Working as a Counselor at a Detox Part 1 of 2
(All names have been changed)
I recently realized I hadnât written down any of my crazy detox stories. The highlights are listed here although I had many more off-the-wall experiences at the 26-bed detox (24 when I first got there). My mom got an earful of craziness nearly every Monday afternoon when I called her, and having no tales from the weekend was rare. The stories below are the only ones I still remember today.
Working at the detox was a wild ride. Some nights (I worked 4pmâ12am Saturday and Sunday from February 2021âMarch 2023) the place would be slow until it wasnât. The flow of work could go from 0â100 mph at the drop of a dime, and what seemed like a slow night would turn into printing and signing my final documents at 11:57, running down the hall to file them, and then clocking out at 12:03. Things immediately changed when Iâd walk outside with my coworkers at 12:04 when weâd actually have a chance to breathe and take in the weather. The detox, to me, seemed like a cross between the action of the Carrier Motor Lodgeâa crime-ridden motel where I worked in the 2000sâand the medical needs of an emergency room since detox programs are medical facilities and we worked closely with the local E.R. which was one block up the hill just over a stoneâs throw away. (The E.R. sent us clients whose drug and alcohol use landed them in the hospital, and we sent them overly drunk clients to sober up and those with medical needs.) How things changed in that first moment outside always seemed eerie to me as if the shift happened to someone else.
I was at the detox for two months before I was told the worst story Iâd ever heard. In group there was a man, about 35 years old, who had a drinking problem. He was your stereotypical drinker. He kept interrupting the other clients to tell more of his story, and he was selfish in getting his needs met. I remember suggesting a few options to him such as one-to-one therapy. After group, he said, âI think therapy would help me. Iâve experienced a lot of trauma.â He went on to say that his fatherâs side of the family drank and his motherâs side of the family used drugs. One night his uncle on his motherâs side was babysitting an infant. He didnât say his relationship to the baby, and I didnât ask. His uncle and his uncleâs girlfriend got high, and somehow the baby died. Worried theyâd get in trouble, the two put the baby in the fireplace, and they tried to burn the baby to ashes. Then there was a family meeting. The family decided they would blame the babyâs death on a mentally challenged aunt, and the aunt was permanently moved into a hospital. He didnât say if the aunt was still alive, but the way he talked about her, her life was over.
The big thing in the social services industry is de-escalating people. If two people are about to fight or if someone is agitated in any way, your job is to try to talk them down. I worked in a transitional home at another company for over seven-and-a-half years, and I learned a thing or two about de-escalating clients. Number one is to check your ego. Does it really matter if youâre right? Do you have to be right all the time? If your answer is yes, then youâre in for a few surprises. One night when the clients were lining up for smoke break, I stepped on a manâs shoe. They were nice shoes, and I told him I was sorry, but he wanted to make it a big deal of it even if I didnât make a mark on his footwear. I thought, no problem, and I kept reassuring him that I was sorry and it was an accident until he started to calm down, but when a nurse, Justine, stepped out of the admissions room and heard this, she got in his face, telling him he needed to show me some respect, and he kept getting more and more worked up until I had to physically walk Justine down the hall because she wasnât helping.
The worst thing that happened at the detox was the death of my coworker, Tonya. She was an ex-heroin addict, and she lived with her fiancĂŠ, who was her former drug partner, and they had two young children around ages 5 and 7. Tonya was open about her home life and that sheâd recently caught her fiancĂŠ cheating on Snapchat a second time. We had a new technician working on our shift. At the time we only had one tech on second shift (we would later have two). The technician had just completed training, and this was her first night on her own. Tonya began chatting up the new tech (which I thought was unprofessional), and they made plans to go to a bar after work. Later, she said to me, âMe and the tech are going out for drinks after work,â so I said, âI heard. You know thatâs not the greatest coping skill,â and she said, âI know!â in a sing-song way that made it sound like she drank all the time and it was no big deal. About 5 or 6 weeks later, she died of an opioid overdose. It was sad especially the first few weeks because it was the first time someone close to me died. She worked at the detox for about six months, and Iâd been giving her more and more responsibilities (this was her first job in the field, and she was still in school). We were a great team, but they found a replacement a couple months later, and everyone moved on.
