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      The Anatomy of a Heroin Relapse The Anatomy of a Heroin Relapse
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      The Anatomy of a Heroin Relapse

      By Tony O'Neill

      March 21, 2016

      This piece was published in partnership with The Influence.

      After ten years off junk, it wasn't something I thought about much anymore.

      In the early days, every morning seemed to begin with an internal debate about whether or not to use. After a while, the voice inside advocating "just one last taste" faded out into a ghostly echo, and then one day it wasn't there at all.

      I had been off junk longer than I had been on it. I had beaten it, moved on. I had built an entirely new life. Become a father. Begun a career as a writer. The likelihood of relapse felt as distant and unlikely as the idea of a piano falling out of the sky and landing on my head.

      Until, that is, I relapsed.

      It started with the accident.

      Of course, nobody expects stuff like this to happen to them. And it was over so quickly. One moment my daughter and I were walking out of the grocery store. She'd been working on her fifth-grade class project, and we both needed a change of scenery after three solid hours of assisting with glue-sticking, coloring in the lines, and cutting things out. So we went to buy a snack.

      I left the house at 9 AM with the vague intention of finding something, and by 1 PM I was back at home with a bundle of smack.

      It was a gloomy Monday in January 2014, around 5 PM, when we left the store.

      I took her hand and waited until the traffic had come to a full stop, stepped out and checked that there was no oncoming traffic on the other side. We were clear. As we began to cross, the world suddenly turned upside down. I remember feeling my ribs compress and the breath being knocked out of me as I hit the asphalt. In the moment of silence that followed, everything took on a dreamlike haze. Then one of the tangerines we had just bought rolled past my line of vision, and I was jolted back to reality.

      I found out later that an SUV had cruised past the car that had stopped to let us cross. Distracted, she had assumed the car in front of her had stopped to make a turn instead of to let pedestrians cross, so she drove around it and creamed us at approximately 20 miles per hour.

      When I made it to my feet people were already out of their cars, everything drenched in the harsh beam of headlights, people yelling at me to stop moving, telling me I might be badly hurt.

      I remember seeing my daughter's sneakers lying surreally in the middle of the road. She had been knocked clean out of them. A few feet away from them I saw my daughter, lying completely motionless in the middle of the street.

      Let me stop for a second to say that she survived the accident and is fine. As I write this, she is running around in the park with a school friend. The extent of her injuries was a concussion, a few teeth knocked loose, and severe bruising. She doesn't even remember the accident, only the events before and after. Lucky her.

      The doctors later told me it could have been much worse. Apparently, in an accident like this, the most important factor is how you land.

      My daughter landed well.

      Of course, when I first saw her splayed motionless in the street, I knew none of this. I stumbled over to her and saw that she was lifeless and limp as a rag doll. Terrified of moving her in case her spine had been damaged, I begged her to wake up, gently stroking her face.

      Luckily enough, an ambulance was on the scene almost immediately (the medics were responding to a nearby emergency), and as they were strapping her into the gurney, she suddenly woke up, gasping as if surfacing from underwater, and began screaming in pain and confusion.

      That in-between period—those interminable moments of crouching over her, screaming for her to wake up, begging her to not be dead—all in all, probably lasted no more than 120 seconds. But even now as I remember them, they seem to stretch on forever. With each passing second that she did not respond to my voice, did not open her eyes—all of this as people were trying to pull me away from her—the possibility that she was, in fact, dead began to dawn on me.

      I don't know if you have to be a parent to really understand what it is like to face the possibility that your child is dead. The chasm of despair that opens up inside of you. I am a writer by trade, and I have spent the last few weeks writing and rewriting this paragraph, trying hopelessly to capture the awful pain that I felt, even though it lasted for just a few fleeting minutes. I keep coming up a blank. This is the best I can do.

      Of course, this isn't a story about an accident; it's a story about a relapse, although the two events are helplessly intertwined in my head. The accident—or those frozen moments of horror following it—marked the dividing line between the Tony O'Neill who wrote some time ago about ten years heroin-free without AA, and the Tony O'Neill writing this piece, conducting a kind of investigation into how this happened.

