What It Feels Like to be an Addict From Someone Who Knows

I’ve been trying to get out more into the blogosphere and I’m amazed and totally psyched by all the great writing. There are so many awesome people sharing their life stories in ways that are both profound and poetic.

This week I was touched by Courtney’s posts at The “Me” Project. Earlier in the year, Courtney waded through some of her old journals and posted some entries about addiction. These are extremely poignant. One is broken into two parts and as I read Part 1, I thought about my sister. I could see her there among the words, particularly these:

At some point, you realize you are using now JUST to stay two steps ahead of your own terrible reality sinking in. When you are already so weakened, so compromised, so ghostly, it is terrifying to entertain the thought of actually turning around & seeing the path of destruction you left in your wake. It’s just too, too much.

Wow. Doesn’t this make your heart ache? Jerri has her own wake of destruction that even today she can’t bear to face. She’s left a canyon in her kids’ lives and wounded them in ways they will never get over. Jerri knows this. She didn’t set out to do it. She told herself as she handed them over one-by-one to our parents to raise that it was the best thing for them. Our parents could give them a life she never could. She tricked herself into believing each time that it was temporary. That she would get herself back together and then they’d be a family again.

But underlying the using was the untreated brain disorder and she couldn’t do it alone. And now, three of her kids are grown and she’s still failing the fourth because she doesn’t have money for the bus trip to even visit him. She’s still not at a place where she could bring her youngest son to live with her. She needs a job and a different housing situation. Even if she had these things, she’s emotionally unprepared to fight a custody battle with our parents and he’s been with them for 7 years. It would be traumatic to uproot him and what if he didn’t want to come? She can’t handle the guilt and the pain of it all so she refuses to think or talk about it. But she has to in order to heal.

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In Part 2, Courtney talks about what it’s like to stop using:

When you wake up in the morning, you are excited about what the day will bring, and when this occurs to you, you press your face into your pillow and you cry. You cry because you forgot what it was like to feel excited about your life, to be glad to be alive, to have hope. You forgot what it was like to be free, except that all along you had tricked yourself into thinking you were doing what you wanted, partying it up. Funny, not one memory from the past eleven years could match, could even come close, to this eager, happy, hopeful, brand-new feeling you had now. And all you did today so far was open your eyes.

There is so much joy in this paragraph. I want this for Jerri. I really do.

Here are the links to Courtney’s full posts. I hope they speak to you as much as they did to me.

Part 1: Memory Lane in a BAD Neighborhood.

Part 2: As Promised Part 2

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Only You Can Prevent Forest Fires (or Caramore Part 1)

The office for Caramore Community was not what I expected. Think non-profit, low budget, scuffed up, battered furnishings, cracked and sterile floor, walls badly in need of paint. Instead, the office appeared interior-decorated. There were two large seating areas with comfy chairs surrounding over-sized square coffee tables. The walls were painted a warm caramel with matching plush carpet. Magazines and plants were scattered about. The receptionist desk was a long white affair that stretched across the length of the room. We were greeted promptly by Samantha who quickly found Jerri’s appointment and brought her coffee.

After a short wait, Jacob, the admissions director, greeted us and escorted us back to his office. He stepped out to get a copy of Jerri’s application giving us a chance to check out his digs. On the wall behind his desk was a portrait of someone who might have been Andrew Jackson. It was hung upside down. To the right was a credenza stacked about a foot high with piles of paper. Above this hung 8 to 10 apple green paper plates as if they were china. Above these, a bathroom scale had been hung and it took me a minute to realize it wasn’t a clock. On the opposite wall, a tree branch reached into the room, it’s base framed with an ornate white frame. Interesting!

Jacob, himself, was soft-spoken but exuded a sense of purpose and authority. He began the interview by saying this was an opportunity for us to learn about Caramore and for him to learn about Jerri. They are very protective about their community. They have limited space and receive hundreds of applications a year. They only have space for 30 individuals in their residential program and there is a 4 to 6 month wait-list. They only accept individuals who are not a threat to the community – you must be stable on medications, no history of violence, clean/sober for 6 months, ready and willing to work. He told Jerri that he would request records from Telecare and it was important that what she shared with him aligned with Telecare’s records. It was important for her to be completely honest with him because dishonesty was a warning flag and would raise concerns about allowing her into the program.

He asked if she wanted me present during the interview or if she would be more comfortable if I waited outside.

“My sister can stay. She knows everything about me so there’s no reason for her not to,” Jerri replied.

He asked about her diagnosis and how she was first diagnosed. Listening to Jerri tell her story was hard – it brought back a lot of difficult memories and all the emotions I’d felt at the time washed over me again. I don’t remember some things exactly the same way Jerri does, but I have a lot of gaps in my memory – things I imagine I’ve blocked because they are just too painful. Jerri talked about repeatedly running away and our parents checking her into Mandala, a private hospital, when she was 15. One of Mom’s friends had a daughter, Connie, who had “acted out” like Jerri and Mandala had helped her. Mandala diagnosed Jerri as having mental illness – the actual diagnosis is unclear – but my parents never accepted the diagnosis. She did not get medication or counseling.

