“Have a good day at School Max…don’t get shot”

“I love you Max,” I say, as my son leaves for high school this morning. He does his usual quick knock on the sliding glass door. Saying “I love you too” is communicated back to me in his unique “Max” way. Our parent-child morning ritual. That quick knock means the world to me, it means more than I can really express. The love for our children, with most parents, transcends a place so deep in our souls that it defies description.

Parents waking up today in Florida, having lost their children in the current school massacre—and I say “current” because I have little faith that it will not happen again—their pain I cannot fathom. I do not pretend to know their pain, but I am deeply sorry they are going through such a senseless loss.

“What did you do at school today Max?” I ask, in my usual after-school banter.

“We hid in the closet.”

“We hid in the closet”—his words swirl in my mind, taking me back to second grade. Tornado drills in the panhandle of Texas. The alarm sounded and we quickly got under our desks.

“A disaster drill for when the mass murderer shows up,” he adds.

Not “if,” but “when,” is his inner dialog to himself. The reality that our children live with this sort of distorted, brutal reality that has happened to their “own” is causing their developing minds to be affected with potential mental health disturbances and myriad psychological symptoms. Perhaps even taking a vulnerable teen and turning him or her into the next murderer.

A cycle. A cycle that will continue to spin unless an obstruction is lodged in the wheel.

A closet will not protect a huddled mass of kids from an assault rifle. In fact, with them all clustered together, it would be like shooting ducks on a pond.

Let’s have some gun-adept teachers, trained and armed, was our president’s remark yesterday. Lesson planning and teaching is their job, and they are woefully underpaid for the important job of preparing our youths for the future. Now we are suggesting they pack a gun. But maybe only 20 percent will be in the battalion of teacher protectors being thrown out as a solution to gun violence.

How long does it take to fire rounds of bullets from a war gun, slaughtering some kids, before Ed the shop teacher manages to run down the hall with his one-bullet pistol hidden in the back of his pants to disarm a deranged murderer? Might the murderer’s lightning-speed gun machine kill Ed first? Or maybe Ed keeps an assault rifle in a secure closet. How long before a twisted student’s mind breaches that closet, is my thought. Keeping guns at school seems unpredictable. As the bullets are heard, Ed is wondering where he left the key to the gun locker.

If it were not so politically incorrect, it would make a laughable skit for Saturday Night Live.

My blogs are on addiction, so let me tell you this: If I was a kid in school today, dealing with the  possibility of being murdered there, daydreaming during a class lecture what I would do if bullets started to fly, then numbing out with pot in the bathroom or a snort of heroin would become way more appealing. Addiction, when it expresses itself in an individual, always has a psychological trigger that pushes its pathology into presenting itself. Anxiety is one of the common triggers I see. Post-traumatic stress is another.

The stress our youths increasingly are made to deal with surely affect their minds.

Get the guns off the streets. Stop selling them. Politicians stop sucking at the NRA’s tits. It is a follow-the-money game hiding behind the Second Amendment.

Times change and constitutions need to change and keep up with modern times and realities. I believe our founding fathers would agree.

Max walks in the door from school. “Hey Buddy, how was school?”

A Day Trip with Heroin

Disheveled and encumbered with unpacked cloths on her lap, my new patient, to be transported to a Southern rehab, shows up curbside at the local airport in her mom’s car, passenger side.

I open the door. “Hello,” I say, and my greeting hangs in the air, apparently like a nuclear bomb. The patient yells, “Get away from me, you f – – – ing c – – t.”

Inwardly, I laugh. Heroin is angry with me today. I’m on his turf, and he is fighting hard to hold onto his signature death grip. But I don’t scare easily, nor back down. He and I meet often. I don’t even see the girl nor take it personally. She is no longer present. Linda Blair is glowering at me.

OK, maybe Lucy, my little dog, will help. “Lucy would like to meet you,” I say, as I plunk Lucy in her lap. “Get that f – – – – – – rat away from me. Turning to her exasperated mom , she screams, “I am not going anywhere with that b – – – – . Just take me to jail.”

