The author died in 2014 at age 29 from endocarditis due to IV drug use with contaminated needles and related conditions—before the heroin problem was being treated like a national crisis.
This piece was published in partnership with the Influence.
Editor's note: The letter below, which has been lightly edited for length and clarity, was written by Elizabeth Elliot* to her mother in late 2010.
Elizabeth was in a halfway house in New Jersey, following a spell in state prison for drug-law violations. The return address on her letter was "10th Circle of Hell."
She experienced problems with heroin throughout her adult life and had previously attended several rehabs without success.
Following her release from the halfway house, she spent her last years in Florida; at that time, the state had no legal syringe exchange programs. She died in 2014, aged 29, from endocarditis due to IV drug use with contaminated needles and related conditions.
Her mother has shared this letter with the Influence because she believes it demonstrates the need for people struggling with drugs to be offered a range of options in addition to abstinence-based treatment, including much wider availability of harm-reduction services.
More details about Elizabeth's life and death, based on her mother's descriptions, are below her letter.
Well I'm sorry I was so cranky when I spoke to you on Friday night. This place is just getting to me, especially the [lost] package thing. I keep myself going each day by saying, "Ok, well at least tomorrow you'll get your stuff," and it's excruciating to feel so impotent in the situation.
I finished Atonement; it was an excellent book with a COMPLETELY bullshit ending. Now I've reduced myself to some Nicholas Sparks mushy drivel, The Guardian, but I haven't started it yet so we'll see. I've got Henry James's Portrait of a Lady but haven't had the concentration for that lately.
I couldn't believe that my own Mommy managed to churn out an almost 8-page letter—there were a lot of spaces. But that is exactly what I've been needing. I've already read it 3 times.
OMG—I traded someone my CD player so I could listen to their radio for a few hours, and guess what's on? "Just to win the love of a girl like you"!
*Do you have Depeche Mode that you can send?
So the first 20 pages of Nicholas Sparks made me nauseous, so I'm starting a book from Oprah's Club, The Story of Edgar Sawtelle. It is a heavy tome, so it should keep me occupied for a little while.
Oh, and Jess and I were talking about this last week. When you come to prison, you're forced to shower w/ other women, so it's like you start becoming critical about parts of your body that you never thought there was anything wrong with before.
So as much as I try to be satisfied with what I've got, it's like you're under constant criticism, but at least I'm not puking—and I'm trying to get more disciplined with my fitness routine.
So now to respond to your letter. I'm really grateful that you're going to help me find someplace safe when I'm released. It really gives me a lot of peace of mind. I realize that the rest of my life is riding on the decisions I make on [January 28, 2011, the day of her release].
Believe me, I am cognizant of the challenges facing me, I've been through this I don't even know how many times anymore.
I do know that I'm sick of sitting in places filled with regret and longing. In all honesty though, even though there have been meetings that I've especially enjoyed and related to, I've always felt like a fake when I'm in the rooms [of AA and NA].
I'm always like, "Are they really deep down glad that they're not using?" Because I know that I still want to get high—I mean, it's one of my favorite things to do, obviously.
I've said this many times: I want to WANT TO stop getting high, but I don't think I've ever, since the first hit of weed, not wanted to. And then when I first did dope, it was like I had finally found what I had always had been looking for.
I could turn off my head and, just by taking some kind of chemical, I could change my mood and be the person I couldn't be without it.
All these consequences SHOULD make me never want to touch anything again, but I'm just not there.
Don't get me wrong: I don't want to pick up a crack pipe or a needle, but I feel like I'm not at my best or where I want to be without a joint or a pill.
I was talking to my friend Barbie and she was telling me her mom was addicted to Xanax but she has [a diagnosis]. Her pharmacist gives her a weekly supply so she won't be able to take too much. I think that's a viable solution; do you?
I do want to eventually get to a place where I can say that I don't need ANY kind of substance for me to live comfortably in my own skin. I think that in an environment with people who are happy in sobriety, like the recovery community in Florida, I can eventually do it.
It's going to be a while before I have my shit together how I want. And I think that some kind of maintenance (benzodiazepines) will help me make it through those stressful times ahead.
I do have a diagnosed Anxiety Disorder and it's always been hard for me in social situations, even when I was just five, just being around extended family.
I feel like I would be setting myself up for failure [by aiming to be completely abstinent] because if I had nothing to help me cope, at the first uncomfortable moment, I would be out running the streets on a mission for a bag.
Maybe it's justification, I don't know, but I feel like it'll give me better odds. I know myself, you know how quickly I've picked up in the past upon release (on release day every time) and there's so much riding on this time that I don't want to crash & burn before I've given myself a chance.