After that she started using drugs and skipping classes with a 38 year old woman who hung out at the high school, buying drugs and alcohol for the kids, and taking them home. Debbie sexually molested Jerri – at the time Jerri thought herself in a relationship with Debbie. She believed she was discovering her true sexual orientation was lesbian. But as an adult, Jerri recognizes Debbie was a predator. Jerri was so desperate for attention and affection, she was willing to go along with Debbie in order to feel loved.

Jacob then delved more into the substance abuse. “When was the last time you used?”

“Four months ago,” she said and explained the situation.

“If that is true, and I have no reason not to believe you, then you don’t mind doing a drug test today, right?”

Silence. Jerri looked at Jacob and said nothing for what seemed like eternity. Her hesitation was a dead give-away. Finally she spoke. “You’ll find crack in my system. I smoked it yesterday.”

Ayyyyyyyyyyyyyyyyy! I could just strangle her. Why would she do something so STUPID? She knew Caramore required 6 months of sobriety to get in. She read it on the website and even talked to me about it beforehand. Did she really not want in the program? Was this some twisted passive-aggressive way to get them not to accept her? Was she purposely sabotaging herself?

Jacob closed his folder and said, “I’m going to end the interview now. If I continue the interview it’s not going to go well with you and could prevent you from ever getting into our program. I’m going to reschedule the interview for 3 months and you will need to provide evidence of 3 months sobriety in order for the interview to occur. It concerns me greatly that when I asked when you last used you said 4 months ago which was not the truth. The truth is you used yesterday. Maybe you lied because you want into the program so badly. But if that is the case, the way in is through sobriety. This development delays when you could be considered for the program. If you are serious about changing your life, I’ll see you again in January. There are some people I’ve worked with for years to get them ready for the program. This is not a ‘no’. It’s a ‘you are not ready.'”

I could learn a lot from this man.

He refused to accept any of Jerri’s excuses. She said, “I don’t crave drugs any more. I wouldn’t use if people weren’t knocking on my door offering it to me for free.”

Jacob’s response: “No one held you down, forced the pipe in your mouth and made you inhale. Even when they bring it to your door, you have to take responsibility and say no. Even in Carrboro, crack is available. It will always be accessible no matter where you live. You can’t use that as an excuse. You are lying to yourself when you say ‘I wouldn’t use if I lived somewhere else.'”

As you might imagine, the drive home was a bit strained. Jerri couldn’t explain why she’d done it. I could feel myself disassociating.

“Here’s the thing, Jerri,” I said. “If you really aren’t interested in Caramore, you should have just said so. I took half a day off from work for this interview, and believe me, come January, I will not do it again if you use at all between now and then. What you did was inconsiderate of everyone – you, Jacob, and me.”

“I knew I’d made a big mistake the minute I did it. I don’t know why I did it. I was just so surprised when he handed me the pipe. I didn’t know how to respond so I just took it.”

“Jerri, the way your life is now is the way it will always be unless you choose to change it. That is if you’re lucky because right now you are dependent on the government and they could pull funding at any moment making your life even more challenging. You need to be dependent on you. You need to make a choice – do you want simply to exist? Or do you want to live? No one can make that choice for you. Only YOU can prevent forest fires.”

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That’s right. Everything I ever needed to know about personal accountability, I learned from Smokey the Bear.

Many of the bad things that happen in our lives are a direct consequence of choices we make. I’m not saying that we are responsible for EVERY bad thing that happens. Bad things happen all the time to good people out of no fault of their own. Last time I checked, 100% of us can expect to experience something devastating in our lifetime. The untimely death of a loved one. Debilitating illness. Estrangement. Divorce. Bankruptcy. Down-sizing. A crime against us. Abuse. We live in a broken world and no matter how good we are, how religious, how smart or careful or risk-adverse, there is no magic formula. Bad things happen, period.

But some bad things are avoidable. If I make my car payment, my car will not be repossessed, for example. I won’t lose my job because I don’t have transportation to get there. Smokey teaches me that if I don’t light a match and throw it into the woods, I won’t start a fire that may eventually consume me.

“If God wants me to get into Caramore then He will make it happen,” Jerri said.

Really? Because I don’t think so. God forgives but I can’t think of a single time that he supernaturally revoked the consequences of someone’s bad choices. He’s not going to, for example, plant the notion in Jacob’s head to rescind the sobriety requirement just for Jerri.

So the visit to Caramore did not go as planned. Jerri continues to talk about the program as something she wants to do. We’ll just have to see how the next three months unfold.


Truth and Freedom

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Growing up, I was a horrible tattletale. It was one of the main reasons Jerri didn’t want me hanging around. Jerri was always intrigued by the forbidden. Telling her not to do something was a sure-fire way of ensuring she would. And she was likely to get away with it as long as I wasn’t around. I was reminded of this as I dialed Bryce, her psychiatrist.

