Stone Heart.

“Too Long a Sacrifice Makes a Stone of the Heart”  – William Butler Yeats

This week I had cause to worry about my child’s commitment to her sobriety. I had been led to believe that she had traveled by train to our hometown to spend time with a friend who is an active alcoholic and was, or still is, a crack cocaine abuser. This friend has a boyfriend who regularly beats her. She is a petite blonde with glassy eyes and bird like bones – but he throws her against walls and routinely blackens her blue eyes. My child was to spend the entire evening with them in a Boston hotel. She did not share this news.

Why would she choose to do these things? What good could come of this?

I felt fear – and anger.  I had a hard time sleeping that night. I took a melatonin, but it didn’t offer much relief. I also turned the phone off. I didn’t want to be woken by what I assumed would be a midnight phone call from an overcrowded emergency room. Or the police demanding I pick her up at 2 am. I imagined changing out of my warm pajamas, programming my gps, and driving into yet another cold, fraught ridden night. And then to be greeted by a kicking, screaming addict, a disgusted police officer, and the mind numbing question: how do you want to handle this?

I am still so tired and it’s been over a year.

I never got that imagined phone call. A few days later I drove up to Maine to see her myself – and she appeared healthy, happy and whole. Which made me ask myself, “why would I turn off the phone when I had a sneaking suspicion that she would get into trouble?” Why would I put limitations on coming to her aid when she had worked so hard for so long? People make mistakes. People relapse. Is it because I didn’t want to look at that fact? Or because I didn’t want to be inconvenienced?

In retrospect I should have made sure my phone was fully charged. I should have had a type written list of detoxes to call when the sun rose. And if her relapse had been fatal (as it often is after having significant clean time) I should have rushed to the emergency room to hold her.

I have a beautiful child. Despite it all she is caring, funny, hard working… and mine. Why had I allowed the past to make a stone of my heart?

I See You Mr. Double Standard.

I know many people believe that healthcare dollars should not be spent on those who choose to use street drugs. I get it. It’s about personal responsibility. Healthcare dollars are stretched enough caring for those who aren’t the agents of their own destruction.

However, I ask you to consider the following:

We cure cancer in those who continue to smoke cigarettes.
We staple the stomachs of those who ignore the food pyramid.
We perform heart surgery on those who have never seen the inside of a gym.
We given insulin to those who knowingly eat donuts.
We fix the broken limbs of those who practice extreme sports.
We pay for the delivery  of babies conceived by high risk mothers.
We stitch back the bodies of those who crash speeding cars.
We treat melanoma in those who refuse to stop sun worshipping.
We treat venereal diseases in sexually promiscuous people.

The costs incurred for treating these examples of “irresponsible behavior” are staggering: According to the Centers for Disease Control and Prevention, smoking is the number one preventable cause of disease in the United States and it costs $170 billion dollars a year in direct medical costs. According to the American Diabetes Association one in three medicare dollars are spent on treating diabetes at a cost of $322 billion dollars a year. And, “American use of tanning beds may lead to upwards of 400,000 cases of skin cancer annually.” (American Academy of Dermatology).

But you know what?  Those individuals receive treatment with care, efficiency, and efficacy. The same can not be said for those with substance use disorder. This time a year ago my nineteen-year old was turned away from a detox center because there were no beds. She then walked to Boston City Hospital’s emergency room, sweating and trembling, for help. They too turned her away. Desperate, she spent that evening trolling Mass Ave looking for the drug she needed to tide her over for one more day. The next morning she returned to both the detox center and the emergency room. And once again she was refused admittance. She called crying; “could I please, please help?”

Help should have been as simple as a request.

I spoke with the ER doctor. He explained, “we don’t treat drug addicts here.” He then explained that he would also not admit her for mental health reasons because he didn’t believe she “would kill herself.”

I felt weak at the knees. How does one mount a spirited defense when powerless?

“My daughter is only nineteen years of age. She is not yet a hardened street addict. She is high on a drug that is killing people at an unprecedented rate. She is asking for help. You are that help.”

Silence.

“We are not asking for charity. She is insured by two separate policies.”

His reply: “Hospital rules do not permit admittance.”

“Surely,” I argued, “it is time for hospital rules to change. This is an epidemic. Turn her away and there is a strong possibility that she will die tonight.”

Silence.

“Why wait for the hospital to change it’s policies in response to a dead child and a lawsuit?”