Incidents at the detox often came in pairs, and something wild happened about once every three weeks. We had strict rules regarding smoke breaks and phone calls and for good reasons. You couldnât go out to smoke if that smoke break followed a group you didnât attend unless that smoke break also followed a meal, and then you could. Not all counselors gave the new clients a summary of the rules, and if you were leading smoke break (this was the techâs job unless they were busy), you had to tell a client who hadnât attended the previous group that they couldnât smoke when you were handing each individual their one cigarette. As you could imagine, this never went over well, and the techs often deferred to me because I led the group immediately preceding the eight oâclock smoke break.
There were three smoke breaks on second shift: the first followed vitals which was after dinner and the first evening group; the eight oâclock smoke break was after the last group (my group), and the ten oâclock smoke break happened after night meds. Anyone could go to any of the three smoke breaks except the eight oâclock smoke break unless they attended my group. Attending all groups on first and second shift was mandatory, and we needed to keep attendance up.
Generally, if they didnât know the rules, Iâd say the rules were in the handbook they signed, and theyâd always ask for an exception. At first, if they were nice and I genuinely believed they didnât know, Iâd let them smoke, but the techs hated this, so I stopped doing that. One guy, shorter than me but heavier, was pissed and wouldnât stop yelling at me. He suddenly shut up and froze as he stood by the outside door. His body language and attitude screamed, âJust make one move toward me, and weâre fighting.â I watched his eyes focus on the space around him, and I realized what he was doing. I laughed to myself, thinking, âOkay. I wonât invade this guyâs personal space, so instead Iâll watch him implode,â and thatâs what happened. A similar thing happened the next night, and unlucky for me, he was on a 10-day benzodiazepine detox, our longest detox, and he was there the next weekend but with fewer issues each night.
About three weeks later, during phone calls (phone calls on second shift lasted from 8pmâ10pm), I had a similar incident. Phone calls were in the counseling office, so in addition to getting your paperwork done (I would be writing my group notes at this time unless I had an intake), you had to answer the phone, complete telephone screenings, and keep tabs on the clients in case they were falling apart talking to their families or plotting to leave detox and get high. Phone calls were twice a day (one on first shift and one on second), and the clients could make 1 call for 5 minutes with no splitting the 5 minutes into separate calls. The biggest reason for these rules was because the longer they talked to their significant other or whomever, especially if they spoke to more than one individual or family member, theyâd start realizing they had things to take care of at home, and then theyâd ask to leave (theyâd leave âagainst medical adviceâ or go âA.M.A.â). If they asked to leave, youâd have to sit with them to convince them to stay (most clients wanted to be talked out of leaving), and if that didnât work, youâd have to kick everyone out of the office and complete the discharge which meant it would take more time and create more paperwork. It was almost always in everyoneâs best interest for the client to stay. Only once did I agree with someone that he should leave. His mom was having emergency surgery, had dogs, and she had no other family in the state.
A young man In his mid-20s was on the phone when I announced that he and another client were talking past 5 minutes and needed to hang up when I heard him whisper under his breath, âNo oneâs going to tell me when to hang up the phone.â I paused for a minute so as not to give him any gratification of an immediate response, and then I got up, stood over him, and said, âYouâve been talking for more than 5 minutes. Hang up the phone.â At this point the other guy mostly stopped talking but stayed on the phone so he could watch this unfold. The younger man said something back, and I repeated, âHang up the phone,â a couple more times. Thatâs when he did that thing where he shut up, froze, and focused on the hang-up button, waiting for me to press it so we could fight. I again laughed to myself and waited for him to implode which he did. After that I kicked the other guy off the phone.
One night this client came to the counselorsâ office, making demands like, âGive me something to eat!â and âGive me a towel!â Sometime later I heard a few guys yelling at each other, so I ran down the hall to break it up. Two of these clients, including the rude, overly demanding guy, were about my age in their late 40s, and the other was about 30. The younger man and one of the older ones were talking in their room when the rude guy said, âGet out of here! Stop making so much noise!â (while he was trying to sleep). I asked the rude guy to come to the office, but instead, he followed the other two into the community room where they continued arguing. I threw the rude guy under the bus, and the 30-year-old walked away, but these two older men kept arguing. Now Iâm physically standing between these two when the rude guy realizes Iâm blaming him for the argument, so he gets even more mad. Now theyâre getting pushy, and theyâre ready to fight each other. Finally, I separated them, and I explained to the rude guy that what he said wasnât wrong but how he said it was, and to his credit he listened to me, and he was âpoliteâ for the rest of the weekend. (He was as polite as a person who doesnât know how to be polite could be.)
