’d use maybe twice a week on pay days, but that was it. Didn’t seem like an issue if I wasn’t using every day, and besides, I told myself that as long as I wasn’t on heroin I was doing great!

Fast forward 4 more years and I remained clean off opiates this whole time, but was now 23 years old and using meth nearly all day every day whenever I got a chance, even at my place of employment which was an inpatient substance abuse treatment facility. I went to work every day facilitating therapy and support groups for addicts whilst I was still writhing in active addiction. At times even using meth inside the facility. I felt horrible about myself, but I still wasn’t willing to admit that meth had become a problem.

It took losing my job, having intense fall outs in my relationships, going to jail multiple times, catching multiple charges, relapsing on heroin, and being forced into outpatient treatment to get me clean.

I can no proudly say I’ve been clean of all substances since November of 2018.

Currently I am studying for my bachelors in criminal justice and have about a year left before I graduate, I am also minoring in psychology. I have two jobs, one working at a youth shelter, another working at the inpatient substance abuse facility at my county’s jail.

I remain active in outpatient treatment, mental health therapy, and psychiatric services (though the pandemic has thrown a real wrench in my counseling and therapy, but I still am taking my meds).

I am a heroin and meth addict with co-occurring bipolar disorder who is functioning working two jobs and going to school. There was a time I didn’t think I’d make it to high school. There was a time I didn’t think I’d make it out of high school. There was a time I didn’t think I’d make it to 21. I certainly never could’ve fathomed I’d make it to 25. But here I am! Committed to growing and learning more about myself and any and everything else I can learn about every single day!

I used to believe that I would die high on a drug, and that I would die young. I no longer have to believe that! I never would’ve thought I’d be capable of experiencing the shifts in perspective that I’ve experienced.

Recovery is truly life altering.

You cry.

You cry and you feel.

You allow yourself to feel.

There is no way of combating it.

There is no method of fighting it.

You just cry.

And you feel.

You feel the heartache.

You feel the pain.

You endure the suffering.

You endure the suffering until you are tired.

You endure the suffering until you are so weary that you cannot stand to bear it any longer.

Until you no longer feel anything at all.

In that lack of feeling you can find clarity.

Only then can you choose to act against the heartache and pain.

Only then can you decide to do whatever is necessary to move past the heartache and pain.

Only then can you truly care for yourself.

Only then can you nurture yourself back to health.

Shame focuses on the self stating "I am bad" and breeds cyclical self-destructive behavior out of the belief that oneself is immoral. Guilt, however, focuses on the behavior stating "I've done something bad" and is based in our sense of morality.

In sum, an individual who feels shame views themselves as a bad person, whereas an individual who is guilty views themselves as a good person who has done something bad.

One cannot navigate through life harboring shame for the wrongs they've committed, lest they be doomed to continue making poor decisions in contempt for themselves creating a toxic cycle of bad feelings about the self and bad behaviors.