That's why I don't want to delay the Florida trip too long. Hopefully I'll be able to save some money from working here—but it's going to be hard considering they take almost 50 percent of your paychecks.
I know that my sobriety has to be my number one priority—that's why I'm going to a Sober House, because believe me, the last thing I want is to be in any kind of structured environment after all this time (it'll be 11 months locked up, give or take a few days by the time I get out). But I know that it will enhance my chances of staying out of trouble.
I really have to work on calling someone when I feel like getting high, because honestly, when I get that mindset, the last thing I want to do is tell on myself & prevent it from going down. I'm going to have to find a sponsor that I really connect w/ bc the few times I've actually had one, I didn't really use them.
I know there is so much riding on this chance as far as family is concerned. But—not to be ungrateful—a letter every now and then and sending stuff once isn't really a strong support system. Not that I'm saying I don't deserve everything I get as far as distance.
But when I am released, I really have no other choice but to sell my ass at first because they don't give General Assistance to people with drug charges. If I didn't have you as my support, I don't know what I'd do.
Alright, I've been serious long enough. I just heard a version of "Stairway to Heaven" w/ the lyrics to Gilligan's Island. It's called "Stairway to Gilligan's Island."
*Before I forget—what's that song I think I told you is my bar theme song by Finger 11?? It's driving me crazy! Please help, lyrics if possible.
I've spent the day reading the 2010 Birnbaum Guide to Walt Disney World [where she and her mother planned to go on the way to a sober living home in Florida]. Tomorrow I'm going to be sitting down with Anissa to go over the itinerary.
I miss you and love you! Hope to talk to you soon!
Love, Little Lizzie
Elizabeth grew up in Pennsylvania. She thrived in elementary school and junior high, achieving straight As through eighth grade. She also excelled at music, arts, and sports, and music remained important to her throughout her life. She suffered from social anxiety from a young age, but insisted she did not want therapy. Funny, kind, and compassionate, she continued to do well academically and at other activities in high school.
She first tried marijuana aged 15; when her mother found out, Elizabeth said she was just experimenting. She later told her mother that she had begun smoking weed both before and after school and before bed during this period.
She went to the University of Delaware for fashion design. However, experiencing severe anxiety and depression, she rarely left her dorm room and dropped out due to non-attendance of classes.
At 19, she got a job as a waitress, and through her co-workers tried cocaine and then heroin. She soon became addicted to heroin.
She told her family that she was addicted, and that she had hepatitis C from sharing needles. Her family sent her to rehab; she ended up going to a total of six 12-step-based rehabs, including a locked facility in New Jersey.
She was kicked out of two facilities for fraternizing with men and escaped from the locked rehab. She always relapsed soon after her release.
She also married and had a baby during her 20s. She lost custody when her baby was six months old, and her husband divorced her while she was in jail.
After Elizabeth was arrested, the authorities didn't want to send her to state prison. But she failed at pre-trial intervention by escaping the locked rehab and was ineligible for drug court due to suicidal thoughts. She failed on probation due to positive drug tests.
She was sentenced to three-to-five years for possession of a controlled substance and paraphernalia. She spent three months in state prison in Clinton, New Jersey, was released on parole, then relapsed, failed parole, and went back to prison for 11 more months.
After her release from the halfway house where the letter was written and her arrival in Florida, Elizabeth called a sober friend who turned out not to be sober. Within days, she was smoking crack and shooting heroin again. She took a job with an escort service to pay for her drugs and rent.
She then moved in with a boyfriend and stopped working as an escort. She and her boyfriend would smoke crack for days at a time, then come down by shooting heroin.
In 2012, she was hospitalized for a few days with a blood infection. Later in 2012, she borrowed money from her grandparents for a final try at rehab. She relapsed the day she got out.
In December 2013, she was hospitalized with endocarditis, which she got from reusing needles; there were no needle exchanges where she lived. She cleaned her needles with bleach, but that was not enough. A surgeon cleared growths off her heart. She was in the hospital for six weeks.
While in the hospital, she planned to go to a burprenorphine clinic. She left the hospital on a Sunday, and found the clinic was closed. She began shooting up again that night.
For the next several months she had recurrences of endocarditis. She went to hospitals but would not stay for treatment because they would not give her enough painkillers.
On April 18, 2014, she went to an ER. That afternoon, a doctor called her mother and said that Elizabeth would not survive. She was unconscious but comfortable. The doctor did not know how she had managed to walk into the ER.
Elizabeth died in the early hours of Saturday, April 19, 2014. Her cause of death was given as severe sepsis, endocarditis from IV drug use, renal failure and respiratory failure.
*Elizabeth's last name and one other identifying detail have been changed, to protect the privacy of some members of her family.