      In the months following the accident, I completely unraveled. Had I always suffered from a kind of depression? I think that yes, I had. There are many branches of my family tree that are not talked about, men of my blood who met their demise at the end of a rope or at the bottom of a whiskey bottle. I am not completely sold on whether there is a genetic component to depression and addiction, but my family history seems to support the idea.

      The transition from pills to heroin happened in the blink of an eye.

      For most of my life my lows tended to be extremely low and my highs extremely high, and I went through long periods where a kind of black cloud descended upon me and the only thing to do was hold on and ride it out. But I had never taken any kind of psychiatric medication, fearing that a blunting of those feelings might upset the delicate chemical balance that allowed me to be creative, either as a musician, as I was in the early days, or as an author.

      If you don't recognize my name, don't worry—I'm not Stephen King, nor Salman Rushdie. But I have managed to write and publish enough books to call it a career without feeling like a fraud. For someone who depends upon that mysterious creative urge, the fear that antidepressants might somehow upset this delicate balance was very real.

      But after the accident, things changed quickly.

      There were the nightmares, of course. I had them several times a night in the first few months, repeatedly reliving the accident, often with horrible variations: mangled flesh, a car bearing down on my child in slow motion while I remained rooted to the spot.

      But the anger was probably the worst. My wife noticed it first. Despite the fact that our daughter made a speedy recovery with no cognitive impairment, my rage at the driver and the insurance companies and fate and myself did not fade over time—it increased. I found myself unable to write, and several times a day would simply space out, slipping into a daydream, reliving the accident again, heart pounding and drenched in cold sweat. I would force myself to change tack when I caught my thoughts drifting back to that day, but it was often too late, and I was either plunged into pervasive sadness or furious rage.

      My wife repeatedly suggested that I speak to someone—a doctor, a therapist, anyone—but I refused. I wasn't crazy, after all. I was angry. And I had every goddamned fucking right to be angry, thank you very much.

      And besides... I had a shitload of painkillers.

      I am not a part of this younger generation of heroin addict, weaned from the teat of pharmaceutical dope. I am of the previous generation, the kind of junkie who idolized Johnny Thunders and William Burroughs and Chet Baker and Lenny Bruce as a child, and for whom it was seemingly only a matter of time before they tried smack. I was in love with the mystique of heroin, its outlaw lifestyle, as well as its artistic connotations. I had no interest in pills, except when there was a drought and I needed something to tide me over. In my junkie days in LA, I became an expert at scamming doctors for scripts, so much so that it was almost a party trick.

      But now I didn't have to do anything: no phony back pain, or spasms, or migraines. Every time I limped into a doctor's office, bruised from head to foot, hunched over like an old man, inevitably they would ask if I needed something for the pain, and inevitably I answered yes.

      One pill, taken as needed, became five pills chewed and swallowed two or three times a day, my intake increasing steadily until a bottle of 30 OxyContin lasted no time at all.

      While the idea of seeing a shrink terrified me, there was something oddly comforting in the familiar blotting out of feelings that opioids gave me. It was only by numbing myself with pills that I could bring myself to pick up the phone and deal with the long, complex negotiations with the insurance companies, hospitals, and lawyers, all of whom seemed determined to make sure that on top of the physical pain of the accident, our family would feel the financial pain as well.

      Due to a quirk in New Jersey law, the burden of our medical expenses fell upon our insurance, and our insurance company made it a point to refuse half of all claims—for x-rays, ambulance rides, CAT scans—leading to a rush of calls from billing departments demanding thousands of dollars that we simply did not have.

      I will not name names, but let's just say I have no fondness for geckos these days.

      Previously, I have written plenty about my years of addiction—the initial romance, the day-to-day adventures of a young junkie living in the underbellies of Los Angeles and London, the pains and the withdrawals—so I won't rehash it all here.

      What I will say is this: I do not believe that it is a "relapse" if someone who was previously addicted to heroin needs to take opioid pain medication. Many people do so without experiencing any problems at all. And if you take precautions—talking to medical professionals about your history, perhaps enlisting a family member to hold your meds—you reduce your risk. I had occasionally done it myself in the years after I quit junk—when I had my wisdom teeth out, for example—with no issues.

      The difference between that and what happened after the accident was slight, but important: In the past, I had used the pills to mask physical pain; now, I used them to mask emotional pain.

      The transition from pills to heroin happened in the blink of an eye.

