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The Anatomy of a Heroin Relapse

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

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.

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.