Pubdate: Tue, 7 Oct 2008
Source: Washington Post (DC)
Page: HE01
Copyright: 2008 The Washington Post Company
Contact:  http://www.washingtonpost.com/
Details: http://www.mapinc.org/media/491
Author: Jacqueline M. Duda
Note: Jacqueline M. Duda is a Washington area freelance writer.

WHY WE COULDN'T SAVE NICOLE

Finding Treatment for Addiction Was Harder Than We Thought

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, Nicole, 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 Nicole 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. Nicole, 
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 Nicole 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 
Nicole, 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 Nicole 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, Nicole 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 
Nicole, 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 Nicole 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 Nicole'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 
Wilson 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, Nicole 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 
Nicole 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.

Nicole 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, Nicole got 
into the Joseph 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."

Nicole 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, Nicole 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, 
Nicole 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 Nicole 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.

Nicole 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, Maryland Chapter. Each time I speak 
at a drug treatment conference or interact with an addict in 
recovery, I can't help but see Nicole and think: We can do better.
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MAP posted-by: Richard Lake