I hadn’t intended to tell him anything. My plan was simply to encourage him to connect with her internist, Dr. F. In fact, I hoped he wouldn’t even pick up and I could leave a vague but motivational voicemail. No such luck.

“Hello, this is Bryce.”

“Um, hi Bryce. This is Terri, Jerri’s sister? I had a conversation with Jerri yesterday and she said she’d spoken with you about Dr. F’s request that you contact him? Jerri said you didn’t want to call Dr. F. and I guess I wanted to see if that is accurate. I was with Jerri when Dr. F. asked her to have you call and I really think you should coordinate care with him. I, um, think that Jerri has, um, perhaps not been completely honest with you and I, um, think its very difficult to help her if you don’t have the complete truth. She said that you were going to um, put it in writing that you don’t have an issue with her getting Adderall–”

“I don’t think she needs Adderall that’s why I don’t write it,” Bryce interrupted. Thank, God! I was starting to flounder. “Jerri believes she needs it. I think she truly believes she has ADHD but I don’t see any evidence of that. She believes she can’t function properly without it. I disagree. If Dr. F, thinks differently . . .”

“Dr. F. told Jerri from the beginning, as long as she would submit to and pass a drug test at each visit, he would write the prescription. Last week, he said he would no longer write Adderall for her and that he wanted to talk to you to, uh, coordinate care.” Come on, Bryce. Don’t make me spell it out for you.

“Interesting. I didn’t know about the drug tests.”

“Yes, well, that’s why I think it’s important for you and Dr. F. to talk. Look, this is really awkward for me. I was at the appointment. I know Jerri isn’t telling you everything. But there’s something you need to know if you’re going to help her. I feel like by telling you, I’m disrespecting Jerri’s right to privacy.”

“You’re only calling because you care about her and want to help her.”

Yes, and how can anyone help Jerri when she doesn’t tell the whole truth? Not only does she lie to others, but she lies to herself. She doesn’t admit Adderall has any euphoric effect on her, although it’s clear to even the most casual observer that she’s operating under the influence when the drug is in her system. She says it doesn’t make her high that it just helps her concentrate and focus. She says people tell her she’s not herself when she takes it but that’s only because when the Adderall is in her system, she stands up for herself-that’s why she’s different. She doesn’t admit her ongoing attraction to cocaine. She says, “It was just one time. I’d felt so bad for so long, I thought it would make me feel better. I won’t do it again.”

Jesus once said, “You shall know the truth and the truth shall set you free.” What I also believe is, “You shall tell the truth and the truth shall set you free.” Jerri will never be free until she is honest with herself and those trying to help her.

On the other hand (and this is what I do to make myself crazy, turn every issue over and over again to look at it from all sides) when you tell the truth, there are consequences you’d likely avoid if you hadn’t. How will Telecare respond to confirmation of drug use? Will they tell Housing for New Hope? Will Housing for New Hope evict her? This is what Jerri is afraid of. Honestly, that worries me too. But more than that, I’m worried Telecare will decide they can’t help her and will fire her as a patient. Jerri needs their help, and frankly, so do I. There is only so much support I can provide on my own.

These are all the thoughts that ran through my head as I weighed what to do. And then I spilled. I told Bryce everything. I told him Jerri’s lab results were positive for cocaine. That this was the second time she’d had a positive test in the past year.

I told Bryce the truth as I know it and then I asked him not to tell Jerri we’d spoken. In essence, I told him the truth and then asked him to lie. How whacked is that? Now, I’m trying to figure out if I should just tell Jerri I spoke to Bryce. Thoughts, anyone?


Truth and Consequences

Jerri’s lab results came back from her internist visit two weeks ago and Marsha, Dr. F’s nurse, called to say she had scheduled a follow-up visit on Thursday. Dr. F wanted me to be there if at all possible. That sounded ominous but Marsha could not elaborate. Thanks to HIPAA (Health Information Portability and Accountability Act), there was one more privacy form Jerri needed to sign to grant permission for Marsha to tell me more.

Immediately, my mind began jumping to conclusions. Either the lab results indicated a potentially serious medical condition or Jerri had failed her tox screen. Dr. F has an agreement with Jerri. He does a drug test every time she comes into the office. As long as she passes, he is willing to write her an Adderall prescription. If you are new to the blog, you might want to check out The-Medication-of-Which-We-Do-Not-Speak for a little background.

So I called Jerri to see what was going on. “Huh. Well, I think I know what that’s about but I don’t want to talk about it now.”

“Sorry. You’re going to have to,” I said. “Otherwise, I’m going to worry for the next three days.”

Silence.

“Are you still there?”

“Yes. . . They probably found cocaine in my system. See, I accidentally smoked a cigarette laced with cocaine and–”

“Accidentally? How does one accidentally do that?”

“Okay, I did it on purpose, alright? I’ve felt so bad for so long. And nobody will do anything to help me so I thought, why not? It’ll make me feel better for a little while. It didn’t, it never does, but I thought it would. Maybe.”