Things really did happen in pairs at the detox. One of the nurses, who was working meds, got a cup of water thrown at her by two separate people two weekends in a row. Whatever happened shouldnât have resulted in battery, but it was always my observation that most of the nurses were rude. Clients would often complain that a nurse wouldnât give them their meds that were prescribed to them by an outside doctor, and Iâd have to calm the client down and then walk them to the nursesâ station and request that the med nurse speak to the client for âclarityâ on why they didnât get their meds and to see if they could resolve the issue. (It took me a long time to get the wording right when speaking to the nurses, and once Iâd figured it out, one of them expressed her frustration with me by saying, â[You donât have to argue with me.] Weâre on the same team, here.â) Clients not getting their prescribed meds happened often, and every time an angered client came to me, we got the desired result of the client getting properly medicated. Once, a client overheard the nurses referring to them as âthe drug addicts.â
Justine, one of the nurses, had bossed around another counselor in front of the clients, and that counselor hated Justine. In fairness it was a medical facility, and when no supervisor was there (which was every weekend and evening), the nurses were in charge, and Justine was often right, but that one counselor didnât like how Justine spoke to her. Justine would often talk to another nurse about them getting their doctorates. They were both in school, and the other nurse almost completed her doctorate by the time she left, but just before I left, I was shocked to find out that Justine didnât even have her bachelorâs yet. I, personally, liked Justine. Sometimes I had to admit when I was wrong, and I think thatâs why she and I got along.
The nurses were paid fairly well, and I was offered the intake counselor position at $16/hour in 2021. I could have earned more money as a clerk or stockperson at Aldi, a German discount supermarket in my neighborhood, or collecting grocery carts at Walmart during the pandemic. A couple times when I was training weekdays during first shift, a nurse called the counselorsâ office to say that the others were ordering lunch, and she wanted to know if the counselors wanted anything. The second time, my coworker told her, âNo! Weâre counselors!â
The longer a nurse stayed, the better she or he got at finding hidden drugs during the admission process. This, of course, led to less overdoses. Yes, overdoses do happen at detox. One man who sold opioids to someone who overdosed was permanently banned from the program.
Before a client entered the facility, the tech checked their temperature, and if they had a fever, they were sent to the hospital for a rapid COVID-19 test. Once they entered the detox, they were walked directly to admissions by the tech where theyâd meet the admissions nurse while the med nurse stayed at the nursesâ station and the other tech did checks and covered the floor. (Checks including doing a head count to make sure everyone was alive and accounted for.) In admissions the nurse documented the clientâs medical history and any present ailments including open wounds along with their current drug and alcohol use while the tech gave them a COVID test, did a urine screen (drug test), and logged their personal items. The client was then strip searched, and they showered. After they showered, they were brought to the counseling office by the admissions nurse to complete an intake. This was followed by a brief orientation by counseling staff before the client was brought to the med nurse to get medicated (if immediately necessary).
Towards the end of my time at the detox, street clothes were banned, and all clients wore scrubs to help cut down on contraband which may have been sewn into their clothing or hidden in other ways. (Before street clothes were banned, the tech used to wash all the clientsâ clothes when they came in.) Two male clients who were both married refused a strip search with the female nurse, so the female nurse then asked me to do it. The nurse framed the strip search as being outside my job description, and both times I refused, so the female nurse told the client there were no other males in the facility and she had to do it. The third time this happened, my refusal didnât work, and I witnessed the strip search. I did the guyâs intake afterward, and about an hour later Iâd almost completely blocked the memory of the admission and the intake. Getting to know a strange man after seeing his penis and asshole wasnât what Iâd signed on for.
Seizures happened too from both benzodiazepines, a 10-day detox, and alcohol, a 6-day detox. The third detox was for opioids and lasted 5 days. Those were the only three medical detoxes required by the state of Connecticut because you could die from withdrawal from those drugs if you didnât have medical supervision. Death occurs mostly by seizure-related trauma from an alcohol or benzodiazepine detox. Although death is rare from an opioid withdrawal, itâs possible. They used to detox people from Methadone, but nowadays those folks are referred back to their Methadone clinic to taper off.
The nurses handled the occasional seizure (there were two or three on my shift in the 25 months I worked there), and my place was to inform and sometimes help the tech gather the clientâs personal items, and then Iâd return to the counselorsâ office to get the paperwork ready and wait for the paramedics.
