Finding Treatment for Addiction Was Harder Than We Thought

[Guest guest]

Why We Couldn't Save

Finding Treatment for Addiction Was Harder Than We Thought

By M. Duda, Special to The Washington Post

Tuesday, October 7, 2008; HE01

We're a hardy family, used to weathering all manner of surprises as

we've seen four kids through various stages of toddlerhood, childhood

and adolescence. So when our fun-loving 22-year-old, , shocked

us by admitting a heroin addiction and asked for our help in

overcoming it, my husband and I froze only an instant. Then we leapt

into action, firmly believing that with the aid of 21st-century

medical treatment, we could help her reclaim her life.

Surely, we thought, college-educated suburbanites like us could locate

professional help: drug counselors, doctors, therapists specializing

in addiction. Surely detoxification centers would treat desperate

addicts and work out a payment plan. Surely we could check her into

some kind of residential treatment program with a minimum of delay.

We were wrong.

The next several months of trying to get her affordable treatment were

like entering some unknown circle of hell. Then the world as we knew

it came crashing down when two policemen showed up -- two years ago

yesterday -- to tell us that had been found dead of an

accidental overdose.

We're still adjusting to life in a reconfigured family that bumps

along like a wagon missing a wheel. Meanwhile, we continue to probe

the gaps in the addiction treatment system to share what we learn in

hopes of helping others avoid tragedy.

The Nightmare Begins

The phone rang at 4 a.m. on the day before Thanksgiving 2005. ,

living in Savage, always came home for holidays, but that's not why

she was calling that night. She was experiencing raging withdrawal

symptoms -- vomiting and muscle tremors -- and fear and physical pain

forced her to reveal her addiction.

Our first response was to leave our suburban enclave outside Frederick

and take to the nearest emergency room, assuming staff there

would admit her directly into some kind of treatment. How naive.

Instead, an ER doctor gave her a clonidine patch and said it would

take the edge off her cravings. Then he released her.

He handed us a single sheet of paper listing dozens of drug treatment

facilities in Baltimore. A sentence at the top advised us to call the

clinics every day, be polite and not burn any bridges. That puzzled

me, at first. Weeks later, with no progress toward finding help for

, I understood the admonition better.

During this initial foray into the drug-treatment world, we trolled

the Internet night and day. We Googled " heroin addiction " and thumbed

through phone books. It wasn't that there was no information; the

information overwhelmed us, without providing answers. We called one

place after another. But when private clinics learned that had

no insurance and had been determined ineligible for Medicaid, most

simply said " sorry " and hung up; and at $15,000 to $25,000 for a

28-day residential stay, they were out of middle-class reach.

The public, government-funded centers were stuffed to the gills, often

with patients from prison-related programs. As one counselor told us,

an addict can get in faster if he commits a crime than if he just asks

for help. " There is a false sense in the public that treatment is one

phone call away, " says Mike Gimbel, former director of substance abuse

education and prevention at Baltimore's Sheppard Pratt Health System,

now president of his own consulting firm. " It's a crisis, because

people believe they can get help, and it's not there. "

We learned about a whole range of treatment measures: detoxification;

individual, group and family therapy; residential treatment; 12-step

programs. And of course, medication. Like many (perhaps most) families

of addicts, we were completely bewildered. I realize now that drug

addiction and the problems in treatment have been old news for

decades. But when it happened to us, it was news to us. We had little

way of evaluating what we learned or figuring out what we didn't know.

Treatment options exist if families know how to navigate the system,

says Mady Chalk, director of the Center for Policy Analysis and

Research at the Treatment Research Institute in Philadelphia.

" Families need to know the right questions to ask, " she says, " and

someone needs to help them figure it out. " We talked to agencies,

crisis hotlines and counseling centers, but we often got conflicting

information, confusing us even more.

Relapsing

As days and then weeks passed, seesawed between wanting to

resume a normal life and craving heroin. Having moved back with us

temporarily, she talked about living drug-free, getting another job

and returning to college in Frederick County. She smiled; She said she

missed my cooking. Her friend Meagan came over, and we ate ice cream

and joked about the old days in middle school. In those moments I

recognized the laughing, affectionate daughter I'd taken to dance

classes for 15 years.

But other days the grim hand of addiction reached out and grabbed

, and she would hitch a ride with someone and head for

Baltimore. She would tell us she had a court date (she'd been charged

with speeding, drug possession, driving with a suspended license), or

she was just going to the movies. When we called to check on her, we

couldn't always locate her. Our hunts for her frequently lasted all night.

This is a normal pattern for most addicts; those who have successfully

gotten clean say it took them several attempts over months or years.

" They've been using and they keep using, because it gives them

something, and they don't want to give that up, " says Yngvild Olsen, a

Harford County internist certified in addiction medicine and the

medical director and acting deputy health officer for the county

Health Department. " Yet they hate the life. "

Three weeks after that pre-Thanksgiving confession, we got a

spot at the local health department's drug treatment program. She

began attending sessions two to three times a week, paying a fee ($20

a session) based on her meager income from a job at a restaurant. Most

of the treatment was group therapy; there were also family sessions,

which included us. We could see that the clinic was swollen with

desperate clients, and the overworked staff members were clearly doing

the best they could.