      Naturally, there came a point when doctors would no longer prescribe to me: I had no lasting injuries. As the bruises faded, the prescriptions dried up. When that happened, the monkey I had carried on my back for so many years was definitely out of his cage. For a decade I had starved the little bastard, locked him away, and after a decade without food, light, or attention, I figured he was probably dead, or near-as-dammit. But after just a few months of tossing OxyContin into its cage, the thing was as big as King Kong.

      I lasted a few days without pills, depressed and listless, and finally managed to convince myself that my present condition was untenable. There seemed to be only two options to quiet the noise in my head. One was suicide. The other was heroin.

      Scoring was as easy as walking to the corner store to buy groceries, even though I had never done it on the East Coast before and knew no one who used anymore.

      I left the house at 9 AM with the vague intention of finding something, and by 1 PM, I was back at home with a bundle of smack. People like me have a special instinct and can home in on junk territory the same way a diviner can find underground rivers.

      This time, it was very different: There was no romance period, no pleasurable "getting to know you," no floating through the days on a blissful cushion of narcotic bliss. Instead, I was dropped off at the exact point where I left off heroin all those years ago—a suffocating cycle of overwhelming need and awful self-loathing, hating myself and hating the drug and, despite my hatred, the overwhelming feeling that I had no choice but to keep using.

      The biggest difference between the old days and this relapse was that I was a father. My daughter had never known the old me, the person I had put away and only took out of his box when I allowed him to become a character in my novels. I hid my double life well, being an old hand at such subterfuge. But after I fell off the wagon, there wasn't a day that went by when I didn't look into my kid's eyes without feeling like some deformed, hunchbacked, sniveling monster. Even though I was able to keep what I was going through from her through sheer strength of will, I knew that each passing day brought me closer and closer to some kind of disaster that would destroy my family forever.

      Now I was the one behind the wheel, barreling toward the wife and child I loved in a car without brakes. There were times, when I'd just scored and was getting ready to get well, that I wondered if this hit might be the one that finished me off.

      I have to confess. I sometimes thought it would be a relief.

      The wheels came off. Needless to say, my wife was no innocent about heroin, having nursed me off it all of those years ago, and my repeated denials in the face of her mounting suspicion became almost comical toward the end. When she finally confronted me with inconvertible proof—a Suboxone packet, from a failed attempt to wean myself off—I did consider concocting another lie to wriggle out of it.

      But I didn't. I was tired, a pitiful beaten dog, and admitting what had happened out loud came as a relief—even though it meant facing that in my self-pitying stupidity, I had almost lost the two most important relationships in my life.

      In the mess that followed, as I writhed in the clutches of a violent cold turkey in the spare bedroom, my wife struck a deal with me: I could stay, if I sought treatment. Even then, I was reluctant to enter a clinic again, as my experiences back in the late 90s had been so awful. I begged her to let me tough it out, to lock me in the room and not let me out, no matter how much I begged.

      She didn't budge, so treatment it was. After three hellish days of sweating the dope out, I began outpatient treatment with Suboxone and—most importantly—therapy.

      Check out our documentary about the shady for-profit rehab industry in America.

      People relapse every day. It is, as they say, a part of recovery. But the crux, for me, is that as well as staying off heroin since then (April 2014), I have also decided to seek treatment for the depression that was the underlying theme of much of my use.

      At first, I saw a therapist. A nice guy, although I remain skeptical of the benefit of talking cures. Sure, it was good to have someone to talk to in those early days, someone who I wasn't worried would be scared if I told him I was still struggling, or repulsed if I let him peer into the cesspool of insanity in my head.

      Years ago, I saw a therapist in rehab, another nice guy, who told me he was a recovering meth addict. You might assume that he would have been my preferred therapist, and it is true that he had a better understanding of my mentality, but for me, the kind of clinical distance that my therapist had was a benefit, not a hindrance.

      For a start, it cuts away at the bullshit. There is no impulse to engage in the ritual of—as my friend Jerry Stahl calls it—"one downmanship." Like it or not, there's a certain twisted pride that most of us have about the depths we plunged to. If we suspect our therapist didn't go as far as we did, we have a tendency to hold his or her opinion in lower esteem. If he or she were even more fucked up, more crazy, shot more drugs, robbed more liquor stores, lost more teeth—"You ain't a real junkie unless you lost at least two teeth," one old-timer told me out in California—then we feel insecure. When your therapist's experience with drugs remains theoretical, this kind of junkie-etiquette crap is negated.