One of the nurses, Judy, a per diem nurse who worked at the county jail (almost all weekend nurses were per diem), liked my calm demeanor. While she and a tech were watching the cameras, waiting for an admission who was outside chain smoking, she called the counselorsâ office and yelled at me to do something about the prospective client, so I walked outside, told him to stop smoking, and brought him to admissions without incident or argument. I was in the nursesâ station a couple weeks later when Judy shared this with another nurse and laughingly told her how I never get flustered âEven when Iâm yelling at him!â
Not all prospective clients made it through admissions. You couldnât stay for an opioid detox if you had Methadone in your system (largely because you were detoxed from opioids with Methadone), and you couldnât stay for any detox without being in withdrawal. If you came in drunk, you might have to wait to begin your detox the next morning, but if you werenât in withdrawal within 24 hours, you were referred to a different program and released. Those who didnât meet criteria for detox were usually denied entry during the screening process, but some slipped through by lying. Some of those folks may have been coached by someone else in the room during their telephone screening (we heard all kinds of things in the background on screenings), or they had called another detox and changed their story to fit our program. Some came to detox to escape jail (by showing initiative in taking care of the problem that led to the crime), and some were homeless and cold and only wanted to get off the street.
Once admitted, clients made smoking one of their highest priorities. Nearly all clients smoked (mostly Newports), and even though many of them felt like shit, couldnât get off the toilet, couldnât sleep, or were nauseous and throwing up, cigarettes were their only moment of peace. We even had free cigarillos we gave out after meals to clients who were out of their own cigarettes. But cigarettes were such an issue that I woke all clients when possible (some were deep sleepers) to remind them that they needed to go to the seven oâclock group to take the eight oâclock smoke break. One client was so angry that I woke him that he came to group and went off for about 10 minutes. I kept saying, âYou can leave group. Itâs your choice. You donât have to stay,â and his response was, âNo! I want to see what was so important about this group that I needed to be woken!â It was actually company policy to wake everyone for group. This guyâs arguing went on for a while (along with my comments such as, âAre you done yet?â), and my supervisor later told me I should have walked him to the counselorsâ office, but that wouldnât have worked. Three weeks later, a client who was in that group with the angry client came back for another detox and told me he liked how I handled it. I didnât blow up at the guy or give in, and he eventually settled into group which was the best outcome.
My most challenging day was with a suicidal client. Supervisors love individualized notes. I knew this going into the job, so each group I ran, I handed out a blank sheet of paper and asked the clients to write down an answer to a pre-planned question that would lead directly into group discussion. That way I had at least one thing to document which was unique to that person. I learned early that picking random clients to speak in group could be disastrous, so I only called on volunteers. After the seven oâclock group, as I was documenting my notes, I came across the writings of a suicidal client. I went down the hall where he was having a snack in the community room, and I asked him to step outside where I confirmed he was suicidal and he had a plan to kill himself. I asked him if it was okay if I shared this with the nurse. He said yes, and I sent him back to his snack and told him the nurse might also want to see him in a few minutes.
He and his wife were drifting apart. He had kids, but he believed alcohol was ruining his relationship. He once quit drinking for a few months in the recent past, and he decided that if he couldnât stop drinking this time, he would hang himself at Lighthouse Park. The nurse dragged her feet and kept saying, âWell, if heâs not going to kill himself here, then itâs not our problem.â Finally, the med nurse said, âJust go talk to him!â
After phoning the director who also spoke to the doctor, the nurse along with the client and myself went to the admissions room and talked for a while. We talked about having realistic expectations from rehab and that the process takes multiple attempts for almost everyone. It was a Sunday night. His discharge was Monday morning, and the director decided we were going to cancel his rehab plans, have the doctor start him on an antidepressant in the morning, and then move him to one of our own rehab programs. She and the doctor determined his detox was most important to him, and all of this would start directly following his detox.
One of my least favorite nights began at 11:38 pm when the tech discovered on her last rounds that two clients were having sex in one of the rooms. I grabbed the admissions nurse, Judy, the jail nurse who liked my demeanor, and as she was hustling out of the nursesâ station, she asked me who they were. I said the clientsâ names, and she said, âThey need to pack their things. Theyâre both outta here.â Three of his buddies were in the community room, and they mustâve heard us because they came into the hallway and said, âIf youâre kicking them out, then weâre leaving too,â so I said, âThen go pack your things.â Meanwhile, it was almost time to go home, and I now had a mountain of paperwork ahead of me.