She is jammed up. It is jail or rehab. Bluffing is my middle name.

“OK, then,” I say. “Detox sucks in jail—you know, no meds—but good luck, goodbye.”

As the girl picks her clothes up from the car floor, I motion silently to the mom to loop her around the airport. And I turn my back and walk away.

It works. Only one loop and she decides I am the better option.

But it’s like she has gotten a restraining order against me. She orders me to stay so many yards away from her. I trail behind, just keeping a close eye out. She shot dope in the car, the mom told me on the phone. I carry naloxone, the antidote drug used for heroin overdose, which I feel is hanging around my neck like a clove of garlic, but my gut is telling me I won’t need it.

Every once in a while, her tough veneer breaks and she glances at me for direction. But then, getting her footing, she demeans me again.

“Disgraceful you are, making money off people like me. You are f – – – – – – unethical!

That, I admit, bugs me. I am not unethical, uncaring, uneducated, inexperienced, or overpriced. I do not take advantage of vulnerable families. But I stay quiet. No arguing with the devil.

Upon arrival at our destination, she can barely walk, she is so weighed down with stuff: dope fatigue, carry-ons, and luggage.

I repeatedly offer to help her. “I’ll ask you if I need help, just shut up,” she retorts.

She is shuffling so slowly and labored, I offer to get a wheelchair. Any second now, I expect her head to spin around.

Finally she asks for help. “I can’t go on, I have to have something to drink.”

Alcohol is not her deal, so I say, “OK, Coke?”

“No, Sprite.”

She has no money. I buy her a soft drink and place the straw in the cup. She grabs it from me with unexpected strength and continues seething. Her needing me has not made her any nicer.

Her bag on the ground, I pick it up because she is now even more labored with a drink.

“Put it down!” she spits at me. I put it down. She juggles everything for a minute, and we carry on.

On the tram now to take us to the baggage claim, where  I am to hand her off to the rehab, I take out my card..I slip it into her bag. “There is my card. Come find me in the future.”

She glares, and we have a staring contest that lasts maybe three minutes.

“I will never come looking for you,” she says. I have zero respect for you.”

“OK,” is my simple response.

Heroin hates me today for attempting and possibly winning the battle. One person at a time.

I hope Lisa comes and finds me one day.

Why are Lucy and I effective at doing Interventions.

Lately I have pondered this question: Why am I so often effective at reaching my goal of getting a person who has substance use disorder, who is resistant to treatment, into rehab?

First, I think, it is my 13 years of performing this job that is helpful.

Like all professions, most people hone their skills by working in their chosen profession.

But I believe it is more than that. 

From the moment I get a call from a family member or loved one about the person in need of an intervention, I carry that person inside of me until we meet. I silently internalize all I am learning about the patient, both through extensive interviews with the family about the patient and also (and this is where I believe a big part of my success comes from) because I am walking with the patient and working out in my mind the best way to approach him or her. This is done on a gut—an instinctual—level if you will.

I grew up in a family where I was enveloped by substance-use disorder and became sick with the disease as well. That experience has been invaluable to me in understanding the dynamics taking place in the family, giving me the skills to deal with the group. This, I believe, is where my instincts were born out of that I now use for the good of other families suffering from substance-use disorder.

For me personally, there is no greater passion then taking something dark in my past life and using those challenges to bring hope and light to another family. 

Then there are the pragmatics that aid me in my skill as an interventionist. As a former registered nurse in an alcohol and drug rehab, I have the ability to make sure the patient is physically capable of being admitted to a rehab instead of a hospital first. 

Then there is little Lucy, my five-pound Chihuahua. If appropriate, she is with me. Lucy transmits unconditional love to people who internally have no love left for themselves. I have literally seen people’s despair blossom to a place of hope with little Lucy sitting in their lap on the way to rehab. 

My attitude as I approach an intervention, first with the family, then with the patient, is one of hope and celebration. An intervention is a time of hopeful renewal and change—not gloom and doom or threats. 