Silence

“You took the Hippocratic Oath.”

Silence.

“You could lie about the reason for her admission…”

Do you know how it feels to beg when you shouldn’t have too? Begging when the stakes are so ridiculously high?  It feels like swimming against the tide while trying to reach your drowning child. Swimming and swimming…and then the dorsal fin appears.  But hope is not lost: a lobster boat comes into view!  You yell for a rope. But they don’t throw one.   No, they don’t.  Instead, they sit back and watch.  Because, you know, she shouldn’t have been swimming in those waters.

I know I sound angry. That’s because I am.  I spend $1500 a month out of pocket for health insurance – and I have had to beg for life saving services.  Addiction is classified as an illness by the Diagnostic and Statistical Manual of Mental Disorders (DSM-III).   But the double standard most assuredly remains.

Triggers Are Not Real.

“TRIGGERS ARE NOT REAL.”

My daughter stated this, firmly, when I tried to stop her from taking a bus through a neighborhood full of triggers. Addicts are supposed to avoid triggers….just like someone on a diet should avoid a bakery, and someone thinking about a new dog should avoid a pet shop. It’s good common sense.

This particular neighborhood, for three years straight, had replaced days meant to be spent at school. It was where she met her first, of many, older, opiate-addicted boyfriends. The neighborhood where she drank with her girlfriends until they couldn’t stand up. The neighborhood she went missing in for nights on end. The neighborhood she partied in to the point of hospital intervention, repeatedly. The neighborhood with the drug store street corner. All of this would be within memorable reach.

“I don’t want you to take the bus. I can get you in the car.  I would be happy to come get you… “

“No.”

Trigger has to be the perfect colloquialism for “classical conditioning.” I appreciate the way it brings to mind the image of a loaded gun to the head. When you are the parent of an addict it becomes that clear. That person, that bent spoon, that ball of singed tinfoil, that street corner…. all become sensorial reminders capable of triggering relapse. And relapse is nothing short of a game of Russian roulette.

To be clear, my fear of triggers isn’t a case of playing probabilities or trusting in a predictable pattern of personal weakness. Classical conditioning is scientifically proven. Most of us are familiar with Pavlov and his bell salivating dogs. This early study in classical conditioning proved that a learned process can change a previously neutral stimulus into a potent stimulus. This potent stimulus in turn creates real biological change in the body. Biological change where none existed before. Replace Pavlov’s bell with a street corner and excessive saliva with irrepressible craving and the problem becomes all too real.

“I want to take the bus. Triggers are not real. Like, everything is a trigger. A song. A boy. The bathroom. The sunshine. A nice day. A bad day. Even the breeze. You have to deal with your stuff, mom. If taking a bus makes me relapse then I haven’t dealt with my stuff. You just don’t understand.”

I am trying to. Classical conditioning is not equivalent to the loss of free will. Biological stimulus does not have to be a siren call to action. We are a little more complicated than a bell drooling hound. But how difficult must it be to retrain our rewired and tired brains to see each situation clearly and non-reactively? Can we be our own psychologists, neurosurgeons, life style coaches and cautiously present Buddhas?

In the end, she took that bus. And you know what?
She made it safely home.

Modern Love

There is a program on National Public Radio that does a spectacularly good job at deconstructing a word most of us feel we can confidently define: love.

In one episode Jason Alexander narrates his love for the family goldfish. The loss of someone close to him has forged his affection for this swimmingly simple little golden fish. Its presence represents an escape, and an embracing, of the crumbling reality of existence.

Can love be tempered by unpleasant realities? The program would say yes. Most of us, especially those of us with decades of life behind us, would agree.

We all have our own “modern love” story. Mine would be about my daughter, who many might describe as hard to love.  They would be wrong.

Admittedly, she was hard to snuggle.  She preferred the plastic embrace of her car seat. The car seat could be parked far from me: she was happy with any room, any corner. She tracked me with her eyes, but she tracked other things with equal interest. I took to forcibly putting her in a snuggly and walking up and down the street with her.

Glowering was also a specialty. She was a beautiful blonde baby with fat pink cheeks, green eyes, and a perma-scowl. Her mouth, right from the get-go, had a natural down turn to it. Glowering with the addition of defiantly crossed arms came later. When asked to give her name during her kindergarten interview she stood up, turned her chair backward to the teacher, crossed her arms, and sat down. She remained that way for the entire interview.