We called the director, and there were other factors happening. It was about 20 degrees and windy outside, and the buses were on their final runs. The woman was discharging in the morning, and the man was discharging the next day. We interviewed each of the two and made statements saying their sex was consensual which they signed, but before this happened I was convinced that my coworker, a per diem counselor, probably went home and left me with three hours of discharges, and I was relieved that the two clients were staying (and that my coworker didnât actually leave).
As I was getting ready to transfer from the detox to a transitional program, I had to give 5 weeks notice because of personnel shortages, and I got to say goodbye to most of my colleagues. One evening I walked into the break room while one of the techs, Corrine, and a newer tech were sharing a pizza. Over my first summer at the detox, Corrineâs husband died in a motorcycle accident, leaving Corrine alone with a newborn. I worked Thanksgiving that year, and Corrine looked miserable. She didnât want to be there. Corrine and the other tech offered me a slice of pizza. I said no, and I told them I gave my notice. I let them get back to their conversation, and about 5 minutes later Corrine said, âIâm not working weekends if youâre not working,â so I tried to convince her that the other counselor was a good employee too. She wasnât (more on her later in part 2).
A couple weeks passed, and I heard a client arguing with Corrine in the community room, and I ran down the hall and quickly got just as heated as them until Justine had to pull me away. Justine was the same nurse I had to pull away from the client whose shoe I stepped on. I didnât expect to get worked up, but I was caught in the emotion of the situation. It was the only time I lost my cool at the detox.
Leading up to my last day, I dreamt of sharing wild drug stories with the nurses. I shared a few stories with a couple of the counselors, but those always got one-upped by their own stories; theyâd heard it all and experienced much worse. For example, I thought my $80 per day crack habit (at its worst) was bad while one of my coworkers had a $1,500 per day coke habit. As I strolled into the office at quarter to four, I got to hear some of the words I hated to hear: âYouâre not going to believe this one.â Someone in a female room smeared feces all over their bathroom walls. No one would admit they did it. Staff members thought they knew who it was, but that client wouldnât own up to it. At that moment the doctor was speaking to her and her roommates to see if someone needed a higher level of care (detox in a psych ward).
Once first shift left, the day went by at a moderate pace. There were two counselors (including myself), two techs, and two nurses. I did two intakes and maybe a couple telephone screenings. My first intake was difficult. She kept stopping me to ask for meds and this or that. I said, âYou can see the med nurse after your intake is complete,â and then she repeated herself in 2â3 minutes. She asked me if she could take a nap to which I said, âIâll assign you a room when your intake is complete,â and then she asked again in 2â3 minutes. Finally after too many questions, I gave in and walked her to the med nurse who gave her a couple detox drugs (getting clients medicated while still in intake was a fairly common task), and we walked back to the counselorsâ office. On the way she stopped at the supplies cart for toiletries.
Back at the intake, a process that takes 50â60 minutes if you hustled, she started asking a new question, âCan I get a new bag?â I told her the bags were in the admissions office, and Iâd get her a new bag later. She asked that question so many times that I finally said to her, âWhy do you need a new bag?â She had put lotion, soap, and shampoo in med cups with no tops in her bag with her toothpaste and other toiletries. Anxious to get rid of her, I probably completed the intake in 45 minutes. (A typical intake took me about 1 hour and 10 minutes, but if I had time and it was late (and there were no more intakes and all my paperwork was done), Iâd do a more thorough job.)
Later, I had another intake. Fifty percent of the people who came in for detox arrived drunk or high, and my second intake was nodding out from opioids. While I was busy, my previous intake kept coming to the office to bother the other counselor. She was asking for food, a cigarette break, more meds, and complaining that she couldnât sleep. Meanwhile, I had almost reached the end of my intake, and I told the client who was high that he could shut his eyes and take a nap while I copied and pasted a few things before Iâd need his signature and could send him on his way when the other counselor went off on the pesty client, telling her she just took extra sleep meds less than 5 minutes ago and another smoke break (to help her sleep) wasnât happening. As Iâm finishing up, the other counselor leaned over and said, âIt wasnât the last night you had envisioned, was it?â I laughed. I didnât tell her how Iâd hoped to share a few drug stories, and I never did tell any stories.
About three weeks later I was training at the transitional program when the new HR director called me at home and pleaded with me to come in for one night at the detox. I kept refusing, but she wasnât taking no for an answer, so I agreed to come in for 4 hours on a Sunday night. When I got there, someone had smeared feces on their bathroom walls.