An intervention is about new beginnings with a solid plan on how and where to go to get help. And above all else, an intervention is facilitated in a nonjudgmental manner, transmitted with respect and love.

Why are Lucy and I effective at Interventions

I have pondered this question: Why am I so often effective at reaching my goal of getting a person who has substance use disorder, who is resistant to treatment, into rehab?

First, I think, it is my 13 years of performing this job that is helpful.

Like all professions, most people hone their skills by working in their chosen profession.

But I believe it is more than that. 

From the moment I get a call from a family member or loved one about the person in need of an intervention, I carry that person inside of me until we meet. I silently internalize all I am learning about the patient, both through extensive interviews with the family about the patient and also (and this is where I believe a big part of my success comes from) because I am walking with the patient and working out in my mind the best way to approach him or her. This is done on a gut—an instinctual—level if you will.

I grew up in a family where I was enveloped by substance-use disorder and became sick with the disease as well. That experience has been invaluable to me in understanding the dynamics taking place in the family, giving me the skills to deal with the group. This, I believe, is where my instincts were born out of that I now use for the good of other families suffering from substance-use disorder.

For me personally, there is no greater passion then taking something dark in my past life and using those challenges to bring hope and light to another family. 

Then there are the pragmatics that aid me in my skill as an interventionist. As a former registered nurse in an alcohol and drug rehab, I have the ability to make sure the patient is physically capable of being admitted to a rehab instead of a hospital first. 

Then there is little Lucy, my five-pound Chihuahua. If appropriate, she is with me. Lucy transmits unconditional love to people who internally have no love left for themselves. I have literally seen people’s despair blossom to a place of hope with little Lucy sitting in their lap on the way to rehab. 

My attitude as I approach an intervention, first with the family, then with the patient, is one of hope and celebration. An intervention is a time of hopeful renewal and change—not gloom and doom or threats. 

An intervention is about new beginnings with a solid plan on how and where to go to get help. And above all else, an intervention is facilitated in a nonjudgmental manner, transmitted with respect and love.

“I hope you’ll join me as a #FacingAddiction Activist by visiting the link below! One simple action step each week – it’s the least we can do combat this public health epidemic.”

https://www.facingaddiction.org/activist_program

Dope/Smack/Carfentanil

“Don’t bother coming; he is dead.”

Those words, a week later, still haunt my world. They echo in my head, roaming my mind and refusing to stay still. I am working through the grief.

It is early morning. The day’s usual routine plays itself out. My son is sleepily wandering the kitchen getting ready for school. The smell of coffee is in the air. I had locked and loaded the coffeemaker the night before. I am sleepy, too, and all I can manage first thing in the morning is to push a button. I can hear the sound of cereal hitting a bowl.

“Max, don’t forget to brush your teeth before you leave,” I yell from my room as I dress.

“Mom, why do you tell me that every day?” Max laments.

I reply, as usual, “It is my job as your Mom to help take care of you; that includes your teeth!”

Max and I have had this conversation over a dozen times. Maybe I should stop reminding him, I think, fleetingly. Am I enabling him, not allowing him to take responsibility for his own teeth, or am I loving and protecting him? As I tell my patients, it is a fine line that separates caring for our loved ones from enabling them. But I have no time this morning to really contemplate my parenting style.

I hear the front door. “I love you Max, make it a great day.” I hear a muffled grunt, which I translate as, “Bye, best mom in the whole world, I love you too.” Ok, maybe I am stretching the meaning of my son’s grunt, but it works for me.

I pull my dress over my head. The dress feels too conservative for my style, but I am working today, transporting a young man who has willingly said he will go to rehab.

Two years earlier, I did an intervention with Todd for his family. Todd was addicted to heroin at the time.

He went on from rehab to attend college for two years in a sober dorm, housing designated for kids that have had treatment for addiction. He went on to be a counselor to other, newly sober students.