“Where did you get it?”

“I don’t want to say.”

“You realize you’re putting your housing in jeopardy? That using is in clear violation of your lease?”

“I wasn’t thinking clearly. If I’d had the-medication-of-which-we-do-not-speak, then I would have been able to think it through and make a better decision.”

I did not bother to ask why Jerri didn’t have the-medication-of-which-we-do-not-speak because it’s a schedule II controlled substance and at least half of the time, it “disappears” immediately after she fills the prescription.

So on Thursday, in the exam room, Dr. F revealed that her lab results were normal except for what looked like a urinary tract infection and, of course, the presence of cocaine.

“I know it looks bad, Dr. F, but it was a one time thing. I have felt so bad and someone offered me a cigarette laced with crack and I thought it might make me feel better for a while. It was three days ago. I didn’t think it would still be in my system.”

“Three days ago, huh?” Dr. F. said. “Do you know how long cocaine stays in your system? Four to six hours.” (BTW, I googled this and cocaine can be detected as much as 2-5 days after use depending on a lot of individual factors such as age, weight, gender, metabolic rate, general health, etc.)

Jerri stuck to her story. “Well then, that’s just evidence that something really is wrong with me. My body is not metabolizing stuff the way its supposed to.”

Did I mention that in the waiting area, Jerri had fretted about what to say to Dr. F about the cocaine? “I’m just going to tell him the truth,” she said. But here’s the issue. My mom and my sister both have the same approach to “the truth.” They revise it and then convince themselves the edited version is what really happened. So when they tell you the “truth”, it’s not really lying. It’s actually what they believe. They have this amazing capacity to not only believe their own fictionalized account, but worse, to tell it so convincingly that even you start believing it. (As strange as this sound, its apparently something we all do to some extent. It’s called “cognitive dissonance.” Sometimes you can’t find a logical, moral or socially acceptable explanation for your actions. If your behavior runs counter to the expectations you have of the person you believe yourself to be, you have to come up with a justification to feel good about what you did.)

When you’re constantly bombarded with this kind of “truth” as a kid, even when you were actually present and saw what really happened, you start second-guessing yourself. You think, “I saw X but Mom said Y is what happened so there must be something I missed.” Talk about crazy-making! To trust my own interpretation of events means calling Mom a liar and that’s really hard when you’re a kid. Heck, it’s hard as an adult. It’s easier to buy in to her version and I find myself falling into this same pattern with Jerri.

Dr. F continued. “Do you know what the standard threshold concentration level is for detection of cocaine in a urine test?” (Jerri shook her head.) “300 ng/ml. Do you know what your levels were?” (Again, Jerri shook her head.) “4700 ng/ml.” (I have no idea if this is really high or if it proves more recent use than 3 days. Anyone?)

Then Dr. F explained he would not be giving Jerri another prescription for Adderall. (To my credit, I refrained from whooping and dancing around the room.) She would need to have several clean tox screens before he would even discuss it with her again. And he wanted to coordinate care with Bryce, her psychiatrist. He asked her to give Bryce permission to call him. FINALLY!

Jerri took it better than expected. She seemed to get that this was a consequence of her own choice to use. Dr. F, after all, had clearly warned her sobriety was a condition for continued prescriptions. As we left, however, Jerri muttered something about finding another doctor. And its been 2 weeks now and I’ve heard very little from her. I’m afraid the victory will be short-lived.


Great Post on Dual Diagnosis and Self Medication

This is the first time I’ve re-posted another author’s work and I’m not sure of proper etiquette. The original post can be found here. I thought about summarizing but the post is so informative, I didn’t want to leave anything out. Of particular interest to me is the part on which came first, the addiction or the mental illness. As I’ve shared before, my mom strongly believes Jerri’s mental illness was triggered by her drug use in her teens. When I look back at our childhood, however, there were a number of signs that indicated something wasn’t quite right long before Jerri hit puberty. I’d heard of the Self Medication Hypothesis, which posits that the addict’s drug of choice is actually selected because of the drug’s effect on the “primary feeling states” of the user. In other words, the user understands, perhaps subconsciously, that something is off and upon trying various drugs, becomes addicted to the one that makes her feel less “off”. Interestingly enough, mood disorders including bipolar and ADHD are more common in cocaine abusers (Jerri’s drug of choice) than opiate abusers (20% vs 1%).

I did not include all the links in the original article so worth visiting it if you find this as fascinating as I do. Hope you find informative and please share your thoughts!

Addiction Causes: Understanding Self Medication And How I Lost My Sister To Substance Abuse

(by Victoria Costello, Posted: 02/25/2012 11:33 am, Huffington Post)

In light of the continuing controversy surrounding Whitney Houston’s death, including questions of blame and responsibility for what the coroner may determine was an overdose involving drugs and alcohol, here is a look at the science behind the central and often misunderstood concept of self-medication in mental illness, addiction and recovery. My interest in this is both professional and personal. My sister Rita died of a multiple drug cocktail at age 38 — after a downward slide that began over 20 years earlier and finally caught up with her. She was, like Whitney Houston, a victim of her own demons and a culture that favors self-medication over getting mental health treatment. As both of their premature deaths demonstrate, self-medication and aging don’t mix well.