But 's seesawing continued. She would disappear and call from an

unknown location, saying she was fine. We wanted to believe her,

despite the wobble in her voice, but we couldn't. When we asked the

police to help find her, they said that because she was older than 18

she wasn't considered a runaway, but they would keep watch for her if

she had a warrant from a missed court date. Many were sympathetic, but

we mainly hunted on our own.

All this was made more difficult by the shame and fear surrounding

addiction. I couldn't help but wonder if everyone I told would look at

me as though I were an addict myself, or simply devoid of any moral

character, and not as a frightened mother. Experts describe addiction

as a chronic, relapsing disease, " like someone with diabetes that ends

up with out-of-control blood sugar that may have been self-inflicted

from not following his diet, " in the words of Compton, director

of the division of Epidemiology, Services and Prevention Research at

the National Institute on Drug Abuse.

But when your kid falls off the wagon, don't expect the same attitude

the diabetic gets. People tend to see addiction as an immoral choice,

a character flaw. And even though treatment has been shown to reduce

drug use by 40 to 60 percent, many people view it as a revolving door

for addicts who thumb their noses at sober living. The media spotlight

on celebrities who drop in and out of rehab doesn't help.

Since the public hasn't bought the disease model, Gimbel says,

politicians aren't willing to invest more public dollars in treatment.

" Politically speaking, it's more expedient to combat the drug problem

by hiring more police and building more prisons, " he says. " The public

thinks we can arrest our way out of this problem. "

Hoping for Detox

Over the next few months, continued the cycle of trying to quit

and relapsing. When the pains of withdrawal became severe, she visited

our local hospital emergency room. Each time, we hoped that she'd be

whisked into detox, a three-day hospital stay during which doctors can

prescribe medications, such as methadone, to ease withdrawal symptoms

and replacement therapy for the addictive substance.

The problem is, most hospitals and local treatment programs don't

offer detox. And few hospital ERs have addiction experts. " Detox is

viewed separately from the treatment system, " Chalk explains, and

never got that kind of medical help.

Even if she had, we now know that we would have faced another race

after the three-day program to find follow-up clinical treatment

without interrupting her care. Timing is crucial: Every once in a

while, such as after a successful detox, addicts reach a point where

they actually want help, Gimbel says: " It's a little window, hours,

maybe days if you're lucky. " But Chalk says that only about 25 percent

of addicts who undergo detox make it into treatment within 30 days.

wanted to stay close to home, so I didn't look hard in

Baltimore. Months after she died, I found that a few hospitals there

offer detox, though they're overburdened and she might not have been

able to get in. Still, I agonize every day over my belated discovery

and wonder why the emergency room didn't have a resource book or some

automatic way of telling people like us where the detox units were.

In May 2006, after months on a waiting list for a bed, got into

the ph S. Massie Unit of the Allegany County Health Department in

Cumberland, Md. She stayed 30 days. My husband and I visited every

Sunday and Wednesday while friends watched our younger children. I

split myself into two people: one, the mom baking cookies for the

elementary school reading party; the other, a worried parent driving

more than 100 miles each way to visit her eldest at a treatment clinic.

It was the only time during these months that we relaxed a little bit

and felt she was safe. By the third week of treatment, I said to my

husband, " I'm starting to see the sparkle back in her eyes. "

was released from Massie on a Friday. The following Monday, she

called us from the road: Instead of staying at the halfway house where

she was assigned after Massie, she had gone to live in Ocean City. She

said, " You know I love the ocean, Mom. " She said she had a job. Our

hearts sank.

Losing the Fight

Over time, told us that she had been doing heroin for about two

years, starting at Baltimore dance clubs and parties. It was part of

the fun, she said; she didn't think she'd get hooked. Again, she was

not unusual. Rather than getting caught up in the whys, Gimbel says,

he wants people to understand that the most pressing need is to find

treatment. " Saying 'All they need is some willpower,' like we used to

with tobacco, doesn't work, " he says. The drugs tell them what to do

24 hours a day, and conniving, manipulative behavior replaces their

old personality. When the drug urges were great, could always

figure out a way to get them.

And that is what happened.

On Oct. 6, 2006, I was at my youngest child's elementary school

helping the teacher. The holiday season was approaching again, and we

expected to come home as usual. After school, the younger girls

and I picked up their brother, Joe, from cross-country practice. Then

we got the " visit. " Two Frederick County police officers showed up as

I was preparing dinner. I left it burning on the stove after they told

us the words no parent ever wants to hear.

had been dead two days when she was found, after an all-day

party at the beach. She had alcohol, cocaine and methadone in her

system; the combination of depressants proved lethal. She'd been out

of Massie less than four months.

Families who know our experience come out of hiding to seek advice. I

see the same exhaustion and worry on their faces. I wince when I

overhear a crime drama on television refer to addicts as " crack hos "

or " junkies. " I'm a parent advocate member of the National Council on

Alcoholism and Drug Dependence, land Chapter. Each time I speak at

a drug treatment conference or interact with an addict in recovery, I

can't help but see and think: We can do better.

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