He returned for a brief time and visited with an old friend—an old friend still using heroin. And with a speed I know all too well from personal experience, Todd used his old enemy, heroin—an enemy disguised as your best friend, a friend that has the ability to manipulate your memory in a way that is incomprehensible, telling you, “We will visit just this one time,” when, in reality, and with rare exception, that “one” visit will end up being a road trip to hell as you once again become addicted.

Todd’s quality sobriety has not been a failure or waste of time, though. He asked for help quickly, within a week of his disease coming out of remission. This is an important point. Addiction/alcoholism is a lifelong chronic illness.

Our success, many times, is when the illness recurs coming out of remission; the addictive stage of addiction becomes much shorter. Addicts who have learned about their disease in treatment and achieved periods of sobriety are armed with facts about the illness coupled with positive experiences of sobriety. These two factors combine and result in the addict seeking help sooner for a relapse.

This is what Todd did—he asked for help quickly—but these days, with strong heroin on the streets, addicts are too frequently passing on before getting the help they need.

That is when I got a text from Todd’s mom, asking for my help in placement and transport to treatment for her youngest son, a son asking for help.

But I was just hours late. The devil beat me to the finish line, and Todd died sometime in the night of a heroin overdose.

Unfortunately, Todd’s death is not unique. Two factors were working against him, increasing his odds of an overdose death.

One, his tolerance for the drug had changed, Having not used heroin for a few years, he needed less of it than he had used previously to obtain the same high. Returning addicts make this mistake all too often, seeking the same old warm euphoria they remember from their previous days of addiction. Simply said, they use a dose of heroin that is too strong for their bodies, which have been abstinent for a period of time. They overshoot the mark and use too much of the opioid; this affects their vital bodily functions, mainly breathing, and they drift off to death.

Two, the heroin of yesteryear is not the heroin of today. The countries that send us illegal heroin are sending America a “weak,” or watered-down, product. Why? Ask them, but I suspect this skimming of the heroin is to save money or make more money. This precious and lucrative commodity comes from countries where a big part of their economy is the illegal export of heroin.

Enter the United States. Drug addicts don’t want to buy a weak product anymore than a person with alcoholism wants to drink .2 beer. So dealers are beefing up the product with fentanyl, a potent synthetic opioid . Fentanyl is also being imported into our country. Where from? Depends on the day. The last big shipment of Fentanyl seized came through Quebec, our northern border. It came into Quebec by ship from a far away port. The point of origin is still debated. The Fentanyl changes hands many times before hitting the US. Currency flows among dealers like the death the drug will bleed down on our citizens. Then there is Carfentanil, a clone of Fentanyl, if you will. I hugely strong form of Fentanyl , originally used to bring down a large animal, like a elephant or lion as a anesthetic.

Amateur chemists add the Fentanyl forms but can’t seem to regulate the strength , and strong batches of heroin laced with it hit the street. Heroin addicts use their usual amount, but that dose has morphed into many times its previous strength, becoming lethal, and the addict dies.

My phone alerts me to a call as I am putting on my shoes to go pick up Todd.

“Don’t bother coming; he is dead.”

I sit on the side of the bed, numb. My first thoughts turn toward Todd’s parents. Their grief is beyond my ability to truly appreciate.

I think of Max, my son, minutes ago slamming the door as he rushed to catch the bus to school.

“God, please watch over my son today, and bring him home to me.”

I will continue my “war on drugs,” as an interventionist, one person, one family at a time. It is my mission as I chase the devil away from the families I am privileged to serve.

Do No Harm/ Safe Interventions

Have you ever thought about committing suicide? I have. Have I had a plan? Yes. Have I attempted it? No. Why?

Two factors I think. The love of my kids and being unwilling to leave behind the psychological trauma that I know they would carry.

My thoughts of suicide always followed the coming down from and off of mood-altering drugs. 

As a former RN I was aware that my brain chemistry, specifically dopamine, was depleted; that because I had supplied my brain with artificial dopamine through drugs, my mind had stopped producing its own brain chemicals. The result of this dopamine depletion was making me feel hopeless, unable to see the light in anything, making suicide an option to provide me relief from extreme mental pain.  