Mystery of the Missing Spoons

When spoons began to disappear from my mother’s silverware drawer in the late 1960s, neither my mother nor I suspected my younger sister Rita’s dope use. It didn’t dawn on us that heroin had be mixed with water and cooked over a flame before it was injected. At that time, my friends and I smoked pot regularly, and we had also tried psychedelics, mushrooms and acid — tried being the operative word. Rita went further and did it much faster and more overtly. She flew through pot and discovered barbiturates, speed and cocaine.

Heroin was too pricey without help from an older dealer-boyfriend. Nonetheless, by the time she was 16, Rita had made it her drug of choice. Between boyfriends, she stole to finance her new habit. Mom’s wedding band was one of the first casualties. Soon, cash could no longer be left in a drawer or purse. This was before drug rehab as a concept had entered the American cultural lexicon, certainly that of the suburban northeast, leaving my mother baffled and ashamed at the behavior of the prettier and once the easier of her two daughters. My mother was an unknowing soldier in what had become all-out guerrilla combat.

What Remains

When President Richard Nixon declared his war on drugs in 1971 — hopelessly lost in the
four decades since — it did one constructive thing by creating a new and favorable climate for
research into the causes of addiction. This research gave birth to the field of drug rehabilitation, and out of this wave of new treatments came the theory of self-medication — the idea that addiction comes about because people are attempting to alleviate the distress of preexisting mental disorders. The concept had come originally from Freud, in 1884, after he noted the antidepressant properties of cocaine.

By the 1970s, the theory of self-medication formally arrived, and immediately caused a storm
of controversy because it challenged views then held by the medical community and law
enforcement that attributed drug abuse to peer pressures, family breakdown, affluence, escapism and lax policing. For the first time, the nation’s newly minted white, middle-class drug addicts (typified by my sister) were joining their less affluent urban counterparts, who were already populating U.S. jails and hospitals. Junkies — hippies, rich and poor, black and white, addicts and alcoholics — constituted an equal-opportunity mental health crisis for public health doctors on the front lines of treatment in big-city hospital emergency rooms.

The father of the self-medication hypothesis is Edward J. Khantzian, a founding member of the Psychiatry Department at Harvard’s Cambridge Hospital. Writing in 1985, Khantzian stated his belief that addicts weren’t victims of random selection. Instead, he explained, they had a drug of choice: a specific drug affinity dictated by “psychopharmacologic action of the drug and the dominant painful feelings with which they struggle.” Like Freud, he pointed to the
energizing effect of cocaine and other stimulants in response to the depletion and fatigue of
addicts dealing with preexisting depression. In his patients who abused opiates, including heroin, Khantzian noted their calming effect on the addicts’ typically problematic impulsivity. This point particularly hit home for me as I recalled my sister Rita’s tendency to get into fist fights with her arresting officers, crash her car and land in the E.R. after passing out in public places.

The idea that human psychological vulnerabilities had anything to do with addiction was a
new piece of the puzzle, and it reflected Khantzian’s psychoanalytic background as much as
his clinical work at the Cambridge Clinic. Decades later, self-medication is accepted medicine
within the mental health field. However, broader cultural understanding of its implications
for individuals with undiagnosed mental disorders who may be self-medicating has lagged far
behind; not unlike continuing popular resistance to addiction as a disease over which the addict has little or no control, and widespread refusal to accept the robustly established precept that treatment for addiction is effective.

One of the major stumbling blocks to greater understanding of the principle of self-medication appears to be the culture’s continuing confusion about which comes first: the mental illness or the addiction.

One sign of this missing understanding has to be the recent vitriolic “debate” over New Jersey’s decision to fly its flag at half-staff in honor of Whitney Houston, one of the century’s greatest musical artists; a celebrity whose cause of death will no doubt reflect her two-decade struggle with the disease of addiction but is not likely to include any recognition of an underlying mental disorder.

Chicken or Egg?

The fundamental question of which comes first when someone has what is now called a “dual
diagnosis” remained unanswered up until the 1990s. In 1992, with a first-of-its-kind national
survey of the state of the nation’s mental health called the National Comorbidity Survey (NCS),
scientific understanding of comorbid addiction and mental illness went mainstream. The NCS
evaluated 8,098 average Americans, ages 15 to 54, interviewed in face-to-face home settings by trained laypersons — making them far less able to lessen or deny symptoms and patterns.

Among the striking results of the NCS survey: 45 percent of those people with an alcohol-use
disorder and 72 percent with a drug-use disorder also had at least one other mental disorder.
Perhaps more important at a time when the self-medication theory was still under attack, the
NCS survey provided a concrete and comprehensive answer to the chicken-and-egg question
about addiction and mental illness.