My husband and I remained enamored. (Why should she perform tricks like a trained seal? Maybe we have the next Hillary!) We affectionately nicknamed her “little black cloud.” We would mimic her mood in a dreary Eeyore voice – desperately trying to add some EB White levity to our situation. Sometimes we would just mime a “brewing storm”  by circling our fluttering hand over our weary heads.

But of course at this young age it isn’t about them loving you. It’s about you loving them.

Loving her could be exhausting. It wasn’t easy for my daughter to accept love. She appeared to weigh it, to quantify it – to find it lacking. She was often displeased. I came to see it as her natural default button. She screamed about sitting in the cart at the grocery store. She screamed at her older sister to claim the best barbie. She screamed if she could hear you chewing during dinner. She screamed for the last cookie, to hold mommy’s hand, to find the most Easter eggs. She screamed over minor transitions. It was relentless. Her ability to express love was buried under an itchy blanket of sensory issues, fear, jealousy, and an unshakeable sadness.

But she loved us too. It was apparent in the way she would fit herself to your side when watching a Disney movie. And in the occasional half smile with tilted head. In the way she kissed her dog’s bearded face. And the gifts of found flowers or crayoned pictures.

So, yeah, love is not only tempered by unpleasant realities… in can grow in them. It may even grow hardier. We are living proof.  We are the dandelions of love.

Partying with the Sober Folk.

This time a year ago I was my daughter’s guest at a recovery barbecue. We made our way there via a South Boston park with harbor views. People were playing what appeared to be a game of “pick up” baseball. A handful of lucky fans sat under the few trees that sported shade. I kept walking through invisible puffs of cigarette smoke. Children were screaming with their mouths entirely full of half eaten hotdogs. It was, you know, quintessential American stuff.

We found the recovery center across the street – in the scrubby back yard of a former church property. Outside an old man with a gold tooth was watering an incredible, and I mean incredible, garden. He smiled at us.

Inside the yard we were handed raffle tickets. Strangers cooked us hamburgers. We drank extremely cold sodas from an overly iced trash can. People made room for us at crowded picnic tables. We ate watermelon and chips from wicker baskets. We listened to top 40 music from speakers slung here and there.

I watched a young man perform a break dance that was skillful and unabashed. He spun with pure joy on a small patch of concrete. His eyes were half closed. My self conscious self had nothing in common with him. At the time I thought it was the dance that enthralled me.

Later this same boy shared his story. His drug use had left him homeless. He had slept under a bridge for a year: through a Boston winter. His life had been saved by another person at the party.  His life had been saved by some guy at the party.

How many of us ever save anything? Maybe we salvage a burning dinner, or retrieve a lost accounts payable receipt. Better yet, we preserve a colleague’s job. Or rescue a stray dog. Those are all great for sure… but not quite the same.

Clearly this was not your typical barbecue.

When the young man won the raffle prize (a long sleeved jersey) he handed it to my daughter. He knew she liked it. Possibly he was trying to impress her, but of that I am not certain. I do know that he most likely owned very little…and he gave it away just to see her smile.

Inside the building we found my daughter’s counselor playing the cello. She had it steadied between her legs, and her tattooed wrist held a delicate, long bow. A young man with the teeth of a meth addict accompanied her on the guitar. The sound of her cello and the sound of his voice broke my heart into a million, billion pieces.

I have been turning this day over in my head for a very long time.

“PTSD” – Post Traumatic Stress Disorder

This is when I am supposed to reference Webster’s dictionary. I can picture the bulleted item list that has been carefully compiled by doctors and psychiatrists, and craftily winnowed down by editors.

Yet words are bound to fail. PTSD creates a feeling that can not be contained by bullets or paragraphs. If forced to use words they would be: “sense of dread.”

A sense of dread accompanied by unwelcome imagery. Imagery that is not imaginary. Dread that is not unjustified.

The ring of the phone makes me ill. Physically ill.
A knock on the door? Visions of a police officer.
An envelope without a return address?  Bad news.
My daughter not texting for a few days? Relapse.
Sad song on the radio? Message of doom.
Bitter snow? Frostbitten child.
Cheap motels off the highway? Sadness, loneliness, death.

My list could be longer. But it hurts to write it. If I suffer from PTSD, how badly must my daughter suffer? I have seen the results of her use, but have not lived through the experience of it.