      It has been a long time, now, since I felt so full of self-loathing and listlessness that it pained me to get out of bed.

      But more useful than talk was medication. My old friend Suboxone has saved my life on more than one occasion and was there for me again, managing to stop me from crawling up the walls long enough to try and get better.

      I have now weaned down to almost nothing and fully intend to stop when the time is right, probably within the next eight to nine months. I'm glad to have Suboxone vs. methadone for two reasons.

      The first is access: With Suboxone, you are more likely to be allowed to pick up a 30 day supply—even a 60 day supply—at a time and manage your own medication. This is a huge factor. Back in the bad old days of the late 90s on methadone, it was routine to have to show up at the pharmacy every morning to take your dose in front of the pharmacist. Supposedly intended to stop diversion, this rule seemed to be a thinly-veiled punishment, a way of ensuring that you began each and every day by being reminded of your lowly status on society's ladder. It still gives me the shivers: first thing in the morning, dragging my aching bones to the local pharmacy, people gawking as I glugged my methadone with shaking hands, mothers pulling their children closer, as though my addict-genes might infect them. Hell, I'm surprised they didn't make us all wear a linctus-green star and be done with it.

      The second benefit is how Suboxone acts as an opioid-blocker. The honest truth is that as soon as I started treatment, I didn't have an urge to use. After all, the relapse had hardly been fun, and once my cravings were satisfied, I had no remaining emotional attachment to the junkie lifestyle. Even so, it is a good feeling to know that if something were to happen, some weird quirk of fate like walking into a bathroom and finding a dropped bundle of smack—unlikely, I know, but bear with me—then at least with Suboxone, that rapidly starving monkey couldn't convince me to toss him a peanut.

      The psychiatric drugs helped me even more, though. I lucked out, and I found a patient, understanding doctor—one who didn't radiate that cold distaste that I remember from trying to get treatment years ago. These days, she and I rarely discuss addiction and relapse at all. We just talk about life; I guess it's her way of taking my psychic pulse. It took a while, but heroin, relapse, the accident, all that stuff is no longer my main concern. Real life is.

      It took a while to get the combination of medication right, but when I did, the difference was stunning. It was as though somebody turned off a blaring radio, a soundtrack of discordant shouting voices that had been on for so long that I had gotten used to it. At first the silence was noticeable, hard to get used to, even. Now it is my new normality—a kind of clear-headedness that I haven't felt in years and years.

      It has been a long time, now, since I felt so full of self-loathing and listlessness that it pained me to get out of bed.

      Not every day is sunshine and roses. Most aren't. After all, I'm taking antidepressants, not MDMA. But by ensuring that my bad hours, days, whatever, are not so bad, the meds have enabled me to push on with life, put the accident behind me, get back to being the person I was before.

      And then there was my big fear. The fear that if I took psychiatric drugs, I would not be able to write. Of course, that was bullshit. A novella I began late last year grew into a novel-length piece of writing (The Savage Life will be released in French in August, and translations into several languages—including English—are slated for later in the year.) My fear was as big a fallacy as the thought that occurred to me when I was 21 and in rehab for the first time, contemplating a life without heroin : But how will I be able to play music?

      The answer was, of course, simple: The same way I always had.

      My biggest regret is that I didn't grasp it earlier. I did all of the things I was most proud of in my life despite my depression, not because of it.

      I have learned, too, in a particularly painful but valuable way, how much I need to fear complacency. In the almost two years since quitting (again), I have immersed myself in the full-time business of trying to fix the mess I left. Slowly, life has begun to move again in the right direction.

      Tony O'Neill is the author of books including Digging the Vein, Down and Out on Murder Mile, and Sick City. He also co-authored the New York Times bestseller Hero of the Underground (with Jason Peter) and the Los Angeles Times bestseller Neon Angel (with Cherie Currie). Follow him on Twitter.

      This article was originally published by The Influence, a news site that covers the full spectrum of human relationships with drugs. Follow The Influence on Facebook or Twitter.

      Topics: Crime, Heroin, Addiction, Drugs, The Influence, Views My Own, Opinion


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