Suicide also occurs during active addiction due to an anesthetized brain. Impulse-control regulation is off-center, and if intense psychological pain is present for whatever reason, a person is more likely to follow through on suicidal ideation.

Having experienced decades of substance-use disorder, I knew the suicidal thoughts would abate, with time. I even learned what helped: extreme exercise to expedite my brain to equilibrium, and community. Never isolate—we need connection to others; it is built into our very existence as human beings. That fact has protected our survival for centuries. We are not built to be alone.  

I have never been diagnosed with severe mental illness, but because I have a strong recurring addiction history, I am statistically at higher risk of suicide than the average person, according to Dr. Carolyn C. Ross in “Suicide: One of Addictions Hidden Risks,” a Psychology Today blog post.

Depression and other mood disorders are the number one risk factor for suicide, but alcohol and drug abuse—even without depression—are a close second. In fact, research has shown that the strongest predictor of suicide is alcoholism, not a psychiatric diagnosis. People with substance-use disorders are about six times more likely to commit suicide than the general population.

That brings me to my style of performing interventions. 

I am not an arm-twisting, hold-a-gun-to–your-head interventionist. I achieve high success rates with the expression of love and no shame communicated by a group of family and friends who care for my patient. 

Saying “I will never speak to you again if you do not go to treatment” not only decreases the odds of long-term recovery—even if the person does go to treatment—but is dangerous. Leaving an alcoholic /addict alone physically or psychology through complete shunning if she refuses treatment increases theodds of suicide. The person many times will try to quit on her own or go on a bender. Either way, she is in the minefield of suicide.

Boundaries and doors left open with love go much further in predicting a person’s odds of accepting help in the future and can help decrease the odds of suicide.

Boundaries are different for every group I work with. Boundaries need thoughtful consideration and should be realistic. An example: You are always welcome in my home, but if I suspect you are under the influence, I will ask you to leave and come back next time sober. Ultimately this approach is more human and helpful in achieving the goal of the addict/alcoholic seeking treatment. 

You would not shun a family member with metastatic cancer who was refusing medical care. 

A text saying “I love you still and am willing to help you get treatment” following an intervention where the person refused help is far more effective and safer than estrangement.

I know this can be hard if you have experienced many negative life events due to a person’s substance-use disorder. You can distance yourself, but please do it with love and leave the door open. Your loved one will be far safer from suicide, the ultimate tragic side effect of addiction. 

One time, I had dropped off a patient at one of my favorite rehabs. My little dog rushed through the doors. “Just follow Lucy,” I told the patient. All five pounds of Lucy were exuding excitement—her eyes bright and tail wagging. I think her indescribable cuteness gives my patients hope and distracts themat this very scary moment in their lives. She has sat in their laps during the drive to rehab, looked back at them as they retrievedtheir luggage, and, with only body language, said, “Hurry up,follow me to heaven on earth,” as she eagerly waited for us to open the door.

I dropped off the patient with the intake counselor. “I will be right back,” I said. “Lucy wants to see her friends.

I opened the doors to the intake department, and she ran to one of her favorite cubicles, where Mike has sat at for 13 years, dispensing hope over the phone to potential patients and their families. 

His chair was empty. “Is Mike off today?” I asked another intake counselor. 

The look on her face and her hesitation about my question was a harbinger of something I was sure I did not want to hear.

“He committed suicide a few days ago, he jumped . . . ”

My first thought was, “This is not possible.”

But he had relapsed after years of sobriety. The devil really never stops chasing us addicts and alcoholics. 

Mike was the third high-functioning alcoholic/addict friend I have lost to suicide since I have been in recovery. 

Lucy, being blessed with no frontal brain lobes, just ran to another cubicle. 

I was silent in my mind.

I returned to say goodbye to my patient. We hugged, and both of us held each other for a long time. She was scared. I was the last familiar person to her. I whispered encouragement into her ear. I continued to hold her close and think of Mike. Not everyone survives this disease. 