“Conquer your fears” is written everywhere nowadays – from business journals to self help magazines. But the kind of fear they often refer to is that of financial risk. (Or a lifestyle change: try that new vegan diet! get a new partner! make a career switch!) I am talking about a different kind of fear. A primal fear. The fear of losing your stormy green eyed child to something so unpredictable, so misunderstood, so maddeningly unacceptable. I have written my daughter’s obituary in my head. I have actually looked in my closet to see if I have an acceptable black dress. These were my attempts to conquer my fear. My attempts to claim and manage the unacceptable.

Nelson Mandela says that “courage is not the absence of fear, but the triumph over it.” That the “brave man is not he who does not feel afraid, but he who conquers that fear.”

I am not there yet. But my daughter is. She is putting one step in front of the other…. steady and straight. Even with those swirling thoughts that must exist in her head. If I had to provide a picture of bravery for Webster’s dictionary it would be of my stubborn green eyed child making her way across a tight rope.

And I am waiting on the other side.

Comfortable with Uncertainty.

Comfortable with Uncertainty is the title of a book by the Tibetan Buddhist monk, Pema Chodron. Pema has written many books… and they all have portentous titles such as “Start Where You Are,” “The Wisdom of No Escape” and “When Things Fall Apart.”

Pema is speaking to me.
But a Buddhist would say that there is no me; we are all one.

“It’s not all about you.”
I have heard this before. My daughter would holler this when I would try to get her to conform, behave, listen, follow.
(She said a lot of things… this being one of the milder retorts!)

But she was right.
It’s not all about me.

A yoga teacher once told me that it is the ego at work when we think we can control the outcome of any event. Even if that outcome has no selfish impetus. Even if that outcome is to solely benefit another – like recovery.

She questioned me: “If you didn’t take credit when your eldest aced the SATs, or won the lead in the play, why would you own your other child’s difficulties?” She further explained; “If you believe you are responsible for another person’s failures that too is the ego at play. You are, in essence, believing you have a Godly amount of control over another individual’s actions.”

So, where does this leave me? If I am no longer an active participant do I assume the role of spectator?   Do I alternate between cheering from the sidelines or averting my ashamed gaze?

No. As Pema reminds, “just start where you are.” Starting necessitates setting off, not standing still. Basically; get yourself back into the game.

The thing is, if you keep playing, at some point you no longer keep track of the wins and the losses. It just becomes a series of parade like hills; some up, some down. Eventually you realize others are playing the game too. We are all part of this shifting, moving, undulating life force. There are no bystanders. And there are no ultimate victors.  We are all on the same team.

“A Bitter Pill.”

I hate idioms….cutesy tidbits of advice that fashion themselves as sage life lessons. You’ve heard them; “it’s a blessing in disguise,” “it takes two to tango” and the ever popular, “let sleeping dogs lie.”

You know what? It’s not always a blessing. And one person alone can perform quite a destructive tango. And let sleeping dogs lie? That’s just a lame excuse for not “getting your hands dirty.”

But I have to admit idioms have their place. There was a time when I relied upon them for their simplicity. Caring for an addict can turn the highest functioning brain into unstable mush. Rational thought processes become clouded by lies, self deception, and blind worry. So you adapt. Part of your mind shuts down and does not allow the conscious brain to record one more crippling incident. Another part goes into hyperdrive and busies itself with layers of extraneous nonsense; so much so that sleep can become a luxury. And then there is the imaginary brain. In order to spare whatever functioning grey matter you may have left you simply believe the lies you tell yourself. And the lies being told to you.

Of course none of these behaviors are symptomatic of good mental health. But what else can you do? Try to make sense of your daughter face down in watery ditch in a blue shiny party dress? Try to accept the presence of a hypodermic needle in the side pocket of your new black leather handbag? Believe in the sincerity of the two men who arrive in the middle of the night and roll your bloodied incoherent child onto the soft colored pea stone that comprises your driveway?

This is what you do. You chant an idiom. It becomes a very effective mantra.  Something like:

Tomorrow is a new day.
One step at a time.
Relapse is part of recovery.

Another that has helped is “detach with love.” I have to admit it is hard to detach without feeling anger or pity. Detaching with love is difficult. It feels like not caring. But if you recite it with added inflection on the word “love” – then it almost works.