So Which Is It?

The NCS showed that when an alcohol disorder accompanied another mental disorder, the alcohol abuse began after the individual was suffering from symptoms of the other mental disorder, usually a year or more after. Not including other forms of substance abuse, the most common preexisting mental disorders reported among those interviewed were anxiety, depression, and, for men, conduct disorders.

When an updated NCS survey was done with a new group of ten thousand people in 2002
(called the NCS-R, for “replicated”), its findings were strikingly similar to the first. Faring
worst by age group in the 2002 numbers were 36- to 44-year-olds, among whom 37 percent
had anxiety disorders and 24 percent had mood disorders in addition to their alcohol abuse
issues. Depressed women in their 30s and 40s have a 2.6 greater risk for heavy drinking,
compared to those without major depression. It occurred to me as I read these numbers that
age 30 to 44, when comorbid disorders are highest, are also women’s prime childbearing years.

A 2012 report by SAMHSA (U.S. Substance Abuse and Mental Health Services Administration) offers an eerie corollary in its finding that 10 percent of American kids today live with an alcoholic parent — certainly a conservative estimate.

Too Late For So Many

My sister Rita died at 38; a year after an overdose of barbiturates and alcohol put her into a
three-week coma and, upon waking, left her unable to walk or talk. It was the end of a torturous 25 years for her and for those of us forced to helplessly stand by and watch. While packing for a move not long ago, I found a letter I’d received from Rita, written during her first stint in Rockland County Jail for robbery a decade earlier, dated March 1982:

I should have known I was heading for trouble again. I was having black outs from small amounts of liquor (small amounts for me). But I went on another drinking binge and now I’m back here again. I guess I’ve hit the pits this time. I just finished speaking to a woman from the jail ministry. She’s quite sure that God brought me back here to save my life or try again. She may be right. I just feel really bad now that I won’t be home for Easter when you come. So much for all that. Meanwhile pray for me, forgive me for letting you all down, try to talk to Mom for me and take care of my beautiful nephew. Love, Rita.

I didn’t have any inkling of the unequal effect of alcohol and drugs on different people back in
the 60s when my friends and I started experimenting with whatever we could get our hands on. Back then, I suppose I went no farther than thinking that Rita and others like her were weaker than I was in some fundamental way. Science now illuminates the finer points of the unequal inheritance of predispositions to addiction even in the same family, as well as the debilitating effects on those who carry the heaviest genetic load, especially when they grow up as my sister and I did in a family and culture where, due to the continuing widespread stigma towards those with a mental disorder, self-medication is the preferred option to seeking mental health treatment.

In this broader and hopefully more enlightened context, simplifications like personal weakness
simply don’t cut it anymore. It’s time for the culture to catch up with the science and practice of treatment and recovery.

Victoria Costello is an Emmy Award winning science writer with articles in Scientific American MIND and Brain World. In addition to HuffPost, she blogs for PsychCentral.com and her own MentalHealthMomBlog. As an advocate for a prevention approach to mental health, she serves on the board of the Mental Health Association of San Francisco and leads workshops for parents and providers around the U.S. Her latest book, A Lethal Inheritance, A Mother Uncovers the Science Behind Three Generations of Mental Illness is available from Prometheus Books.


Ghosts of My Past

When I was in ninth grade, Angela told me Jerri was using drugs. We were in the fellowship hall of King First Baptist Church either before or after youth group and completely out of the blue, as I remember it, she said,”your sister is doing drugs, you know.” She said it, not as a friend out of concern for another friend, but as an adversary who knows something that will hurt you and has picked the exact moment when you are most unsuspecting to slap you with it.

I can still physically feel the pain of that moment. The queasy sensation of my stomach bottoming out, the dull ache in my chest of hot wax being poured in and hardening, dizziness, my brain turning to cotton. My body went cold all over and then my face burned with, what? Shame? Anger? Fear? Something inside me knew Angela was not just being cruel. She knew something I didn’t.

“She is not!” I shouted. “My sister would NEVER do something like that.”

Angela smirked. “She is, too. I saw her. But you can believe what you want. I just thought you’d want to know.”

I didn’t want to know. I wasn’t ready to leave the imaginary land of happy, healthy family. I think there’s a voice inside all of us that whispers, “if you don’t acknowledge it, it’s not really real.” You know the one I’m talking about. It’s called Denial.

I tried to push the accusation aside and ignore it. I told myself all the things you usually do when people say things that hurt you. Angela is just jealous. Angela was just taking her bad day out on me. But in the end, I couldn’t let it go and I confronted Jerri.

“Are you doing drugs, Jerri? Because Angela said she saw you.”

“No! You know me better than that. I wouldn’t do that!” It was the smoothest lie that had ever been told. She looked me directly in the eye, her expression genuine, her tone of voice the perfect balance of sincerity and righteous indignation. Not a flex of a facial muscle to give her away.

Cut to the present.