If an intervention is not successful at the moment the group has set up, please do not abandon the person completely. 

We are a fragile population, living with this still-maligned and misunderstood disease.

Love always . . . 

 

 

Joani Gammill, AIS

www.JoaniTheInterventionist.com

Joani@jJoaniTheInterventionist.com

443 926 4519

Heroin took my Friend

Disheartened. Depressed. “Why bother, Joani, you are working at a losing game. Whack a mole, that is it, that is what you are doing.”

Do I believe in what I’m doing, interventions, to get people into treatment for their disease?

I am just plain sad and discouraged. My sweet (sometimes pain-in-the-ass friend) is gone. She answered my tweets often. She was the kind of person who stayed in touch. She took selfies with everyone she knew. Did she know her short life was going to need to be chronicled? Did she leave us gifts of pictures? Her singing voice had a range and beauty that literally made you stop and listen; it was so good that if you did not see her you swore it was someone streaming from a playlist. Then you would turn a corner and there she was, usually sitting on the floor, legs crossed. Her guitar, as it turns out, was gently weeping.

My last selfie with me was a month preceding her unintentional death at a mutual friend’s wedding. Her life was taken by a disease few comprehend, even those who have been in its vise grip. Addiction.

A monster is roaming this earth—strong, altered heroin, laced with fentanyl and ketamine. Fentanyl is a potent narcotic; ketamine is commonly known as an elephant tranquilizer. They combine with heroin to make a powder keg of unpredictable strength. The people who are making this aberrant form of heroin not only don’t have an FDA approval stamp for the dosage strength, they apparently have no morals. So addicts are rolling the dice as their disease overrides the rationality in their hijacked brains and they snort or inject the poison and they fall asleep. The brain stem that is the control center for vital functions in the body slumbers as well, shutting down respiration, and the person with no oxygen circulating through his body to supply all organs with necessary air drifts off to death.

The “heroin epidemic” is so much larger than me that I have faltered in my desire to fight it. It looms tall with a huge knife pointed at my neck. It laughs at me, “I won, Joani, I took your friend.”

But that was yesterday. A day of disbelief, tears, and grief.

Today, you son of a bitch, I will continue to hunt you. If enough of us play whack a mole, maybe we could win. Maybe, probably not.

But remember the Jewish proverb that came to the forefront of our modern recognition when a war raged, when another monster was roaming the European continent and murdering millions: “When you save one person you save the world entire.”

I will not give up, no matter how big the knife. In fact, my dear monster, you have ignited in me a bigger urge to carry on in my mission to save that one person. I laugh back at you. You are in fact stoking the flames of all of us in this fight against your poison . . . to cut your throat.

The last song I heard my friend sing was “Good Riddance.” The words now ring in my ears as a harbinger of what was going to be her fate:

Another turning point, a fork stuck in the road

Time grabs you by the wrist, directs you where to go

So make the best of this test, and don’t ask why

It’s not a question, but a lesson learned in time

It’s something unpredictable, but in the end it’s right

I hope you had the time of your life.

It was her life’s journey, I do not know why. I do know I will miss her.

I am not an “ Alcoholic”

I am a person with the disease of alcoholism and addiction ,I am not “an alcoholic.”

Similarly, some people call my children autistic. In reality, they are teenagers who have the neurobiological disease of autism. They are my children—quirky, lovable, with multiple personal traits that make them uniquely who they are. They are Mary and Max.

The distinction is important, especially to a person who has a disease that can be used to describe that person. “This is Erin, she is a diabetic.” She is a teacher, a daughter, a wife, a warm, funny person with a smile that can light up a room. She is human, good and bad, full of characteristics that make her the human being that she is. There is only one of her in the whole universe. To whittle her down to “a diabetic” negates the rest of her essence.

We are defined many times by what we choose to do to bring light and positive change to the disorder we have been presented with.

But we are not the disease. I am not an alcoholic.

I have alcoholism.