My all time favorite idiom is “don’t get sucked in by the tornado.” It is very hard to not be reactive. You want to fix the issue, defend yourself, or argue a point. But you can’t win with someone who is actively using. While the world around you is starting to blow hard you calmly recite “don’t get sucked in by the tornado.” Over and over and over again. It’s a form of detaching with self love.

Pretty Rat Cage.

There is a popular TED talk by Johann Hari that has received nearly five million views. In it he reports that after three years of extensive research he is convinced that we are incorrectly addressing addiction treatment. Instead of using punishment as a deterrent we should be saying “I love you.”

I wish I could have said I laughed. Instead my breath died in my throat. Of course I take this particular TED talk a little more personally than most. The premise that a lack of love had somehow been the missing ingredient… well, let’s just say I took umbrage.

Hari bases his conclusion partly on research done in the 1970s by Professor Alexander of Vancouver. Alexander recreated an experiment done earlier in the century that showed caged rats consistently chose heroin laced water over fresh water. In Alexander’s experiment the rat cage was outfitted like a rat “park.” They had room to exercise, ate good food, and had females to fraternize with. The result? The rats hardly ever touched the heroin water. The conclusion? Addiction is about your “cage.” (If only we had prettier more loving cages….)

I venture to say that such a conclusion is over simplified. If this were true the poor would be more likely to suffer from addiction than the rich. (This, by the way, is categorically untrue.) And, from personal experience, if loving an addict cured addiction – well then my daughter would be well. There are thousands of us who love our sick children – love them unconditionally! – and they remain addicted.

However, I do believe that self love is lacking. Parents of addicts report a higher number of children that suffer from low self esteem, personality disorder, social anxiety or depression. I have also heard parents say that these children were uncharacteristically giving…almost to a fault. And that they naturally gravitated to connecting with the “underdog.” Addicts themselves nearly unanimously acknowledge feeling uncomfortable in their “own skin.” They report feeling “different,” “misunderstood,” or “alone.” Hari cites this as failure of social engagement – a result of our bigger homes and social media interactions. But here again I beg to differ. We have always had addicts, even when we had closer knit social circles. The social disengagement is more likely an internal process, not an external one.

I have three children, only one of whom suffers from addiction. I told each one of them that they were important, beautiful, and loved by me. My middle child did not believe me. I could see it in her eyes. When she slept at night I would sneak into her room and whisper these things again into her ear. I was hoping that somehow, just somehow, my words would imprint themselves on her unconscious brain. I was singing her love songs.

Observing the Pattern.

“I woke up twice last night. And not to go to the bathroom. My body was sweating, heart racing, my eyes impossibly open. Normal nightmare body response. Except this was not a typical nightmare. I wasn’t falling, or being chased, or recycling scary bits from a ridiculous movie. This was real. I saw Sarah running up to my car window proclaiming that she had been discharged from the hospital, and asking me to buy her some cigarettes, that “she’ll owe me one.” I was so happy to see her. And then it dawned on me that she had run. That she wasn’t going to accept any help. And I was filled with anger, and fear, and sadness and anger and fear and sadness – I was spinning, and sweating, and desperate. And she was tying a long pink lace on a fancy hightop sneaker.”

Just another dream. But it is uncanny how the subconscious pinpoints the most fearsome fact of substance abuse: that the addict appears ignorant to the danger they are courting. The family, however, sees the train wreck approaching. It’s a well worn cyclical pattern. First you note the restlessness, the mounting body tension and the explosive language. Then comes the quiet storm of evasiveness brought on by late nights, sickness and lies.

This is the worst part of living with an addict. Seeing all the signs that they apparently miss. I have heard it said that the addict is a “selfish person.” A “liar.” And “hopeless.”

Addicts definitely lie to cover their tracks for as long as possible. And they are selfish – to a degree. But it is hard to think of someone who is self destructive as truly “selfish.” Hopeless? – yes, it often does seem hopeless.

Putting all labels aside; how in God’s name can you help someone who does not think they are in trouble? Who will sweetly tie a pink shoelace while contemplating where to score their next hit?

I am convinced that the addict has to slow down long enough to recognize the internal rhythms of their own bodies and minds.  Not an easy process considering man’s natural tendency is to tread the well worn path – thoughtlessly.

Unfortunately the addicts behavior is so extreme. And the consequences of their behavior that much more obvious. What they really need is the space and time to redefine their relationship with their own patterned responses.

Insurance companies, in our experience, have offered ten days within which to make this lifestyle change.   Ten days!