Jerri’s birthday was Thursday. I gave her a low-end microwave from Walmart. She eats a lot of frozen dinners and uses her neighbor’s microwave frequently. This creates some tension in their relationship so we both thought a microwave was a good idea. I bought the microwave several weeks ago knowing my workload was about to get hectic.

A few days before her birthday, Jerri called. “You know I’ve changed my mind about my present. I’d rather have a PS2. It costs about the same as a microwave and it will give me something to do.”

“I think you need a microwave more than a PS2, Jerri. Besides, I already bought it.”

So Thursday night, I delivered the microwave to her apartment, unpacked it, plugged it in and then took her to dinner at her favorite restaurant. As we left her apartment, she locked the door from the inside then pulled it shut. She then pushed on it to verify it was locked. It pushed open. She slammed it and locked it with her key and checked it again. This time the door stayed locked. As we left the apartment building, I noted that someone had propped the outer door open with the mat.

“That’s really dangerous for everyone, Jerri, why don’t you pull the mat out so the door locks?”

“I wasn’t the one who put it there.”

“Yeah, but it’s your building too. It’s your security.” She shrugged and left the door propped open.

At dinner, she tried to convince me to drive her to her doctor’s office the next morning but just the thought of trying to juggle that was giving me high blood pressure so I said, “sorry, you’ll have to take the bus.” She grumbled about this saying it takes 3 hours round trip on the bus whereas if I’d take her, it would be more like an hour.

On Friday at 11:30 am, Jerri called me at work. “I just got back from the doctor and my microwave is gone.”

“What?!! How could that happen? Wasn’t your door locked?”

“Well, I thought so but I must not have checked it.”

“Was the door to the building propped open when you left?”

“Yes. Should I call the police and report it? They aren’t going to do anything about it anyway. It’s not like they are going to get it back for me.”

“I don’t know. Did you talk to Brian [property manager]?”

“No, he’s not here.”

“Was anything else taken? Your TV or your computer?”

“No, the TV is too heavy and the computer would be a hassle to take.”

“Well, the microwave was heavy too.” I’d been lugging the thing around, from the store to my car, my car to the garage, the garage to my car, the car to Jerri’s apartment. Given Jerri’s neighborhood, whoever took it was probably on foot and that’s all he could handle. It might even have been taken by a neighbor and still be in her building somewhere. Would the police be willing to search door to door? Probably not. Would Brian? What to do. What to do.

My brain raced around in circles and then came to a screeching halt. Everything Jerri said added up. Her door not catching and locking – I’d witnessed this myself numerous times. The building door propped open. Unsavory characters routinely cutting across the property. Jerri not home for several hours because of the bus and her doctor’s appointment. But something was bothering me. It seemed too predictable. Hadn’t another client told Telecare she saw Jerri talking to her dealer all the time? Was I being played here? And wait just a minute. Jerri wanted a PS2. Couldn’t she have brokered a trade?

“Jerri, I hate asking you this, but I have to. Did you sell the microwave to someone?”

“No! You know me better than that. I wouldn’t do that!”

Huh. Now let’s see. Where have I heard that before?

This particular ghost won’t stop haunting me. Am I crazy to keep applying something that happened over 30 years ago to present day situations? Is that part of your being which we refer to as character already intact by the time you reach your teens, and if so, is it fixed or can it change? Is it possible to ever trust someone again after they’ve lied to you so smoothly and so soundly about something that devastated the world as you knew it?

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I called Brian to report the theft and confessed “there could be other explanations for the missing microwave but Jerri said it was stolen. Her story aligns with several key facts I’ve witnessed myself. So, at least for now, I’m choosing to believe her.”

“I think you have to,” Brian said, “until you have evidence to suggest otherwise.” And then he went on to describe the steps Housing for New Hope is taking to improve security by replacing all locks on apartments with good quality locks and installing video cameras. He also explained that the bigger problem was the community there doesn’t take care of each other. Every man is out for himself. Neighbors may appear to be friendly but it’s not real and they will stab you the minute your back is turned. He has worked in other housing communities where they were able to turn this around. He hopes to transform this community but knows it won’t happen over night.

“Propping the door mat open is a real problem and I’m aware of it. But here’s the thing. No one is going to pull the mat out if they didn’t position it in the first place. Given the current climate in the community, that would just set them up as a target. They are afraid of retribution.”

Hmmm. The fear Jerri deals with is on a whole other level from my own. So thinking about my particular ghost, I ask myself, “So what if Jerri is lying? What are you afraid of?” I realize my biggest fear is of looking stupid. Of standing up for Jerri while everyone else shakes their head and says “how pathetic.” My dad used to say, “Fool me once, shame on you. Fool me twice, shame on me.” And that’s it in a nutshell. Jerri fooled me once. I’m finding it takes a lot of strength to put myself at risk to her doing it again.


The Dilemma of Duality

My sister and I went to lunch today. When she called to discuss restaurants, she suggested a pricey place where we’d gone as an early Thanksgiving treat. Keep in mind that whenever we go out, I pay.

“That’s a restaurant for special occasions, Jerri. That’s not the kind of place I go for an everyday lunch.”

“Yeah, I know. I’m just hungry. And I was thinking about that wedge salad. It was so good and I feel like wine.”

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“Well, I want it.”

“The place where we’re going doesn’t serve it.”

“Well then, let’s go some place else.”

Grrrr. It’s not that I have issues with wine. Or that I’m a cheapskate. Its just that Jerri has a dual diagnosis of bipolar disorder and substance use disorder—its irresponsible to buy her alcohol.

Jerri hates the substance disorder label. Moving here gave her the opportunity for a fresh start and she didn’t want me to tell any of the mental health professionals about that diagnosis. I couldn’t honor that request. She was in pretty bad shape and I’m not equipped to determine what is psychosis and what is drugs. When Jerri was in her 20’s, she was terribly addicted to cocaine. She believes the ECT treatments she had in her 30’s cured her of cravings and I’m pretty aware of where her money goes each month. I’m confident she’s not buying street drugs but I’d only be fooling myself if I didn’t acknowledge there are other ways to get them.

What most disturbs me is the unhealthy relationship she has with ADHD meds. I’ve seen her beg and conjole her psychiatrist and her internist for a prescription. In the past when she’s been told “no”, she’s looked for another doctor. That is a classic red flag. Bryce has been very clear that if she does that with him, she will lose Telecare as a service provider.

I’ve been quite vocal with both Bryce and her internist about my concerns. Bryce will not prescribe ADHD meds for her but her internist continues to do so. He sees her monthly and tests for substances each time before writing the prescription. I still think its a bad idea.

Ritalin is the only one of her meds that she never forgets to fill. It’s also a schedule 2 controlled substance. “I need it”—three of the scariest words in sister-of-dual-world— “and I can’t focus without it,” she says. “I can’t read. I can’t crochet. If you only knew what it was like for me when I don’t have it, you’d understand.” I am concerned that Jerri tries to solve every issue with medication.

Before she moved to her current living arrangement, she would hide the bottle or carry it everywhere she went. It was like her most prized possession. “Do you know the street value of this stuff? Everyone is after my medicine.”

In the past year, there have been about 6 times that her medicine has “disappeared” or she’s gone out of her right mind after filling the prescription or she’s “flushed it” because she’s realized she can’t trust herself with it. Really? Do I seem that naïve?

Once when we went to the beach together and I was keeping up with her meds, she took 4 pills when I wasn’t looking. She woke the entire house that night talking to herself. I thought she was having a manic episode until I did a pill count. She denied taking them and even went so far as to accuse my sister-in-law and my husband–utterly ridiculous to anyone who knows them. She became so out of control, I forced her into the car at 4 am and drove the 3 hours back to Durham where her case worker stepped in to help.

Afterwards, I started second-guessing myself. Maybe I’d been wrong and she was manic. Maybe I’d handled the whole thing terribly wrong.  I contacted one of Jerri’s former psychiatrists – someone who’d been helpful to me in the past – and described the beach episode. Before I mentioned the missing pills, she said “that’s not mania, that’s substance abuse.”

And see, that’s my problem. I can’t always tell the difference. And I can’t rely on Jerri to help me. Jeffrey, a therapist, says, “You know how you can tell an addict is lying? Her lips are moving.” It’s incredibly difficult to have a relationship with someone you have to assume is always bending the truth.

How do you know when it’s mania verses substance abuse verses a side effect of her medication? Once she had an episode so bad, she couldn’t figure out how to put on clothes. Her internist found cocaine in her system. Jerri denied having any knowledge of how it got there – she said her rooming house mates must have slipped it to her. Jeffrey would say “lying” but her story is not entirely improbable. Both housemates were also unstable and she was not getting along with them. She found a new living arrangement shortly thereafter.

Another time, I stopped by and Jerri wasn’t herself. She wasn’t thinking clearly and had strange muscular contortions. I called Bryce, thinking she had taken too much of her medication, and he said what I was describing actually occurs when someone has missed 2 to 3 days of the antipsychotic she takes.

Its also difficult for me to view substance use disorder the same way I view bipolar disorder. I’m just being honest. Experts consider both to be biological illnesses. There’s a fine line between substance abuse, where a person might still exercise choice and quit, and addiction, where the brain is biologically transformed with insatiable craving. How do I know she’s actually crossed that line and this is not just self-medicating?

In the end, I’m not sure it really makes that much difference. What I do know is the old adage you-got-to-let-em-hit-rock-bottom doesn’t work with Jerri. So I’ve had to draw boundaries. I’ve told her I don’t believe Ritalin or drugs like it are in her best interest. I will not help her with this medication. I won’t drive her to the pharmacy to pick it up or to her monthly doctor’s appointment. And I will not listen to any stories about how it mysteriously disappeared or someone stole it or how it must have fallen out of her backpack on the bus. My sister may be bipolar but she is still an adult free to make her own choices even ones that interfere with her recovery. I cannot control her. I can only control me.